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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] [MESH Headings] [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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2
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Lee CK, Huan PT, Chai CN, Ng LJ, Koay ESC, Lee OF, Tan M, Loh TP. Novel thiopurine S-methyltransferase ( TPMT) variant identified in Malay individuals. Clin Chem Lab Med 2024; 0:cclm-2024-0494. [PMID: 38661453 DOI: 10.1515/cclm-2024-0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Chun Kiat Lee
- Department of Laboratory Medicine, 150744 National University Health System , Singapore, Singapore
| | - Pei Tee Huan
- Department of Paediatrics, Yong Loo Lin School of Medicine, 37580 National University of Singapore , Singapore, Singapore
| | - Chean Nee Chai
- Department of Laboratory Medicine, 150744 National University Health System , Singapore, Singapore
| | - Li Jie Ng
- Department of Laboratory Medicine, 150744 National University Health System , Singapore, Singapore
| | - Evelyn Siew-Chuan Koay
- Department of Pathology, Yong Loo Lin School of Medicine, 37580 National University of Singapore , Singapore, Singapore
| | - Ogestelli Fabia Lee
- School of Life and Physical Sciences, 464889 PSB Academy , Singapore, Singapore
| | - Malcolm Tan
- Department of Gastroenterology and Hepatology, 37581 Singapore General Hospital , Singapore, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, 150744 National University Health System , Singapore, Singapore
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3
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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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Lee CK, Ng SY, Chai CN, Lim YF, Hu TJ, Lee OF, Yan G. Successful Confirmation of Dual Genital Herpes Co-Infection with Herpes Simplex Virus 1 and Herpes Simplex Virus 2 Using Unbiased Metagenomic Next-Generation Sequencing. Viruses 2023; 15:1957. [PMID: 37766363 PMCID: PMC10534666 DOI: 10.3390/v15091957] [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: 08/27/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Dual co-infection with both HSV-1 and HSV-2 is rare, with few cases reported in the literature. In this case report, we describe the successful use of unbiased metagenomic next-generation sequencing (mNGS) as a rapid and alternative method for confirming dual genital herpes co-infection. Our case involves a 74-year-old woman who presented with genital lesions and initially tested positive for both HSV-1 and HSV-2 via the Luminex ARIES HSV 1&2 assay. The entire mNGS process, from nucleic acid extraction to result analysis, was completed in less than 48 h. Using mNGS, we identified mapped reads specific to either HSV-1 or HSV-2 and screened the sequences to rule out mis-genotyping by the Luminex ARIES assay. Notably, the generated sequences can reveal sequence variations within multiple gene regions, demonstrating the potential of mNGS for identifying novel HSV-1 and HSV-2 variants. Our findings suggest that mNGS can serve as a rapid and reliable alternative confirmatory method for dual genital herpes infections, providing valuable information to guide appropriate treatment options for patients. By eliminating the need for prior knowledge of causative agents, mNGS offers an unbiased approach for detecting and characterizing viral co-infections.
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Affiliation(s)
- Chun Kiat Lee
- Department of Laboratory Medicine, National University Health System, Singapore 119228, Singapore
| | - Sau Yoke Ng
- Department of Laboratory Medicine, National University Health System, Singapore 119228, Singapore
| | - Chean Nee Chai
- Department of Laboratory Medicine, National University Health System, Singapore 119228, Singapore
| | - Yu Feng Lim
- Department of Laboratory Medicine, National University Health System, Singapore 119228, Singapore
| | - Tiffany Jingyan Hu
- Department of Laboratory Medicine, National University Health System, Singapore 119228, Singapore
| | - Ogestelli Fabia Lee
- School of Life and Physical Sciences, PSB Academy, Singapore 039594, Singapore
| | - Gabriel Yan
- Department of Laboratory Medicine, National University Health System, Singapore 119228, Singapore
- Department of Medicine, National University Health System, Singapore 119228, Singapore
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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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9
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Koh WLC, Poh SE, Lee CK, Chan THM, Yan G, Kong KW, Lau L, Lee WYT, Cheng C, Hoon S, Seow Y. Towards a Rapid-Turnaround Low-Depth Unbiased Metagenomics Sequencing Workflow on the Illumina Platforms. Bioengineering (Basel) 2023; 10:bioengineering10050520. [PMID: 37237590 DOI: 10.3390/bioengineering10050520] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Unbiased metagenomic sequencing is conceptually well-suited for first-line diagnosis as all known and unknown infectious entities can be detected, but costs, turnaround time and human background reads in complex biofluids, such as plasma, hinder widespread deployment. Separate preparations of DNA and RNA also increases costs. In this study, we developed a rapid unbiased metagenomics next-generation sequencing (mNGS) workflow with a human background depletion method (HostEL) and a combined DNA/RNA library preparation kit (AmpRE) to address this issue. We enriched and detected bacterial and fungal standards spiked in plasma at physiological levels with low-depth sequencing (<1 million reads) for analytical validation. Clinical validation also showed 93% of plasma samples agreed with the clinical diagnostic test results when the diagnostic qPCR had a Ct < 33. The effect of different sequencing times was evaluated with the 19 h iSeq 100 paired end run, a more clinically palatable simulated iSeq 100 truncated run and the rapid 7 h MiniSeq platform. Our results demonstrate the ability to detect both DNA and RNA pathogens with low-depth sequencing and that iSeq 100 and MiniSeq platforms are compatible with unbiased low-depth metagenomics identification with the HostEL and AmpRE workflow.
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Affiliation(s)
- Winston Lian Chye Koh
- Bioinformatic Institute, A*STAR (Agency for Science, Technology and Research), Singapore 138632, Singapore
| | - Si En Poh
- Institute of Molecular and Cell Biology, A*STAR (Agency for Science, Technology and Research), Singapore 138673, Singapore
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Hospital, Singapore 119228, Singapore
| | - Tim Hon Man Chan
- Department of Laboratory Medicine, National University Hospital, Singapore 119228, Singapore
| | - Gabriel Yan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Division of Microbiology, Department of Laboratory Medicine, National University Health System, Singapore 119228, Singapore
| | - Kiat Whye Kong
- Institute of Molecular and Cell Biology, A*STAR (Agency for Science, Technology and Research), Singapore 138673, Singapore
| | - Lalita Lau
- Institute of Molecular and Cell Biology, A*STAR (Agency for Science, Technology and Research), Singapore 138673, Singapore
| | | | - Clark Cheng
- Paths Diagnostics Pte Limited, Singapore 349317, Singapore
| | - Shawn Hoon
- Institute of Molecular and Cell Biology, A*STAR (Agency for Science, Technology and Research), Singapore 138673, Singapore
| | - Yiqi Seow
- Institute of Molecular and Cell Biology, A*STAR (Agency for Science, Technology and Research), Singapore 138673, Singapore
- Genome Institute of Singapore, A*STAR (Agency for Science, Technology and Research), Singapore 138672, Singapore
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Ng IKS, Lee PL, Ng LJ, Chua RP, Ng YJA, Lee CK, Tan JG, Chan THM, Yan B, Prasad V. Compound in-cis JAK2 mutant polycythemia vera manifesting as first-onset transient ischemic attack with erythrocytosis and an attenuated JAK2 V617F mutant signal on a quantitative DD-PCR assay. Int J Lab Hematol 2023; 45:e28-e31. [PMID: 36205319 DOI: 10.1111/ijlh.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/17/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Isaac K S Ng
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Peak-Ling Lee
- Molecular Diagnosis Center, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Li Jie Ng
- Molecular Diagnosis Center, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Rui Ping Chua
- Molecular Diagnosis Center, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Yu-Jin Alvin Ng
- Molecular Diagnosis Center, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Chun Kiat Lee
- Molecular Diagnosis Center, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Jun Guan Tan
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Tim Hon Man Chan
- Molecular Diagnosis Center, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Benedict Yan
- Molecular Diagnosis Center, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Vishnu Prasad
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
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11
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Tang JW, Dilcher M, Bird PW, Kok J, Lee CK, Nishimura H, Oon L, Alston G, Dwyer DE, Holmes CW, Jennings LC. Practical problems and responses for SARS-CoV-2 laboratory testing during the COVID-19 pandemic. Clin Microbiol Infect 2023; 29:560-562. [PMID: 36773772 PMCID: PMC9911976 DOI: 10.1016/j.cmi.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Julian W. Tang
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom,Respiratory Sciences, University of Leicester, Leicester, United Kingdom,Corresponding author. Julian W. Tang, Clinical Microbiology, 5/F Sandringham Building, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, United Kingdom
| | - Meik Dilcher
- Canterbury Health Laboratories, Christchurch, New Zealand
| | - Paul W. Bird
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom,Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Hospital, Singapore
| | | | - Lynette Oon
- Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Ginna Alston
- Canterbury Health Laboratories, Christchurch, New Zealand
| | - Dominic E. Dwyer
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Christopher W. Holmes
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom,Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Lance C. Jennings
- Canterbury Health Laboratories, Christchurch, New Zealand,Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
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12
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Koh LCW, Seow Y, Kong KW, Lau MLL, Kumar SK, Yan G, Lee CK, Yan B, Tambyah PA, Hoon S. Sub genomic analysis of SARS-CoV-2 using short read amplicon-based sequencing. Front Genet 2023; 14:1086865. [PMID: 36911398 PMCID: PMC9998678 DOI: 10.3389/fgene.2023.1086865] [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: 11/01/2022] [Accepted: 01/25/2023] [Indexed: 02/26/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic poses a serious public health risk. In this report, we present a modified sequencing workflow using short tiling (280bp) amplicons library preparation method paired with Illumina's iSeq100 desktop sequencer. We demonstrated the utility of our workflow in identifying gapped reads that capture characteristics of subgenomic RNA junctions within our patient cohort. These analytical and library preparation approaches allow a versatile, small footprint and decentralized deployment that can facilitate comprehensive genetics characterizations during outbreaks. Based on the sequencing data, Taqman assays were designed to accurately capture the quantity of subgenomic ORF5 and ORF7a RNA from patient samples and demonstrated utility in tracking subgenomic titres in patient samples when combined with a standard COVID-19 qRT-PCR assay.
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Affiliation(s)
- Lian Chye Winston Koh
- Bioinformatics Institute, Agency for Science Technology and Research, Singapore.,Institute for Bioengineering and Bioimaging, Agency for Science Technology and Research, Singapore
| | - Yiqi Seow
- Institute for Bioengineering and Bioimaging, Agency for Science Technology and Research, Singapore.,Institute for Molecular and Cell Biology, Agency for Science Technology and Research, Singapore
| | - Kiat Whye Kong
- Institute for Molecular and Cell Biology, Agency for Science Technology and Research, Singapore
| | - Ming Li Lalita Lau
- Institute for Molecular and Cell Biology, Agency for Science Technology and Research, Singapore
| | - Shoban Krishna Kumar
- Division of Advanced Internal Medicine, Department of Medicine, National University Health System, Singapore
| | - Gabriel Yan
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore
| | - Chun Kiat Lee
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Health System, Singapore
| | - Benedict Yan
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Health System, Singapore
| | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore
| | - Shawn Hoon
- Institute for Molecular and Cell Biology, Agency for Science Technology and Research, Singapore
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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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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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15
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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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16
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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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17
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Pan J, Tang J, Caniza M, Heraud JM, Koay E, Lee HK, Lee CK, Li Y, Nava Ruiz A, Santillan-Salas CF, Marr LC. Correlating indoor and outdoor temperature and humidity in a sample of buildings in tropical climates. Indoor Air 2021; 31:2281-2295. [PMID: 34138487 DOI: 10.1111/ina.12876] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
The incidence of several respiratory viral infections has been shown to be related to climate. Because humans spend most of their time indoors, measures of indoor climate, rather than outdoor climate, may be better predictors of disease incidence and transmission. Therefore, understanding the relationship between indoor and outdoor climate will help illuminate their influence on the seasonality of diseases caused by respiratory viruses. Indoor-outdoor relationships between temperature and humidity have been documented in temperate regions, but little information is available for tropical regions, where seasonal patterns of respiratory viral diseases differ. We have examined indoor-outdoor correlations of temperature, relative humidity (RH), and absolute humidity (AH) over a 1-year period in each of seven tropical cities. Across all cities, the average monthly indoor temperature was 25 ± 3°C (mean ± standard deviation) with a range of 20-30°C. The average monthly indoor RH was 66 ± 9% with a range of 50-78%, and the average monthly indoor AH was 15 ± 3 g/m3 with a range of 10-23 g/m3 . Indoor AH and RH were linearly correlated with outdoor AH when the air conditioning (AC) was off, suggesting that outdoor AH may be a good proxy of indoor humidity in the absence of AC. All indoor measurements were more strongly correlated with outdoor measurements as distance from the equator increased. Such correlations were weaker during the wet season, especially when AC was in operation. These correlations will provide insight for assessing the seasonality of respiratory viral infections using outdoor climate data, which is more widely available than indoor data, even though transmission of these diseases mainly occurs indoors.
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Affiliation(s)
- Jin Pan
- Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Julian Tang
- Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Miguela Caniza
- Global Infectious Diseases Program, Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Evelyn Koay
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Hong Kai Lee
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Health System, Singapore City, Singapore
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | | | | | - Linsey C Marr
- Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
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18
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Kothary AS, Mahendra C, Tan M, Min Tan EJ, Hong Yi JP, Gabriella, Hui Jocelyn TX, Haruman JS, Tan Z, Lee CK, Lezhava A, Yan B, Irwanto A. Validation of a multi-gene qPCR-based pharmacogenomics panel across major ethnic groups in Singapore and Indonesia. Pharmacogenomics 2021; 22:1041-1056. [PMID: 34693729 DOI: 10.2217/pgs-2021-0071] [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: 12/12/2022] Open
Abstract
Aim: The clinical utility of pharmacogenomics (PGx) has been gaining traction alongside growing evidence that adverse drug reactions (ADRs) have significant genetic associations. Nala PGx Core® is a multi-gene qPCR-based panel of 20 allele variants, comprising 18 SNPs and two CYP2D6 copy number markers across four pharmacogenes - CYP2C9, CYP2C19, CYP2D6 and SLCO1B1. Methods: In this study, we validated the performance of Nala PGx Core® against benchmark methods, on the Singaporean and Indonesian populations. Results & conclusion: Nala PGx Core® demonstrated robust and accurate genotyping when compared with other established benchmarks. Furthermore, the panel successfully characterized alleles of clinical relevance, such as CYP2D6*10 and CYP2D6*36, across major ethnic groups present of Singapore and Indonesia, suggesting its potential for adoption in clinical workflows regionally.
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Affiliation(s)
- Anar Sanjaykumar Kothary
- Nalagenetics Pte Ltd, Singapore, 169204, Singapore.,Center for Genome Diagnostics, Genome Institute of Singapore, Agency for Science, Technology & Research (A*STAR), 138672, Singapore
| | | | - Mingchen Tan
- Nalagenetics Pte Ltd, Singapore, 169204, Singapore
| | - Eunice Jia Min Tan
- Department of Laboratory Medicine, National University Health System, 119074, Singapore
| | | | - Gabriella
- Nalagenetics Pte Ltd, Singapore, 169204, Singapore
| | | | | | - Zhihao Tan
- Nalagenetics Pte Ltd, Singapore, 169204, Singapore.,Center for Genome Diagnostics, Genome Institute of Singapore, Agency for Science, Technology & Research (A*STAR), 138672, Singapore
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Health System, 119074, Singapore
| | - Alexander Lezhava
- Center for Genome Diagnostics, Genome Institute of Singapore, Agency for Science, Technology & Research (A*STAR), 138672, Singapore
| | - Benedict Yan
- Department of Laboratory Medicine, National University Health System, 119074, Singapore.,Stronghold Diagnostics Lab, Agency for Science, Technology & Research, 138672, Singapore
| | - Astrid Irwanto
- Nalagenetics Pte Ltd, Singapore, 169204, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, 117559, Singapore
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19
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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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20
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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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21
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Tay JK, Cross GB, Toh ST, Lee CK, Loh J, Lim ZY, Ngiam N, Chee J, Gan SW, Saraf A, Chow WTE, Goh HL, Siow CH, Lian DWQ, Loh WS, Loh KS, Lim CM, Chua YY, Tan TT, Tan HK, Yan B, Ko K, Chan KS, Oon L, Chow VTK, Wang DY, Fuh JYH, Yen CC, Wong JEL, Allen DM. Design and Multicenter Clinical Validation of a 3-Dimensionally Printed Nasopharyngeal Swab for SARS-CoV-2 Testing. JAMA Otolaryngol Head Neck Surg 2021; 147:418-425. [PMID: 33599684 DOI: 10.1001/jamaoto.2020.5680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Three-dimensionally printed nasopharyngeal swabs (3DP swabs) have been used to mitigate swab shortages during the coronavirus disease 2019 (COVID-19) pandemic. Clinical validation for diagnostic accuracy and consistency, as well as patient acceptability, is crucial to evaluate the swab's performance. Objective To determine the accuracy and acceptability of the 3DP swab for identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Design, Setting, and Participants A diagnostic study was conducted from May to July 2020 at 2 tertiary care centers in Singapore with different reference swabs (FLOQSwab [COPAN Diagnostics] or Dacron swab [Deltalab]) and swab processing techniques (wet or dry) to evaluate the performance of the 3DP swab compared with traditional, standard-of-care nasopharyngeal swabs used in health care institutions. The participants were patients with COVID-19 in the first 2 weeks of illness and controls with acute respiratory illness with negative test results for SARS-CoV-2. Paired nasopharyngeal swabs were obtained from the same nostril and tested for SARS-CoV-2 by reverse-transcriptase polymerase chain reaction. The sequence of swabs was randomized based on odd and even participant numbers. Main Outcomes and Measures Primary outcome measures were overall agreement (OA), positive percentage agreement (PPA), and negative percentage agreement of the 3DP swab compared with reference swabs. Secondary outcome measures were the correlation of cycle threshold (Ct) values of both swabs. Results The mean (SD) age of participants was 45.4 (13.1) years, and most participants were men (87 of 89 [97.8%]), in keeping with the epidemiology of the COVID-19 pandemic in Singapore. A total of 79 patients with COVID-19 and 10 controls were recruited. Among the patients with COVID-19, the overall agreement and PPA of the 3DP swab was 91.1% and 93.5%, respectively, compared with reference swabs. The PPA was 100% for patients with COVID-19 who were tested within the first week of illness. All controls tested negative. The reverse-transcriptase polymerase chain reaction Ct values for the ORF1ab and E-gene targets showed a strong correlation (intraclass correlations coefficient, 0.869-0.920) between the 3DP and reference swab on independent testing at each institution despite differences in sample processing. Discordant results for both gene targets were observed only at high Ct values. Conclusions and Relevance In this diagnostic study of 79 patients with COVID-19 and 10 controls, the 3DP swab performed accurately and consistently across health care institutions and could help mitigate strained resources in the escalating COVID-19 pandemic.
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Affiliation(s)
- Joshua K Tay
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore
| | - Gail B Cross
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, National University of Singapore, Singapore
| | - Song Tar Toh
- Department of Otolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Chun Kiat Lee
- Molecular Diagnostic Centre, Department of Laboratory Medicine, National University Hospital, Singapore
| | - Jerold Loh
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Zhen Yu Lim
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Nicholas Ngiam
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Jeremy Chee
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore
| | - Soo Wah Gan
- Centre for Additive Manufacturing, National University of Singapore, Singapore
| | - Anmol Saraf
- Centre for Additive Manufacturing, National University of Singapore, Singapore
| | | | - Han Lee Goh
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore
| | - Chor Hiang Siow
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore
| | - Derrick W Q Lian
- Department of Pathology, National University of Singapore, Singapore
| | - Woei Shyang Loh
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore
| | - Chwee Ming Lim
- Department of Otolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Ying Ying Chua
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Hiang Khoon Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore
| | - Benedict Yan
- Molecular Diagnostic Centre, Department of Laboratory Medicine, National University Hospital, Singapore
| | - Karrie Ko
- Department of Laboratory Medicine, Singapore General Hospital, Singapore
| | - Kian Sing Chan
- Department of Laboratory Medicine, Singapore General Hospital, Singapore
| | - Lynette Oon
- Department of Laboratory Medicine, Singapore General Hospital, Singapore
| | - Vincent T K Chow
- Department of Microbiology and Immunology, National University of Singapore, Singapore
| | - De Yun Wang
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore
| | - Jerry Y H Fuh
- Centre for Additive Manufacturing, National University of Singapore, Singapore.,Department of Mechanical Engineering, National University of Singapore, Singapore
| | - Ching-Chiuan Yen
- Keio-NUS CUTE Center, National University of Singapore, Singapore.,Division of Industrial Design, National University of Singapore, Singapore
| | - John E L Wong
- Department of Medicine, National University of Singapore, Singapore.,Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - David M Allen
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, National University of Singapore, Singapore
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22
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Dickens BSL, Lim JT, Low JW, Lee CK, Sun Y, Nasir HBM, Akramullah FABM, Yan G, Oon J, Yan B, Sun L, Cook AR, Tambyah PA, Chai LYA. Simple "Rule-of-6" Predicts Severe Coronavirus Disease 2019 (COVID-19). Clin Infect Dis 2021; 72:1861-1862. [PMID: 32628752 PMCID: PMC7454428 DOI: 10.1093/cid/ciaa938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Jue Tao Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Jere Wenn Low
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Yinxiaohe Sun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Haziq Bin Mohamad Nasir
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, and
| | | | - Gabriel Yan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, and
| | - Jolene Oon
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, and
| | - Benedict Yan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Laboratory Medicine, National University Hospital, Singapore
| | - Louisa Sun
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, and.,Alexandra Hospital, National University Health System, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Paul Anantharajah Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, and
| | - Louis Yi Ann Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, and
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23
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Tang JW, Kwok KO, Loh TP, Lee CK, Heraud JM, Dancer SJ. Can we do better? A guide to pandemics - some Dos and Don'ts for the next one. J Infect 2021; 83:119-145. [PMID: 33894274 PMCID: PMC8061089 DOI: 10.1016/j.jinf.2021.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Julian W Tang
- Respiratory Sciences, University of Leicester, Leicester, UK; Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Shenzhen Research Institute of The Chinese University of Hong Kong, Shenzhen, China
| | - Tze Ping Loh
- Laboratory Medicine, National University Hospital, Singapore
| | - Chun Kiat Lee
- Laboratory Medicine, National University Hospital, Singapore
| | | | - Stephanie J Dancer
- Department of Microbiology, NHS Lanarkshire, and Edinburgh Napier University, UK
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24
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Lee CK, Tham JWM, Png S, Chai CN, Ng SC, Tan EJM, Ng LJ, Chua RP, Sani M, Seow Y, Yan G, Tang J. Clinical performance of Roche cobas 6800, Luminex ARIES, MiRXES Fortitude Kit 2.1, Altona RealStar, and Applied Biosystems TaqPath for SARS-CoV-2 detection in nasopharyngeal swabs. J Med Virol 2021; 93:4603-4607. [PMID: 33719033 PMCID: PMC8250924 DOI: 10.1002/jmv.26940] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 01/21/2023]
Abstract
We compared the performance of five assays for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) detection on nasopharyngeal swab samples: Roche “cobas,” Luminex “ARIES,” MiRXES “Fortitude,” Altona “RealStar,” and Thermo Fisher Scientific “TaqPath.” A total of 94 nasopharyngeal swab samples were obtained from 80 confirmed coronavirus disease 2019 cases in the first 2 weeks of illness (median, 7 days; range, 2–14 days) and 14 healthy controls. After collection, all samples were transported to the hospital clinical laboratory within 24 h. These samples were tested on all five assays within 3 days of sample receipt. Of the 94 samples, 69 yielded the same result on all platforms, resulting in an agreement of 73.4% (69 of 94). Of these, 14 were the healthy control swabs which all tested negative, demonstrating good specificity across all platforms. The ARIES assay had the lowest detection rate (68.8%), followed by Fortitude (85.0%), RealStar (86.3%), cobas (95.0%), and TaqPath (100%). Statistically significant differences were observed for ARIES, Fortitude, and RealStar when compared against the best performing TaqPath using McNemar's χ2 test. A consensus result was established based on the results obtained by the cobas, Fortitude, RealStar, and TaqPath. Six discrepancies had failed to reach a consensus and were adjudicated using the Cepheid Xpert Xpress SARS‐CoV‐2. Overall, the TaqPath and cobas assays were the most sensitive at detecting their designated SARS‐CoV‐2 gene targets. On the other hand, the ARIES assay was the least sensitive, thus warranting the need for assay re‐optimization before go‐live at the testing laboratory.
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Affiliation(s)
- Chun Kiat Lee
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Jason Wei Ming Tham
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Siyu Png
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Chean Nee Chai
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Shu Chi Ng
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Eunice Jia Min Tan
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Li Jie Ng
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Rui Ping Chua
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Musa Sani
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Yiqi Seow
- Institute of Bioengineering and Nanotechnology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Gabriel Yan
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Julian Tang
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
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25
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Ooi KH, Liu MM, Tay JWD, Teo SY, Kaewsapsak P, Jin S, Lee CK, Hou J, Maurer-Stroh S, Lin W, Yan B, Yan G, Gao YG, Tan MH. An engineered CRISPR-Cas12a variant and DNA-RNA hybrid guides enable robust and rapid COVID-19 testing. Nat Commun 2021; 12:1739. [PMID: 33741959 PMCID: PMC7979722 DOI: 10.1038/s41467-021-21996-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/22/2021] [Indexed: 12/13/2022] Open
Abstract
Extensive testing is essential to break the transmission of SARS-CoV-2, which causes the ongoing COVID-19 pandemic. Here, we present a CRISPR-based diagnostic assay that is robust to viral genome mutations and temperature, produces results fast, can be applied directly on nasopharyngeal (NP) specimens without RNA purification, and incorporates a human internal control within the same reaction. Specifically, we show that the use of an engineered AsCas12a enzyme enables detection of wildtype and mutated SARS-CoV-2 and allows us to perform the detection step with loop-mediated isothermal amplification (LAMP) at 60-65 °C. We also find that the use of hybrid DNA-RNA guides increases the rate of reaction, enabling our test to be completed within 30 minutes. Utilizing clinical samples from 72 patients with COVID-19 infection and 57 healthy individuals, we demonstrate that our test exhibits a specificity and positive predictive value of 100% with a sensitivity of 50 and 1000 copies per reaction (or 2 and 40 copies per microliter) for purified RNA samples and unpurified NP specimens respectively.
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Affiliation(s)
- Kean Hean Ooi
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore
| | - Mengying Mandy Liu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore
| | - Jie Wen Douglas Tay
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Seok Yee Teo
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Pornchai Kaewsapsak
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore
| | - Shengyang Jin
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Jingwen Hou
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Sebastian Maurer-Stroh
- Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Singapore
| | - Weisi Lin
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Benedict Yan
- Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Gabriel Yan
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Yong-Gui Gao
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Meng How Tan
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.
- Genome Institute of Singapore, Agency for Science Technology and Research, Singapore, Singapore.
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26
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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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27
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Tay JK, Cross GB, Sun L, Chia A, Chee J, Loh J, Lim ZY, Ngiam N, Khang WP, Yeap S, Goh HL, Siow CH, Loh WS, Loh KS, Lee CK, Yan B, Chow VTK, Wang DY, Boey F, Wong JEL, Allen DM. Clinical Diagnostic Study of a Novel Injection Molded Swab for SARS-Cov-2 Testing. Infect Dis Ther 2021; 10:1015-1022. [PMID: 33432534 PMCID: PMC7799401 DOI: 10.1007/s40121-020-00391-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction The gold standard for COVID-19 diagnosis is currently a real-time reverse transcriptase polymerase chain reaction (RT-PCR) to detect SARS-CoV-2. This is most commonly performed on respiratory secretions obtained via a nasopharyngeal swab. Due to supply chain limitations and high demand worldwide because of the COVID-19 pandemic, access to commercial nasopharyngeal swabs has not been assured. 3D printing methods have been used to meet the shortfall. For longer-term considerations, 3D printing may not compare well with injection molding as a production method due to the challenging scalability and greater production costs of 3D printing. Methods To secure sufficient nasopharyngeal swab availability for our national healthcare system, we designed a novel injection molded nasopharyngeal swab (the IM2 swab). We performed a clinical diagnostic study comparing the IM2 swab to the Copan FLOQSwab. Forty patients with a known diagnosis of COVID-19 and 10 healthy controls were recruited. Paired nasopharyngeal swabs were obtained from the same nostril of each participant and tested for SARS-CoV-2 by RT-PCR. Results When compared to the Copan FLOQswab, results from the IM2 swab displayed excellent overall agreement and positive percent agreement of 96.0% and 94.9%, respectively. There was no significant difference in mean RT-PCR cycle threshold values for the ORF1ab (28.05 vs. 28.03, p = 0.97) and E-gene (29.72 vs. 29.37, p = 0.64) targets, respectively. We did not observe any significant adverse events and there was no significant difference in patient-reported pain. Conclusion In summary, the IM2 nasopharyngeal swab is a clinically safe, highly accurate option to commercial nasopharyngeal swabs. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-020-00391-6.
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Affiliation(s)
- Joshua K Tay
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore, Singapore
| | - Gail B Cross
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Louisa Sun
- Department of Medicine, National University of Singapore, Singapore, Singapore.,Department of Infectious Diseases, Alexandra Hospital, Singapore, Singapore
| | - Alfred Chia
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Jeremy Chee
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore, Singapore
| | - Jerold Loh
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Zhen Yu Lim
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Nicholas Ngiam
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Wen Pang Khang
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore, Singapore
| | - Stephanie Yeap
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore, Singapore
| | - Han Lee Goh
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore, Singapore
| | - Chor Hiang Siow
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore, Singapore
| | - Woei Shyang Loh
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore, Singapore
| | - Chun Kiat Lee
- Molecular Diagnostic Centre, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Benedict Yan
- Molecular Diagnostic Centre, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Vincent T K Chow
- Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore
| | - De Yun Wang
- Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore, Singapore
| | - Freddy Boey
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - John E L Wong
- Department of Medicine, National University of Singapore, Singapore, Singapore.,Department of Hematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - David M Allen
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore. .,Department of Medicine, National University of Singapore, Singapore, Singapore.
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28
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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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29
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Loh J, Tham SM, Tambyah PA, Yan G, Lee CK, Chai LYA. Range of Varicella Zoster Co-Infections with COVID-19, Singapore. Infect Chemother 2021; 53:391-394. [PMID: 34216133 PMCID: PMC8258286 DOI: 10.3947/ic.2020.0154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
There have been recent descriptions of the novel coronavirus disease 2019 (COVID-19) presenting as 'varicella-like exanthem'. We report three cases of patients with Varicella-Zoster Virus (VZV) and COVID-19 co-infections, presenting in three varied ways. These cases highlight the need for heightened alertness to how such co-infections can present, to pick up overlapping 'dual pathologies' during this current pandemic given that infection control measures including airborne precautions are crucial for both COVID-19 and VZV.
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Affiliation(s)
- Jerold Loh
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.
| | - Sai Meng Tham
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gabriel Yan
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Microbiology, Department of Laboratory Medicine, National University Health System, Singapore
| | - Chun Kiat Lee
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Health System, Singapore
| | - Louis Yi Ann Chai
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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30
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Tham JWM, Ng SC, Chai CN, Png S, Tan EJM, Ng LJ, Chua RP, Sani M, Chiang D, Tan KX, Tee NWS, Jureen R, Tan SS, Yan G, Yan B, Lee CK. Parallel testing of 241 clinical nasopharyngeal swabs for the detection of SARS-CoV-2 virus on the Cepheid Xpert Xpress SARS-CoV-2 and the Roche cobas SARS-CoV-2 assays. Clin Chem Lab Med 2020; 59:e45-e48. [PMID: 33554503 DOI: 10.1515/cclm-2020-1338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/08/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Jason Wei Ming Tham
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Shu Chi Ng
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Chean Nee Chai
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Siyu Png
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Eunice Jia Min Tan
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Li Jie Ng
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Rui Ping Chua
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Musa Sani
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Donald Chiang
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Ker Xin Tan
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Nancy Wen Sim Tee
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Shaun S Tan
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Gabriel Yan
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Benedict Yan
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore.,Stronghold Diagnostic Lab, Agency for Science, Technology and Research, Singapore, Singapore
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
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31
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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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32
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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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33
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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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34
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Tham SM, Lim WY, Lee CK, Loh J, Premkumar A, Yan B, Kee A, Chai L, Tambyah PA, Yan G. Four Patients with COVID-19 and Tuberculosis, Singapore, April-May 2020. Emerg Infect Dis 2020; 26:2764-2766. [PMID: 32667283 PMCID: PMC7588516 DOI: 10.3201/eid2611.202752] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Coronavirus disease (COVID-19) and tuberculosis (TB) developed in 4 foreign workers living in dormitories in Singapore during April–May 2020. Clinical manifestations and atypical radiographic features of COVID-19 led to the diagnosis of TB through positive interferon-gamma release assay and culture results. During the COVID-19 pandemic, TB should not be overlooked.
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35
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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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Tan SS, Yan B, Saw S, Lee CK, Chong AT, Jureen R, Sethi S. Practical laboratory considerations amidst the COVID-19 outbreak: early experience from Singapore. J Clin Pathol 2020; 74:257-260. [PMID: 32198190 DOI: 10.1136/jclinpath-2020-206563] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) is a zoonotic viral infection originating from Wuhan, China in December 2019. The World Health Organization has classified this pandemic as a global health emergency due to its virulent nature of transmission, which may lead to acute respiratory distress syndrome. Singapore's health ministry has responded with enhanced surveillance of COVID-19 for all suspected pneumonia cases, further increasing the volume of testing via real-time reverse transcription PCR, as well as samples necessitating stringent infectious control. Collectively, this has implications on the total testing process, laboratory operations and its personnel due to biosafety concerns. Turnaround time for routine testing may also be affected. The aim of this article is to present our tertiary institution's early experience with managing this emerging crisis and offer practical considerations for the preanalytical, analytical and postanalytical phases of laboratory testing in this cohort of patients.
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37
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Yan G, Lee CK, Lam LTM, Yan B, Chua YX, Lim AYN, Phang KF, Kew GS, Teng H, Ngai CH, Lin L, Foo RM, Pada S, Ng LC, Tambyah PA. Covert COVID-19 and false-positive dengue serology in Singapore. Lancet Infect Dis 2020; 20:536. [PMID: 32145189 PMCID: PMC7128937 DOI: 10.1016/s1473-3099(20)30158-4] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Gabriel Yan
- Department of Medicine, National University Health System, 119228, Singapore.
| | - Chun Kiat Lee
- Department of Laboratory Medicine, University Medicine Cluster, National University Health System, Singapore
| | - Lawrence T M Lam
- Pioneer Polyclinic, National University Polyclinics, National University Health System, Singapore
| | - Benedict Yan
- Department of Laboratory Medicine, University Medicine Cluster, National University Health System, Singapore
| | - Ying Xian Chua
- Pioneer Polyclinic, National University Polyclinics, National University Health System, Singapore
| | - Anita Y N Lim
- Department of Medicine, National University Health System, 119228, Singapore
| | - Kee Fong Phang
- Department of Medicine, National University Health System, 119228, Singapore
| | - Guan Sen Kew
- Department of Medicine, National University Health System, 119228, Singapore
| | - Hazel Teng
- Department of Medicine, National University Health System, 119228, Singapore
| | - Chin Hong Ngai
- Department of Medicine, National University Health System, 119228, Singapore
| | - Li Lin
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Rui Min Foo
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Surinder Pada
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore
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38
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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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39
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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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40
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Mo Y, Lee CK, Loh TP, Koay ESC, Tang JW, Lee CC. Next generation sequencing identifies multi-drug resistant herpes simplex virus- associated scrotal ulceration. J Infect 2019; 80:232-254. [PMID: 31634492 DOI: 10.1016/j.jinf.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Yin Mo
- Division of Infectious disease, Medical University Cluster, National University Hospital, National University Health System, Singapore
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Evelyn Siew Chuan Koay
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Julian W Tang
- Clinical Microbiology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, 5/F Sandringham Building, Infirmary Square, Leicester LE1 5WW, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK.
| | - Cheng Chuan Lee
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
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41
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Yan G, Pang L, Cook AR, Ho HJ, Win MS, Khoo AL, Wong JG, Lee CK, Yan B, Jureen R, Ho SS, Lye DC, Tambyah PA, Leo YS, Fisher D, Oon J, Bagdasarian N, Chow A, Smitasin N, Chai LYA. Distinguishing Zika and Dengue Viruses through Simple Clinical Assessment, Singapore. Emerg Infect Dis 2019; 24:1565-1568. [PMID: 30016242 PMCID: PMC6056111 DOI: 10.3201/eid2408.171883] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Dengue virus and Zika virus coexist in tropical regions in Asia where healthcare resources are limited; differentiating the 2 viruses is challenging. We showed in a case–control discovery cohort, and replicated in a validation cohort, that the diagnostic indices of conjunctivitis, platelet count, and monocyte count reliably distinguished between these viruses.
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42
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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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Lee CK, Chai CN, Capinpin SM, Ang A, Ng SY, Lee PL, Ng CWS, Yan G, Lee HK, Chiu LL, Jureen R, Yan B, Loh TP. Evaluation of the Luminex ARIES HSV 1&2 Assay and Comparison with the FTD Neuro 9 and In-house Real-Time PCR Assays for Detecting Herpes Simplex Viruses. Ann Lab Med 2018; 38:440-445. [PMID: 29797814 PMCID: PMC5973918 DOI: 10.3343/alm.2018.38.5.440] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/15/2017] [Accepted: 05/03/2018] [Indexed: 11/20/2022] Open
Abstract
Background Human herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are responsible for a plethora of human diseases, of which cutaneous and mucocutaneous infections are the most prevalent. In its most severe form, HSV infection can cause meningitis/encephalitis. We compared the Luminex ARIES HSV 1&2 assay (Luminex Corp., Austin, TX, USA), an automated sample-to-result molecular solution, to two non-automated HSV DNA assays. Methods A total of 116 artificial controls were used to determine the analytical performance of the ARIES assay. Controls were prepared by spiking universal transport medium (UTM) and cerebrospinal fluid (CSF) samples from patients who tested negative for HSV by an in-house HSV-1 and -2 DNA assay with reference materials (SeraCare Life Sciences, MA, USA; ZeptoMetrix Corp., MA, USA). Another 117 clinical samples were then used to compare the clinical performance of the ARIES assay with those of an in-house assay and the FTD Neuro 9 assay (Fast Track Diagnostics, Junglinster, Luxembourg). Results The analytical sensitivity (95% limit of detection) of the ARIES assay was 318 copies/mL (UTM samples) and 935 copies/mL (CSF samples) for HSV-1 strain 96 and 253 copies/mL (UTM samples) and 821 copies/mL (CSF samples) for HSV-2 strain 09. No cross-reactivity was observed in samples spiked with 14 non-HSV microorganisms. Compared with the reference result (agreement between the in-house and FTD Neuro 9 results), the ARIES assay had overall concordance rates of 98.2% (111/113) and 100% (113/113) for HSV-1 and HSV-2, respectively. Conclusions The ARIES assay appears to be an excellent alternative for rapid detection and differentiation of HSV in skin and genital infections, meningitis, and encephalitis.
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Affiliation(s)
- Chun Kiat Lee
- Department of Laboratory Medicine, National University Hospital, Singapore.
| | - Chean Nee Chai
- Department of Laboratory Medicine, National University Hospital, Singapore
| | | | - Alynn Ang
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sau Yoke Ng
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Peak Ling Lee
- Department of Laboratory Medicine, National University Hospital, Singapore
| | | | - Gabriel Yan
- Department of Medicine, National University Health System, Singapore
| | - Hong Kai Lee
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Lily Lily Chiu
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Benedict Yan
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore.,Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore
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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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Chai JH, Lee CK, Lee HK, Wong N, Teo K, Tan CS, Thokala P, Tang JWT, Tambyah PA, Oh VMS, Loh TP, Yoong J. Cost-benefit analysis of introducing next-generation sequencing (metagenomic) pathogen testing in the setting of pyrexia of unknown origin. PLoS One 2018; 13:e0194648. [PMID: 29664913 PMCID: PMC5903630 DOI: 10.1371/journal.pone.0194648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 03/07/2018] [Indexed: 02/06/2023] Open
Abstract
Pyrexia of unknown origin (PUO) is defined as a temperature of >38.3°C that lasts for >3 weeks, where no cause can be found despite appropriate investigation. Existing protocols for the work-up of PUO can be extensive and costly, motivating the application of recent advances in molecular diagnostics to pathogen testing. There have been many reports describing various analytical methods and performance of metagenomic pathogen testing in clinical samples but the economics of it has been less well studied. This study pragmatically evaluates the feasibility of introducing metagenomic testing in this setting by assessing the relative cost of clinically-relevant strategies employing this investigative tool under various cost and performance scenarios using Singapore as a demonstration case, and assessing the price and performance benchmarks, which would need to be achieved for metagenomic testing to be potentially considered financially viable relative to the current diagnostic standard. This study has some important limitations: we examined only impact of introducing the metagenomic test to the overall diagnostic cost and excluded costs associated with hospitalization and makes assumptions about the performance of the routine diagnostic tests, limiting the cost of metagenomic test, and the lack of further work-up after positive pathogen detection by the metagenomic test. However, these assumptions were necessary to keep the model within reasonable limits. In spite of these, the simplified presentation lends itself to the illustration of the key insights of our paper. In general, we find the use of metagenomic testing as second-line investigation is effectively dominated, and that use of metagenomic testing at first-line would typically require higher rates of detection or lower cost than currently available in order to be justifiable purely as a cost-saving measure. We conclude that current conditions do not warrant a widespread rush to deploy metagenomic testing to resolve any and all uncertainty, but rather as a front-line technology that should be used in specific contexts, as a supplement to rather than a replacement for careful clinical judgement.
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Affiliation(s)
- Jia Hui Chai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Hong Kai Lee
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Nicholas Wong
- Department of Clinical Microbiology, University Hospital of Leicester NHS Trust, Leicester, United Kingdom
| | - Kahwee Teo
- Department of Paediatrics, University Hospital of Leicester NHS Trust, Leicester, United Kingdom
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Praveen Thokala
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Julian Wei-Tze Tang
- Department of Clinical Microbiology, University Hospital of Leicester NHS Trust, Leicester, United Kingdom
- Department of Infection, Immunity, Inflammation, University of Leicester, Leicester, United Kingdom
| | | | - Vernon Min Sen Oh
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
- * E-mail:
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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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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Yusrina F, Chua CW, Lee CK, Chiu L, Png TSY, Khoo MJ, Yan G, Lee GH, Yan B, Lee HK. Comparison of cobas HCV GT against Versant HCV Genotype 2.0 (LiPA) with confirmation by Sanger sequencing. J Virol Methods 2018; 255:8-13. [PMID: 29428399 DOI: 10.1016/j.jviromet.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/29/2018] [Accepted: 02/04/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Correct identification of infecting hepatitis C virus (HCV) genotype is helpful for targeted antiviral therapy. OBJECTIVES Here, we compared the HCV genotyping performance of the cobas HCV GT assay against the Versant HCV Genotype 2.0 (LiPA) assay, using 97 archived serum samples. STUDY DESIGN In the event of discrepant or indeterminate results produced by either assay, the core and NS5B regions were sequenced. RESULTS Of the 97 samples tested by the cobas, 25 (26%) were deemed indeterminate. Sequencing analyses confirmed 21 (84%) of the 25 samples as genotype 6 viruses with either subtype 6m, 6n, 6v, 6xa, or unknown subtype. Of the 97 samples tested by the LiPA, thirteen (13%) were deemed indeterminate. Seven (7%) were assigned with genotype 1, with unavailable/inconclusive results from the core region of the LiPA. Notably, the 7 samples were later found to be either genotype 3 or 6 by sequencing analyses. Moreover, 1 sample by the LiPA was assigned as genotypes 4 (cobas: indeterminate) but were later found to be genotype 3 by sequencing analyses, highlighting its limitation in assigning the correct genotype. CONCLUSIONS The cobas showed similar or slightly higher accuracy (100%; 95% CI 94-100%) compared to the LiPA (99%; 95% CI 92-100%). Twenty-six percent of the 97 samples tested by the cobas had indeterminate results, mainly due to its limitation in identifying genotype 6 other than subtypes 6a and 6b. This presents a significant assay limitation in Southeast Asia, where genotype 6 infection is highly prevalent.
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Affiliation(s)
- Falah Yusrina
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Cui Wen Chua
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Chun Kiat Lee
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Lily Chiu
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Tracy Si-Yu Png
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Mui Joo Khoo
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Gabriel Yan
- Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Guan Huei Lee
- Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Benedict Yan
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore; Translational Centre for Development and Research, National University Health System, Singapore
| | - Hong Kai Lee
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore.
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