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Law JH, Ng CZM, Lauw SK, So JBY, Kim G, Shabbir A. A 10-year experience with anastomotic leaks in upper gastrointestinal surgery-Retrospective cohort study. Surgeon 2024; 22:e87-e93. [PMID: 38172002 DOI: 10.1016/j.surge.2023.11.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Anastomotic leak (AL) in upper gastrointestinal (UGI) surgery continues to be a diagnostic challenge. We seek to identify clinical parameters that predict AL and examine the effectiveness of investigations in evaluating AL following UGI surgeries. METHODS 592 patients underwent UGI surgeries with an anastomosis between January 2011 and January 2021. Data on patient characteristics, surgery, postoperative investigations and outcomes were prospectively collected and analysed. RESULTS The overall occurrence of AL was 6.4 %. Tachycardia >120 BPM (OR 6.959, 95 % CI 1.856-26.100, p = 0.004) and leukocyte count >19 × 109/L (OR 3.327, 95 % CI 1.009-10.967, p = 0.048) were independent predictors of AL. On multivariate analysis, patients whose anastomosis was deemed high risk and had pre-emptive investigation done postoperatively to exclude a leak were less likely to require intervention and were more likely to be managed conservatively (66.7 % vs 14.3 %, p = 0.025). Methylene blue test, oral contrast study and Computed Tomography scan with intravenous and oral contrast had 50.0 %, 20.0 % and 9.1 % false negative results, while esophagogastroduodenoscopy had none. There was no misdiagnosed AL when more than 1 investigation (n = 15, 39.5 %) were performed. CONCLUSION Our study demonstrates that the presence of a triad including desaturation, tachycardia and leucocytosis predicts for AL following UGI surgery and for confirmation of a leak, evaluation with 2 or more investigation is needed. A practice of evaluating high risk anastomosis prior to commencement of feeding decreased the need for surgical intervention and improves success of conservative treatment.
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Affiliation(s)
- Jia-Hao Law
- Division of Upper Gastrointestinal Surgery, Department of Surgery, National University Hospital, Singapore
| | - Charmaine Zhi-Mei Ng
- Division of Upper Gastrointestinal Surgery, Department of Surgery, National University Hospital, Singapore
| | - Sarah-Kei Lauw
- Division of Upper Gastrointestinal Surgery, Department of Surgery, National University Hospital, Singapore
| | - Jimmy Bok Yan So
- Division of Upper Gastrointestinal Surgery, Department of Surgery, National University Hospital, Singapore.
| | - Guowei Kim
- Division of Upper Gastrointestinal Surgery, Department of Surgery, National University Hospital, Singapore
| | - Asim Shabbir
- Division of Upper Gastrointestinal Surgery, Department of Surgery, National University Hospital, Singapore
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Masuda Y, Leong EKF, So JBY, Shabbir A, Lam Jia Wei T, Chia DKA, Kim G. A systematic review and meta-analysis of mediastinoscopy-assisted transhiatal esophagectomy (MATHE). Surg Oncol 2024; 53:102042. [PMID: 38330804 DOI: 10.1016/j.suronc.2024.102042] [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: 10/02/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Transhiatal esophagectomy (THE) avoids thoracotomy but sacrifices mediastinal lymphadenectomy. Mediastinoscopy-assisted transhiatal esophagectomy (MATHE) allows for visualisation and en-bloc dissection of mediastinal lymph nodes while retaining the benefits of THE. However, given its novel inception, there is a paucity of literature. This study aimed to conduct the first meta-analysis to explore the efficacy of MATHE and clarify its role in the future of esophagectomy. METHODS Four databases (PubMed, EMBASE, Scopus, and Cochrane Library) were searched from inception to May 1, 2023. Studies were included if they reported outcomes for patients with esophageal cancer who underwent MATHE. Meta-analyses of proportions and pooled means were performed for the outcomes of intraoperative blood loss, lymph node (LN) harvest, mean hospital length of stay (LOS), mean operative time, R0 resection, conversion rates, 30-day mortality rate, 5-year OS, and surgical complications (anastomotic leak, cardiovascular [CVS] and pulmonary complications, chyle leak and recurrent laryngeal nerve palsy [RLN]). Sensitivity analyses were performed for outcomes with substantial statistical heterogeneity. RESULTS The search yielded 223 articles; 28 studies and 1128 patients were included in our analysis. Meta-analyses of proportions yielded proportion rates: 30-day mortality (0 %, 95 %CI 0-0), 5-year OS (60.5 %, 95 %CI 47.6-72.7), R0 resection (100 %, 95 %CI 99.3-100), conversion rate (0.1 %, 95 %CI 0-1.2). Among surgical complications, RLN palsy (14.6 %, 95 %CI 9.5-20.4) were most observed, followed by pulmonary complications (11.3 %, 95 %CI 7-16.2), anastomotic leak (9.7 %, 95 %CI 6.8-12.8), CVS complications (2.3 %, 95 %CI 0.9-4.1) and chyle leak (0.02 %, 95 %CI 0-0.8). Meta-analysis of pooled means yielded means: LN harvest (18.6, 95 %CI 14.3-22.9), intraoperative blood loss (247.1 ml, 95 %CI 173.6-320.6), hospital LOS (18.1 days, 95 %CI 14.4-21.8), and operative time (301.5 min, 95 %CI 238.4-364.6). There was moderate-to-high statistical heterogeneity. Findings were robust to sensitivity analyses. CONCLUSION MATHE is associated with encouraging post-operative mortality and complication rates, while allowing for radical mediastinal lymphadenectomy with reasonable lymph node harvest.
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Affiliation(s)
- Yoshio Masuda
- Ministry of Health Holdings Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jimmy Bok Yan So
- Upper Gastrointestinal Surgery, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Asim Shabbir
- Upper Gastrointestinal Surgery, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Daryl Kai Ann Chia
- Upper Gastrointestinal Surgery, National University Hospital, Singapore.
| | - Guowei Kim
- Upper Gastrointestinal Surgery, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Kim JY, Lee S, Kim G, Shin HJ, Lee EJ, Lee CS, Yoon S, Lee E, Lim A, Kim SH. Ameliorating effect of 2'-Fucosyllactose and 6'-Sialyllactose on lipopolysaccharide-induced intestinal inflammation. J Dairy Sci 2024:S0022-0302(24)00568-X. [PMID: 38490539 DOI: 10.3168/jds.2024-24325] [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: 10/19/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024]
Abstract
Human milk oligosaccharides (HMO) affect gut microbiota during neonatal development, particularly with respect to the immune system. Bovine milk-based infant formulas have low oligosaccharide contents. Thus, efforts to fortify infant formulas with HMO are being undertaken. Two major HMO, 2'-fucosyllactose (2'-FL) and 6'-sialyllactose (6'-SL), exert anti-inflammatory effects; however, the associations between anti-inflammatory effects induced by 2'-FL and 6'-SL co-treatment and gut microbiota composition and metabolite modulation remain unclear. Therefore, in this study, we evaluated the effects of a mixture of these HMO. To determine the optimal HMO ratio for anti-inflammatory effects and elucidate its mode of action, LPS-induced inflammatory HT-29 epithelial cells and intestinal inflamed suckling mice were treated with various mixtures of 2'-FL and 6'-SL. 2'-FL:6'-SL ratio of 5:1 was identified as the most effective pre-treatment HMO mixture in vitro; thus, this ratio was selected and used for low, middle, and high-dose treatments for subsequent in vivo studies. In vivo, high-dose HMO treatment restored LPS-induced inflammation symptoms, such as body weight loss, colon length reduction, histological structural damage, and intestinal gene expression related to inflammatory responses. High-dose HMO was the only treatment that modulated the major phyla Bacteroidetes and Firmicutes and the genera Ihubacter, Mageeibacillus, and Saccharofermentans. These changes in microbial composition were correlated with intestinal inflammation-related gene expression and short-chain fatty acid production. To our knowledge, our study is the first to report the effects of Ihubacter, Mageeibacillus, and Saccharofermentans on short chain fatty acid levels, which can subsequently affect inflammatory cytokine and tight junction protein levels. Conclusively, the HMO mixture exerted anti-inflammatory effects through changes in microbiota and metabolite production. These findings suggested that supplementation of infant formula with HMO may benefit formula-fed infants by forming unique microbiota contributing to neonatal development.
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Affiliation(s)
- J-Y Kim
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea; Institute of Life Science and Natural Resources, Korea University, Seoul 02841, Republic of Korea
| | - S Lee
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
| | - G Kim
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
| | - H J Shin
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
| | - E J Lee
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea
| | - C S Lee
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea; Institute of Life Science and Natural Resources, Korea University, Seoul 02841, Republic of Korea
| | - S Yoon
- Lotte R&D Center, Seoul, Republic of Korea
| | - E Lee
- Lotte R&D Center, Seoul, Republic of Korea
| | - A Lim
- Lotte R&D Center, Seoul, Republic of Korea
| | - S H Kim
- College of Life Sciences and Biotechnology, Korea University, Seoul 02841, Republic of Korea; Institute of Life Science and Natural Resources, Korea University, Seoul 02841, Republic of Korea.
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Lee S, Kim G, Park GM, Jeong J, Jung E, Lee BS, Jo E, Lee S, Yoon H, Jo KW, Kim SH, Lee J. Management of newborns and healthcare workers exposed to isoniazid-resistant congenital tuberculosis in the neonatal intensive care unit. J Hosp Infect 2024; 147:40-46. [PMID: 38432587 DOI: 10.1016/j.jhin.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Management of newborns and healthcare workers (HCWs) exposed to congenital tuberculosis (TB) in the neonatal intensive care unit (NICU) has been reported rarely. AIM To outline a contact investigation process for individuals exposed to congenital TB in the NICU and investigate nosocomial transmission. Additionally, to assess the efficacy and safety of window prophylaxis in exposed newborns. METHODS A baby, born at a gestational age of 28 + 1 weeks, was diagnosed with isoniazid-resistant congenital TB on the 39th day of admission to the level IV NICU. Newborns and HCWs exposed cumulatively for ≥8 h underwent contact investigation and follow-up for a year. FINDINGS Eighty-two newborns underwent contact investigation. All newborns displayed normal chest X-rays, and 42 hospitalized newborns tested negative for acid-fast bacilli stain and Xpert® MTB/RIF assay in their endotracheal sputum or gastric juices. Eighty received window prophylaxis: six of 75 on rifampin experienced mild adverse events, and none of the five on levofloxacin. After 12 weeks, five (6.1%) had a positive tuberculin skin test, all of whom had already received the Bacillus Calmette-Guérin vaccine and tested negative on TB interferon-gamma releasing assay. Of 119 exposed HCWs, three (2.5%) were diagnosed with latent TB infection and completed a four-month rifampin therapy. There was no active TB disease among exposed newborns and HCWs during a one-year follow-up. CONCLUSION Timely diagnosis of congenital TB is crucial for minimizing transmission among exposed neonates and HCWs in the NICU setting. In cases of isoniazid-resistant index patients, even premature newborns may consider the use of rifampin or levofloxacin for window prophylaxis.
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Affiliation(s)
- S Lee
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - G Kim
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - G-M Park
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - J Jeong
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - E Jung
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - B S Lee
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - E Jo
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - S Lee
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - H Yoon
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - K-W Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - S-H Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea; Department of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - J Lee
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; Office for Infection Control, Asan Medical Center, Seoul, South Korea.
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Choi SW, Agbese E, Kim G, Makhlouf MD, Leslie DL. Uninsured immigrants in the United States significantly delayed the initiation of prenatal care after the changes to the Public Charge Rule. Public Health 2023; 225:1-7. [PMID: 37913609 DOI: 10.1016/j.puhe.2023.09.020] [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: 04/10/2023] [Revised: 08/18/2023] [Accepted: 09/23/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE We estimated the impact of the changes made to the Public Charge Rule on the initiation of prenatal care among uninsured immigrants in the United States. STUDY DESIGN We used a difference-in-differences approach to analyse the impact of the changes made to the Public Charge Rule (first difference) on initiation of prenatal care between uninsured and privately insured immigrants (second difference). METHODS We used the natality data by the National Center for Health Statistics as the main data source, which includes all singleton births in a hospital to an immigrant birthing person aged from 15 to 44. The study covers three phases: (1) the period prior to the leaked draft Executive Orders concerning changes made to the public charge policy-from January 2014 to December 2016; (2) the period after the draft Executive Orders were leaked until the proposal of the Public Charge Rule-from January 2017 to September 2018; and (3) post proposal of the Public Charge Rule -from October 2018 to December 2019. RESULTS After the proposal of the Public Charge Rule in 2018, the odds of initiating prenatal care in the first trimester decreased among uninsured immigrants by 12% (odds ratio [OR]: 0.880; 95% confidence interval [CI]: 0.832, 0.931) compared to privately insured immigrants. The odds of second trimester initiation of prenatal care was also negatively associated with the leak of the draft Executive Orders (OR: 0.942; 95% CI: 0.905, 0.981). CONCLUSION The results of this study suggest that uninsured immigrants in the United States significantly delayed prenatal care after the changes were made to the Public Charge Rule.
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Affiliation(s)
- S W Choi
- Department of Health Administration, Penn State School of Public Affairs, Harrisburg, United States.
| | - E Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, United States
| | - G Kim
- Department of Health Administration, Penn State School of Public Affairs, Harrisburg, United States
| | - M D Makhlouf
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, United States; Penn State Dickinson Law, Carlisle, United States
| | - D L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, United States
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Law JH, Han NX, So JBY, Kim G, Shabbir A. Single-incision transgastric resection for gastric gastrointestinal stromal tumors in anatomically challenging locations. Surg Today 2023; 53:1401-1408. [PMID: 37204500 DOI: 10.1007/s00595-023-02694-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
Surgical resection is the mainstay treatment for resectable gastrointestinal stromal tumors (GISTs). However, resection in anatomically challenging locations, such as near the gastroesophageal junction, lesser curve and fundus, remain technically challenging. We herein report the outcomes of the largest series of patients who underwent single-incision transgastric resection of an intraluminal gastric GIST. Our reduced-port resection technique for intraluminal GISTs in these anatomically challenging locations involves a single incision in the left hypochondrium, deepened to access the gastric lumen, with the surgery completed in a transgastric manner. A total of 22 patients received surgery with this technique at the National University Hospital in Singapore from November 2012 to September 2020. The median operative time was 101 (range 50-253) min, with no conversions to open surgery, median lesion size 3.6 (range 1.8-8.2) cm and median postoperative length of stay 5 (range 1-13) days. There was no 30-day mortality and no recurrence during the follow-up period. Our laparoscopic approach for reduced-port transgastric excision of intraluminal GISTs allows for adequate surgical clearance, convenient extraction and secure gastrostomy closure with low morbidity.
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Affiliation(s)
- Jia Hao Law
- Division of Upper Gastrointestinal Surgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Nicole Xinrong Han
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jimmy Bok Yan So
- Division of Upper Gastrointestinal Surgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Guowei Kim
- Division of Upper Gastrointestinal Surgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Asim Shabbir
- Division of Upper Gastrointestinal Surgery, Department of Surgery, National University Health System, Singapore, Singapore.
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Kim JK, Tam M, Karp JM, Oh C, Kim G, Solomon E, Concert CM, Vaezi AE, Li Z, Tran T, Zan E, Corby P, Feron-Rigodon M, Del Vecchio Fitz C, Goldberg JD, Hochman T, Givi B, Jacobson A, Persky M, Hu KS. A Phase II Trial Evaluating Rapid Mid-Treatment Nodal Shrinkage to Select for Adaptive Deescalation in p16+ Oropharyngeal Cancer Patients Undergoing Definitive Chemoradiation. Int J Radiat Oncol Biol Phys 2023; 117:S68-S69. [PMID: 37784553 DOI: 10.1016/j.ijrobp.2023.06.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The purpose of this study is to determine if rapid mid-treatment nodal shrinkage (RMNS) can identify patients with p16+ oropharyngeal cancer (OPC) who can be safely deescalated with reduced dose chemoradiation therapy (CRT). The primary endpoint was 2-year progression free survival (PFS). MATERIALS/METHODS Inclusion criteria were as follows: T1-3, N1, M0 (AJCC 8th edition) p16+ OPC with <10 pack-year smoking history. All patients were initially planned for standard dose CRT (70 Gy) and weekly cisplatin. Patients were evaluated with a CT scan at week 4 for RMNS, defined as >40% nodal volumetric reduction from baseline. If RMNS was achieved, they proceeded to deescalated CRT (60 Gy). If not, they received standard CRT. Biomarker correlates were collected at baseline and week 4 of CRT including plasma TTMV (tumor tissue modified viral) HPV DNA and MRI diffusion weighted imaging (DWI). Univariate logistic regression analyses (UVA) were performed to evaluate predictors of RMNS. Odds ratios with 95% CI are reported, using a p<0.05 for statistical significance with a two-sided test. Wilcoxon rank sum tests were used to evaluate differences between the two groups using p < 0.05, 2-sided) for statistical significance. All statistical procedures were performed using R () with no adjustments for multiple testing. RESULTS Thirty-six patients were enrolled: median age: 60 years; 81% male; primary site: 36% base of tongue, 53% tonsil, 11% both; T-stage: 39% T1, 50% T2, 11% T3; N-stage: 100% N1; any smoking history: 58% yes, 42% no; 67% (n = 24) had RMNS and received deescalated CRT while the remaining proceeded to standard CRT. At a median follow-up of 32.4 months, 2-year PFS between the standard and deescalated groups were 91.7% vs 90.9%, respectively (p = 0.97). All patients with recurrence underwent successful salvage treatment with 2-year OS 100% for all patients. On UVA, rapid TTMV HPV DNA clearance (baseline to week 4) (OR 12.0 [1.65-250], p = 0.034), lower MRI diffusivity (ADC) at baseline (OR 0.79 [0.61-0.97], p = 0.042) and week 4 (OR 0.76 [0.60-0.91], p = 0.009), and higher MRI diffusional kurtosis at baseline (OR 1.09 [1.01-1.21], p = 0.051) and week 4 (OR 1.24 [1.09-1.52], p = 0.009) were significantly associated with RMNS. When comparing the deescalated and standard cohorts, the mean baseline and week 4 MRI ADC were significantly lower and week 4 MRI diffusional kurtosis was significantly higher in the deescalated group. CONCLUSION In this phase II study, rapid mid-treatment nodal shrinkage appeared to select favorable risk p16+ oropharynx cancer patients for treatment de-escalation. Rapid clearance of TTMV HPV DNA at week 4 as well as MRI DWI biomarkers of low ADC and high diffusional kurtosis values were correlated with RMNS. A larger study is planned to incorporate RMNS and biomarkers for further treatment de-escalation. Additional trial information is available at ClinicalTrials.gov (Identifier: NCT03215719).
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Affiliation(s)
- J K Kim
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | - M Tam
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | - J M Karp
- NYU Grossman School of Medicine, Department of Radiation Oncology, New York City, NY
| | - C Oh
- Biostatistics, Department of Population Health, NYU Langone Health, New York, NY
| | - G Kim
- NYU Langone Health, New York, NY
| | - E Solomon
- Weill Cornell Medicine, Cornell University, New York, NY
| | - C M Concert
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | - A E Vaezi
- Perlmutter Cancer Center NYU Langone Long Island, Mineola, NY
| | - Z Li
- Department of Medical Oncology, NYU Langone Health, New York, NY
| | - T Tran
- Department of Otolaryngology, NYU Langone Health, New York, NY
| | - E Zan
- NYU School of Medicine and Langone Medical Center, New York, NY, United States
| | - P Corby
- University of Pennsylvania, School of Dental Medicine, Philadelphia, PA
| | | | | | - J D Goldberg
- New York University School of Medicine, New York, NY
| | - T Hochman
- NYU Langone Medical Center, New York, NY
| | - B Givi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, NY
| | - M Persky
- Department of Otolaryngology, NYU Langone Health, New York, NY
| | - K S Hu
- NYU Langone Medical Center, New York, NY
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Li JW, Wu CCH, Lee JWJ, Liang R, Soon GST, Wang LM, Koh XH, Koh CJ, Chew WD, Lin KW, Thian MY, Matthew R, Kim G, Khor CJL, Fock KM, Ang TL, So JBY. Real-World Validation of a Computer-Aided Diagnosis System for Prediction of Polyp Histology in Colonoscopy: A Prospective Multicenter Study. Am J Gastroenterol 2023; 118:1353-1364. [PMID: 37040553 DOI: 10.14309/ajg.0000000000002282] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Computer-aided diagnosis (CADx) of polyp histology could support endoscopists in clinical decision-making. However, this has not been validated in a real-world setting. METHODS We performed a prospective, multicenter study comparing CADx and endoscopist predictions of polyp histology in real-time colonoscopy. Optical diagnosis based on visual inspection of polyps was made by experienced endoscopists. After this, the automated output from the CADx support tool was recorded. All imaged polyps were resected for histological assessment. Primary outcome was difference in diagnostic performance between CADx and endoscopist prediction of polyp histology. Subgroup analysis was performed for polyp size, bowel preparation, difficulty of location of the polyps, and endoscopist experience. RESULTS A total of 661 eligible polyps were resected in 320 patients aged ≥40 years between March 2021 and July 2022. CADx had an overall accuracy of 71.6% (95% confidence interval [CI] 68.0-75.0), compared with 75.2% (95% CI 71.7-78.4) for endoscopists ( P = 0.023). The sensitivity of CADx for neoplastic polyps was 61.8% (95% CI 56.9-66.5), compared with 70.3% (95% CI 65.7-74.7) for endoscopists ( P < 0.001). The interobserver agreement between CADx and endoscopist predictions of polyp histology was moderate (83.1% agreement, κ 0.661). When there was concordance between CADx and endoscopist predictions, the accuracy increased to 78.1%. DISCUSSION The overall diagnostic accuracy and sensitivity for neoplastic polyps was higher in experienced endoscopists compared with CADx predictions, with moderate interobserver agreement. Concordance in predictions increased this diagnostic accuracy. Further research is required to improve the performance of CADx and to establish its role in clinical practice.
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Affiliation(s)
- James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
| | - Clement Chun Ho Wu
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore Health Services, Singapore
| | - Jonathan Wei Jie Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Raymond Liang
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, National Healthcare Group, Singapore
| | - Gwyneth Shook Ting Soon
- Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Lai Mun Wang
- Department of Laboratory Medicine, Changi General Hospital, Singapore Health Services, Singapore
| | - Xuan Han Koh
- Department of Health Sciences Research, Changi General Hospital, Singapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Wei Da Chew
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, National Healthcare Group, Singapore
| | - Kenneth Weicong Lin
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
| | - Mann Yie Thian
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, National Healthcare Group, Singapore
| | - Ronnie Matthew
- Department of Colorectal Surgery, Singapore General Hospital, Singapore Health Services, Singapore
| | - Guowei Kim
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- University Surgical Cluster, National University Hospital, Singapore
| | - Christopher Jen Lock Khor
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore Health Services, Singapore
| | - Kwong Ming Fock
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
- Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore
| | - Jimmy Bok Yan So
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- University Surgical Cluster, National University Hospital, Singapore
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9
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Loethen A, Lavelle R, Sadzak M, Bucio J, Sarswat N, Chung B, Smith B, Kalantari S, Grinstein J, Nguyen A, Belkin M, Murks C, Riley T, Powers J, Jones A, Kim G, Pinney S. Use of Complement-Fixing Assays to Expand the Donor Pool for Highly Sensitized Heart Transplant Recipients - The Role of C1q Testing. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1659] [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: 04/05/2023] Open
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10
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Han J, Moayedi Y, Truby L, Foroutan F, Bofarull JG, Saha S, Angleitner P, Sabatino M, Henricksen E, Luikart H, van Zyl J, Tremblay-Gravel M, Noly P, Segovia-Cubero J, Alesina ER, Potena L, Takeda K, Felius J, Clarke B, DeVore A, Kim G, Miller R, Zuckermann A, Farr M, Crespo-Leiro M, Hall S, Torres MF, Fan C, Ross H, Khush K, Chih S. Incidence and Predictors of Vasoplegia after Heart Transplantation: Results from the International PGD Consortium. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.185] [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: 04/05/2023] Open
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11
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Lavelle R, Loethen A, Murks C, Riley T, Powers J, Jones A, Belkin M, Nguyen A, Grinstein J, Chung B, Kalantari S, Smith B, Sarswat N, Kim G, Pinney S. Impact of Early Belatacept Use on 1-Year CAV Progression in Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1358] [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: 04/05/2023] Open
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12
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Watanabe T, Nemoto A, Nguyen A, Grinstein J, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Onsager D, Song T, Salerno C, Jeevanandam V, Ota T. Impact on Non-Cardiac Surgery for Patients with Lvad Support. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1585] [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: 04/05/2023] Open
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13
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Sorensen K, Rodgers D, Uppalapati SC, Siddiqi U, Jain S, Paluri S, Madhushanka A, Sudheendra K, Johnson K, Bangaru S, Ram K, Hynes D, Ozcan C, Lee L, Kim G, Jeevanandam V. A Retrospective Study on Gender, LAA Morphology and Stroke Risk. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.565] [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: 04/05/2023] Open
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14
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Loethen A, Lavelle R, Sarswat N, Chung B, Smith B, Kalantari S, Grinstein J, Nguyen A, Belkin M, Murks C, Riley T, Powers J, Jones A, Kim G, Pinney S. Efficacy and Tolerability of Belatacept in Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.179] [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: 04/05/2023] Open
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15
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Loethen A, Lavelle R, Sarswat N, Chung B, Smith B, Kalantari S, Grinstein J, Nguyen A, Belkin M, Kim G, Pinney S. Successful Use of Carfilzomib and Belatacept to Lower Alloantibodies Prior to Heart Transplant: A Case Series. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1359] [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: 04/05/2023] Open
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16
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Nemoto A, Belkin M, Sarswat N, Chung B, Nguyen A, Smith B, Kalantari S, Kim G, Grinstein J, Pinney S, Onsager D, Song T, Salerno C, Jeevanandam V, Ota T. Impact of Surgical Techniques on Survival and Hemodynamics after Orthotopic Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1535] [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: 04/05/2023] Open
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17
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Kim G, Kim H, Lee M, Kim M, Jeong Y. Abstract No. 262 90Y Radioembolization for Hepatocellular Carcinoma with Portal Vein Thrombosis: Prognostic Factors in 115 Patients. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.327] [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: 02/26/2023] Open
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18
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Chia DKA, Sundar R, Kim G, Ang JJ, Shabbir A, So JBY, Yong WP. Outcomes of a Phase II Study of Intraperitoneal Paclitaxel Plus Systemic Capecitabine and Oxaliplatin (XELOX) for Gastric Cancer with Peritoneal Metastases. Ann Surg Oncol 2023; 30:1889-1890. [PMID: 36564654 DOI: 10.1245/s10434-022-12877-3] [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: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Daryl K A Chia
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Guowei Kim
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Jia Jun Ang
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Asim Shabbir
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Jimmy B Y So
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore.
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
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19
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Han K, Kim S, Liaw V, Kim M, Kwon J, Moon S, Kim G, Won J, Park J, Kim H. Abstract No. 145 Resorbable Gelatin Microspheres versus Tris-Acryl Microspheres: Randomized Controlled Trial Comparing Pain, Inflammatory Response and Embolic Effect after Uterine Artery Embolization for Symptomatic Fibroids. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.198] [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: 02/26/2023] Open
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20
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Park B, Shin J, Son G, Lee S, Park J, Jhoo J, Kim G. Effects of full fat oil seeds on milking performance,
milk composition and milk quality in lactating Holstein cows. J Anim Feed Sci 2023. [DOI: 10.22358/jafs/159227/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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21
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Choe L, Lau J, Yip LTS, Kim G, Tan KK. Gastroscopy after positive screening for faecal immunochemical tests and colonoscopy: A systematic review. PLoS One 2023; 18:e0281557. [PMID: 36763684 PMCID: PMC9916633 DOI: 10.1371/journal.pone.0281557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/26/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening using the faecal immunochemical test (FIT) kits based on the detection of occult blood in stool is widely advocated in numerous screening programs worldwide. However, CRC is not commonly diagnosed in positive cases. We undertook this review to determine if there is evidence to suggest the use of opportunistic oesophago-gastro-duodenoscopy (OGD) in patients without CRC. METHODS A systematic review encompassing three electronic databases was performed. All peer-reviewed studies of FIT-positive patients who underwent either OGD and colonoscopy concurrently or OGD post-colonoscopy were included. Only studies from 2008 to 2022 using FIT kits were included to ensure studies not previously included in an earlier review were being analysed. A forward citation search of the included articles was also conducted to ensure no relevant articles were missed. RESULTS A total of 2409 records were extracted. Only four studies fulfilled the selection criteria and were included. Although the rates of abnormal OGD results were relatively high in the four studies, only 3 of 605 (0.50%) patients had gastric cancer in the entire review sample. No other malignancies were identified in all four studies. Other notable pathologies such as gastric polyps and gastritis were also reported. CONCLUSIONS There is little overall evidence to recommend UGI screening for all FIT-positive patients following a colonoscopy. However, there may be a role for clinicians to consider opportunistic OGD in this group of patients. Future research should examine patient populations from other sociocultural contexts including cost-effective analysis when considering changes in health guidelines on UGI screening.
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Affiliation(s)
- Lina Choe
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jerrald Lau
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Larry Teck-Seng Yip
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Guowei Kim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- University Surgical Cluster, National University Health System, Singapore, Singapore
- Division of Surgical Oncology, National University Cancer Institute, Singapore (NCIS), National University Health System, Singapore, Singapore
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- University Surgical Cluster, National University Health System, Singapore, Singapore
- Division of Surgical Oncology, National University Cancer Institute, Singapore (NCIS), National University Health System, Singapore, Singapore
- * E-mail:
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22
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Gwee YX, Chia D, Provenzano L, Lonardi S, Conca V, Cremolini C, Yong WP, Tan P, So JBY, Kim G, Shabbir A, Ong J, Pietrantonio F, Sundar R. Malignant ascites as a marker of peritoneal carcinomatosis burden in patients with colorectal and gastroesophageal cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.455] [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: 01/25/2023] Open
Abstract
455 Background: Malignant ascites occurs frequently in patients with gastric cancer (GC) and colorectal cancer (CRC) with peritoneal metastasis (PM). The presence of PM and malignant ascites have been independently reported to confer resistance to systemic therapy and poorer prognosis. However, the occurrence of malignant ascites as a function of increasing peritoneal carcinomatosis burden has been less studied and reported. Methods: We reviewed prospective cohorts of gastric cancer and colorectal cancer patients with PM. The first cohort was a prospective group of GCPM patients receiving bi-directional systemic and peritoneal-directed therapies (catheter-based intraperitoneal chemotherapy and/or pressurized intraperitoneal aerosol chemotherapy respectively) at a tertiary oncology center in Singapore. Clinico-pathological data, including Peritoneal Cancer Index (PCI) and the presence or absence of ascites based on diagnostic laparoscopy, was collected. To orthogonally validate the hypothesis of malignant ascites as a function of peritoneal carcinomatosis burden in gastrointestinal malignancies, we studied the relationship between ascites, PM and survival in an independent cohort of metastatic CRC patients eligible for first-line systemic treatment enrolled in two randomized clinical trials in different Italian cancer centers. Results: In the first cohort of 82 patients with GCPM, the median PCI was 19 (inter-quartile range (IQR) 8 – 26) in the group with ascites and 3 (IQR 1 – 12) in the group without ascites (p=0.005), suggesting ascites occurs with higher PM burden. The median overall survival (OS) was poorer in patients with ascites (13.4 vs 16.4 months, HR 1.6, 95% CI 0.9 – 2.8, p=0.082). The median OS in patients with PCI of <7 was 17.3 months (95% 12.0 – 22.7) and 13.8 months (95% CI 11.0 – 16.6) in those with PCI score >7. In the validation cohort of 900 CRC patients, presence of malignant ascites and PM resulted in poorer survival compared to patients with PM and no malignant ascites (HR for OS PM with ascites vs PM without ascites 2.01 (95% CI 1.37 - 2.96), p<0.001). Interestingly, those with PM and ascites had a poorer survival to those with stage IV disease without peritoneal involvement, while those with PM without ascites did not have a statistically significant difference (PM with malignant ascites vs. no peritoneal disease, HR for OS 2.14, 95% CI 1.57 – 3.01, p=0.007; PM without ascites vs no peritoneal disease, HR for OS 1.10, 95% CI 0.91 – 1.34). Conclusions: Our study of patients with colorectal or gastric cancer and peritoneal metastases suggest the presence of malignant ascites as a function of increased peritoneal carcinomatosis burden among patients with metastatic gastrointestinal malignancies, with correspondingly poorer survival outcomes.
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Affiliation(s)
- Yong Xiang Gwee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore, Singapore
| | - Daryl Chia
- Department of Surgery, National University Health System, Singapore, Singapore
| | - Leonardo Provenzano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Lonardi
- Medical Oncology 3, Veneto Institute of Oncology IOV–IRCCS, Padova, Italy
| | - Veronica Conca
- Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research, Unit of Medical Oncology, Pisa, Italy
| | - Chiara Cremolini
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Wei Peng Yong
- National University Cancer Institute, Singapore, Singapore
| | - Patrick Tan
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Jimmy Bok Yan So
- National University Cancer Institute Singapore, Singapore, Singapore
| | - Guowei Kim
- National University Hospital, Singapore, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Johnny Ong
- National Cancer Centre of Singapore, Singapore, Singapore
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Raghav Sundar
- National University Cancer Institute Singapore, Singapore, Singapore
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23
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Chew HSJ, Lim SL, Kim G, Kayambu G, So BYJ, Shabbir A, Gao Y. Essential elements of weight loss apps for a multi-ethnic population with high BMI: a qualitative study with practical recommendations. Transl Behav Med 2023; 13:140-148. [PMID: 36689306 DOI: 10.1093/tbm/ibac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Smartphone weight loss apps are constantly being developed but the essential elements needed by a multi-ethnic population with overweight and obesity remains unclear. Purpose: To explore the perceptions of an Asian multi-ethnic population with overweight and obesity on the essential elements of weight loss apps. Twenty two participants were purposively sampled from a specialist weight management clinic in Singapore from 13 April to 30 April 2021. Recorded interviews were conducted using face-to-face and videoconferencing modalities. Data saturation was reached at the 18th participant. Data analysis was performed using inductive content analysis with constant comparison between and within transcripts. Findings: Three themes and eight subthemes on the essential app components emerged-(a) comprehensive and flexible calorie counters; (b) holistic, gradual and individualized behavior change recommendations tailored for people with overweight and obesity, and (c) just-in-time reminders of future consequences. There was a need to incorporate flexible options for food logging; break down general recommendations into small steps towards sustainable changes; tailor app contents for people with overweight and obesity; and evoke one's considerations of future consequences. Future weight loss apps should be designed to meet the needs of those with overweight and obesity, the very population that needs assistance with weight loss. Future apps could consider leveraging the capacity of artificial intelligence to provide personalized weight management in terms of sustaining self-regulation behaviors, optimizing goal-setting and providing personalized and timely recommendations for weight loss.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Su Lin Lim
- Dietetics Department, National University Hospital, 5 Lower Kent Ridge Road Singapore 119074, Singapore
| | - Guowei Kim
- Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road Singapore 119074, Singapore
| | - Geetha Kayambu
- Rehabilitation Department, National University Hospital, 5 Lower Kent Ridge Road Singapore 119074, Singapore
| | - Bok Yan Jimmy So
- Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road Singapore 119074, Singapore
| | - Asim Shabbir
- Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road Singapore 119074, Singapore
| | - Yujia Gao
- Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road Singapore 119074, Singapore
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24
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Ju H, Kim J, Lee S, Lee J, Kim G, Bae J. 535 A New Classification and Treatment Outcome of Hand Vitiligo: A Cluster Analysis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.550] [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: 11/19/2022]
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25
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Chia DKA, Sundar R, Kim G, Ang JJ, Lum JHY, Nga ME, Goh GH, Seet JE, Chee CE, Tan HL, Ho J, Ngoi NYL, Lee MXW, Muthu V, Chan GHJ, Pang ASL, Ang YLE, Choo JRE, Lim JSJ, Teh JL, Lwin A, Soon Y, Shabbir A, So JBY, Yong WP. ASO Visual Abstract: Outcomes of a Phase II Study of Intraperitoneal Paclitaxel Plus Systemic Capecitabine and Oxaliplatin (XELOX) for Gastric Cancer with Peritoneal Metastases. Ann Surg Oncol 2022; 29:8608-8609. [PMID: 36207480 DOI: 10.1245/s10434-022-12043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Daryl K A Chia
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Guowei Kim
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jia Jun Ang
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jeffrey H Y Lum
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Giap Hean Goh
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Je Ee Seet
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Cheng Ean Chee
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Hon Lyn Tan
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Jingshan Ho
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Natalie Y L Ngoi
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Matilda X W Lee
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Vaishnavi Muthu
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Gloria H J Chan
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Angela S L Pang
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Yvonne L E Ang
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Joan R E Choo
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Joline S J Lim
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Jun Liang Teh
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Aung Lwin
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Yuen Soon
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Asim Shabbir
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Jimmy B Y So
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore.
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
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Jeon H, Kim G, Nam H, Suh S. The Function of Bedtime Procrastination in Individuals with Clinical Insomnia. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jee B, Kang Y, Kim G, Kang M. 168P Transcriptional profiling of metastatic hormone sensitive prostate cancer (mHSPC) and distinct features are associated with clinical outcome. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.205] [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: 12/07/2022] Open
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Kim J, Tam M, Oh C, Feron-Rigodon M, Joseph B, Vaezi A, Li Z, Tran T, Kim G, Zan E, Corby P, Vecchio Fitz CD, Goldberg J, Hochman T, Givi B, Jacobson A, Persky M, Persky M, Hu K. Circulating Tumor HPV-DNA Kinetics in p16+ Oropharyngeal Cancer Patients Undergoing Adaptive Radiation De-Escalation Based on Mid-Treatment Nodal Response. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1385] [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: 10/31/2022]
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Nishida H, Jeevanandam V, Salerno C, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Ota T. Concomitant left atrial appendage closure with left ventricular assist device surgery can reduce ischemic cerebrovascular accidents. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1009] [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: 11/12/2022] Open
Abstract
Abstract
Background
It remains unknown if concomitant left atrial appendage closure (LAAC) at the time of left ventricular assist device (LVAD) surgery can reduce ischemic cerebrovascular accidents.
Purpose
The purpose of this study is to assess the impact of LAAC at LVAD surgery on the incidence of ischemic cerebrovascular accidents.
Methods
Between January 2012 and November 2021, 310 patients underwent LVAD surgery with HeartMate II or III. Out of 310 patients, 98 patients (31.6%) underwent concomitant LAAC. The cohort was divided into two groups: patients with LAAC (Group A, n=98) and without LAAC (Group B, n=212). To minimize device bias, LVAD surgery with HeartWare HVAD device was excluded. The ischemic cerebrovascular accident was defined as ischemic stroke, hemorrhagic stroke or transient ischemic attack. We reviewed early and long-term clinical outcomes. The incidence of ischemic cerebrovascular accidents was compared between two groups using the Kaplan-Meier method. We also investigated if LAAC was associated with ischemic cerebrovascular accidents by Cox proportional hazards analysis.
Results
There were no significant differences in baseline characteristics between two groups including age (Group A: 55.0±12.3 years old, Group B: 56.9±14.1 years old, p=0.26), preoperative CHADS2 score (Group A: 2.40±1.1, Group B: 2.58±1.1, p=0.19) and history of atrial fibrillation (Group A: 42.9%, Group B: 42.5%, p=0.95). In-hospital mortality was not significantly different between the two groups (Group A: 7.1%, Group B: 12.3%, p=0.16). In terms of postoperative complications, there were no significant differences between two groups in requiring extracorporeal membrane oxygenation, re-exploration for bleeding and newly required hemodialysis. Median follow up period was 474 days. Thirty-five patients (11.2%) developed ischemic cerebrovascular accidents (5 patients in Group A and 30 patients in Group B). The rate of freedom from ischemic cerebrovascular accidents in Group A (94.1% at 500 days and 94.1% at 1500 days) was significantly higher than that in Group B (88.2% at 500 days and 77.4% at 1500 days; log rank=0.024). In a Cox proportional hazards regression analysis including LAAC, age, history of atrial fibrillation, diabetes mellitus and Heartmate 3 device implantation, LAAC was associated with reducing the incidence of ischemic cerebrovascular accidents (hazard ratio 0.37, 95% CI 0.13–0.89, p=0.02).
Conclusion
Concomitant LAAC at the time of LVAD surgery can reduce ischemic cerebrovascular accidents without increasing perioperative mortality and complications.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Nishida
- University of Chicago Medicine , Chicago , United States of America
| | - V Jeevanandam
- University of Chicago Medicine , Chicago , United States of America
| | - C Salerno
- University of Chicago Medicine , Chicago , United States of America
| | - T Song
- University of Chicago Medicine , Chicago , United States of America
| | - D Onsager
- University of Chicago Medicine , Chicago , United States of America
| | - A Nguyen
- University of Chicago Medicine , Chicago , United States of America
| | - J Grinstein
- University of Chicago Medicine , Chicago , United States of America
| | - B Chung
- University of Chicago Medicine , Chicago , United States of America
| | - B Smith
- University of Chicago Medicine , Chicago , United States of America
| | - S Kalantari
- University of Chicago Medicine , Chicago , United States of America
| | - N Sarswat
- University of Chicago Medicine , Chicago , United States of America
| | - G Kim
- University of Chicago Medicine , Chicago , United States of America
| | - S Pinney
- University of Chicago Medicine , Chicago , United States of America
| | - T Ota
- University of Chicago Medicine , Chicago , United States of America
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Chia DKA, Ang JJ, Sundar R, Kim G, Shabbir A, So JBY, Yong WP. ASO Author Reflections: Combination Intra-Peritoneal and Systemic Chemotherapy for Gastric Cancer with Peritoneal Metastases. Ann Surg Oncol 2022; 29:8606-8607. [PMID: 36192514 DOI: 10.1245/s10434-022-12102-1] [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: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Daryl K A Chia
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jia Jun Ang
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer, Institute National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Guowei Kim
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Asim Shabbir
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Jimmy B Y So
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore.
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer, Institute National University Health System, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
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Chia DKA, Sundar R, Kim G, Ang JJ, Lum JHY, Nga ME, Goh GH, Seet JE, Chee CE, Tan HL, Ho J, Ngoi NYL, Lee MXW, Muthu V, Chan GHJ, Pang ASL, Ang YLE, Choo JRE, Lim JSJ, Teh JL, Lwin A, Soon Y, Shabbir A, So JBY, Yong WP. Outcomes of a Phase II Study of Intraperitoneal Paclitaxel plus Systemic Capecitabine and Oxaliplatin (XELOX) for Gastric Cancer with Peritoneal Metastases. Ann Surg Oncol 2022; 29:8597-8605. [PMID: 36070113 DOI: 10.1245/s10434-022-11998-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adding intraperitoneal paclitaxel (IP-PTX) to paclitaxel/5-fluoropyrimidine has shown promising results in patients with gastric cancer peritoneal metastases (GCPM) but has not been studied with standard-of-care platinum/fluoropyrimidine combinations. Our goal to was evaluate IP-PTX with capecitabine/oxaliplatin (XELOX) in GCPM. METHODS Forty-four patients with GCPM received IP PTX (40 mg/m2, Days 1, 8), oral capecitabine (1000 mg/m2 twice daily, Days 1-14) and intravenous oxaliplatin (100 mg/m2, Day 1) in 21-day cycles. Patients with synchronous GCPM underwent conversion surgery if they had good response after chemotherapy, conversion to negative cytology, no extraperitoneal metastasis, and no peritoneal disease during surgery. The primary endpoint was overall survival and secondary endpoints were progression-free survival and safety. Outcomes from the trial were compared against a matched cohort of 39 GCPM patients who received systemic chemotherapy (SC) comprising platinum/fluoropyrimidine. RESULTS The median OS for the IP and SC groups was 14.6 and 10.6 months (hazard ratio [HR] 0.44; 95% confidence interval [CI], 0.26-0.74; p = 0.002). The median PFS for the IP and SC group was 9.5 and 4.4 months respectively (HR 0.39; 95% CI 0.25-0.66; p < 0.001). Patients in the SC group were younger (IP vs. SC, 61 vs. 56 years, p = 0.021) and had better performance status (ECOG 0, IP vs. SC, 47.7% vs. 76.9%, p = 0.007) compared with the IP cohort. In IP group, conversion surgery was performed in 36.1% (13/36) of patients, with a median OS of 24.2 (95% CI 13.1-35.3) months and 1-year OS of 84.6%. CONCLUSIONS IP PTX with XELOX is a promising treatment option for GCPM patients. In patients with good response, conversion surgery was feasible with favourable outcomes.
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Affiliation(s)
- Daryl K A Chia
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Guowei Kim
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jia Jun Ang
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jeffrey H Y Lum
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Giap Hean Goh
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Ju Ee Seet
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Cheng Ean Chee
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Hon Lyn Tan
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Jingshan Ho
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Natalie Y L Ngoi
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Matilda X W Lee
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Vaishnavi Muthu
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Gloria H J Chan
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Angela S L Pang
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Yvonne L E Ang
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Joan R E Choo
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Joline S J Lim
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore
| | - Jun Liang Teh
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Aung Lwin
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Yuen Soon
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Asim Shabbir
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Jimmy B Y So
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore.
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
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Kamarajah S, Evans R, Nepogodiev D, Hodson J, Bundred J, Gockel I, Gossage J, Isik A, Kidane B, Mahendran H, Negoi I, Okonta K, Sayyed R, van Hillegersberg R, Vohra R, Wijnhoven B, Singh P, Griffiths E, Kamarajah S, Hodson J, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, MA N, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández Díaz M, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez L, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel Gijs, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit. J Thorac Cardiovasc Surg 2022; 164:674-684.e5. [PMID: 35249756 DOI: 10.1016/j.jtcvs.2022.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. METHODS This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. RESULTS Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. CONCLUSIONS Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.
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Lee J, Lee TR, Kim G, Ahn J, Park S, Song KB, Jun E, Oh D, Lee JW, Park Y, Song GW, Byeon JS, Kim B, Lee J, Kim D, Ki CS, Cho E, Choi J. 916P Deep learning-based multimodal ensemble algorithm for multi-cancer detection and classification using cf-WGS. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1041] [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: 11/01/2022] Open
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Volkmann E, Tashkin D, Wilhalme H, Lyons M, Kim G, Goldin J, Roth M, Assassi S. POS0859 C-REACTIVE PROTEIN AND INTERLEUKIN-6: POTENTIAL BIOMARKERS OF DISEASE ACTIVITY AND TREATMENT RESPONSE IN SYSTEMIC SCLEROSIS-INTERSTITIAL LUNG DISEASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1374] [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: 11/03/2022]
Abstract
BackgroundClinically feasible and valid biomarkers of systemic sclerosis-interstitial lung disease (SSc-ILD) are needed. While promising candidate biomarkers are under investigation (e.g., KL-6, CCL-8), clinical assays for these proteins are not currently available. C-reactive protein (CRP) measurements are feasible, cost-effective, and have been shown to predict mortality in SSc.1 Measuring interleukin (IL)-6, a proinflammatory cytokine implicated in SSc-ILD pathogenesis, is also feasible in most clinical settings.Objectives(1) To investigate whether CRP and IL-6 levels change in response to treatment with immunosuppression in SSc-ILD; (2) To explore whether the change in CRP and IL-6 predict the future course of forced vital capacity (FVC).MethodsCRP and IL-6 levels were measured in serum at baseline and after 12 months in participants of Scleroderma Lung Study (SLS) II (patients with active SSc-ILD receiving 24 months of mycophenolate or 12 months cyclophosphamide followed by 12 months of placebo2). Measured values were log-transformed to remove skewness. The FVC%-predicted was measured every 3 months over the course of 24 months. Spearman’s correlations evaluated the relationship between baseline CRP or IL-6 measurements and other patient parameters. Paired t-tests were used to compare the change in individual CRP and IL-6 measurements from baseline to 12 months. Linear mixed effects models were used to examine the relationship between the change in CRP and IL-6 (baseline to 12 months) and the subsequent course of the FVC (12 to 24 months). All analysis were performed for the entire cohort and separately by treatment arm.ResultsOf the 142 participants of SLS II, 101 had CRP and IL-6 measurements at baseline and 12 months. Baseline CRP and IL-6 levels correlated significantly with higher modified Rodnan skin score (CRP: r=0.3, P=0.005; IL-6: r=0.2, P=0.01) and shorter disease duration (CRP: r=-0.3, P=0.005; IL-6: r=-0.2, P=0.01) and were higher in patients with diffuse SSc (CRP: P=0.007; IL-6: P=0.01). Relationships to baseline FVC and DLCO were not observed. CRP decreased significantly from baseline to 12 months in the whole group (P=0.01), but the decrease was slightly greater in patients randomized to mycophenolate versus cyclophosphamide (-0.47 vs. -0.33 ug/mL). IL-6 also decreased from baseline to 12 months in the whole group with a trend towards significance (P=0.10) (Figure 1). The mean decrease in IL-6 was again slightly greater in patients randomized to mycophenolate versus cyclophosphamide (-0.31 vs. -0.10 pg/mL). After controlling for baseline FVC and treatment arm in the mixed effects model, there was a relationship between the decrease in CRP from baseline to 12 months and an improved course of FVC 12 to 24 months (Estimate -0.64), but this did not reach significance (P=0.14). However, after controlling for baseline FVC and treatment arm, a greater decrease in IL-6 from baseline to 12 months was significantly associated with a greater improvement in FVC from 12 to 24 months (Estimate -1.28; P=0.01).Figure 1.Change in CRP (A) and IL-6 (B) from baseline to 12 months by treatment arm in SLS II. CYC=cyclophosphamide (Blue), MMF=mycophenolate (red)ConclusionPatients with active SSc-ILD receiving one year of immunosuppressive therapy in the SLS II study experienced reductions in their CRP and IL-6 levels over this interval. The magnitude of the decrease in CRP and IL-6 over the first year also correlated with the course of FVC over the ensuing 12 months. These findings suggest a dynamic relationship between CRP and IL-6 measurements and the course of SSc-ILD in patients on immunosuppressive therapy. Further investigation of these findings is warranted.References[1]Liu et al. Arthritis Care Res 2013.[2]Tashkin et al. Lancet Resp Med 2016.Disclosure of InterestsElizabeth Volkmann Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Grant/research support from: Forbius, Kadmon, Horizon, Boehringer Ingelheim, Donald Tashkin: None declared, Holly Wilhalme: None declared, Marka Lyons: None declared, Grace Kim: None declared, Jonathan Goldin: None declared, Michael Roth Grant/research support from: Genentech, Shervin Assassi Consultant of: Boehringer Ingelheim
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Volkmann E, Tashkin D, Leng M, Kim G, Goldin J, Roth M. POS0852 SYMPTOMS OF GASTROESOPHAGEAL REFLUX ARE A BETTER PREDICTOR OF SYSTEMIC SCLEROSIS-RELATED INTERSTITIAL LUNG DISEASE PROGRESSION THAN QUANTITATIVE RADIOGRAPHIC ASSESSMENT OF ESOPHAGEAL PARAMETERS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.946] [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: 11/03/2022]
Abstract
BackgroundEsophageal dysfunction affects the majority of patients with systemic sclerosis (SSc). Gastroesophageal reflux (GERD)-associated microaspiration may serve as an inciting and/or exacerbating factor in the pathogenesis of interstitial lung disease (ILD) in SSc. Few studies have investigated the relationship between objective measures of esophageal involvement in SSc and the progression of SSc-ILD.Objectives(1) To investigate whether patient-reported symptoms of GERD predict SSc-ILD severity and progression; (2) To explore whether quantitative radiographic measurements of esophageal parameters predict SSc-ILD severity and progression.MethodsParticipants of Scleroderma Lung Study (SLS) II (24 months of mycophenolate versus 12 months cyclophosphamide followed by 12 months of placebo in patients with active SSc-ILD) were included.1 The UCLA SCTC GIT 2.0 was used to assess the severity of reflux at baseline. Quantitative image analysis was used to calculate the diameter and area of the esophagus in the area of maximum dilation. Univariate and multivariable linear regression analyses were used to evaluate the relationship between baseline reflux scores/esophageal parameters and the severity and progression of SSc-ILD based on the quantitative radiographic extent of ILD (QILD) and fibrosis (QLF) in the lobe of maximum involvement (LM). All multivariable models controlled for treatment arm and baseline ILD severity, as well as proton pump inhibitor (PPI) use.ResultsAmong the 141 of 142 SLS II participants with patient-reported reflux scores at baseline, the mean score was 0.57, indicating moderate reflux. The mean maximal esophageal diameter and area at baseline were 22 mm and 242 mm2, respectively. There were no significant correlations between reflux scores, esophageal diameter, esophageal area and QILD-LM and QLF-LM at baseline. However, in the 96 participants with HRCT scans available at 24 months, increased reflux scores were significantly associated with worsening of QLF-LM and QILD-LM (Figure 1). Even after controlling for disease severity at baseline, treatment arm and PPI use, reflux scores remained significantly associated with change in QLF-LM (P-value 0.05) and QILD-LM (P-value 0.003). Neither the maximum esophageal area, nor the maximum esophageal diameter was associated with the change in QILD-LM or QLF-LM in univariate or multivariate analyses.Figure 1.Increased reflux scores at baseline are associated with increased progression (worsening) of QILD (A) and QLF (B) in the lobe of maximum involvement in patients with SSc-ILD.ConclusionIncreased self-reported reflux was independently associated with worsening radiographic fibrosis and ILD in patients receiving treatment for SSc-ILD. The maximum esophageal diameter and esophageal area did not correlate with reflux scores and did not predict severity or progression of SSc-ILD. These findings illustrate the importance of eliciting a careful patient history of reflux symptoms in patients with ILD and further highlight the need for improved objective measures of esophageal dysfunction in SSc.References[1]Tashkin et al. Lancet Resp Med 2016.Disclosure of InterestsElizabeth Volkmann Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Grant/research support from: Forbius, Horizon, Kadmon, Boehringer Ingelheim, Donald Tashkin: None declared, Mei Leng: None declared, Grace Kim: None declared, Jonathan Goldin: None declared, Michael Roth Grant/research support from: Genentech
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Lee YH, Choe YJ, Kim G, Min HS. Age-period-cohort analysis of TB mortality in South Korea, 1983-2017. Int J Tuberc Lung Dis 2022; 26:577-579. [PMID: 35650690 DOI: 10.5588/ijtld.22.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Y H Lee
- Korea University Anam Hospital and Korea University College of Medicine, Seoul, South Korea
| | - Y J Choe
- Korea University Anam Hospital and Korea University College of Medicine, Seoul, South Korea
| | - G Kim
- National Medical Center, Seoul, South Korea
| | - H S Min
- National Medical Center, Seoul, South Korea
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Yeo J, Yoon SH, Kim JY, Koo JM, Lee JS, Lee EY, Pourzand L, Goldin J, Kim G, Ha YJ. POS0068 CHANGES IN QUANTITATIVE INTERSTITIAL LUNG DISEASE SCORES ON HIGH-RESOLUTION CT IN IDIOPATHIC INFLAMMATORY MYOSITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1682] [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: 11/03/2022]
Abstract
BackgroundThe idiopathic inflammatory myopathies (IIM) are autoimmune connective tissue diseases affecting skeletal muscle, skin and other organ systems. IIM-related interstitial lung disease (IIM-ILD) is the most common extra-muscular manifestation, being the leading cause of morbidity and mortality. Several studies have suggested that ILD pattern based on chest high-resolution computed tomography (HRCT) can be related to disease course and treatment response, but the results vary considerably. Moreover, the clinical impact of the quantitative ILD (QILD) score, a validated computer-aided scoring system in assessing ILD severity from HRCT, and its longitudinal changes have not yet been evaluated in IIM-ILD.ObjectivesThis study aims to investigate ILD patterns and QILD scores in patients with IIM-ILD, to identify their clinical impact, and to delineate longitudinal changes of QILD measurement.MethodsA total of 80 patients with IIM (polymyositis 22, and dermatomyositis 58) who underwent at least 2 times of serial HRCT scans were included. Visual ILD patterns were assessed by multiple thoracic radiologists. Quantitative analysis of HRCT was presented as total extent of QILD scores (%) in whole lung and most severe zone. Individual time-estimated ΔQILD score between first 2 visits was derived using a linear approximation of yearly change, where the duration of median (IQR) was 1.0 (0.4-1.6) years in the first 2 HRCT scans.ResultsThe median (IQR) age of the patients was 52.0 (43.5-58.5) years and 60 (75.0%) were women. Baseline median score of whole lung-QILD and most severe zone-QILD were 28.1% (19.1-43.8) and 68.0% (45.5-81.8), respectively, and QILD score showed significant correlations with pulmonary function tests (r=-0.349, p=0.002 for % predicted forced vital capacity; and r=-0.381, p=0.001 for % predicted diffusing capacity for carbon monoxide). The individual time-estimated yearly ΔQILD score between first 2 visits presented that approximately half of the patients showed improvement or stability in QILD scores; however, when patients were sorted by visual assessment in ILD subtype on HRCT, approximately two-thirds of the patients with usual interstitial pneumonia (UIP) pattern were aggravated in QILD scores and less than half of subjects with nonspecific interstitial pneumonia and organizing pneumonia were aggravated (Figure 1, 80% for UIP vs. 44.4% for non-UIP, p=0.013). There was no immunosuppressive drugs related to meaningful improvement in QILD scores during first 2 visits. Notably, we observed significant aggravation of QILD scores in tacrolimus users (n=7, median time-estimated whole lung-yarly ΔQILD 20.3 (2.7-38.4)) compared with tacrolimus non-users (n=73, median time estimated whole lung-yearly ΔQILD -1.2 (-8.3-6.5)). Among 80 patients, 6 (7.5%) were died due to various lung complications. Higher baseline QILD scores were noted in deaths (median whole lung-QILD 45.4 (32.9-56.5)) than in survivors (median whole lung-QILD 26.9 (19.0-42.4)), albeit not significant (p=0.084). Poor survival rate was observed in patients with high grade of ground glass opacity by visual assessment in right upper lobe (log-rank test, p=0.042). Among subgroup of patients with 3 serial HRCT scans (n=41), dynamic changes of four distinct patterns (improving, worsening, convex, and concave) were observed.Figure 1.Cleveland dot plot of individual time-estimated yearly ΔQILD during fist 2 visits.ConclusionThe changes in QILD score in IIM-ILD are dynamic and present different by visual assessment. QILD score has the potential for evaluation of the severity changes, prognosis and medication response in patients with IIM-ILD.References[1]Tashkin DP, et al. Ann Rheum Dis 2016;75(2):374-81.7 truncated values in the graph A. NSIP: nonspecific interstitial pneumonia; OP: organizing pneumonia; UIP: usual interstitial pneumonia.Disclosure of InterestsNone declared
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac016] [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: 11/06/2022]
Abstract
Abstract
Background
Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.
Methods
Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).
Results
Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.
Conclusion
Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022; 109:439-449. [PMID: 35194634 DOI: 10.1093/bjs/znac016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. METHODS Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). RESULTS Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. CONCLUSION Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Belkin M, Siddiqi U, Kalantari S, Kanelidis A, Miller T, Nguyen A, Chung B, Rodgers D, Li Z, Smith B, Sarswat N, Kim G, Pinney S, Grinstein J. Accuracy of Estimated versus Calculated Mean Pulmonary Arterial Pressure. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.788] [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] Open
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Moayedi Y, Foroutan F, Truby L, Han J, Angleitner P, Guzman J, Sabatino M, Felius J, Zafar H, Law D, Van Zyl J, Tremblay-Gravel M, Segovia J, Devore A, Kim G, Lasarte MR, Knezevic I, Noly P, Farr M, Zuckermann A, Potena L, Ferrero M, Miller R, Fan S, Chih S, Hall S, Khush K, Ross H. Using Machine Learning to Develop a Contemporary Primary Graft Dysfunction Prediction Model: The International Consortium on PGD. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.022] [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: 10/18/2022] Open
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Dela Cruz M, Riley T, Husain A, Kim G. Pulmonary Amyloidoma: A Rare Entity Complicating a Post-Heart Transplant Course. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1707] [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: 10/18/2022] Open
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Plana A, Siddiqi U, Belkin M, Nguyen A, Chung B, Rodgers D, Li Z, Grinstein J, Kalantari S, Sarswat N, Kim G, Pinney S, Smith B. The Effect of Race on Heart Transplant Outcomes by Age. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.184] [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] Open
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Dela Cruz M, Lin H, Adler E, Khalid M, Boissiere J, Kim G, Pinney S, Pamer E, Nguyen A. The Gut Microbiome as a Marker of Early Cardiac Allograft Injury. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.285] [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: 11/26/2022] Open
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Li Z, Yu D, Siddiqi U, Hoang R, Hu K, Rodgers D, Belkin M, Dela Cruz M, Nguyen A, Smith B, Jeevanandam V, Kim G. A Case of Myocardial Recovery and Relapse Following Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1244] [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: 11/28/2022] Open
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Kim H, Jang J, Song MJ, Kim G, Park CH, Lee DH, Lee SH, Chung JH. Attenuation of intrinsic aging of the skin via elimination of senescent dermal fibroblasts with senolytic drugs. J Eur Acad Dermatol Venereol 2022; 36:1125-1135. [PMID: 35274377 DOI: 10.1111/jdv.18051] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 11/02/2021] [Accepted: 02/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin aging is caused by numerous factors that result in structural and functional changes in cutaneous components. Research has shown that senescent cells are known to accumulate in skin aging, however, the role of senescent cells in skin aging has not been defined. OBJECTIVES To elucidate the role of senescent cell in skin aging, we evaluated the effect of known senolytic drugs on senescent dermal fibroblasts. METHODS Primary human dermal fibroblasts (HDFs) were induced to senescence by long-term passaging, UV irradiation, and H2O2 treatment. Cell viability was measured after treatment of ABT-263 and ABT-737 on HDFs. Young and aged hairless mice were intradermally injected with drugs or vehicle on the dorsal skin for 10 days. Skin specimens were obtained and reverse-transcription quantitative PCR, western blotting, and histological analysis were performed. RESULTS We found that ABT-263 and ABT-737 induced selective clearance of senescent dermal fibroblasts, regardless of the method of senescence induction. Aged mouse skin treated with ABT-263 or ABT-737 showed increased collagen density, epidermal thickness, and proliferation of keratinocytes, as well as decreased senescence-associated secretory phenotypes, such as MMP-1 and IL-6. CONCLUSIONS Taken together, our results indicate that selective clearance of senescent skin cells can attenuate and improve skin aging phenotypes and that senolytic drugs may be of potential use as new therapeutic agents for treating aging of the skin.
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Affiliation(s)
- H Kim
- Department of Dermatology, Seoul National University College of Medicine.,Department of Biomedical Sciences, Seoul National University Graduate School.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - J Jang
- Department of Dermatology, Seoul National University College of Medicine.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - M J Song
- Department of Dermatology, Seoul National University College of Medicine.,Department of Biomedical Sciences, Seoul National University Graduate School.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - G Kim
- Department of Dermatology, Seoul National University College of Medicine.,Department of Biomedical Sciences, Seoul National University Graduate School.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - C-H Park
- Department of Dermatology, Seoul National University College of Medicine.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - D H Lee
- Department of Dermatology, Seoul National University College of Medicine.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - S-H Lee
- Department of Dermatology, Seoul National University College of Medicine.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University
| | - J H Chung
- Department of Dermatology, Seoul National University College of Medicine.,Department of Biomedical Sciences, Seoul National University Graduate School.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University.,Institute on Aging, Seoul National University, Seoul, Republic of Korea
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Kumar V, Ramnarayanan K, Sundar R, Padmanabhan N, Srivastava S, Koiwa M, Yasuda T, Koh V, Huang KK, Tay ST, Ho SWT, Tan ALK, Ishimoto T, Kim G, Shabbir A, Chen Q, Zhang B, Xu S, Lam KP, Lum HYJ, Teh M, Yong WP, So JBY, Tan P. Single-Cell Atlas of Lineage States, Tumor Microenvironment, and Subtype-Specific Expression Programs in Gastric Cancer. Cancer Discov 2022; 12:670-691. [PMID: 34642171 PMCID: PMC9394383 DOI: 10.1158/2159-8290.cd-21-0683] [Citation(s) in RCA: 145] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 01/07/2023]
Abstract
Gastric cancer heterogeneity represents a barrier to disease management. We generated a comprehensive single-cell atlas of gastric cancer (>200,000 cells) comprising 48 samples from 31 patients across clinical stages and histologic subtypes. We identified 34 distinct cell-lineage states including novel rare cell populations. Many lineage states exhibited distinct cancer-associated expression profiles, individually contributing to a combined tumor-wide molecular collage. We observed increased plasma cell proportions in diffuse-type tumors associated with epithelial-resident KLF2 and stage-wise accrual of cancer-associated fibroblast subpopulations marked by high INHBA and FAP coexpression. Single-cell comparisons between patient-derived organoids (PDO) and primary tumors highlighted inter- and intralineage similarities and differences, demarcating molecular boundaries of PDOs as experimental models. We complemented these findings by spatial transcriptomics, orthogonal validation in independent bulk RNA-sequencing cohorts, and functional demonstration using in vitro and in vivo models. Our results provide a high-resolution molecular resource of intra- and interpatient lineage states across distinct gastric cancer subtypes. SIGNIFICANCE We profiled gastric malignancies at single-cell resolution and identified increased plasma cell proportions as a novel feature of diffuse-type tumors. We also uncovered distinct cancer-associated fibroblast subtypes with INHBA-FAP-high cell populations as predictors of poor clinical prognosis. Our findings highlight potential origins of deregulated cell states in the gastric tumor ecosystem. This article is highlighted in the In This Issue feature, p. 587.
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Affiliation(s)
- Vikrant Kumar
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
| | | | - Raghav Sundar
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,The N.1 Institute for Health, National University of Singapore, Singapore.,Singapore Gastric Cancer Consortium, Singapore
| | - Nisha Padmanabhan
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
| | | | - Mayu Koiwa
- Gastrointestinal Cancer Biology, International Research Center for Medical Sciences (IRCMS), Kumamoto University, Kumamoto, Japan
| | - Tadahito Yasuda
- Gastrointestinal Cancer Biology, International Research Center for Medical Sciences (IRCMS), Kumamoto University, Kumamoto, Japan
| | - Vivien Koh
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Kie Kyon Huang
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
| | - Su Ting Tay
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
| | - Shamaine Wei Ting Ho
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Angie Lay Keng Tan
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
| | - Takatsugu Ishimoto
- Gastrointestinal Cancer Biology, International Research Center for Medical Sciences (IRCMS), Kumamoto University, Kumamoto, Japan
| | - Guowei Kim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Asim Shabbir
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Qingfeng Chen
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore.,Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, Singapore
| | - Biyan Zhang
- Singapore Immunology Network (SIgN), A*STAR, Singapore
| | - Shengli Xu
- Singapore Immunology Network (SIgN), A*STAR, Singapore.,Department of Physiology, National University of Singapore, Singapore
| | - Kong-Peng Lam
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, Singapore.,Singapore Immunology Network (SIgN), A*STAR, Singapore.,School of Biological Sciences, Nanyang Technological University, Singapore
| | | | - Ming Teh
- Department of Pathology, National University Health System, Singapore
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Singapore Gastric Cancer Consortium, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Jimmy Bok Yan So
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Singapore Gastric Cancer Consortium, Singapore.,Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Division of Surgical Oncology, National University Cancer Institute, Singapore
| | - Patrick Tan
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore.,Singapore Gastric Cancer Consortium, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Physiology, National University of Singapore, Singapore.,Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore.,SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore.,Corresponding Author: Patrick Tan, Cancer and Stem Cell Biology Program, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore. Phone: 65-6516-1783; Fax: 65-6221-2402; E-mail:
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Zagatina A, Kim G, Kappushev R, Pyagay V, Shmatov D. Right ventricle function before and after different types of cardiac surgery. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.167] [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.
Background
Right ventricular (RV) dysfunction is an established independent predictor for adverse prognosis in a heterogeneous group of cardiac surgery patients (pts). However, there is lack of information about normal and abnormal dynamics of echocardiographic parameters for different types of cardiac surgery.
The aim of the study was to define changes in RV parameters after cardiac surgery.
Methods
sixty-five pts (39 men, 62 ± 9 years old) were selected into prospective study (NCT03953755). There were the groups of pts with left-sided valves surgery with/ without tricuspid valve (TV) repair, and pts with left-sided coronary artery bypass surgery without lesions of right coronary artery were included control group. A transthoracic echocardiography assessment before and an average of 101 days (88-115) following the operation was performed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), strain of the RV free wall (SRV), and right atrial volume were assessed in groups of patients with and without tricuspid valve repair as in CABG-group. Follow-up during 12 months was available in all pts.
Results
Valve repair for secondary tricuspid regurgitation was performed in nineteen patients undergoing left-sided valve surgery. Thirty-six patients had repair and/or replacement of left-sided valves without a tricuspid valve operation. There was a strong correlation between TAPSE, FAC, and RV strain before the operation (R = 0.61-0.67, p < 0.000001). However, there was no correlation between TAPSE and FAC; TAPSE, and RV strain after the operation. TAPSE and RV strain significantly decreased after the operations and were below the normal range in both the groups with valve surgery, whereas, the CABG group showed only significantly TAPSE decreasing, RV strain was unchanged. TAPSE was 20 ± 5mm vs. 13 ± 2 mm, p < 0.0003 for the group which underwent tricuspid valve repair; 22 ± 4mm vs. 14 ± 4 mm, p < 0.0000001 for the group with tricuspid valves which were not operated on; 25 ± 6mm vs. 16 ± 3 mm, p < 0.009 for CABG group. There was no difference in TAPSE and SRV ranges among patients with and without tricuspid valve repair. Dynamics in SRV didn’t correlate with patients’ clinical status or with normalized right chambers volumes. An increase in FAC correlated with a decrease in right chamber sizes after operations (R=-0.46, p < 0.03). More prominent decreasing in TAPSE was connected in adverse events during follow-up (dTAPSE 6.7 ± 3.5 mm vs. 12.7 ± 5.1 mm, p < 0.02)
Conclusion
TAPSE significantly decreases in all patients after CABG or valve cardiac operations with/without tricuspid valve repair, range of TAPSE were below normal standard in all patients. However more severe decreasing in TAPSE is connected with further adverse outcomes.
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Affiliation(s)
- A Zagatina
- Saint-Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - G Kim
- Saint-Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - R Kappushev
- Saint-Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - V Pyagay
- Saint-Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - D Shmatov
- Saint-Petersburg State University Hospital, Saint Petersburg, Russian Federation
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Kim G, Xu YJ, Farha AK, Sui ZQ, Corke H. Bactericidal and antibiofilm properties of Rumex japonicus Houtt. on multidrug-resistant Staphylococcus aureus isolated from milk. J Dairy Sci 2021; 105:2011-2024. [PMID: 34955261 DOI: 10.3168/jds.2021-21221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 01/15/2023]
Abstract
Multidrug-resistant (MDR) Staphylococcus aureus and its biofilm formation have been challenging to control in milk and dairy industries. Biofilms formed by Staph. aureus may result in the failure of antibacterial agents and disinfectants to penetrate the biofilm in an attempt to control contamination. Novel natural antibacterial agents are required to combat MDR bacteria and biofilms. In this study, we evaluated the bactericidal, antibiofilm, and antimotility effects of Rumex japonicus Houtt. (RJH) extract on MDR Staph. aureus isolated from milk. The RJH extract exhibited good antibacterial activity against MDR strains with minimum inhibitory concentrations (MIC) ranging from 0.78 to 6.25 mg/mL and minimum bactericidal concentrations ranging from 3.125 to 12.5 mg/mL. The extract showed strong inhibition of biofilm formation (81.9%) at sub-MIC value and eradication of biofilm at higher concentrations. The motility of Staph. aureus was effectively blocked by the extract. Major compounds emodin, chrysophanol, and physcion were identified in RJH extract using HPLC-linear trap quadrupole (LTQ)/Orbitrap-mass spectrometry. The extract was nontoxic to human epithelial cell lines such as Caco-2 and HT-29 cell lines at concentrations ranging from 0.1 to 0.5 mg/mL, and from 0.1 to 0.75 mg/mL, respectively. These findings suggest that RJH extract could be an alternative to synthetic preservatives in milk and dairy products.
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Affiliation(s)
- G Kim
- Department of Food Science and Technology, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Y J Xu
- Department of Food Science and Technology, Shanghai Jiao Tong University, Shanghai 200240, China
| | - A K Farha
- Department of Food Science and Technology, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Z Q Sui
- Department of Food Science and Technology, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - H Corke
- Biotechnology and Food Engineering Program, Guangdong Technion-Israel Institute of Technology, Shantou 515063, China; Faculty of Biotechnology and Food Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel.
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Douchi D, Yamamura A, Matsuo J, Melissa Lim YH, Nuttonmanit N, Shimura M, Suda K, Chen S, Pang S, Kohu K, Abe T, Shioi G, Kim G, Shabbir A, Srivastava S, Unno M, Bok-Yan So J, Teh M, Yeoh KG, Chuang LSH, Ito Y. Induction of Gastric Cancer by Successive Oncogenic Activation in the Corpus. Gastroenterology 2021; 161:1907-1923.e26. [PMID: 34391772 DOI: 10.1053/j.gastro.2021.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 07/17/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Metaplasia and dysplasia in the corpus are reportedly derived from de-differentiation of chief cells. However, the cellular origin of metaplasia and cancer remained uncertain. Therefore, we investigated whether pepsinogen C (PGC) transcript-expressing cells represent the cellular origin of metaplasia and cancer using a novel Pgc-specific CreERT2 recombinase mouse model. METHODS We generated a Pgc-mCherry-IRES-CreERT2 (Pgc-CreERT2) knock-in mouse model. Pgc-CreERT2/+ and Rosa-EYFP mice were crossed to generate Pgc-CreERT2/Rosa-EYFP (Pgc-CreERT2/YFP) mice. Gastric tissues were collected, followed by lineage-tracing experiments and histologic and immunofluorescence staining. We further established Pgc-CreERT2;KrasG12D/+ mice and investigated whether PGC transcript-expressing cells are responsible for the precancerous state in gastric glands. To investigate cancer development from PGC transcript-expressing cells with activated Kras, inactivated Apc, and Trp53 signaling pathways, we crossed Pgc-CreERT2/+ mice with conditional KrasG12D, Apcflox, Trp53flox mice. RESULTS Expectedly, mCherry mainly labeled chief cells in the Pgc-CreERT2 mice. However, mCherry was also detected throughout the neck cell and isthmal stem/progenitor regions, albeit at lower levels. In the Pgc-CreERT2;KrasG12D/+ mice, PGC transcript-expressing cells with KrasG12D/+ mutation presented pseudopyloric metaplasia. The early induction of proliferation at the isthmus may reflect the ability of isthmal progenitors to react rapidly to Pgc-driven KrasG12D/+ oncogenic mutation. Furthermore, Pgc-CreERT2;KrasG12D/+;Apcflox/flox mice presented intramucosal dysplasia/carcinoma and Pgc-CreERT2;KrasG12D/+;Apcflox/flox;Trp53flox/flox mice presented invasive and metastatic gastric carcinoma. CONCLUSIONS The Pgc-CreERT2 knock-in mouse is an invaluable tool to study the effects of successive oncogenic activation in the mouse corpus. Time-course observations can be made regarding the responses of isthmal and chief cells to oncogenic insults. We can observe stomach-specific tumorigenesis from the beginning to metastatic development.
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Affiliation(s)
- Daisuke Douchi
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiro Yamamura
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Junichi Matsuo
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Yi Hui Melissa Lim
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Napat Nuttonmanit
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Mitsuhiro Shimura
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuto Suda
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Sabirah Chen
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - ShuChin Pang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Kazuyoshi Kohu
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Takaya Abe
- Laboratory for Animal Resources and Genetic Engineering, RIKEN Center for Biosystems Dynamics Research, Kobe, Japan
| | - Go Shioi
- Laboratory for Animal Resources and Genetic Engineering, RIKEN Center for Biosystems Dynamics Research, Kobe, Japan
| | - Guowei Kim
- Department of Surgery, National University Health System, National University of Singapore, Singapore
| | - Asim Shabbir
- Department of Surgery, National University Health System, National University of Singapore, Singapore
| | | | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jimmy Bok-Yan So
- Department of Surgery, National University Health System, National University of Singapore, Singapore
| | - Ming Teh
- Department of Pathology, National University of Singapore, Singapore
| | - Khay Guan Yeoh
- Department of Medicine, National University of Singapore, Singapore
| | | | - Yoshiaki Ito
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.
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