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Tan E, Kennedy H, Rademaker M. Exploring the Association Between Isotretinoin and Sexual Dysfunction: A Comprehensive Scoping Review. Clin Exp Dermatol 2024:llae168. [PMID: 38703072 DOI: 10.1093/ced/llae168] [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] [Received: 02/11/2024] [Revised: 03/28/2024] [Accepted: 05/02/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The potential link between isotretinoin and sexual dysfunction has been reported in various studies. However, such an association has not been explored within the context of a literature review until now. OBJECTIVES To evaluate the methodology and quality of studies investigating this association, and to examine the definitions of sexual dysfunction used. METHODS A scoping review approach was used to identify peer-reviewed research articles. The search terms used were: "isotretinoin", "sexual dysfunction", "erectile dysfunction", "ejaculatory disorders" "decreased libido", "female sexual interest", "female arousal disorder", "libido", "pelvic pain", "dyspareunia", "orgasmic disorder", "impotence", "ovaries", "fertility" and "menstrual irregularity". RESULTS 54 peer-reviewed manuscripts consisting of 8 animal studies and 46 human studies consisting of 2,420 patients were included. Of the studies in humans, there were 18 case reports/case series, 2 case-controls, 4 cross-sectional studies, 6 longitudinal studies, 3 pharmacovigilance reports and 13 cohort studies. The most frequently observed dose range of isotretinoin was 0.5-1.0mg/kg/day usually for a duration of 1-6 months. More than half of the studies (54%, n=25) reported a beneficial or neutral effect of isotretinoin on sexual function. The majority of studies (89%, n = 41) were categorized as Oxford evidenced-based-medicine level 4. CONCLUSIONS This scoping review revealed very weak evidence supporting a link between isotretinoin and sexual dysfunction. Notably, the diverse definitions of sexual dysfunction pose a significant challenge for comparative analysis. The authors advocate for a standardized definition of sexual dysfunction and a framework for determining causality in order to contribute to a more comprehensive understanding of the relationship between isotretinoin and sexual dysfunction.
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Affiliation(s)
| | - Harriet Kennedy
- Auckland City Hospital, Te Whatu Ora, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Marius Rademaker
- Clinical Trials New Zealand, Waikato Hospital Campus, Hamilton, New Zealand
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2
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Tan E. Sustainable dermatology-A practical guide for the Australian dermatologist. Australas J Dermatol 2024; 65:14-23. [PMID: 37902158 DOI: 10.1111/ajd.14178] [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: 05/12/2023] [Revised: 09/06/2023] [Accepted: 10/08/2023] [Indexed: 10/31/2023]
Abstract
Globally, healthcare systems can account for up to 10% of national CO2 emissions. There is increasing awareness of the need to act to reduce the impact on our planet by living sustainably in our personal and professional lives. Literature on sustainability can be complex, and with so many demands on our attention and time, it is challenging for the practising dermatologist to grasp where to begin. This manuscript provides a practical guide with quantifiable impacts for each action. With mindful use of resources, both profitability and the well-being of patients and doctors can align with environmental protection.
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3
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Tan E, Tran M, Rademaker M, Lin FPY. Bridging AI development with clinical relevance-A scoping review of skin cancer models since CLEAR Derm. Where to next? Australas J Dermatol 2023. [PMID: 38146087 DOI: 10.1111/ajd.14207] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023]
Affiliation(s)
| | - Minh Tran
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Marius Rademaker
- Clinical Trials New Zealand, Waikato Hospital Campus, Hamilton, New Zealand
| | - Frank P Y Lin
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
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Tan E, Kennedy H, Rademaker M. When science and evidence is not enough: challenging the recommendations from the Commission on Human Medicines Isotretinoin Expert Working Group. Br J Dermatol 2023; 190:116-117. [PMID: 37742060 DOI: 10.1093/bjd/ljad363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/14/2023] [Accepted: 09/22/2023] [Indexed: 09/25/2023]
Abstract
The Commission on Human Medicines (CHM) Isotretinoin Expert Working Group recently released a report with several major recommendations. The authors scrutinized the evidence cited by the CHM and presented the case that their recommendations undermine evidence-based medicine and scientific thinking.
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Affiliation(s)
| | - Harriet Kennedy
- Auckland City Hospital, Te Whatu Ora, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Marius Rademaker
- Clinical Trials New Zealand, Waikato Hospital Campus, Hamilton, New Zealand
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5
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Stor MLE, Horbach SER, Lokhorst MM, Tan E, Maas SM, van Noesel CJM, van der Horst CMAM. Genetic mutations and phenotype characteristics in peripheral vascular malformations: A systematic review. J Eur Acad Dermatol Venereol 2023. [PMID: 38037869 DOI: 10.1111/jdv.19640] [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] [Received: 01/27/2023] [Accepted: 08/29/2023] [Indexed: 12/02/2023]
Abstract
Vascular malformations (VMs) are clinically diverse with regard to the vessel type, anatomical location, tissue involvement and size. Consequently, symptoms and disease impact differ significantly. Diverse causative mutations in more and more genes are discovered and play a major role in the development of VMs. However, the relationship between the underlying causative mutations and the highly variable phenotype of VMs is not yet fully understood. In this systematic review, we aimed to provide an overview of known causative mutations in genes in VMs and discuss associations between the causative mutations and clinical phenotypes. PubMed and EMBASE libraries were systematically searched on November 9th, 2022 for randomized controlled trials and observational studies reporting causative mutations in at least five patients with peripheral venous, lymphatic, arteriovenous and combined malformations. Study quality was assessed with the Newcastle-Ottawa Scale. Data were extracted on patient and VM characteristics, molecular sequencing method and results of molecular analysis. In total, 5667 articles were found of which 69 studies were included, reporting molecular analysis in a total of 4261 patients and 1686 (40%) patients with peripheral VMs a causative mutation was detected. In conclusion, this systematic review provides a comprehensive overview of causative germline and somatic mutations in various genes and associated phenotypes in peripheral VMs. With these findings, we attempt to better understand how the underlying causative mutations in various genes contribute to the highly variable clinical characteristics of VMs. Our study shows that some causative mutations lead to a uniform phenotype, while other causal variants lead to more varying phenotypes. By contrast, distinct causative mutations may lead to similar phenotypes and result in almost indistinguishable VMs. VMs are currently classified based on clinical and histopathology features, however, the findings of this systematic review suggest a larger role for genotype in current diagnostics and classification.
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Affiliation(s)
- M L E Stor
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - S E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - M M Lokhorst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - E Tan
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - S M Maas
- Department of Clinical Genetics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - C J M van Noesel
- Department of Pathology, Molecular Diagnostics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
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Tan E, Kennedy H, Rademaker M. Burden of proof-Critical flaws in the recommendations from the commission on human medicines Isotretinoin expert working group. Australas J Dermatol 2023; 64:579-580. [PMID: 37822144 DOI: 10.1111/ajd.14169] [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: 08/08/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Eugene Tan
- Department of Dermatology, Skintel, Auckland, New Zealand
| | - Harriet Kennedy
- Auckland City Hospital, Te Whatu Ora, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Marius Rademaker
- Clinical Trials New Zealand, Waikato Hospital Campus, Hamilton, New Zealand
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Kaplan MA, McDaneld CP, Brown J, Selden IM, Jiang H, Tan E, Selden R, Spradley MK, Huston S. Alternative workflows for identifying transnational missing persons. Forensic Sci Int Synerg 2023; 7:100445. [PMID: 38025091 PMCID: PMC10630773 DOI: 10.1016/j.fsisyn.2023.100445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
Mass migration and migrant death at the U.S. southern border highlight the disconnectedness of the systems for transnational decedent identifications. Death investigation cases in Texas face delays and barriers at all stages of an investigation. Additionally, fragmentation of DNA databases exacerbate challenges in comparing genetic samples from unidentified human remains (UHR) and families of the missing. We sought to pilot alternative workflows for processing UHR and family reference samples (FRS) for the identification of probable migrant decedents. Primarily using Rapid DNA, but also accredited non-CODIS DNA laboratories, the piloted approaches were conducted in parallel to existing medicolegal workflows under the relevant case jurisdictional guidance. Our data show that Rapid DNA is a valid path for anthropology laboratories to support identification hypotheses and that accredited non-CODIS forensic and genetic laboratories also can support families to identify remains, especially when families reside outside of the United States.
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Affiliation(s)
- Molly A. Kaplan
- Forensic Anthropology Center, Department of Anthropology, Texas State University, San Marcos, TX, USA
| | - Chloe P. McDaneld
- Forensic Anthropology Center, Department of Anthropology, Texas State University, San Marcos, TX, USA
| | | | | | - Hua Jiang
- ANDE Corporation LLC, Waltham, MA, USA
| | | | | | - M Kate Spradley
- Forensic Anthropology Center, Department of Anthropology, Texas State University, San Marcos, TX, USA
| | - Sara Huston
- Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University, Chicago, IL, USA
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Zeng J, Zhou T, Xu Y, Lin Q, Tan E, Zhang Y, Wu X, Zhang J, Liu X. The fusion of multiple scale data indicates that the carbon sink function of the Qinghai-Tibet Plateau is substantial. Carbon Balance Manag 2023; 18:19. [PMID: 37695559 PMCID: PMC10494389 DOI: 10.1186/s13021-023-00239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The Qinghai-Tibet Plateau is the "sensitive area" of climate change, and also the "driver" and "amplifier" of global change. The response and feedback of its carbon dynamics to climate change will significantly affect the content of greenhouse gases in the atmosphere. However, due to the unique geographical environment characteristics of the Qinghai-Tibet Plateau, there is still much controversy about its carbon source and sink estimation results. This study designed a new algorithm based on machine learning to improve the accuracy of carbon source and sink estimation by integrating multiple scale carbon input (net primary productivity, NPP) and output (soil heterotrophic respiration, Rh) information from remote sensing and ground observations. Then, we compared spatial patterns of NPP and Rh derived from the fusion of multiple scale data with other widely used products and tried to quantify the differences and uncertainties of carbon sink simulation at a regional scale. RESULTS Our results indicate that although global warming has potentially increased the Rh of the Qinghai-Tibet Plateau, it will also increase its NPP, and its current performance is a net carbon sink area (carbon sink amount is 22.3 Tg C/year). Comparative analysis with other data products shows that CASA, GLOPEM, and MODIS products based on remote sensing underestimate the carbon input of the Qinghai-Tibet Plateau (30-70%), which is the main reason for the severe underestimation of the carbon sink level of the Qinghai-Tibet Plateau (even considered as a carbon source). CONCLUSIONS The estimation of the carbon sink in the Qinghai-Tibet Plateau is of great significance for ensuring its ecological barrier function. It can deepen the community's understanding of the response to climate change in sensitive areas of the plateau. This study can provide an essential basis for assessing the uncertainty of carbon sources and sinks in the Qinghai-Tibet Plateau, and also provide a scientific reference for helping China achieve "carbon neutrality" by 2060.
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Affiliation(s)
- Jingyu Zeng
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Tao Zhou
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China.
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China.
| | - Yixin Xu
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Qiaoyu Lin
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - E Tan
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Yajie Zhang
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Xuemei Wu
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Jingzhou Zhang
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Xia Liu
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
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9
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Ji Y, Tan E, Hengelage T, Quinlan M, Hendriks BS. Exploratory Food Effect Assessment in Patients in Early Clinical Development of Oncology Drugs. Clin Pharmacol Ther 2023; 114:288-302. [PMID: 37078098 DOI: 10.1002/cpt.2911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
Instructions for administration with regard to food are a key aspect of how patients experience oral drugs. Through potential effects on pharmacokinetics, the food condition can influence safety and efficacy, and thereby is one of many dimensions of dose optimization. Regulatory guidance from major health authorities advocates for the early investigation of food effect (FE) in clinical development. In oncology, exploratory FE (eFE) evaluation is often incorporated into the first-in-human (FIH) studies in patients to inform food condition of later clinical studies. However, the design aspects of such exploratory assessments are generally under-reported and barely described, and yet complex, due to uniqueness of FIH study design and drug development process in oncology. Herein, we review literature of eFE assessment study design in oncology in patients, and present the Novartis experience in the design, execution, and impact of eFE in FIH oncology studies from 2014 to 2021. Based on this, we propose a roadmap for eFE assessment in early clinical drug development for oncology drugs in patients, including a framework for common study design options with a focus on study- and patient-level timing for typical scenarios. We also provide a broad spectrum of decision-making factors which should be evaluated to drive the design and implementation of eFE assessment, spanning from clinical development strategy, FIH study design, to compound-specific features.
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Affiliation(s)
- Yan Ji
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Eugene Tan
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Michelle Quinlan
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Bart S Hendriks
- Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA
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Tan E, Selden RF. Rapid and Sensitive Human-Specific DNA Quantitation Using a Microfluidic Amplification Module at the Point-of-Care. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-6. [PMID: 38083671 DOI: 10.1109/embc40787.2023.10340932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
A rapid microfluidic human-specific DNA quantitation assay module was developed for chip-based amplification of the human TH01 and Alu loci in the presence of PicoGreen. The method makes use of the thermal cycler and 488 nm Solid State laser-based optical train that are components of the fully-integrated, sample-in to results out, ANDE Rapid Nucleic Acid Analysis system. The assay was effective in quantitating human DNA from a variety of sample types, including blood, buccal, and forensic touch samples mixed with varying amounts of non-human DNA. The 28-cycle TH01 and 10-cycle Alu reactions were completed in 18 minutes and 7 minutes, respectively. The observed limit of detection (LOD) of the assay is approximately 0.3 ng, and the flexibility of assay design allows an LOD of as little as 0.005 femtograms.Clinical Relevance-We have developed a fully-integrated, sample-in to results-out, Rapid Nucleic Acid Analysis system that characterizes nucleic acid fragments (whether generated by PCR, rt-PCR, sequencing, or SNP reactions) by electrophoresis in plastic microfluidic channels. Here we describe the development, characterization, and validation of the microfluidic quantitation module. The quantitation module is the first that can be incorporated into integrated microfluidic workflows for the analysis of highly-multiplexed clinical diagnostic assays interrogating hundreds of genomic targets in a single sample. In particular, the use of a microfluidic quantitation module allows reaction volumes, thermal cycling conditions, and electrophoretic injection protocols to be determined based on nucleic acid content during and throughout fully-automated processing-dramatically enhancing the power of the fully-automated diagnostic system.
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Tan E, Lim D, Lin F. Response to Felmingham C. et al's "Improving Skin cancer Management with ARTificial Intelligence (SMARTI): a pre-post intervention trial of an Artificial Intelligence system used as a diagnostic aid for skin cancer management in a real-world specialist dermatology setting". J Am Acad Dermatol 2023:S0190-9622(23)00744-2. [PMID: 37121484 DOI: 10.1016/j.jaad.2023.03.062] [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: 02/21/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 05/02/2023]
Affiliation(s)
| | | | - Frank Lin
- University of New South Wales, Sydney, Australia; Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, Australia; NHMRC Clinical Trials Centre, University of Sydney, NSW
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12
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Tan E, Wang MQW, Leong S, Chou H, Too CW. Neurological pain relief interventional radiology procedures. Clin Radiol 2023; 78:254-264. [PMID: 35773096 DOI: 10.1016/j.crad.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/29/2022] [Indexed: 11/24/2022]
Abstract
Neurological interventions have taken on a significant role in interventional radiology (IR) practice. Indications fall under three main categories: (1) intraprocedural pain management, (2) cancer pain palliation, and (3) chronic non-cancer pain control. Short-term regional anaesthesia can be achieved with local anaesthetics, while longer-term pain control can be attained with radiofrequency neuromodulation (pulsed or otherwise) or thermal/chemical neurolysis. This review article summarises the therapeutic options, applications, and techniques of commonly used peripheral nerve and plexus interventions in IR.
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Affiliation(s)
- E Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - M Q W Wang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - S Leong
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - H Chou
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - C W Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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David RJ, Tan E, Teo MK. Trial of dexamethasone for chronic subdural hematoma. Br J Neurosurg 2023; 37:241. [PMID: 33606591 DOI: 10.1080/02688697.2021.1886245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R J David
- North Bristol NHS Trust, Westbury on Trym, UK
| | - E Tan
- North Bristol NHS Trust, Westbury on Trym, UK
| | - M K Teo
- North Bristol NHS Trust, Westbury on Trym, UK
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14
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Tan E, Algar S, Corrêa D, Small M, Stemler T, Walker D. Selecting embedding delays: An overview of embedding techniques and a new method using persistent homology. Chaos 2023; 33:032101. [PMID: 37003815 DOI: 10.1063/5.0137223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/07/2023] [Indexed: 06/19/2023]
Abstract
Delay embedding methods are a staple tool in the field of time series analysis and prediction. However, the selection of embedding parameters can have a big impact on the resulting analysis. This has led to the creation of a large number of methods to optimize the selection of parameters such as embedding lag. This paper aims to provide a comprehensive overview of the fundamentals of embedding theory for readers who are new to the subject. We outline a collection of existing methods for selecting embedding lag in both uniform and non-uniform delay embedding cases. Highlighting the poor dynamical explainability of existing methods of selecting non-uniform lags, we provide an alternative method of selecting embedding lags that includes a mixture of both dynamical and topological arguments. The proposed method, Significant Times on Persistent Strands (SToPS), uses persistent homology to construct a characteristic time spectrum that quantifies the relative dynamical significance of each time lag. We test our method on periodic, chaotic, and fast-slow time series and find that our method performs similar to existing automated non-uniform embedding methods. Additionally, n-step predictors trained on embeddings constructed with SToPS were found to outperform other embedding methods when predicting fast-slow time series.
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Affiliation(s)
- Eugene Tan
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Shannon Algar
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Débora Corrêa
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Michael Small
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Thomas Stemler
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009, Australia
| | - David Walker
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009, Australia
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Bouffet E, Geoerger B, Moertel C, Whitlock JA, Aerts I, Hargrave D, Osterloh L, Tan E, Choi J, Russo M, Fox E. Efficacy and Safety of Trametinib Monotherapy or in Combination With Dabrafenib in Pediatric BRAF V600-Mutant Low-Grade Glioma. J Clin Oncol 2023; 41:664-674. [PMID: 36375115 PMCID: PMC9870224 DOI: 10.1200/jco.22.01000] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/09/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE BRAF V600 mutations occur in many childhood cancers, including approximately 20% of low-grade gliomas (LGGs). Here, we describe a phase I/II study establishing pediatric dosing and pharmacokinetics of trametinib with or without dabrafenib, as well as efficacy and safety in a disease-specific cohort with BRAF V600-mutant LGG; other cohorts will be reported elsewhere. METHODS This is a four-part, phase I/II study (ClinicalTrials.gov identifier: NCT02124772) in patients age < 18 years with relapsed/refractory malignancies: trametinib monotherapy dose finding (part A) and disease-specific expansion (part B), and dabrafenib + trametinib dose finding (part C) and disease-specific expansion (part D). The primary objective assessed in all patients in parts A and C was to determine pediatric dosing on the basis of steady-state pharmacokinetics. Disease-specific efficacy and safety (across parts A-D) were secondary objectives. RESULTS Overall, 139 patients received trametinib (n = 91) or dabrafenib + trametinib (n = 48). Trametinib dose-limiting toxicities in > 1 patient (part A) included mucosal inflammation (n = 3) and hyponatremia (n = 2). There were no dose-limiting toxicities with combination therapy (part C). The recommended phase II dose of trametinib, with or without dabrafenib, was 0.032 mg/kg once daily for patients age < 6 years and 0.025 mg/kg once daily for patients age ≥ 6 years; dabrafenib dosing in the combination was as previously identified for monotherapy. In 49 patients with BRAF V600-mutant glioma (LGG, n = 47) across all four study parts, independently assessed objective response rates were 15% (95% CI, 1.9 to 45.4) for monotherapy (n = 13) and 25% (95% CI, 12.1 to 42.2) for combination (n = 36). Adverse event-related treatment discontinuations were more common with monotherapy (54% v 22%). CONCLUSION The trial design provided efficient evaluation of pediatric dosing, safety, and efficacy of single-agent and combination targeted therapy. Age-based and weight-based dosing of trametinib with or without dabrafenib achieved target concentrations with manageable safety and demonstrated clinical efficacy and tolerability in BRAF V600-mutant LGG.
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Affiliation(s)
- Eric Bouffet
- Department of Paediatrics, The Hospital for Sick Children/University of Toronto, Toronto, ON, Canada
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | | | - James A Whitlock
- Department of Paediatrics, The Hospital for Sick Children/University of Toronto, Toronto, ON, Canada
| | - Isabelle Aerts
- Institut Curie, PSL Research University, Oncology Center SIREDO, Paris, France
| | - Darren Hargrave
- Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Eugene Tan
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Jeea Choi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Mark Russo
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Elizabeth Fox
- Comprehensive Cancer Center, St Jude Children's Research Hospital, Memphis, TN
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Turmel N, Hentzen C, Tan E, Haddad R, Chesnel C, Le Breton F, Amarenco G. Aqua: A new questionnaire assessing anticholinergic side effects in neurogenic population (Aqua: Anticholinergic side effects questionnaire). Prog Urol 2022; 32:751-755. [PMID: 35729028 DOI: 10.1016/j.purol.2022.05.001] [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: 02/17/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
AIMS Validate a new questionnaire to assess the side effects secondary to anticholinergics in neurogenic population suffering from Adult neurogenic lower urinary tract dysfunction (ANLUTD). METHODS We conducted a prospective, monocentric study in a Neuro-urology Department of a University Hospital between February 2015 and April 2020. To allow a full psychometric validation of a questionnaire, the study protocol included 3 steps: qualitative interviews, feasibility study and validation study. The primary outcome was good psychometric properties defined with good internal consistency reliability (Cronbach's α>0.7) and good test-retest reliability (intraclass correlation coefficient (ICC)>0.7). RESULTS we included 64 patients with ANLUTD secondary to neurogenic disorders. Feasibility study demonstrate very good acceptation and comprehension for 97% of patients. Validation study showed good internal consistency with Cronbach's α=0,69 and very good ICC=0,73. AQUA is composed with 8 items scoring 0 (no side effect) to 2 (major side effect) for a total score between 0 to 16. Time to fulfill is very quick. Mean score in our population was 4,1 (sd 2,9). CONCLUSION AQUA is the first validated tool to assess side effects secondary to antimuscarinic treatment for neurogenic population suffering from ANLUTD. LEVEL OF PROOF 2.
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Affiliation(s)
- N Turmel
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de médecine physique et réadaptation, hôpital Danielle Casanova, 11, rue Danielle Casanova, 93200 St Denis, France.
| | - C Hentzen
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - E Tan
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - R Haddad
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - C Chesnel
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - F Le Breton
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Amarenco
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
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Tan E, Tuffet S, Rousseau A, Fautrel B, Rannou F, Berenbaum F, Sellam J, Courties A. POS1111 WHAT DOES GRIP STRENGTH REFLECT IN HAND OSTEOARTHRITIS? RESULTS FROM THE DIGICOD COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAmong the general population over 60 years-old, the decrease in grip strength is a marker of morbidity and mortality: its measurement during follow-up consultations is considered as a predictive marker of good health status or the patient’s overall fragility (1). However, hand osteoarthritis (HOA), which can modulate grip strength and is also associated with comorbidities is never taken into account, while it is a very common disease.ObjectivesThe objectives of this study are to describe grip strength in a symptomatic HOA population, to investigate painful osteoarthritic joints associated with decreased grip strength, and to determine whether decreased grip strength is independently associated with comorbidities in this population.MethodsDIGICOD is a hospital-based observational cohort including patients with radiographic features of HOA of at least 2 joints or radiographic thumb base OA. Inflammatory rheumatism or crystal arthropathy were excluded. The data at baseline were used for the analysis. Grip strength was the higher score of 3 repeated measures using a Jamar dynamometer. Baseline grip strength of the dominant hand was compared in the cohort between men and women (Student’s T test) and was described by age (by 10-year age groups using Kruskal-Wallis test). In this cross-sectional study, factors associated with a decreased grip strength were investigated using univariate and then multivariate linear regression analysis (with adjustment on age, BMI and variables with p ≤ 0.2 in univariate analysis) with stratification by sex. Results were presented by beta coefficients and their 95% confidence intervals. A first analysis focused on the association of grip strength with local factors: painful locations in the dominant hand by row and radiographic severity according to the total Kellgren-Lawrence (KL) score. The second analysis assessed the patient-level association between decreased grip strength and general characteristics, including cumulative comorbidities and markers of radio-clinical severity of hand OA, namely the AUSCAN pain score and total KL score. A sensitivity analysis was performed to look for association between grip strength and each comorbidity.Results394 patients were analyzed, including 329 women (mean ± SD of the dominant hand’s grip strength of 21.6 ± 6.9 kg) and 65 men (34.9 ± 9.8 kg) with a mean age of 66.9 ± 7.3 years. Grip strength decreased with age (p<0.001) and was lower for women (p<0.0001).Among women, locally, decreased grip strength was independently associated with painful involvement of at least 2 metacarpophalangeal joints (MCPs) (estimated coefficient [95% CI] -3.6 [-6.2; -1.0] kg versus no painful MCPs) but not with proximal and distal interphalangeal joints, and with a high KL total sum score (-0.06 [-0.10; -0.01] kg per additional point). At the patient-level, decreased grip strength was not associated with comorbidities but with radio-clinical severity (p<0.05), i.e. a higher KL total sum score and AUSCAN pain score.Among men, neither radiographic severity nor painful locations were independently associated with a decrease of grip strength. Conversely, decreased grip strength was associated with at least 3 comorbidities (-8.5 [-15.5; -1.43] kg versus a single comorbidity being OA), independently of radiographic severity. The study of comorbidities individually did not show any particular association with grip strength.ConclusionIn this cohort of symptomatic HOA, the decrease of grip strength reflects the radio-clinical severity of hand OA among women, whereas among men, it is independently associated with the accumulation of comorbidities. The presence of hand OA should be considered for further studies investigation the relationship between grip strength and morbi-mortality.References[1]Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. CIA. oct 2019;Volume 14:1681‑91.Graph 1.Grip strength according to the number of comorbidities among men and womenDisclosure of InterestsNone declared
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Desprez C, Turmel N, Chesnel C, Sheikh Ismael S, Tamiatto M, Tan E, Haddad R, Le Breton F, Leroi AM, Hentzen C, Amarenco G. Fecal incontinence subtype assessment (FI-SA): A new tool to distinguish among subtypes of fecal incontinence in a neurogenic population. Clin Res Hepatol Gastroenterol 2022; 46:101900. [PMID: 35259498 DOI: 10.1016/j.clinre.2022.101900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Two subtypes of fecal incontinence (FI) are defined in the literature (urge and passive FI). The pertinence of this classification is unknown due to conflicting findings and heterogeneity of definitions. However, no questionnaire is available to clearly classify patients among subtypes. The objective of the present study was to develop and validate a new tool (Fecal incontinence subtype assessment, FI-SA) in order to better classify patients among the different subtypes of FI. METHODS A prospective monocentric study was conducted in consecutive patients with FI according to Rome IV criteria. To validate psychometric properties of the FI-SA questionnaire, a literature review and qualitative interviews were performed and discussed with an expert panel. A feasibility study was realized to assess acceptability and comprehension of items. The reproducibility was investigated in a validation study. RESULTS Comprehension and acceptability were excellent in 90% of patients in the feasibility study (n = 30). Validation study (n = 100) showed a good reproducibility with an intra-class correlation coefficient of 0.91 and 0.89 for questions 1 and 2. Time to fill the questionnaire was 40.0 s. 98.0% patients were classified among subtypes of FI: 34.0% passive FI, 32.0% urge FI and 32.0% mixed FI. CONCLUSION FI-SA is the first questionnaire to classify patients among subtypes of FI with good psychometric characteristics and the first questionnaire introducing the concept of mixed FI. FI-SA could help to determine the pertinence of this classification of FI in the management of these patients.
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Affiliation(s)
- C Desprez
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Rouen University Hospital, Digestive physiology Department, 76000 Rouen, France.
| | - N Turmel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Casanova Hospital, 93200 Saint-Denis, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - S Sheikh Ismael
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; ELSAN, Clinique Le Floride, 66420 Le Barcarès, France
| | - M Tamiatto
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - E Tan
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - R Haddad
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - F Le Breton
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - A-M Leroi
- Rouen University Hospital, Digestive physiology Department, 76000 Rouen, France
| | - C Hentzen
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
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Tan VH, Loo G, Tun MH, De Leon J, Boey E, Soh R, Tan E, Gan HH, Lee JY, Teo JTL, Yeo C, Seow SC, Kojodjojo P. Acute and medium-term outcomes of His-bundle pacing with or without electrophysiology recording system using propensity score-matching. Heart Rhythm 2022; 19:1394-1396. [PMID: 35447309 DOI: 10.1016/j.hrthm.2022.04.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, Singapore.
| | - Germaine Loo
- Department of Cardiology, Changi General Hospital, Singapore
| | - Mon Hnin Tun
- Department of Health Services Research, Changi General Hospital, Singapore
| | - Jhobeleen De Leon
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Elaine Boey
- Division of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Rodney Soh
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Eugene Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Hiong Hiong Gan
- Division of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Jie Ying Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | | | - Colin Yeo
- Department of Cardiology, Changi General Hospital, Singapore
| | - Swee Chong Seow
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Division of Cardiology, Ng Teng Fong General Hospital, Singapore
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Kojodjojo P, De Leon J, Boey E, Soh R, Tan E, Yeo C, Tan VH, Seow SC. ADOPTING PERMANENT HIS BUNDLE PACING: LEARNING CURVES AND MEDIUM-TERM OUTCOMES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Loo G, De Leon J, Seow SC, Boey E, Soh R, Tan E, Gan HH, Lee JY, Teo JTL, Yeo C, Kojodjojo P, Tan VH. Acute procedural outcomes of his bundle pacing with or without electrophysiology mapping system: a multicenter study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
His bundle pacing (HBP) is associated with improved clinical outcomes compared to right ventricular apical pacing. However, it can be technically challenging and may result in prolonged fluoroscopy and procedural time.
Purpose
We sought to compare the feasibility of performing HBP with or without electrophysiology mapping (EP) system, focusing on evaluating acute procedural success, complication rates and short-term outcomes.
Methods
HBP patients at 3 hospitals were recruited between August 2018 to December 2020. HBP was performed with EP mapping system in 1 center, and without EP mapping in the other 2 centers. Acute procedural success was defined as either selective or non-selective His bundle capture with a threshold of less than or equal to 1.5V at 1ms at the end of procedure implantation.
Results
A total of 233 patients were recruited, of which HBP was performed with EP mapping in 77 patients (33.0%) and without EP mapping in 156 patients (67.0%). Both groups were similar in age (73.2 ± 11.0 years vs 75.3 ± 9.5 years, p = 0.125) and male sex (58.4% vs 48.1%, p = 0.136). There were more patients with ischemic heart disease (45.5% vs 22.4%, p < 0.01) and reduced left ventricular ejection fraction ≤ 40% (28.6% vs 10.9%, p < 0.01) in the group with EP mapping. The indications for HBP was for high-grade atrioventricular block (55.8%), sick sinus syndrome (35.6%) and cardiac resynchronization therapy (CRT) (8.6%). There were more patients who required CRT in the center with EP mapping (18.2% vs 3.8%, p < 0.01). HBP was successful in 39 patients (50.6%) with EP mapping and 93 patients (59.6%) without EP mapping (p= 0.382). The median R wave at implant was similar in both groups [4.0 (2.9 – 6.2) mV vs 4.3 (4.3 – 7.0) mV, p = 0.808]. Impedance at implant (607 ± 195 ohms vs 547 ± 166 ohms, p < 0.01) and selective His bundle bipolar threshold at implant [1.25 (0.75-1.75) V vs 0.7 (0.5 – 1.25) V, p = 0.01] was higher in patients with EP mapping while non-selective His bundle bipolar threshold at implant [1.75 (1.0 – 3.0) V vs 1.5 (0.9 – 2.2) V, p = 0.133] and paced QRS duration (116.4 ± 25.4 ms vs 114.4 ± 24.2 ms, p =0.655) were similar. There were no differences in procedural or fluoroscopy time between groups (111 ± 36.9 min vs 107 ± 40.7 min, p = 0.479; and 10.3 ± 8.9 min vs 12.1± 14.0 min, p = 0.328 respectively). There was a similar rate of acute procedural complications (5.2% vs 1.3%, p = 0.076) and patients requiring wound or lead revision (6.8% vs 1.9%, p = 0.115) after a median follow up duration of 205 days (67-397). The prevalence of new onset paroxysmal atrial fibrillation (11.7% vs 4.2%, p = 0.037) and all cause mortality (12.3% vs 3.2%, p = 0.029) was increased in patients who underwent HBP with EP mapping.
Conclusion
HBP in centers with or without EP mapping showed similar acute procedure success and complication rates. The use of EP mapping system was not shown to affect procedural or fluoroscopy duration.
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Affiliation(s)
- G Loo
- Changi General Hospital, Cardiology, Singapore, Singapore
| | - J De Leon
- National University Hospital, Cardiology, Singapore, Singapore
| | - S C Seow
- National University Hospital, Cardiology, Singapore, Singapore
| | - E Boey
- Ng Teng Fong Hospital, Cardiology, Singapore, Singapore
| | - R Soh
- National University Hospital, Cardiology, Singapore, Singapore
| | - E Tan
- National University Hospital, Cardiology, Singapore, Singapore
| | - H H Gan
- Ng Teng Fong Hospital, Cardiology, Singapore, Singapore
| | - J Y Lee
- National University Hospital, Cardiology, Singapore, Singapore
| | - J T L Teo
- Changi General Hospital, Cardiology, Singapore, Singapore
| | - C Yeo
- Changi General Hospital, Cardiology, Singapore, Singapore
| | - P Kojodjojo
- Ng Teng Fong Hospital, Cardiology, Singapore, Singapore
| | - V H Tan
- Changi General Hospital, Cardiology, Singapore, Singapore
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Tan E, Abuhelwa AY, Badaoui S, Modi ND, Wiese MD, McKinnon RA, Sorich MJ, Hopkins AM. Association between Patient-Reported Outcomes and Survival in Patients with Advanced Urothelial Carcinoma Treated with Atezolizumab. Bladder Cancer 2021. [DOI: 10.3233/blc-211613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Atezolizumab is an immune checkpoint inhibitor (ICI) and a frontline treatment of patients with cisplatin-ineligible advanced urothelial carcinoma (UC). There is limited evidence on the prognostic value of patient reported outcomes (PROs) in advanced UC treatment, particularly in the context of ICI therapy. OBJECTIVE: To investigate the prognostic association of PROs with survival in patients with advanced UC treated with atezolizumab. METHODS: This study used data from 467 patients with advanced UC initiating atezolizumab in the IMvigor211 trial. Pre-treatment PROs association with overall survival (OS) and progression free survival (PFS) was assessed using Cox proportional hazard analysis. PROs were recorded via the European Organisation for Research and Treatment of Cancer QLQ-C30. Discrimination performance was assessed via the C-statistic (c). RESULTS: Patient reported physical function, pain, appetite loss, global health, fatigue, role function, constipation, nausea and vomiting, dyspnoea, and insomnia were significantly associated with OS and PFS on univariable and adjusted analysis (P < 0.05). Physical function (c = 0.63), pain (c = 0.63), appetite loss (c = 0.62), global health status (c = 0.62), and fatigue (c = 0.62), were the most prognostic factors of OS. The OS discrimination performance of physical function (c = 0.61) was superior to ECOG PS (c = 0.58). Of patients assessed by investigators as having no performance restrictions (ECOG PS of 0), 38 (18%) and 91 (42%) self-reported low and intermediate physical function scores, respectively. CONCLUSION: Pre-treatment PROs were identified as independent prognostic factors of OS and PFS. Patient-reported physical function was more prognostic of OS than ECOG PS. This highlights a potential for PROs to enable improved patient stratification in ICI trials.
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Affiliation(s)
- Eugene Tan
- College of Medicine and Public Health, Flinders University, SA, Australia
| | - Ahmad Y. Abuhelwa
- College of Medicine and Public Health, Flinders University, SA, Australia
| | - Sarah Badaoui
- College of Medicine and Public Health, Flinders University, SA, Australia
| | - Natansh D. Modi
- College of Medicine and Public Health, Flinders University, SA, Australia
| | - Michael D. Wiese
- Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ross A. McKinnon
- College of Medicine and Public Health, Flinders University, SA, Australia
| | - Michael J. Sorich
- College of Medicine and Public Health, Flinders University, SA, Australia
| | - Ashley M. Hopkins
- College of Medicine and Public Health, Flinders University, SA, Australia
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Tan E, Corrêa D, Stemler T, Small M. Grading your models: Assessing dynamics learning of models using persistent homology. Chaos 2021; 31:123109. [PMID: 34972316 DOI: 10.1063/5.0073722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
Assessing model accuracy for complex and chaotic systems is a non-trivial task that often relies on the calculation of dynamical invariants, such as Lyapunov exponents and correlation dimensions. Well-performing models are able to replicate the long-term dynamics and ergodic properties of the desired system. We term this phenomenon "dynamics learning." However, existing estimates based on dynamical invariants, such as Lyapunov exponents and correlation dimensions, are not unique to each system, not necessarily robust to noise, and struggle with detecting pathological errors, such as errors in the manifold density distribution. This can make meaningful and accurate model assessment difficult. We explore the use of a topological data analysis technique, persistent homology, applied to uniformly sampled trajectories from constructed reservoir models of the Lorenz system to assess the learning quality of a model. A proposed persistent homology point summary, conformance, was able to identify models with successful dynamics learning and detect discrepancies in the manifold density distribution.
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Affiliation(s)
- Eugene Tan
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Débora Corrêa
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Thomas Stemler
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009, Australia
| | - Michael Small
- Complex Systems Group, Department of Mathematics and Statistics, The University of Western Australia, Crawley, Western Australia 6009, Australia
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Sun L, Tan E. Neglected cutaneous skin malignancy: A patient with concurrent giant basal cell carcinoma and melanoma. Skin Health and Disease 2021; 1:e68. [PMID: 35663778 PMCID: PMC9060086 DOI: 10.1002/ski2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/18/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
Background Giant basal cell carcinomas (BCCs) are a rare subtype of BCC that grow to be greater than 5 cm in diameter. With the increase in size, there is a corresponding increase in metastatic rate and state of local invasion, with a clinical morphology that can be hard to differentiate from other subtypes of cutaneous malignancy. Although histologically equivalent to their common sub‐centimetre counterparts, giant BCCs can precipitate significant systematic medical morbidity as well as psychological trauma, and can be a real surgical reconstructive challenge to clinicians. Aims To add breadth to the existing cases in the literature, as well as a fresh patient perspective on the psychological challenges in a patient with Giant BCC. Materials & Methods A case from the Waikato Hospital, New Zealand referred to the Plastic and Reconstructive Department is carefully photographed, ordered, and presented. Results We present a case of a 15 cm giant BCC of the back existing alongside a neglected thick exophytic melanoma of the elbow in a patient who had been too embarrassed to approach healthcare professionals. These skin lesions were an incidental discovery by the general practitioner after the patient presented with symptoms of shortness of breath. Discussion Neglected skin cancers can fungate and be clinically morphologically confusing. Photographs of examples of these tumours can hone clinician awareness of the existance of Giant BCCs. Conclusion Giant BCCs are an entity yet to receive standardized treatment stratification. Prompt diagnosis and staging scans mean an expedited path to wide local excision and reconstruction, resulting in timely resolution of patients' immediate morbidity from their oncological disease burden.
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Affiliation(s)
- L. Sun
- Department of Plastic Surgery Waikato Hospital Hamilton New Zealand
| | - E. Tan
- Department of Plastic Surgery Waikato Hospital Hamilton New Zealand
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De Leon J, Seow SC, Boey E, Soh R, Tan E, Gan HH, Lee JY, Teo LJT, Yeo C, Tan VH, Kojodjojo P. Adopting permanent His bundle pacing: learning curves and medium-term outcomes. Europace 2021; 24:606-613. [PMID: 34849722 DOI: 10.1093/europace/euab278] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 06/09/2021] [Accepted: 10/30/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS This study aims to determine procedural characteristics, acute success rates, and medium-term outcomes of consecutive patients undergoing His bundle pacing (HBP); and learning curves of experienced electrophysiologists adopting HBP. METHODS AND RESULTS Consecutive HBP patients at three hospitals were recruited. Clinical characteristics, acute procedural details, and medium-term outcomes were extracted from electronic medical records. Two hundred and thirty-three patients [mean age 74.6 ± 10.1 years, 48% female, 68% narrow QRS, 71% normal left ventricular ejection fraction (LVEF), 55.8% atrioventricular block] underwent HBP. Acute procedural success was 81.1% (mean procedural and fluoroscopic times of 105.5 ± 36.5 and 13.8 ± 9.3 min). Broad QRS was associated with lower HBP success (odds ratio 0.39, P = 0.02). Fluoroscopic and procedural times decreased and plateaued after 30-40 cases per operator. Implant HBP threshold was 1.3 ± 0.7 V at 1.0 ± 0.2 ms and R wave was 5.0 ± 3.9 mV. During follow-up, loss of HBP occurred in a further 12.4% and 11.3% of patients experienced a ≥1 V increase in HBP threshold. Five (2.6%) patients required HBP revision for pacing difficulties. About 8.6% of patients had a >50% decrease in R wave but lead revision for sensing issues was not necessary. On an intention to treat basis, 56.7% of patients in whom HBP was attempted had persisting HBP capture and thresholds of <2 V. CONCLUSION Physicians adopting HBP should be cognizant of the learning curve and preferentially select non-dependent patients with normal QRS and LVEF, to minimize risk of lead revision. Further rises in HBP threshold may increase battery drain and need for reoperations, important considerations when choosing HBP for cardiac resynchronization therapy.
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Affiliation(s)
- Jhobeleen De Leon
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Elaine Boey
- Division of Cardiology, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore 609606, Singapore
| | - Rodney Soh
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Eugene Tan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Hiong Hiong Gan
- Division of Cardiology, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore 609606, Singapore
| | - Jie Ying Lee
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Lisa Jie Ting Teo
- Department of Cardiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Colin Yeo
- Department of Cardiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.,Division of Cardiology, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore 609606, Singapore
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Tan E, Zammit A. 1351 Primary Pituitary Abscess Presenting as An Isolated Bitemporal Hemianopia. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.371] [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: 11/13/2022]
Abstract
Abstract
Pituitary abscesses are rare yet life-threatening entities. Most common presenting features are headache, hypopituitarism, and visual changes. Majority of patients are found to have a predisposing risk factor, such as a pre-existing pituitary lesion, recent pituitary surgery or irradiation, or a primary source of infection. We present the case of a 53-year-old male with a spontaneous pituitary abscess, who presented with an isolated bitemporal hemianopia, but was otherwise asymptomatic with no known risk factors. Magnetic resonance imaging showed a sellar and suprasellar mass, thought to be a pituitary macroadenoma. He underwent endoscopic transsphenoidal adenectomy and cystic fluid was seen intraoperatively. Microbiology analysis showed Staphylococcus Aureus, and a course of intravenous ceftriaxone was commenced. Histopathology reported no evidence of adenoma and impression was of a pituitary abscess. Following transsphenoidal resection and commencement of antibiotic therapy, the bitemporal hemianopia resolved. We therefore report a rare case of primary pituitary abscess and emphasise the importance of including this condition as a differential diagnosis in any patient with a visual deficit or new pituitary lesion.
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Affiliation(s)
- E Tan
- Southmead Hospital, Bristol, United Kingdom
| | - A Zammit
- Southmead Hospital, Bristol, United Kingdom
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Tan A, Lai G, Saw S, Chua K, Takano A, Ong B, Koh T, Jain A, Tan W, Ng Q, Kanesvaran R, Rajasekaran T, Kalshnikova E, Shchegrova S, H. -Ta, Lin J, Renner D, Sethi H, Zimmermann B, Aleshin A, Lim W, Tan E, Skanderup A, Ang M, Tan D. MA07.06 Circulating Tumor DNA for Monitoring Minimal Residual Disease and Early Detection of Recurrence in Early Stage Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Jin W, Tan E, Ghartey-Kwansah G, Jia Y, Xi G. Expression of 20-hydroxyecdysone-related genes during gonadal development of Teleogryllus emma (Orthoptera: Gryllidae). Arch Insect Biochem Physiol 2021; 108:e21824. [PMID: 34272758 DOI: 10.1002/arch.21824] [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] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
Insect gonads develop under endocrine signals. In this study, we assessed the characters of partial complementary DNAs encoding the Teleogryllus emma orthologs of 20-hydroxyecdysone (20E)-related genes (RXR, E75, HR3, Hsc70, and Hsp90) and analyzed their expression patterns in both nymph and adult crickets. 20E treatment suppressed expression of TeEcR, TeRXR, TeE75, TeHR3, TeHsc70, and TeHsp90. Temporal expression analysis demonstrated that TeERR and 20E-related genes were expressed in four stages of gonadal development from the fourth-instar nymph stage to the adult stage. The expression pattern of these genes differed in testicular and ovarian development. TeRXR, HR3, TeHsc70, and TeHsp90 were irregularly expressed in gonads of the same developmental stages, while mRNAs encoding TeERR, TeEcR, and TeE75 accumulated in higher levels in ovaries than in testes. RNA interference (RNAi) of TeEcR expression led to decrease of the expression levels of TeEcR, TeRXR, TeHR3, and TeHsc70, while it enhanced TeE75 and TeHsp90 expressions. These results demonstrate that the TeERR and 20E-related genes help regulate gonadal development, while TeEcR appears to inhibit TeE75 expression, TeE75 inhibits HR3 expression. Hsc70 indirectly regulated the expression of the primary and secondary response genes E74A, E75B, and HR3. Hsp90 regulated Usp expression with no direct regulatory relationship with EcR.
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Affiliation(s)
- Wenjie Jin
- State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining, China
- College of Eco-Environmental Engineering, Qinghai University, Xining, China
- Laboratory of Animal Reproduction and Development, College of Life Science, Shaanxi Normal University, Xi'an, China
| | - E Tan
- Laboratory of Animal Reproduction and Development, College of Life Science, Shaanxi Normal University, Xi'an, China
| | - George Ghartey-Kwansah
- Laboratory of Animal Reproduction and Development, College of Life Science, Shaanxi Normal University, Xi'an, China
| | - Yishu Jia
- Laboratory of Animal Reproduction and Development, College of Life Science, Shaanxi Normal University, Xi'an, China
| | - Gengsi Xi
- Laboratory of Animal Reproduction and Development, College of Life Science, Shaanxi Normal University, Xi'an, China
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Hapuarachchi HC, Wong WY, Koo C, Tien WP, Yeo G, Rajarethinam J, Tan E, Chiang S, Chong CS, Tan CH, Tan LK, Ng LC. Transient transmission of Chikungunya virus in Singapore exemplifies successful mitigation of severe epidemics in a vulnerable population. Int J Infect Dis 2021; 110:417-425. [PMID: 34380087 DOI: 10.1016/j.ijid.2021.08.007] [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] [Received: 06/10/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Singapore experienced two major outbreaks of chikungunya in 2008-09 and 2013-14. Despite repeated virus introductions, fresh local outbreaks have not emerged after 2014. The present study reviews the success of chikungunya control in Singapore, despite repeated introduction of virus strains, presence of competent vectors and an immunologically naïve population. METHODS Chikungunya virus (CHIKV) sequences (421 envelope 1 genes and 56 polyproteins) were analysed to distinguish the indigenous virus groups from 2008 to 2020. Vector surveillance data was used to incriminate the vector/s associated with local outbreaks. The population exposure to CHIKV was determined by assessing the seroprevalence status in three cohorts of sera collected in 2009 (n=2,008), 2013 (n=2,000) and 2017 (n=3,615). RESULTS Four distinct groups of CHIKV of East, Central and South African genotype have mainly circulated since 2008, transmitted primarily by Aedes albopictus. The age weighted CHIKV IgG prevalence rates were low (1-5%) and showed a non-significant increase from 2009 to 2013, but a significant decrease in 2017. In contrast, the prevalence of CHIKV neutralising antibodies in the population increased significantly from 2009 to 2013, with no significant change in 2017, but the levels remained below 2%. CONCLUSIONS The evidence suggested that surveillance and vector control strategies implemented were robust to avert severe epidemics, despite repeated introduction of virus strains, presence of competent vectors and an immunologically naïve population.
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Affiliation(s)
| | - Wing-Yan Wong
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Carmen Koo
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Wei-Ping Tien
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Gladys Yeo
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Jayanthi Rajarethinam
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Eugene Tan
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Suzanna Chiang
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Chee-Seng Chong
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Cheong-Huat Tan
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Li-Kiang Tan
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667
| | - Lee-Ching Ng
- Environmental Health Institute, National Environment Agency, 11, Biopolis Way, #06-05-08, Singapore 138667; School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551
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30
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Brana I, Shapiro G, Johnson ML, Yu HA, Robbrecht D, Tan DSW, Siu LL, Minami H, Steeghs N, Hengelage T, Tan E, Biette K, Xu K, Moody SE, Jove M. Initial results from a dose finding study of TNO155, a SHP2 inhibitor, in adults with advanced solid tumors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3005 Background: SHP2 transduces signals from activated receptor tyrosine kinases to downstream pathways including MAPK. TNO155 is a selective, allosteric, oral inhibitor of SHP2. Methods: CTNO155X2101 (NCT03114319) is an ongoing first-in-human, open-label dose escalation/expansion trial of TNO155 in adults with advanced solid tumors. The primary objective is to characterize the safety and tolerability of TNO155 and identify regimen(s) for future study. Secondary assessments included pharmacokinetics, pharmacodynamics, and preliminary clinical efficacy. Here we present data from TNO155 single agent escalation. Results: As of 10/26/2020, 118 patients received TNO155 in variable schedules: once (QD; 1.5–70 mg; n = 55) or twice daily (BID; 30–50 mg; n = 25) in a 2 weeks on/1 week off (2w/1w) cycle; or QD in a 3w/1w cycle (30–60 mg; n = 32), or continuously (40 or 50 mg QD; n = 6). The most common cancer diagnoses treated were colorectal (54%), gastrointestinal stromal tumor (16%), non-small cell lung (12%), and head & neck (8%). The median number of prior antineoplastic therapies was 4 (range 1–10). Overall 109 patients (92%) have discontinued study treatment, 94 (80%) for progressive disease and 6 (5%) for adverse events (AEs). TNO155 showed rapid absorption (median day 1 Tmax ̃1.1 hours), an effective median T½ of ̃34 hours, and near dose-proportional exposure at day 14 (power model: AUCτ beta = 1.09 [90% CI 1.02–1.16]). AEs were mostly Grade 1/2 and generally consistent with on-target effects of SHP2 inhibition. The most common treatment-related AEs (all grades) were increased blood creatine phosphokinase (n = 33, 28%), peripheral edema (n = 31, 26%), diarrhea (n = 31, 26%), and acneiform dermatitis (n = 27, 23%). The most common treatment-related Grade ≥3 AEs were decreased platelets (n = 5, 4%), increased aspartate aminotransferase, diarrhea, and decreased neutrophils (each n = 4, 3%). The best observed response was stable disease (SD) per RECIST 1.1, reported in 24 (20%) patients, with a median duration of SD of 4.9 months (range 1.7–29.3). Evidence of SHP2 inhibition, as measured by change in DUSP6 expression by qPCR in paired pre- vs. on-treatment tumor samples, was seen in the majority of patients treated with TNO155 doses ≥20 mg/day (≥25% reduction, 38/42 [90%]; ≥50% reduction, 25/42 [60%]). Analysis of tumor whole-transcriptome RNA sequencing data is ongoing. Conclusions: TNO155 shows favorable pharmacokinetic properties and promising early safety and tolerability data at doses with evidence of target inhibition. The optimal dose using several schedules is still under evaluation. Studies of TNO155 in combination with other agents, including nazartinib (mutant-selective EGFR inhibitor[i]), adagrasib (KRAS G12Ci), spartalizumab (anti-PD-1 antibody), ribociclib (CDK4/6i), and dabrafenib (BRAFi) with LTT462 (ERKi), are ongoing (NCT03114319, NCT04330664, NCT04000529, NCT04294160). Clinical trial information: NCT03114319.
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Affiliation(s)
- Irene Brana
- Vall d’Hebron University Hospital, Vall d’Hebrón Institute of Oncology, Barcelona, Spain
| | | | | | | | | | | | | | | | - Neeltje Steeghs
- Netherlands Cancer Institute Antoni Van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Eugene Tan
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Kelly Biette
- Novartis Institutes for Biomedical Research, Cambridge, MA
| | - Kun Xu
- Novartis Pharmaceuticals Corporation, East Hannover, NJ
| | | | - Maria Jove
- Institut Català d'Oncologia, Barcelona, Spain
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Gao JM, Garioch JJ, Fadhil M, Tan E, Shah N, Moncrieff M. Planning slow Mohs excision margins for lentigo maligna: a retrospective nonrandomized cohort study comparing reflectance confocal microscopy margin mapping vs. visual inspection with dermoscopy. Br J Dermatol 2021; 184:1182-1183. [PMID: 33377177 DOI: 10.1111/bjd.19764] [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: 08/19/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- J M Gao
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
| | - J J Garioch
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Fadhil
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - E Tan
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - N Shah
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - M Moncrieff
- Norwich Medical School, University of East Anglia, Norwich, UK.,Department of Plastic Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Tan W, Chua B, Yin D, Tan S, Tan D, Ang M, Kanesvaran R, Jain A, Rajasekaran T, Lai G, Toh C, Tan E, Ng Q, Lim W. P76.46 First-Line Osimertinib in Asian Patients with Advanced EGFR-Mutant Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yuan J, Lim E, Ma S, Chua K, Lee Y, Lim M, Yeo X, Phua C, Takano A, Aung Z, Lim K, Tan E, Tan D, Chew G, Tam W. P69.05 Molecular and Cellular Heterogeneity Underpin Treatment Response Across a Spectrum of EGFR-Mutant Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Tan A, Lai G, Tan G, Seet A, Takano A, Alvarez J, Skanderup A, Tan W, Ang M, Kanesvaran R, Ng Q, Jain A, Rajasekaran T, Lim W, Tan E, Lim K, Tan D. FP14.13 Molecular Characterisation and Clinical Outcomes in RET Rearranged Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Tan A, Ong B, Koh T, Chen J, Oo H, Lai G, Tan W, Ang M, Kanesvaran R, Ng Q, Jain A, Rajasekaran T, Zhai W, Skanderup A, Lim K, Tan E, Lim W, Tan D, Takano A. P38.03 Immunohistochemical, Histologic and Genomic Characterisation of Early Stage Pulmonary Invasive Mucinous Adenocarcinoma. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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36
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Ma J, Tan S, Yin D, Tran A, Tan D, Ang M, Takano A, Lim K, Kanesvaran R, Jain A, Rajasekaran T, Tan E, Lim D, Ng Q, Tan W. P76.88 Real-World Data of Osimertinib in Patients with Metastatic EGFRm+ NSCLC who Progressed on First-Line EGFR TKIs. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lai G, Alvarez J, Yeo J, Sim N, Tan A, Zhou S, Suteja L, Lim T, Rohatgi N, Yeong J, Takano A, Lim K, Gogna A, Too C, Zhuang K, Jain A, Tan W, Kanesvaran R, Ng Q, Ang M, Rajasekaran T, Wang L, Toh C, Lim W, Tam W, Ginhoux F, Tan S, Skanderup A, Tan D, Tan E. OA01.06 Randomised Phase 2 Study of Nivolumab (N) Versus Nivolumab and Ipilimumab (NI) Combination in EGFR Mutant NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Saw S, Lai G, Zhou S, Chen J, Ang M, Chua K, Kanesvaran R, Ng Q, Jain A, Tan W, Rajasekaran T, Lim D, Fong K, Takano A, Cheng X, Lim K, Koh T, Ong B, Tan E, Skanderup A, Tan D. OA06.05 Molecular and Clinical Features Associated with Relapse in Early Stage EGFR-Mutated NSCLC: A Single Institution Knowledge Bank. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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39
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Tan A, Chua K, Teng Y, Takano A, Alvarez J, Nahar R, Rohatgi N, Lai G, Aung Z, Yeong J, Lim K, Naeini M, Kassam I, Jain A, Tan W, Gogna A, Too C, Kanesvaran R, Ng Q, Ang M, Rajasekaran T, Devanand A, Phua G, Tan B, Lee Y, Wang L, Teo A, Khng A, Lim M, Suteja L, Toh C, Lim W, Iyer N, Tam W, Tan E, Zhai W, Hillmer A, Skanderup A, Tan D. MA13.08 Genomic and Transcriptomic Features of Distinct Resistance Trajectories in EGFR Mutant Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Alvarez J, Chua K, Sim N, Abedi M, Chen J, Tan A, Lai G, Takano A, Lim W, Tan E, Lim K, Zhai W, Tan D, Skanderup A. P59.08 THOR: Multi-Ethnic, Open Access Thoracic Cancer Genomics Resource. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Healthcare is a potent emitter of greenhouse gases amounting up to 7% of total estimated greenhouse gas emissions (CO2 e) for Australia. Australia has one of the highest incidences of skin cancer in the world but there is a paucity of data on the ecological impact of skin cancer excision/dermatologic surgery. The authors reviewed the various impact inventories in order to perform a life cycle assessment of skin cancer excision. A total of 8641 tonnes of estimated CO2 e are produced from dermatologic surgery annually in Australia (6751 tonnes from private clinical rooms and 1890 tonnes from hospitals) and the waste generated contributes significantly to terrestrial ecotoxicity and acidification of land and water. Various means can be carried out to reduce this impact, ranging from simple behavioural changes to larger, policy changes.
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Affiliation(s)
- Eugene Tan
- Western Skin Institute, St. Albans, Victoria, Australia
| | - David Lim
- Skin Institute, Auckland, New Zealand
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Tan E, Chan S, Oi W, Chong J, Prickett T, Leong K, Yeo P, Ong H, Jaufeerally F, Yap J, Sim D, Ng T, Ling L, Lam C, Richards A. Atrial fibrillation and the prognostic performance of biomarkers in heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Consideration of circulating biomarkers for risk stratification in heart failure (HF) is recommended in authoritative international guidelines but the influence of atrial fibrillation (AF) on the prognostic performance of many markers is unclear. Therefore we investigated the interactions between AF and biomarkers in prediction of important clinical outcomes in HF.
Methods
NT-proBNP, pro-atrial natriuretic peptide (MR-proANP), C-type natriuretic peptide (CNP), NT-proCNP, high-sensitivity troponin-T, high-sensitivity troponin-I, mid-regional-propeptide adrenomedullin (MR-proADM), co-peptin (PAVP), growth differentiation factor-15 (GDF-15), sST2, Galectin-3 and procalcitonin levels were measured in a prospectively designed, multicenter, longitudinal study of adults with HF. AF was defined as a documented history of AF based on medical records, and/or presence of AF/atrial flutter on baseline 12-lead ECG. The primary outcome considered was the composite of HF-hospitalization or all-cause mortality on prospective follow-up at 2-years. Cox proportional-hazards models were used in the prognostic evaluation of biomarkers, and each was tested for interaction with AF.
Results
Among 1,099 patients with HF (mean age 62±12 years, 28% female, mean left ventricular ejection fraction 35±16%), 261 (24%) patients had AF. Median levels of NT-proBNP, GDF-15, ST2, MR-proADM, proANP and CNP were higher in AF (p<0.05). Above-median levels of all 12 biomarkers were independently associated with increased risk of the primary outcome. Significant interactions with AF were detected for Galectin-3 and sST2. Galectin-3 (>7.7ng/mL) was associated with increased HF-hospitalizations (adjusted hazard ratio [AHR] 1.75, 95% C.I. 1.10–2.77) and all-cause mortality (AHR 1.95, 95% C.I. 1.04–3.63) only among patients with AF. The prognostic performance of sST2 (>35.6ng/mL) was also stronger in AF especially for the primary outcome (AF: AHR 2.06 95% C.I. 1.32–3.21; non-AF: AHR 1.49 95% C.I. 1.18–1.88) and HF-hospitalization (AF: AHR 1.65, 95% C.I. 1.01–2.69; non-AF: AHR 1.32, 95% C.I. 1.02–1.71). The association of Galectin-3 with the composite outcome was not modified by HF type (HFpEF vs HFrEF) (p for 3-way interaction=0.61) except for sST2 (p for 3-way interaction=0.018) where the association appeared stronger in patients with HFpEF and AF (HR 3.12, 95% C.I. 1.26–7.78) compared to those with HFrEF and AF (HR 1.83, 95% C.I. 1.01–3.33) although numbers of events in each subgroup were small. Notably, no such interactions were observed for the most frequently measured prognostic markers in HF including NT-proBNP and the high-sensitivity cardiac troponins.
Conclusion
AF modified the prognostic utility of guideline-endorsed HF-biomarkers, wherein prognostic associations of Galectin-3 and ST2 were limited to, or stronger in, patients with AF. Application of markers for prognostic purposes in HF requires consideration of the presence or absence of AF.
Figure 1
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): National Medical Research Council of Singapore
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Affiliation(s)
- E Tan
- National University Heart Centre, Singapore, Singapore
| | - S.P Chan
- National University Heart Centre, Singapore, Singapore
| | - W.L Oi
- National University of Singapore, Singapore, Singapore
| | - J.P.C Chong
- National University of Singapore, Singapore, Singapore
| | - T Prickett
- University of Otago Christchurch, Christchurch, New Zealand
| | - K.T.G Leong
- Changi General Hospital, Singapore, Singapore
| | - P.S.D Yeo
- Tan Tock Seng Hospital, Singapore, Singapore
| | - H.Y Ong
- Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - J Yap
- National Heart Centre Singapore, Singapore, Singapore
| | - D Sim
- National Heart Centre Singapore, Singapore, Singapore
| | - T.P Ng
- National University of Singapore, Singapore, Singapore
| | - L.H Ling
- National University Heart Centre, Singapore, Singapore
| | - C.S.P Lam
- National Heart Centre Singapore, Singapore, Singapore
| | - A.M Richards
- National University Heart Centre, Singapore, Singapore
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Henderson A, Paterson DL, Chatfield MD, Tambyah PA, Lye DC, De PP, Lin RTP, Chew KL, Yin M, Lee TH, Yilmaz M, Cakmak R, Alenazi TH, Arabi YM, Falcone M, Bassetti M, Righi E, Ba R, Kanj SS, Bhally H, Iredell J, Mendelson M, Boyles TH, Looke DFM, Runnegar NJ, Miyakis S, Walls G, Ai Khamis M, Zikri A, Crowe A, Ingram PR, Daneman NN, Griffin P, Athan E, Roberts L, Beatson SA, Peleg AY, Cottrell KK, Bauer MJ, Tan E, Chaw K, Nimmo GR, Harris-Brown T, Harris PNA. Association between minimum inhibitory concentration, beta-lactamase genes and mortality for patients treated with piperacillin/tazobactam or meropenem from the MERINO study. Clin Infect Dis 2020; 73:e3842-e3850. [PMID: 33106863 DOI: 10.1093/cid/ciaa1479] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [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: 12/08/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial. METHODS Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations. RESULTS 320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam non-susceptible breakpoint (MIC > 16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% CI 2.8 - 87.2). The absolute risk increase for 30-day mortality for patients treated with piperacillin/tazobactam compared with meropenem was 9% (95% CI 3% - 15%) and 8% (95% CI 2% - 15%) for the original PA population and the post-hoc MA populations, which reduced to 5% (95% CI -1% - 10%) after excluding strains with piperacillin/tazobactam MIC values > 16 mg/L. Isolates co-harboring ESBL and OXA-1 genes were associated with elevated piperacillin/tazobactam MICs and the highest risk increase in 30-mortality of 14% (95% CI 2% - 28%). CONCLUSION After excluding non-susceptible strains, the 30-day mortality difference was from the MERINO trial was less pronounced for piperacillin/tazobactam. Poor reliability in susceptibility testing performance for piperacillin/tazobactam and the high prevalence of OXA co-harboring ESBLs suggests meropenem remains the preferred choice for definitive treatment of ceftriaxone non-susceptible E. coli and Klebsiella.
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Affiliation(s)
- A Henderson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD
| | - D L Paterson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - M D Chatfield
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - P A Tambyah
- Department of Infectious Diseases, National University Hospital, Singapore
| | - D C Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Hospital, Singapore
| | - P P De
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
| | - R T P Lin
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - K L Chew
- Division of Microbiology, National University Hospital, Singapore
| | - M Yin
- Department of Infectious Diseases, National University Hospital, Singapore
| | - T H Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - M Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - R Cakmak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - T H Alenazi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Y M Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - M Falcone
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino Genoa, Italy
| | - E Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Udine, Italy.,Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Rogers Ba
- Monash University, Centre for Inflammatory Diseases, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Victoria, Australia
| | - S S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - H Bhally
- Department of Medicine and Infectious Diseases, North Shore Hospital, Auckland
| | - J Iredell
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, Australia
| | - M Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - T H Boyles
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - D F M Looke
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD.,University of Queensland, Brisbane, Australia
| | - N J Runnegar
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD.,University of Queensland, Brisbane, Australia
| | - S Miyakis
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - G Walls
- Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand
| | - M Ai Khamis
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - A Zikri
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - A Crowe
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia.,Department of Microbiology, St Vincent's Hospital, Melbourne, Australia
| | - P R Ingram
- School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch , Australia.,Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia
| | - N N Daneman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - P Griffin
- University of Queensland, Brisbane, Australia.,Department of Medicine and Infectious Diseases, Mater Hospital and Mater Medical Research Institute, Brisbane, Australia.,QIMR Berghofer, Brisbane, Queensland, Australia
| | - E Athan
- Department of Infectious Diseases, Barwon Health and Deakin University, Geelong, Victoria, Australia
| | - L Roberts
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia
| | - S A Beatson
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia
| | - A Y Peleg
- Infection & Immunity Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia.,Department of Microbiology, Monash University, Clayton, Australia
| | - K K Cottrell
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - M J Bauer
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - E Tan
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - K Chaw
- Department of Microbiology, Pathology Queensland, Toowoomba Laboratory, Australia.,Department of Microbiology, Mater Pathology, Australia.,Infectious Diseases Department, Redcliffe Hospital, Australia
| | - G R Nimmo
- Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - T Harris-Brown
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - P N A Harris
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Wong B, Tan E, McLean-Tooke A. Pulmonary granulomas in a patient with positive ANCA and history of tuberculosis: case report. BMC Pulm Med 2020; 20:219. [PMID: 32795275 PMCID: PMC7427886 DOI: 10.1186/s12890-020-01258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/05/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Granulomatous polyangiitis (GPA) is a rare multisystem autoimmune disease of unknown aetiology that is pathologically characterised by necrotising vasculitis, tissue necrosis and granulomatous inflammation, typically in the presence of anti-neutrophil cytoplasmic antibodies (ANCA). However infectious diseases may induce high titre ANCA and mimic vasculitis. Tuberculosis may share many clinical features with GPA including fever, arthralgia, granulomatous inflammation and pulmonary lesions and patients. CASE PRESENTATION A 39 year old patient was admitted with ocular irritation and redness, arthralgia and multiple new pulmonary lesions. The past medical history was significant for two episodes of tuberculosis previously requiring prolonged treatment. ANCA antibodies were positive and CT showed multiple pulmonary lesions including cavitatory lesions. After extensive investigation, the patient was treated for GPA with high dose immune suppression with good clinical response. CONCLUSIONS Here we review the diagnostic considerations between differentiating GPA and tuberculosis in patients from endemic regions. It is recommended that biopsies of lung lesions, sputum microscopy and multidisciplinary team input are sought as part of the workup when these two differentials are being considered.
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Affiliation(s)
- B Wong
- Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia.
| | - E Tan
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia
| | - A McLean-Tooke
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia
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Tan E, Kim D, Imanirad I, Carballido E, Zhou J, Schell M, Jimenez MM, Kim R. P-47 A phase I/II study of pembrolizumab in combination with ibrutinib for advanced, refractory microsatellite stable colorectal cancers. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Muto J, Fukuda S, Shirakata Y, Tsuda T, Tan E, Dai X, Shiraishi K, Mori H, Murakami M, Higashiyama S, Sayama K. 796 Effect of novel disaccharide for construction of living skin equivalents. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gin K, Tovar J, Bartelink EJ, Kendell A, Milligan C, Willey P, Wood J, Tan E, Turingan RS, Selden RF. The 2018 California Wildfires: Integration of Rapid DNA to Dramatically Accelerate Victim Identification. J Forensic Sci 2020; 65:791-799. [PMID: 32128817 PMCID: PMC7318200 DOI: 10.1111/1556-4029.14284] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 11/21/2019] [Revised: 12/28/2019] [Accepted: 01/03/2020] [Indexed: 12/02/2022]
Abstract
In November 2018, Butte County, California, was decimated by the Camp Fire, the deadliest wildfire in state history. Over 150,000 acres were destroyed, and at its peak, the fire consumed eighty acres per minute. The speed and intensity of the oncoming flames killed scores of people, and weeks before the fire was contained, first responders began searching through the rubble of 18,804 residences and commercial buildings. As with most mass disasters, conventional identification modalities (e.g., fingerprints, odontology, hardware) were utilized to identify victims. The intensity and duration of the fire severely degraded most of the remains, and these approaches were useful in only 22 of 84 cases. In the past, the remaining cases would have been subjected to conventional DNA analysis, which may have required months to years. Instead, Rapid DNA technology was utilized (in a rented recreational vehicle outside the Sacramento morgue) in the victim identification effort. Sixty‐nine sets of remains were subjected to Rapid DNA Identification and, of these, 62 (89.9%) generated short tandem repeat profiles that were subjected to familial searching; essentially all these profiles were produced within hours of sample receipt. Samples successfully utilized for DNA identification included blood, bone, liver, muscle, soft tissue of unknown origin, and brain. In tandem with processing of 255 family reference samples, 58 victims were identified. This work represents the first use of Rapid DNA Identification in a mass casualty event, and the results support the use of Rapid DNA as an integrated tool with conventional disaster victim identification modalities.
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Affiliation(s)
- Kim Gin
- Sacramento County Coroner's Office, 4800 Broadway, Sacramento, CA, 95820
| | - Jason Tovar
- Sacramento County Coroner's Office, 4800 Broadway, Sacramento, CA, 95820
| | - Eric J Bartelink
- Department of Anthropology, California State University, 400 West First Street, Chico, CA, 95929
| | - Ashley Kendell
- Department of Anthropology, California State University, 400 West First Street, Chico, CA, 95929
| | - Colleen Milligan
- Department of Anthropology, California State University, 400 West First Street, Chico, CA, 95929
| | - P Willey
- Department of Anthropology, California State University, 400 West First Street, Chico, CA, 95929
| | - James Wood
- Sonoma County Sheriff-Coroner Office, 3336 Chanate Road, Santa Rosa, CA, 95404
| | - Eugene Tan
- ANDE Corporation, 266 Second Avenue, Waltham, MA, 024551
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Turingan RS, Tan E, Jiang H, Brown J, Estari Y, Krautz-Peterson G, Selden RF. Developmental Validation of the ANDE 6C System for Rapid DNA Analysis of Forensic Casework and DVI Samples. J Forensic Sci 2020; 65:1056-1071. [PMID: 32040208 PMCID: PMC7383818 DOI: 10.1111/1556-4029.14286] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 10/06/2019] [Revised: 01/01/2020] [Accepted: 01/06/2020] [Indexed: 12/13/2022]
Abstract
A developmental validation was performed to demonstrate reliability, reproducibility, and robustness of the ANDE Rapid DNA Identification System for processing of crime scene and disaster victim identification (DVI) samples. A total of 1705 samples were evaluated, including blood, oral epithelial samples from drinking containers, samples on FTA and untreated paper, semen, bone, and soft tissues. This study was conducted to address the FBI’s Quality Assurance Standards on developmental validation and to accumulate data from a sufficient number of unique donors and sample types to meet NDIS submission requirements for acceptance of the ANDE Expert System for casework use. To date, no Expert System has been approved for such samples, but the results of this study demonstrated that the automated Expert System performs similarly to conventional laboratory data analysis. Furthermore, Rapid DNA analysis demonstrated accuracy, precision, resolution, concordance, and reproducibility that were comparable to conventional processing along with appropriate species specificity, limit of detection, performance in the presence of inhibitors. No lane‐to‐lane or run‐to‐run contamination was observed, and the system correctly identified the presence of mixtures. Taken together, the ANDE instrument, I‐Chip consumable, FlexPlex chemistry (a 27‐locus STR assay compatible with all widely used global loci, including the CODIS core 20 loci), and automated Expert System successfully processed and interpreted more than 1200 unique samples with over 99.99% concordant CODIS alleles. This extensive developmental validation data provides support for broad use of the system by agencies and accredited forensic laboratories in single‐source suspect‐evidence comparisons, local database searches, and DVI.
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Affiliation(s)
| | - Eugene Tan
- ANDE Corporation, 266 Second Avenue, Waltham, MA, 02451
| | - Hua Jiang
- ANDE Corporation, 266 Second Avenue, Waltham, MA, 02451
| | - Jessi Brown
- ANDE Corporation, 266 Second Avenue, Waltham, MA, 02451
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Bhat A, Makarious D, Mahajan V, Husen Y, Tan E, Burdusel C, Gan G, Lee L, Chow C, Tan T. 720 Characterisation of Recent Trends in Cardiovascular Risk Factors in Young Patients With Ischaemic Stroke. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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