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Girard L, Koh YJ, Koh LP, Chee YL, Chan HL, Lee J, de Mel S, Poon LM, Samuel M. Role of upfront autologous transplant for peripheral T-cell lymphoma patients achieving a complete remission with first-line therapy: a systematic review and meta-analysis. Bone Marrow Transplant 2024:10.1038/s41409-024-02254-x. [PMID: 38443704 DOI: 10.1038/s41409-024-02254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/12/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
There is currently no consensus on the role of upfront autologous transplantation (ASCT) for patients with peripheral T-cell lymphomas (PTCL), especially in patients achieving first complete remission (CR1) following chemotherapy, and data in the literature is conflicting. A systematic review and meta-analysis was performed to address this question. We searched key databases from January 2000 to February 2022. Six prospective and eleven retrospective studies were included among 2959 unique records. Median follow up in these studies ranged from 22 to 94 months. There was a trend towards benefit in PFS (HR = 0.80, 95% CI 0.62-1.05, p = 0.11) and OS (HR = 0.79, 95% CI 0.57-1.09, p = 0.15) in the ASCT compared to chemotherapy only group. Importantly, in transplant eligible patients in CR1, a significant benefit was demonstrated in both OS (HR = 0.59, 95% CI 0.36-0.95, p = 0.03) and PFS (HR = 0.61, 95% CI 0.47-0.81, p = 0.0004) in the ASCT group. Amongst the nodal PTCL subgroups, ASCT showed a significant PFS benefit for the AITL subgroup (HR = 0.43, 95% CI 0.20-0.94, p < 0.03) but not PTCL-NOS or ALK-ve ALCL subgroups. Our findings support upfront ASCT for transplant eligible PTCL patients achieving CR1 post chemotherapy. In particular, patients with AITL exhibited a significantly better PFS after upfront ASCT.
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Affiliation(s)
- L Girard
- Aberdeen Royal Infirmary, National Health Service Grampian, Aberdeen, UK
| | - Y J Koh
- University College London Medical School, London, UK
| | - L P Koh
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore
| | - Y L Chee
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore
| | - H L Chan
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore
| | - J Lee
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore
| | - S de Mel
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore
| | - L M Poon
- Department of Haematology Oncology, National University Cancer Institute, Singapore, Singapore.
| | - M Samuel
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Lim YS, Chan HL, Ahn SH, Seto WK, Ning Q, Agarwal K, Janssen HL, Pan CQ, Chuang WL, Izumi N, Fung S, Shalimar, Brunetto M, Hui AJ, Chang TT, Lim SG, Abramov F, Flaherty JF, Wang H, Yee LJ, Kao JH, Gane E, Hou J, Buti M. Tenofovir alafenamide and tenofovir disoproxil fumarate reduce incidence of hepatocellular carcinoma in patients with chronic hepatitis B. JHEP Rep 2023; 5:100847. [PMID: 37771546 PMCID: PMC10522903 DOI: 10.1016/j.jhepr.2023.100847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 09/30/2023] Open
Abstract
Background & Aims Antiviral therapy may attenuate the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). We aimed to explore how tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) affect HCC risk in patients with CHB. Methods The REACH-B, aMAP, and mPAGE-B models were utilized to assess HCC risk in patients with CHB from two global randomized-controlled trials evaluating the impact of TAF vs. TDF treatment. Standard incidence ratios (SIRs) were calculated using data from the REACH-B model as a ratio of observed HCC cases in the TAF- or TDF-treated patients vs. predicted HCC cases for untreated historical controls. Proportions of treated patients shifting aMAP and mPAGE-B risk categories between baseline and Week 240 were calculated. Results Of the 1,632 patients (TAF, n = 1,093; TDF, n = 539) followed for up to 300 weeks, 22 HCC cases developed. Those receiving TAF had an SIR that was lower compared to the SIR of individuals receiving TDF: 0.32 (p <0.001) vs. 0.56 (p = 0.06). In the general study population, individuals without cirrhosis at baseline had an SIR that was lower compared to the SIR of individuals with cirrhosis at baseline: 0.37 (p <0.001) vs. 0.58 (p = 0.15). Of the patients at low risk of HCC at baseline, the majority (97%) remained low risk by mPAGE-B and aMAP scoring at Week 240. Among those at medium or high risk at baseline, substantial portions shifted to a lower risk category by Week 240 (mPAGE-B: 22% and 42%; aMAP: 39% and 63%, respectively). Conclusions This evaluation provides evidence that treatment with TAF or TDF can reduce HCC risk in patients with CHB, particularly in patients without cirrhosis. Impact and implications Despite the substantial impact of HCC on long-term outcomes of patients with CHB, the differential risk of HCC development among those receiving treatment with TAF vs. TDF has not been well elucidated. Using three validated risk prediction models, we found that TAF is at least as effective as TDF in reducing HCC risk in patients with CHB. While TDF is well-studied in the context of HCC risk reduction, our novel findings underscore the effectiveness of TAF as a treatment option for patients with CHB. Clinical trial numbers NCT01940341; NCT02836249; NCT01940471; NCT02836236.
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Affiliation(s)
- Young-Suk Lim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Sang Hoon Ahn
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Qin Ning
- Tongji Hospital, Tongji Medical College, Wuhan, China
| | - Kosh Agarwal
- Institute of Liver Studies, Kings College Hospital, United Kingdom
| | - Harry L.A. Janssen
- Toronto Western Hospital, Toronto, ON, Canada
- Division of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Calvin Q. Pan
- NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Wan Long Chuang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Scott Fung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Shalimar
- All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | | | | | | | | | | | | | | | - Jia-Horng Kao
- National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Edward Gane
- Auckland Clinical Studies, Auckland, New Zealand
| | - Jinlin Hou
- Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Maria Buti
- Hospital Universitario Vall d’Hebron, Barcelona, Spain
- CIBEREHD del Instituto Carlos III., Barcelona, Spain
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Yuen HM, Chan HL, Au CT, Chan KC, Lui LM, Li AM. 0882 Local Deformation Analysis of Lateral Cephalogram for Childhood OSA Classification. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Craniofacial profile is one of the anatomical causes of obstructive sleep apnea (OSA). Cephalometry provides information on patients’ skeletal structures and soft tissues. Traditional cephalometric analysis focuses on linear distances, angles, ratios and area of specific variables. Its classification power is often disappointed. In this study, a novel approach to cephalometric analysis using local deformation information was carried out to assess its efficacy in OSA classification.
Methods
This study was a retrospective analysis based on 60 case-control pairs who were Chinese children recruited for sleep studies in the Prince of Wales Hospital, with accessible lateral cephalometry and polysomnography (PSG) data. Local deformation technique was adopted to derive 1215 deformations from 15 manual landmarking on each cephalogram. In addition, three linear distances (hyoid bone to mandibular plane, hyoid bone to posterior pharyngeal wall, and minimal distance between tongue base and posterior pharyngeal wall) were measured from each cephalogram. A total of 1218 information features were obtained per subject. Classification models were built with an equal ratio between OSA and non-OSA groups (defined by OAHI≥1 and OAHI<1 respectively). Forty pairs were used as training data and twenty pairs were used as testing data.
Results
Three model settings which used all 1218 cephalometric features, 800 features, and 500 features were tested. The accuracy for the three settings were 67.5% (sensitivity: 70%, specificity: 65%), 87.5% (sensitivity: 90%, specificity: 85%), and 92.5% (sensitivity: 95%, specificity: 90%) respectively. Apart from the three distances, the 500 topmost discriminative features were predominantly landmarks around the nasal cavity.
Conclusion
A new approach to cephalometric analysis using local deformation information can provide additional details on each cephalogram, hence, achieving better classification. The classification models using 500 features yielded the highest accuracy among the three settings. This setting could benefit most from the comprehensive comparison while avoiding overfitting.
Support
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Affiliation(s)
- H M Yuen
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, HONG KONG
| | - H L Chan
- Department of Mathematics, The Chinese University of Hong Kong, Shatin, HONG KONG
| | - C T Au
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, HONG KONG
| | - K C Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, HONG KONG
| | - L M Lui
- Department of Mathematics, The Chinese University of Hong Kong, Shatin, HONG KONG
| | - A M Li
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, HONG KONG
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Lai T, Chan HL, Zhou W, Chan KK, Tsui KL. P375The role of cardiac magnetic resonance imaging in the management of a young patient with end stage renal failure presented with cardiac arrest. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Lai
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - H L Chan
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - W Zhou
- The University of Hong Kong - Shenzhen Hospital, Hong Kong, Hong Kong
| | - K K Chan
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - K L Tsui
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
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Sun W, Zhang Y, Wong KC, Liu K, Yang Y, Wu B, Tong JH, Chan AW, Chan HL, Yu J. Increased expression of GATA zinc finger domain containing 1 through gene amplification promotes liver cancer by directly inducing phosphatase of regenerating liver 3. Hepatology 2018; 67:2302-2319. [PMID: 29266303 PMCID: PMC6001784 DOI: 10.1002/hep.29750] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/13/2017] [Accepted: 12/17/2017] [Indexed: 12/15/2022]
Abstract
UNLABELLED We identified that GATA zinc finger domain containing 1 (GATAD1), a transcriptional factor, was significantly up-regulated in hepatocellular carcinoma (HCC) through gene amplification. We demonstrated the critical role, molecular mechanisms, and clinical implications of GATAD1 as a novel oncogenic factor in HCC. We found that GATAD1 protein was expressed in 76.6% of primary HCCs (85/111) but silenced in normal liver tissues. Gene amplification of GATAD1 was positively correlated with its overexpression in primary HCCs (R = 0.629, P < 0.0001). GATAD1 significantly increased cell proliferation, G1 -S cell cycle transition, and migration/invasion but suppressed apoptosis in liver cell lines and promoted tumor growth and lung metastasis in both xenograft and orthotopic mouse models. Mechanistically, GATAD1 induced the transcriptional expression of phosphatase of regenerating liver 3 (PRL3) by binding to its promoter identified by RNA sequencing and chromatin immunoprecipitation-PCR analyses. PRL3 played an oncogenic role in HCC. Knockdown of PRL3 blunted the tumorigenic effect of GATAD1. In addition, GATAD1 activated Akt signaling, evidenced by increased phosphorylation levels of total Akt, Akt1, Akt2, and Akt target glycogen synthase kinase 3β, while knockdown of PRL3 abolished this effect of GATAD1. We further unveiled that PRL3 activated Akt signaling by dephosphorylating phosphatase and tensin homolog at tyrosine residue, thus reducing phosphatase and tensin homolog protein. The PRL3 inhibitor 5-[[5-bromo-2-[(2-bromophenyl)methoxy]phenyl]methylene]-2-thioxo-4-thiazolidinone significantly suppressed HCC growth by inhibiting Akt activation. Moreover, high GATAD1 nuclear protein expression was associated with poor survival of HCC patients as an independent prognostic factor. CONCLUSION GATAD1 plays a pivotal oncogenic role in HCC by directly inducing PRL3 transcription to activate the Akt signaling pathway. GATAD1 may serve as an independent poor prognostic factor for HCC patients. (Hepatology 2018;67:2302-2319).
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Affiliation(s)
- Wei Sun
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong
| | - Yanquan Zhang
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong,CUHK‐Shenzhen Research InstituteShenzhenChina
| | - Ka Chun Wong
- Department of Computer ScienceCity University of Hong KongHong Kong
| | - Ken Liu
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong,Faculty of MedicineThe University of SydneySydneyNSWAustralia
| | - Yidong Yang
- Department of GastroenterologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdong ProvinceChina
| | - Bin Wu
- Department of GastroenterologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdong ProvinceChina
| | - Joanna H.M. Tong
- Department of Anatomical and Cellular PathologyThe Chinese University of Hong KongHong Kong
| | - Anthony W.H. Chan
- Department of Anatomical and Cellular PathologyThe Chinese University of Hong KongHong Kong
| | - Henry L.Y. Chan
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong
| | - Jun Yu
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong,CUHK‐Shenzhen Research InstituteShenzhenChina
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Pei XH, Chan HL, Zhang L, Wang C, Robbins DJ, Capobianco T, Bai F. Abstract P2-08-01: Loss of function of Brca1 or Gata3 induces basal-like breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-08-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND:
Breast cancer is mainly divided into estrogen receptor (ER)-positive luminal and ER-negative basal-like tumors. Luminal-type tumors are associated with better survival and respond to hormone therapies whereas basal-like tumors are more aggressive and associated with a poor prognosis. Mammary epithelia are mainly composed of luminal and basal cells that are maintained by luminal and basal progenitors, respectively. The maintenance of luminal cell fate is orchestrated by networks of transcription factors, including BRCA1 and GATA3. Functional loss of BRCA1 by germline or somatic mutation or by promoter methylation is associated with more than one third of basal-like breast cancers. GATA3 expression is reduced in basal-like breast cancers and cancers that metastasize. Overexpression of GATA3 in cancer cells inhibits tumor formation. Deletion of Brca1 or Gata3 in mice results in early lethality or growth defects. How BRCA1 and GATA3 suppress breast cancer remains elusive.
METHODS:
We generated mice lacking Brca1 or Gata3 in mammary epithelia. Due to the proliferative defects and induction of p18Ink4c (p18), an inhibitor of CDK4/6, in mammary epithelial cells of these mice, we then generated mice lacking Brca1 or Gata3 in p18 deficient mammary epithelia. We determined spontaneous mammary tumor development in mutant mice and the mechanisms underlying the role of Brca1 and Gata3 in suppressing tumorigenesis and progression.
RESULTS:
Depletion of Brca1 or Gata3 led to growth defects of mammary epithelial cells, which was rescued by loss of p18. Depletion of Brca1 or Gata3 in a p18 null background induced heterogeneous mammary tumors with less luminal and more basal-like features and accelerated metastasis. Deletion of Brca1 eliminated Gata3 expression in human and mouse mammary tissues and cells. How Brca1 interacts with Gata3 to control mammary tumor development and progression is currently under investigation.
CONCLUSION: Our results suggest that loss of function of either Brca1 or Gata3 induces basal-like mammary tumors in p18 deficient background.
Citation Format: Pei X-H, Chan HL, Zhang L, Wang C, Robbins DJ, Capobianco T, Bai F. Loss of function of Brca1 or Gata3 induces basal-like breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-08-01.
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Affiliation(s)
- X-H Pei
- Dewitt Daughtry Family, University of Miami, Miami, FL; Lanzhou University, Lanzhou, China; Xi'an Jiaotong University Health Science Center, Xian, China; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - HL Chan
- Dewitt Daughtry Family, University of Miami, Miami, FL; Lanzhou University, Lanzhou, China; Xi'an Jiaotong University Health Science Center, Xian, China; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - L Zhang
- Dewitt Daughtry Family, University of Miami, Miami, FL; Lanzhou University, Lanzhou, China; Xi'an Jiaotong University Health Science Center, Xian, China; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - C Wang
- Dewitt Daughtry Family, University of Miami, Miami, FL; Lanzhou University, Lanzhou, China; Xi'an Jiaotong University Health Science Center, Xian, China; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - DJ Robbins
- Dewitt Daughtry Family, University of Miami, Miami, FL; Lanzhou University, Lanzhou, China; Xi'an Jiaotong University Health Science Center, Xian, China; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - T Capobianco
- Dewitt Daughtry Family, University of Miami, Miami, FL; Lanzhou University, Lanzhou, China; Xi'an Jiaotong University Health Science Center, Xian, China; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - F Bai
- Dewitt Daughtry Family, University of Miami, Miami, FL; Lanzhou University, Lanzhou, China; Xi'an Jiaotong University Health Science Center, Xian, China; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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7
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Pei XH, Chan HL, Liu S, Scott A, Pimentel E, Slingerland J, Robbins D, Capobianco A, Bai F. Abstract P6-08-08: GATA3 inhibits breast basal-like tumorigenesis. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-08-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Breast cancer can be broadly categorized into two groups depending on the cell type affected. Luminal-type tumors are typically estrogen receptor (ER) positive that are associated with better survival and respond to hormone therapies whereas basal-like tumors are ER negative, more aggressive, and associated with a poor prognosis. GATA3 is a transcription factor well studied for its role as a master regulator of cellular differentiation and stem cell self renewal. Loss of Gata3 in mouse mammary glands blocks luminal cell differentiation and induces growth defects, and low levels of GATA3 are associated with basal-like and metastatic human breast cancers with epithelial-to-mesenchymal transition (EMT). Importantly, luminal cells have been shown to be the origin of some basal-like breast cancers. Due to the proliferation defects caused by GATA3 deficiency, it remains elusive how loss of function of GATA3 contributes to breast cancers development and progression.
METHODS: We previously demonstrated that p18Ink4c (p18), a cell cycle inhibitor, is a downstream target of GATA3 in regulating mammary luminal cell proliferation and loss of p18 leads to luminal type tumorigenesis. To test the role of Gata3 deficiency in tumorigenesis, we generated p18-/-;Gata3+/- mice. Mammary gland development and tumorigenesis were characterized in vivo using a panel of cellular and molecular assays. Results were further confirmed in vitro with well established cell lines.
RESULTS: Loss of p18 rescued mammary growth defects caused by Gata3 heterozygosity. Gata3 heterozygosity impaired luminal, but promoted basal gene expression in mammary epithelial cells. Gata3 heterozygosity in p18 null mice accelerated spontaneous mammary tumorigenesis, reducing the average latency of tumor onset. More importantly, Gata3 heterozygosity transformed the luminal type tumors of p18 null mice into heterogeneous basal-like breast cancers with activated EMT. Conversely, reintroduction of GATA3 inhibited tumor growth and reduced expression of EMT markers in basal-like tumor xenografts. We discovered that expression of GATA3 and Vimentin, an EMT marker, is inversely related in human breast cancers.
CONCLUSION: Our data indicates that GATA3 promotes luminal but suppresses basal cell differentiation in the mammary gland and in tumor development.
Mechanisms underlying the role of GATA3 in suppressing basal-like tumor development are under investigation.BACKGROUND: Breast cancer can be broadly categorized into two groups depending on the cell type affected. Luminal-type tumors are typically estrogen receptor (ER) positive that are associated with better survival and respond to hormone therapies whereas basal-like tumors are ER negative, more aggressive, and associated with a poor prognosis. GATA3 is a transcription factor well studied for its role as a master regulator of cellular differentiation and stem cell self renewal. Loss of Gata3 in mouse mammary glands blocks luminal cell differentiation and induces growth defects, and low levels of GATA3 are associated with basal-like and metastatic human breast cancers with epithelial-to-mesenchymal transition (EMT). Importantly, luminal cells have been shown to be the origin of some basal-like breast cancers. Due to the proliferation defects caused by GATA3 deficiency, it remains elusive how loss of function of GATA3 contributes to breast cancers development and progression.
METHODS: We previously demonstrated that p18Ink4c (p18), a cell cycle inhibitor, is a downstream target of GATA3 in regulating mammary luminal cell proliferation and loss of p18 leads to luminal type tumorigenesis. To test the role of Gata3 deficiency in tumorigenesis, we generated p18-/-;Gata3+/- mice. Mammary gland development and tumorigenesis were characterized in vivo using a panel of cellular and molecular assays. Results were further confirmed in vitro with well established cell lines.
RESULTS: Loss of p18 rescued mammary growth defects caused by Gata3 heterozygosity. Gata3 heterozygosity impaired luminal, but promoted basal gene expression in mammary epithelial cells. Gata3 heterozygosity in p18 null mice accelerated spontaneous mammary tumorigenesis, reducing the average latency of tumor onset. More importantly, Gata3 heterozygosity transformed the luminal type tumors of p18 null mice into heterogeneous basal-like breast cancers with activated EMT. Conversely, reintroduction of GATA3 inhibited tumor growth and reduced expression of EMT markers in basal-like tumor xenografts. We discovered that expression of GATA3 and Vimentin, an EMT marker, is inversely related in human breast cancers.
CONCLUSION: Our data indicates that GATA3 promotes luminal but suppresses basal cell differentiation in the mammary gland and in tumor development.
Mechanisms underlying the role of GATA3 in suppressing basal-like tumor development are under investigation.
Citation Format: Pei X-H, Chan HL, Liu S, Scott A, Pimentel E, Slingerland J, Robbins D, Capobianco A, Bai F. GATA3 inhibits breast basal-like tumorigenesis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-08-08.
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Affiliation(s)
- X-H Pei
- University of Miami, Miami, FL
| | - HL Chan
- University of Miami, Miami, FL
| | - S Liu
- University of Miami, Miami, FL
| | - A Scott
- University of Miami, Miami, FL
| | | | | | | | | | - F Bai
- University of Miami, Miami, FL
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Ruan JW, Statt S, Huang CT, Tsai YT, Chan HL, Tan TH, Kao CY. A multi-prong global study provides insights to gut microbiota and mucosal immunity in dusp6-deficiency conferred obesity-resistance. The Journal of Immunology 2016. [DOI: 10.4049/jimmunol.196.supp.67.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Obesity is now a plague in developed countries and more than one third of U.S. adults are obese. Gut microbiota plays profound roles in host energy harvest, metabolism and inflammatory response associated with the development of obesity. Dusp6-deficient mice have been shown to be resistant to diet-induced-obesity (DIO) but the mechanism is still unclear. Using a gnotobiotic mouse model, we found that the transplantation of fecal/gut microbiota derived from dusp6-deficient mice can significantly increase energy expenditure and reduce weight-gain of the recipient mice. By analyzing fecal 16s rRNA genes, dusp6-deficient mice have different composition of gut microbiota when compared with wild-type mice. We also demonstrated that dusp6-deficient mice were resistant to DIO-mediated dysbiosis of gut microbiota. Upon further analysis of the intestinal transcriptome, we found that dusp6 deficiency is an important regulator of several metabolic pathways and genes related to intestinal barrier. Moreover, our analyses have shown that dusp6-deficient mice could alleviate DIO-induced inflammation.. This study demonstrates that dusp6 deficiency is a strong genetic factor that dominates diet effect on shaping gut microbiota and it remodels mucosal immunity to retain HFD-resistant homeostasis of gut microbiota. Our findings shed lights on obesity and obesity-derived metabolic disease treatment with novel therapeutic candidates/strategies such as DUSP6 pharmacological inhibitors and the development of microbiota-based therapeutics.
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Affiliation(s)
- JW Ruan
- 1Natl. Hlth. Research Inst., Taiwan
| | | | - CT Huang
- 1Natl. Hlth. Research Inst., Taiwan
| | | | | | - TH Tan
- 1Natl. Hlth. Research Inst., Taiwan
| | - CY Kao
- 1Natl. Hlth. Research Inst., Taiwan
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Tian Y, To KF, Lai PB, Cheung YS, Yu J, Wong VW, Chan HL, Cheng AS. Abstract 2073: Histone deacetylase 8 impairs insulin sensitivity and activates β-catenin signaling in NAFLD-associated hepatocellular carcinoma. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-2073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic fat accumulation tightly associated with central obesity, insulin resistance and other features of the metabolic syndrome that elevates the risk of hepatocellular carcinoma (HCC). Emerging evidence suggests that deregulated metabolic pathways can trigger epigenetic changes, thereby modifying the expression of critical genes associated with carcinogenesis (ref 1). However, the role of epigenetic regulation in NAFLD-associated HCC remains elusive. Here we identified and characterized a novel epigenetic regulator that contributes to insulin resistance and tumorigenesis in NAFLD. Gene expression profiling revealed histone deacetylase 8 (Hdac8) as the sole commonly up-regulated chromatin regulator in both murine dietary and genetic obesity-promoted HCC models. HDAC8 was up-regulated by the lipogenic transcription factor sterol regulatory element-binding protein-1 (SREBP-1) via direct promoter binding. In a murine dietary-induced NAFLD model and an insulin resistant cell model, RNA interference and pharmacological inhibition by a selective HDAC8 inhibitor, PCI-34051, significantly rescued insulin sensitivity (p<0.05). Further functional characterization demonstrated the oncogenic activities of HDAC8 via inhibition of apoptosis, G2/M-phase arrest and stimulation of β-catenin-dependent proliferation. Mechanistically, HDAC8 was found to physically interact with the polycomb protein EZH2 to cooperatively repress Wnt antagonists via histone H4 deacetylation and H3 lyine 27 trimethylation (H3K27me3). To further validate the oncogenicity of HDAC8 in NAFLD-associated HCC, we infected lentivirus expressing short-hairpin RNA against Hdac8 in the dietary obesity-promoted HCC model. Notably, knockdown of HDAC8 restored the metabolic profiles (blood glucose, cholesterol, triglyceride and non-esterified fatty acid) to normal states and dramatically reduced hepatic tumorigenicity (p<0.01). In 24 pairs of human NAFLD-associated HCC specimens, SREBP-1, HDAC8, EZH2, H3K27me3 and active β-catenin were found to be concordantly up-regulated in tumors compared to non-tumor tissues. In conclusions, our findings demonstrated the functional significance of HDAC8 in NAFLD-associated hepatocarcinogenesis and unveiled the molecular basis for its regulation and oncogenicity, providing a strong impetus for therapeutic intervention against the rapidly rising incidence of HCC in obese and diabetic patients.
Reference: 1. Tian Y et al., Semin Cancer Biol 2013
Citation Format: Yuan Tian, Ka F. To, Paul B.S. Lai, Yue S. Cheung, Jun Yu, Vincent W.S Wong, Henry L.Y. Chan, Alfred S.L. Cheng. Histone deacetylase 8 impairs insulin sensitivity and activates β-catenin signaling in NAFLD-associated hepatocellular carcinoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2073. doi:10.1158/1538-7445.AM2015-2073
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Affiliation(s)
- Yuan Tian
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ka F. To
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Paul B.S. Lai
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yue S. Cheung
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jun Yu
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Cheng ASL, Zhu R, Mok MT, Kang W, To KF, Sung JJ, Chan HL. Abstract 814: Truncated HBx-dependent silencing of growth arrest-specific 2 promotes hepatocarcinogenesis through inhibition of p53-mediated apoptosis. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Hepatocellular carcinoma (HCC) is a worldwide threat to public health, especially in China where chronic hepatitis B virus (HBV) infection is found in 80-90% of all HCCs. The HBV encoded X antigen (HBx) is a trans-regulatory protein involved in the virus-induced hepatocarcinogenesis. Although the carboxyl-terminus truncated HBx, rather than the full-length counterpart, is frequently overexpressed in human HCCs, its functional mechanisms have yet been fully defined. In this study, we investigated the molecular pathogenesis of a naturally-occurring HBx variant which has 35 amino acids deleted at C-terminus (HBxΔ35). By performing genome-wide scanning analysis and PCR validation, we identified growth arrest-specific 2 (GAS2) as a direct target of HBxΔ35 at transcriptional level in human immortalized liver cells. HBxΔ35 was found to bind the promoter region of GAS2 and suppress its expression to promote hepatocellular proliferation and tumorigenicity. Further functional assays showed that overexpression of GAS2 inhibited tumor growth both in vitro and in vivo by inducing p53-dependent apoptosis. Conversely, siRNA-mediated knockdown of GAS2 in hepatocytes attenuated apoptotic response and reduced cell susceptibility to etoposide-induced apoptosis. Notably, GAS2 expression was significantly down-regulated in truncated HBx-expressing HCCs compared with the corresponding normal tissues. In conclusion, our integrated study uncovered a novel viral mechanism in hepatocarcinogenesis, wherein HBxΔ35 ablates p53-driven apoptosis via direct silencing of GAS2, and thereby provides survival advantage for pre-neoplastic hepatocytes to facilitate cancer development.
Citation Format: Alfred S. L. Cheng, Ranxu Zhu, Myth T.S. Mok, Wai Kang, Ka-Fai To, Joseph J.Y. Sung, Henry L.Y. Chan. Truncated HBx-dependent silencing of growth arrest-specific 2 promotes hepatocarcinogenesis through inhibition of p53-mediated apoptosis. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 814. doi:10.1158/1538-7445.AM2015-814
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Affiliation(s)
| | - Ranxu Zhu
- Chinese Univ. of Hong Kong, Shatin, Hong Kong
| | | | - Wai Kang
- Chinese Univ. of Hong Kong, Shatin, Hong Kong
| | - Ka-Fai To
- Chinese Univ. of Hong Kong, Shatin, Hong Kong
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Lao TT, Chung MK, Cheung TK, Lau TS, Law LW, Wong VW, Chan HL, Leung TY. Placental hepatitis B virus infection and maternal liver function in HBsAg positive women. Placenta 2013. [DOI: 10.1016/j.placenta.2013.06.145] [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: 10/26/2022]
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Lee JKT, Tsui KL, Cheung CY, Chau CH, Chan HL, Wu KL, Cheung GSH, Choi MC, Chan KK, Li SK. Aspirin desensitisation for Chinese patients with coronary artery disease. Hong Kong Med J 2013; 19:207-13. [PMID: 23650199 DOI: 10.12809/hkmj133914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE. To assess the efficacy and safety of aspirin desensitisation in Chinese patients with coronary artery disease. DESIGN. Case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Chinese patients with coronary artery disease and a history of a hypersensitivity reaction to aspirin or non-steroidal anti-inflammatory drug, who underwent aspirin desensitisation between February 2008 and July 2012. RESULTS. There were 24 Chinese patients with coronary artery disease who were admitted to our unit for aspirin desensitisation during this period. The majority (79%) were clinical admissions for desensitisation; eight (33%) of them developed a hypersensitivity reaction during desensitisation. Half of the latter had only limited cutaneous reactions and were able to complete the desensitisation protocol and developed aspirin tolerance. Overall, 20 (83%) of the patients were successfully desensitised at the initial attempt. No serious adverse reactions occurred in the cohort. Twelve of the patients had significant coronary artery disease revealed by coronary angiography and received a percutaneous coronary intervention, nine of whom received drug-eluting stents while three received bare metal stents due to financial constraints. All 11 successfully desensitised patients received aspirin and clopidogrel as double antiplatelet therapy after percutaneous coronary intervention. The remaining patient had a bare metal stent implant due to failed aspirin desensitisation. CONCLUSION. Given the potentially different genetic basis of aspirin hypersensitivity in different ethnicities, recourse to desensitisation in the Chinese population has not previously been addressed. This study demonstrated that aspirin desensitisation using a rapid protocol can be performed effectively and safely in Chinese patients. Our results were comparable to those in other reported studies involving other ethnicities. Successful aspirin desensitisation permits patients to pursue long-term double antiplatelet therapy that includes aspirin after percutaneous coronary intervention, and thus allows the use of drug-eluting stents as a feasible option.
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Affiliation(s)
- Joe K T Lee
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Wu KL, Tsui KL, Lee KT, Chau CH, Chan HL, Cheung SH, Cheung CY, Choi MC, Chan KK, Li SK. Reperfusion strategy for ST-segment elevation myocardial infarction: trend over a 10-year period. Hong Kong Med J 2012; 18:276-283. [PMID: 22865170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES. To review the 10-year trend of reperfusion strategies in patients with ST-segment elevation myocardial infarction, and the adoption rate of percutaneous coronary interventions as opposed to thrombolytic therapy. Also to explore why some patients did not receive reperfusion therapy, and document changes in reperfusion strategies after the introduction of primary percutaneous coronary intervention programmes. DESIGN. Case series. SETTING. A regional hospital, Hong Kong. PATIENTS. All patients with ST-segment elevation myocardial infarction from January 2000 to December 2009. RESULTS. There were 1835 patients with ST-segment elevation myocardial infarction in that period, of which 1179 (64.3%) received reperfusion therapy (thrombolytic therapy, 46.0%; primary percutaneous coronary intervention, 17.5%; emergency coronary artery bypass graft, 0.7%). After introduction of the primary percutaneous coronary intervention programme, significantly more ST-segment elevation myocardial infarction cases underwent that particular intervention (1.6% in 2000 increasing to 30.6% in 2009), while the proportion receiving thrombolytic therapy declined (57.4% in 2000 decreasing to 35.0% in 2009). Seven reasons for no reperfusion therapy were identified. The commonest ones were delayed presentation (45.1%), succumbed before reperfusion (16.0%), multiple medical co-morbidities (15.2%), and contra-indication to thrombolytic therapy (14.8%). The proportion without reperfusion therapy due to a contra-indication to thrombolytic therapy declined (22.7% in 2000 decreasing to 4.9% to 2009), whilst an increasing proportion received primary percutaneous coronary interventions. CONCLUSIONS. Primary percutaneous coronary intervention is increasingly used as the reperfusion therapy in ST-segment elevation myocardial infarction and is replacing thrombolytic therapy, though the latter still remains a mainstay of therapy. A significant proportion of ST-segment elevation myocardial infarction cases received no reperfusion due to various reasons.
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Affiliation(s)
- K L Wu
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
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Bai F, Smith MD, Chan HL, Pei XH. Germline mutation of Brca1 alters the fate of mammary luminal cells and causes luminal-to-basal mammary tumor transformation. Oncogene 2012; 32:2715-25. [PMID: 22777348 DOI: 10.1038/onc.2012.293] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Breast cancer developed in familial BRCA1 mutation carriers bears striking similarities to sporadic basal-like breast tumors. The mechanism underlying the function of BRCA1 in suppressing basal-like breast cancer remains unclear. We previously reported that the deletion of p18(Ink4c) (p18), an inhibitor of G1 cyclin Ds-dependent CDK4 and CDK6, stimulates mammary luminal progenitor cell proliferation and leads to spontaneous luminal tumor development. We report here that germline mutation of Brca1 in p18-deficient mice blocks the increase of luminal progenitor cells, impairs luminal gene expression and promotes malignant transformation of mammary tumors. Instead of the luminal mammary tumors developed in p18 single-mutant mice, mammary tumors developed in the p18;Brca1 mice, similar to breast cancer developed in familial BRCA1 carriers, exhibited extensive basal-like features and lost the remaining wild-type allele of Brca1. These results reveal distinct functions of the RB and BRCA1 pathways in suppressing luminal and basal-like mammary tumors, respectively. These results also suggest a novel mechanism--causing luminal-to-basal transformation--for the development of basal-like breast cancer in familial BRCA1 carriers and establish a unique mouse model for developing therapeutic strategies to target both luminal and basal-like breast cancers.
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Affiliation(s)
- F Bai
- Molecular Oncology Program, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Cheung GSH, Tsui KL, Lau CC, Chan HL, Chau CH, Wu KL, Cheung CY, Choi MC, Tse TS, Chan KK, Li SK. Primary percutaneous coronary intervention for ST elevation myocardial infarction: performance with focus on timeliness of treatment. Hong Kong Med J 2010; 16:347-353. [PMID: 20889998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE To review primary percutaneous coronary interventions performed for patients with ST elevation myocardial infarction with a focus on door-to-treatment time, especially after introduction of a new management programme in November 2003. DESIGN Retrospective study. SETTING Regional hospital, Hong Kong. PATIENTS All patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention in our hospital from January 2002 to December 2007. RESULTS In all, 209 patients with ST elevation myocardial infarction had primary percutaneous coronary interventions between January 2002 and December 2007; 140 of them were admitted within office hours, 125 of whom came directly from Accident and Emergency Department. The mean door-to-balloon time of these patients was 115 minutes, and in 41% the time was less than 90 minutes (as recommended by the American College of Cardiology/American Heart Association guidelines). Since introduction of the new programme, the mean door-to-balloon time has diminished significantly, from 146 to 116 minutes (P=0.047). Delay in diagnosis (28%) and Cardiac Catheterization Laboratory being occupied (20%) were the two most common reasons for prolonged door-to-balloon times. CONCLUSION We achieved satisfactory performance in our primary percutaneous coronary intervention programme, providing timely reperfusion therapy for patients with ST elevation myocardial infarction. A well-organised and systematic clinical pathway is a prerequisite for a centre that provides a timely and effective primary percutaneous coronary intervention service for patients with ST elevation myocardial infarction. Better public education and greater awareness on the part of medical service providers are needed, so as to facilitate urgent revascularisation and improve outcomes in patients with ST elevation myocardial infarction.
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Affiliation(s)
- Gary S H Cheung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong.
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Chan HC, Mai L, Oikonomopoulou A, Chan HL, Richardson AS, Wang SK, Simmer JP, Hu JCC. Altered enamelin phosphorylation site causes amelogenesis imperfecta. J Dent Res 2010; 89:695-9. [PMID: 20439930 DOI: 10.1177/0022034510365662] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Defects in the enamelin gene (ENAM) cause amelogenesis imperfecta (AI). Our objective was to identify the genetic etiology of enamel hypoplasia in a Caucasian proband. Our hypothesis was that ENAM was defective. The proband and his father have an AG insertion (g.13185_13186insAG; p.422FsX448) in ENAM previously identified in AI kindreds from Slovenia and Turkey. The proband, his brother, and his mother have a novel missense mutation (g.12573C>T) that substitutes leucine for a phosphorylated serine (p.S216L) in the 32-kDa enamelin cleavage product. In this family, a defect in one ENAM allele caused minor pitting or localized enamel hypoplasia, whereas defects in both alleles caused severe enamel malformations, with little or no mineral covering dentin. Ser(216) is one of two serines on the 32-kDa enamelin that is phosphorylated by Golgi casein kinase and is thought to mediate calcium binding. We propose that phosphorylation of enamelin is critical for its function.
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Affiliation(s)
- H-C Chan
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, 1011 N. University, Ann Arbor, MI 48109-1078, USA
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Abstract
Defects in FAM83H on human chromosome 8q24.3 cause autosomal-dominant hypocalcified amelogenesis imperfecta (ADHCAI). FAM83H does not encode a recognizable signal peptide, so we predicted that the Fam83h protein functions within the cell. We tested this hypothesis by constitutively expressing mouse Fam83h with green fluorescent protein (GFP) fused to its C-terminus in HEK293 and HeLa cell lines. Green fluorescent signal from the Fam83h-GFP fusion protein was associated with perinuclear vesicles, usually in the vicinity of the Golgi apparatus. No signal was observed within the nucleus. In addition, we identified FAM83H nonsense mutations in Hispanic (C1330C>T; p.Q444X) and Caucasian (c.1192C>T; p.Q398X) families with ADHCAI. We conclude that Fam83h localizes in the intracellular environment, is associated with vesicles, and plays an important role in dental enamel formation. FAM83H is the first gene involved in the etiology of amelogenesis imperfecta (AI) that does not encode a secreted protein.
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Affiliation(s)
- Y Ding
- Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, 1011 N. University, Ann Arbor, MI 48109-1078, USA
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Tsoi KK, Wong VW, Chan HL, Sung JJ. PL-009 Interferon and nucleoside/tide analog reduce risk of hepato-cellular carcinoma among hepatitis B patients: a meta-analysis. Int J Infect Dis 2009. [DOI: 10.1016/s1201-9712(09)60327-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Yeo W, Chan TC, Leung NW, Lam WY, Mo FK, Chu MT, Chan HL, Hui EP, Lei KI, Mok TS, Chan PK. Hepatitis B Virus Reactivation in Lymphoma Patients With Prior Resolved Hepatitis B Undergoing Anticancer Therapy With or Without Rituximab. J Clin Oncol 2009; 27:605-611. [DOI: 10.1200/jco.2008.18.0182] [Citation(s) in RCA: 473] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose Reactivation of hepatitis B virus (HBV) infection is a well-recognized complication in cancer patients with chronic HBV (hepatitis B surface antigen [HBsAg] positive) undergoing cytotoxic chemotherapy. In patients who have resolved HBV (HBsAg negative and antibody to hepatitis B core antigen [anti-HBc] ± antibody to hepatitis B surface antigen [anti-HBs] positive), such incidence has been much less common until recent use of rituximab. In this study on HBsAg-negative/anti-HBc–positive lymphoma patients, the objectives were to determine the HBV reactivation rate in patients treated with rituximab-containing chemotherapy and to compare it with the rate in patients treated without rituximab. Patients and Methods Between January 2003 and December 2006, all patients diagnosed with CD20+ diffuse large B-cell lymphoma (DLBCL) had HBsAg determined before anticancer therapy. They were treated with either cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone or rituximab plus CHOP (R-CHOP). HBsAg-negative patients had anti-HBc determined; serum was stored for anti-HBs and HBV DNA. All patients were observed for HBV reactivation, which was defined as detectable HBV DNA with ALT elevation during and for 6 months after anticancer therapy. Results Among 104 CD20+ DLBCL patients, 80 were HBsAg negative. Of the latter, 46 patients (44.2%) were HBsAg negative/anti-HBc positive; 25 of these patients were treated with CHOP, and none had HBV reactivation. In contrast, among the 21 patients treated with R-CHOP, five developed HBV reactivation, including one patient who died of hepatic failure (P = .0148). Exploratory analysis identified male sex, absence of anti-HBs, and use of rituximab to be predictive of HBV reactivation. Conclusion Among HBsAg-negative/anti-HBc–positive DLBCL patients treated with R-CHOP, 25% developed HBV reactivation. Close monitoring until at least 6 months after anticancer therapy is required, with an alternative approach of prophylactic antiviral therapy to prevent this potentially fatal condition.
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Affiliation(s)
- Winnie Yeo
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
| | - Tung C. Chan
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
| | - Nancy W.Y. Leung
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
| | - Wai Y. Lam
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
| | - Frankie K.F. Mo
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
| | - Miu Ting Chu
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
| | - Henry L.Y. Chan
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
| | - Edwin P. Hui
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
| | - Kenny I.K. Lei
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
| | - Tony S.K. Mok
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
| | - Paul K.S. Chan
- From the Departments of Clinical Oncology, Microbiology, and Medicine and Therapeutics, and Stanley Ho Centre for Emerging Infectious Diseases, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and Department of Medicine, Alice Ho Mui Ling Nethersole Hospital, Tai Po, Hong Kong Special Administrative Region, China
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Dong Q, Chan HL, Liu Z, Chan DP, Zhang B, Chen Y, Kung HF, Sung JJ, He ML. A1762T/G1764A mutations of hepatitis B virus, associated with the increased risk of hepatocellular carcinoma, reduce basal core promoter activities. Biochem Biophys Res Commun 2008; 374:773-6. [DOI: 10.1016/j.bbrc.2008.07.115] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 07/23/2008] [Indexed: 12/21/2022]
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Abstract
Heartbeat detection is very important for retrieving the vital signs of heart functions. The morphologies and inter-beat intervals of heartbeats can reveal the condition of heart contraction. In this paper, we developed a heartbeat information integration scheme to deal with the information yielded by the energy thresholding and template match methods, which are usually used to detect the heartbeats and match the QRS, respectively. The proposed method are developed in SIMULINK 2.0 and assessed by the MIT/BIH arrhythmia database. The result demonstrated excellent sensitivity of detecting QRS and ventricular premature contraction in the proposed method.
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Affiliation(s)
- H L Chan
- Department of Electrical Engineering, Chang Gung University, TaoYuan, Taiwan
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22
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Fang SC, Chan HL, Chen WH. Approximate entropy analysis of electroencephalogram in vasovagal syncope on tilt table test. Conf Proc IEEE Eng Med Biol Soc 2007; 2006:590-2. [PMID: 17271745 DOI: 10.1109/iembs.2004.1403226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Thirty vasovagal attacks on sublingual nitroglycerin stressed tilting test were selected. By the method of shifting window along the continuous EEG signals the linear (spectral power and coherence) and nonlinear (approximate entropy) EEG features of the whole course in the tilt table test were demonstrated. Of all the EEG parameters approximate entropy is a more sensitive index in clarifying stages of various degree of tilting stress and in identifying the syncopal transient.
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Affiliation(s)
- S C Fang
- Dept. of Neurology, Shin-Kong WHS Memorial Hospital, Taipei, Taiwan
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Abstract
The coma is common in intensive care units. The bedside physical examination provides a means to measuring the neurological status, but it cannot be a continuous evaluation, whereas electroencephalogram (EEG) can reflect the immediate electrical activities of the brain. In this paper, we investigate the spectral parameters, complexity and irregular measures, and spectral entropy in the coma. Compared to the normal subject, the EEG of the coma has a dominance of slow wave, low complexity, less irregularity, and low spectral entropy. This result demonstrates the possibility to use EEG analysis for the monitoring of neurological function.
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Affiliation(s)
- H L Chan
- Dept. of Electr. Eng., Chang-Gung Univ., Taoyuan, Taiwan
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Abstract
Spectral analysis of heart rate variability provides a probe to assess the function of the sympathetic and parasympathetic nervous systems. Time-frequency analysis of heart rate variability is useful for investigating autonomic nervous function in patients with syncope or non-sustained ventricular tachycardia, or in anaesthesia, etc. In this paper, we developed an algorithm for continuous and online analysis of heart rate variability. The algorithm was simulated and evaluated in MATLAB, and implemented on the digital signal processor. The electrocardiogram signals from MIT/BIH arrhythmia database and one patient with syncope demonstrate the capability of the proposed method in the continuous and online analysis of heart rate variability.
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Affiliation(s)
- H L Chan
- Department of Electrical Engineering, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan.
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Lim MK, Sadarangani P, Chan HL, Heng JY. Complementary and alternative medicine use in multiracial Singapore. Complement Ther Med 2005; 13:16-24. [PMID: 15907674 DOI: 10.1016/j.ctim.2004.11.002] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2003] [Revised: 04/27/2004] [Accepted: 11/23/2004] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the prevalence of complementary and alternative medicine (CAM) use in Singapore, the factors influencing CAM use, and the attitudes, beliefs and perceptions of the general population towards CAM. DESIGN An interviewer-administered questionnaire survey in a housing estate with demographic and socioeconomic characteristics closely matching that of Singapore. RESULTS 76% (95% C.I. 73.9-77.9%) used CAM over a 12-month period. Females were 2.1 times (95% C.I. 1.3-3.4) more likely than males to use CAM. Chinese (84%) were the most frequent users, followed by Malays (69%) and Indians (69%), with adjusted odds ratios of 0.4 (95% C.I. 0.2-0.7) for Malays and 0.4 (95% C.I. 0.2-0.8) for Indians. Traditional Chinese Medicine (88%) was the most widely used form of CAM, followed by Traditional Malay (Jamu) Medicine (8%) and Traditional Indian (Ayuverdic) Medicine (3%). Similar to western studies, CAM was more likely to be used for maintenance of health than for treatment of illness. Different from western studies, CAM use was not independently associated with household income, marital status, age and education. Seventy-four percent did not discuss their use of CAM with their western-trained doctors. CONCLUSIONS The high prevalence of CAM use in multi-racial Singapore suggests the same may be true in other Asian countries. Western-trained doctors need to understand CAM better and communicate more with their patients regarding CAM use. The lack of a scientific evidence base for most forms of CAM notwithstanding, its ubiquitous use worldwide is something that governments and the medical profession cannot afford to ignore.
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Affiliation(s)
- M K Lim
- Department of Community, Occupational and Family Medicine, Faculty of Medicine, National University of Singapore, MD316 Medical Drive, Singapore 117597, Singapore.
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Chan HL, Lam TW, Sung WK, Wong PWH, Yiu SM, Fan X. The mutated subsequence problem and locating conserved genes. Bioinformatics 2005; 21:2271-8. [PMID: 15746277 DOI: 10.1093/bioinformatics/bti371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
MOTIVATION For the purpose of locating conserved genes in a whole genome scale, this paper proposes a new structural optimization problem called the Mutated Subsequence Problem, which gives consideration to possible mutations between two species (in the form of reversals and transpositions) when comparing the genomes. RESULTS A practical algorithm called mutated subsequence algorithm (MSS) is devised to solve this optimization problem, and it has been evaluated using different pairs of human and mouse chromosomes, and different pairs of virus genomes of Baculoviridae. MSS is found to be effective and efficient; in particular, MSS can reveal >90% of the conserved genes of human and mouse that have been reported in the literature. When compared with existing softwares MUMmer and MaxMinCluster, MSS uncovers 14 and 7% more genes on average, respectively. Furthermore, this paper shows a hybrid approach to integrate MUMmer or MaxMinCluster with MSS, which has better performance and reliability.
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Affiliation(s)
- H L Chan
- Department of Computer Science, University of Hong Kong, Hong Kong, China.
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Abstract
INTRODUCTION The multifocal visual-evoked potential (mfVEP) has been widely used in the study of diseases of the visual system. However, the sensitivity of the mfVEP in the objective detection of relative field defects has not been determined. This study investigates variations in mfVEP responses while simulating relative field defects by using different luminous transmission masks [neutral density (ND) filters] on the stimulus pattern. METHODS Simulated relative field defects with four different luminous transmissions were obtained by using 0.2, 0.4, 0.6, and 0.8 ND filters, 5 degrees in size, at two different retinal eccentricities (10 and 16 degrees) on a standard mfVEP dartboard stimulus. Eleven normal subjects were recruited for mfVEP measurements. The response amplitudes and latencies of the N1 and P1 of the mfVEP, with and without small simulated relative field defects, were compared. RESULTS The mfVEP amplitudes of N1 and P1 decreased substantially when 0.6 and 0.8 ND filters were introduced. The effects were similar at both the 10- and 16-degree eccentricities but there was no change in latency with simulated field defects at either location. CONCLUSIONS The mfVEP can detect a simulated relative field defect 5 degrees in size starting with 0.6 log unit reduction in luminance at both 10-degree and 16-degree eccentricities. This illustrates that the sensitivity of the mfVEP measurement is nearly comparable with that of the Humphrey Visual Field Analyser.
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Affiliation(s)
- H L Chan
- Department of Optometry and Radiography, The Hong Kong Polytechnic University, China.
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Ng GYF, Chan HL. The immediate effects of tension of counterforce forearm brace on neuromuscular performance of wrist extensor muscles in subjects with lateral humeral epicondylosis. J Orthop Sports Phys Ther 2004; 34:72-8. [PMID: 15029940 DOI: 10.2519/jospt.2004.34.2.72] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [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] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Within-subject repeated-measures study. OBJECTIVES To examine the immediate effects of counterforce forearm brace on isokinetic strenght stretch reflex, passive stretching pain threshold of the wrist extensors, and proprioception of the wrist in subjects with lateral humeral epicondylosis for different strap tensions of a forearm brace. BACKGROUND Counterforce forearm bracing has been used for treating lateral humeral epicondylosis, but the effect of brace tension has not been well reported. METHODS AND MEASURES Fifteen subjects diagnosed with lateral humeral epicondylosis on their dominant arm were tested under 4 randomized conditions: (1) no brace, (2) brace with minimal tension, (3) brace with 25-N tension, and (4) brace with 50-N tension. The tests included isokinetic wrist extensors strength, passive stretching force in wrist flexion to elicit pain in the wrist extensors, wrist proprioception, and stretch reflex latency of the extensor carpi ulnari. A repeated-measures MANOVA was used to analyze the data and significant results were further analyzed with post hoc linear contrasts (alpha = .05). RESULTS Among the 4 conditions, significant differences were found in wrist proprioception P = .032) and pain threshold to passive stretching of the wrist extensors (P = .05), but were not found in wrist extension isokinetic strength and stretch reflex latency of the extensor carpi ulnaris. CONCLUSION A forearm counterforce brace, as applied in this study, affects wrist joint proprioception and increases the pain threshold to passive stretching of the wrist extensors in subjects with lateral humeral epicondylosis, but it has no effect on wrist extensor strength and stretch reflex latency of the extensor carpi ulnaris.
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Affiliation(s)
- G Y F Ng
- Department of Rehabilitation Sciences, The Hong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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Aw DCW, Thong JY, Chan HL. Delusional parasitosis: case series of 8 patients and review of the literature. Ann Acad Med Singap 2004; 33:89-94. [PMID: 15008571] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Delusional parasitosis (DP) is a condition in which a person has the unshakeable and mistaken belief of being infested with parasites. PATIENTS AND METHODS All patients with DP seen by the Division of Dermatology, Department of Medicine, National University Hospital were reviewed. The case histories of 8 Chinese patients are discussed. RESULTS The patients with DP were predominantly women above 50 years of age, with medical co-morbidities and presented with a variety of symptoms and signs. The patients were prescribed various antipsychotics including the atypical antipsychotics. Response was variable, and the patients often defaulted follow-up. An approach to the management of DP is proposed together with a review of the literature.
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Affiliation(s)
- D C W Aw
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
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Abstract
INTRODUCTION The multifocal visual-evoked potential (mfVEP) has been widely investigated in the study of diseases of the visual system. However, the sensitivity of the mfVEP in objective detection of field defects has not been determined. This study investigates the variation of the mfVEP responses whilst simulating field defects by using different sizes of mask on the stimulus pattern. METHODS Simulated field defects of four different sizes (2, 3, 5, and 7 degrees) at two different eccentricities (10 and 16 degrees) were generated on a standard mfVEP dartboard stimulus using opaque masks. These masks were placed at the centre of each dartboard sector and the modified stimuli were used to elicit mfVEPs from 10 normal subjects. The response densities and latencies of N1, P1 of the mfVEP were compared, without and with small simulated field defects. RESULTS The minimum size of simulated field defect causing significant response density reduction in P1 and N1 was 5 degrees at both retinal eccentricities. N1 showed similar reduction in response density at both retinal eccentricities, but P1 showed larger reduction at the 10-degree location than at the 16-degree location. There was no change in latencies with simulated field defect at either location. CONCLUSIONS The mfVEP is only sensitive to a simulated field defect equal to or larger than 5 degrees in diameter, and mfVEP has greater sensitivity at 10-degree eccentricity than at 16-degree eccentricity.
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Affiliation(s)
- H L Chan
- Department of Optometry and Radiography, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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Abstract
OBJECTIVES We examined (1) the effect of a counterforce forearm brace on isokinetic strength, stretch reflex, passive stretching, and proprioception of the forearm muscles in healthy subjects and (2) the effect of different strap tensions of the brace on the above variables. DESIGN The dominant hand of 15 healthy subjects were tested under four randomized conditions: (1) no brace, (2) brace with minimal tension, (3) brace with 2.5 kg force tension, and (4) brace with 5 kg force tension. The tests included isokinetic wrist extensors strength, passive stretching to the wrist extensors until onset of pain, joint proprioception, and reflex latency of forearm extensor muscles. A repeated measures multivariate analysis of variance test was used to analyze the data, and significant results were further analyzed with post hoc linear contrasts with alpha at 0.0083. RESULTS There was no difference in isokinetic strength, proprioception, and stretch reflex latency among the four conditions. For passive stretching, there was a significant difference (P = 0.001) in that using a brace produced a higher pain threshold than without a brace. CONCLUSION A forearm counterforce brace has no effect on strength, proprioception, and stretch reflex latency, but it increases the pain threshold.
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Affiliation(s)
- H L Chan
- Department of Physical Therapy, Prince of Wales Hospital, Hong Kong
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Abstract
INTRODUCTION The first-order kernel response of multifocal electroretinogram (mfERG) decreases in myopia. A recent study indicates that the flash ERG is also reduced with increased axial length. The aim of this study was to investigate the variations in the first-order response (K1) and the first slice of second-order response (K2.1) across the retina for different axial lengths. METHODS Thirty healthy subjects with axial length from 23.72 to 28.13 mm (spherical equivalent refractive errors from plano to -10.50 D) were recruited for mfERG measurement using VERIS 4.0. All subjects were fully corrected after cycloplegic refraction and pupils were dilated prior to mfERG recording. There is one trough, n1, and one peak, p1, in the K1 response and three troughs, n1, n2, n3, and three peaks, p1, p2, p3, in the K2.1 response. The amplitudes and implicit times of K1 and K2.1 responses were analysed to determine the characteristic of the responses across retina and the correlation to axial length. RESULTS The amplitudes of p1 (in the first-order kernel-K1) decreased in the central region and the paracentral region (ring 3) as the axial length increased. The central retinal region showed high rates of reduction in both n1 and p1 (in K1). The amplitudes of n1p1 and n2p2 (in the first slice of the second-order kernel-K2.1) were reduced in the paracentral region (from ring 2 to ring 5) as axial length increased. The average n1 and p1 in K1, and n1p1 and n2p2 in K2.1 mfERG responses are decreased in amplitude by 6-10% per millimetre elongation of axial length. CONCLUSION Eyes with longer axial lengths, usually with high myopia, have a weaker mfERG response and this attenuation is across the measured retina (from central to paracentral regions) but different kernel responses show a different pattern of attenuation at different retinal eccentricities. The weaker mfERG responses may be related to the morphological changes associated with increased axial length.
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Affiliation(s)
- H L Chan
- Department of Optometry and Radiography, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
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Abstract
PURPOSE Unclear ocular media is a very common condition of older eyes characterized by significant light scattering and image degradation. The multifocal electroretinography (MERG) is a useful objective technique to measure retinal activity but its validity in the presence of cloudy ocular media remains unclear. We tested the MERG under controlled light scattering conditions using a liquid crystal diffuser (LCD) that simulated different degrees of image degradation. METHODS The MERG were taken from 13 normal young subjects seated behind a LCD set under two conditions: scatter (visual acuity approximately 6/18) and non-scatter (visual acuity approximately6/6). The pupils had been dilated and the eyes were optically corrected for the working distance. The first-order kernel MERG response was analysed. Three subjects underwent MERG measurement with two additional intermediate light scattering levels (i.e. visual acuity approximately 6/9 and 6/12). RESULTS The macular MERG response density was reduced (p < 0.001), but the peripheral MERG response densities were increased (p < 0.001) under the scattering condition. A similar trend was also observed with intermediate degrees of light scattering. Comparing the MERG waveforms without light scattering, a new retinal response was identified with a characteristic latency of about 60 ms (P60), but it was diminished in size under the scattering conditions. CONCLUSIONS The veiling luminance might have caused the reduction in the macular MERG response and an elevation in the peripheral retina with light scatter. The functional suppression of P60 observed under the influence of light scatter may be related to retinal adaptation. Unclear optical media will affect the interpretation of MERG results.
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Abstract
BACKGROUND Trials of thymosin treatment in chronic hepatitis B virus infection have been small and the results have been inconsistent. AIM To conduct a meta-analysis to evaluate the efficacy of thymosin treatment in chronic hepatitis B virus infection. METHODS Randomized controlled trials comparing thymosin for over 24 weeks vs. placebo (or usual care) in the treatment of chronic hepatitis B virus infection were identified through MEDLINE, EMBASE and the Cochrane Register of Clinical Trials. Biochemical (normalization of transaminases) and virological (loss of hepatitis B virus DNA and hepatitis B e antigen) responses were analysed using the intention-to-treat method. The odds ratio was used to measure the magnitude of the efficacy. RESULTS Five trials (353 patients) were identified. The odds ratio (95% confidence interval) of the virological response of thymosin over placebo at the end of treatment, 6 months post-treatment and 12 months post-treatment were 0.56 (0.2-1.52), 1.67 (0.83-3.37) and 2.67 (1.25-5.68), respectively. There was an increasing trend of the virological response with time since the cessation of thymosin treatment (P=0.02). There was no difference in the biochemical response between the thymosin and placebo groups at the end of treatment, 6 months post-treatment and 12 months post-treatment. CONCLUSIONS Thymosin is effective in suppressing viral replication in chronic hepatitis B virus infection, but the effect is delayed until 12 months after the cessation of treatment.
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Affiliation(s)
- H L Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Yeo W, Chan PK, Chan HL, Mo FK, Johnson PJ. Hepatitis B virus reactivation during cytotoxic chemotherapy-enhanced viral replication precedes overt hepatitis. J Med Virol 2001; 65:473-7. [PMID: 11596081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The diagnosis of HBV reactivation during cytotoxic chemotherapy is based on an abrupt rise in levels of serum HBV DNA in conjunction with a hepatitic picture and in the absence of other causes of hepatitis. However, several cases of "hepatitis" have been noted during chemotherapy in HBsAg-positive patients, for which no cause could be found and in which HBV DNA levels were negative. One possible explanation is that HBV reactivation may, indeed, have been the cause but that HBV DNA levels became negative by the time ALT levels peaked and the clinical diagnosis of hepatitis was made. During the course of a longitudinal study of HBsAg-seropositive cancer patients who were monitored during standard chemotherapy, the opportunity was available to test this hypothesis.
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Affiliation(s)
- W Yeo
- Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Abstract
The spectral characteristics of heart rate variability (HRV) are related to the modulation of the autonomic nervous system. As the physiological condition is changed by such external stimuli such as drugs, postural changes, and anesthesia, or by internal deregulation such as in syncope, adjective autonomic responses could alter HRV characteristics. Time-frequency analysis is commonly used to investigate the time-related HRV characteristics. An alteration of the autonomic regulation resulting in a change in mean heart rate induces a transient component in heart rate, which, with any analysis method based on signals from multiple beats, results in the apparent spread of the spectrum of frequencies. This obscures the spectral components related to the autonomic function. In this paper we investigated the influence of the transient component in several time-frequency methods including the short-time Fourier transform, the Choi-Williams distribution, the smoothed pseudo Wigner-Ville distribution (SPWVD), the filtering SPWVD compensation, and the discrete wavelet transform. One simulated signal and two heart rate signals during general anesthesia and postural change were used for this assessment. The result demonstrates that the filtering SPWVD compensation and the discrete wavelet transform have small spectrum interference from the transient component.
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Affiliation(s)
- H L Chan
- Department of Electrical Engineering, Chang-Gung University, Kwei-Shan, Tao-Yuan, Taiwan,.
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Tsang SW, Chan HL, Leung NW, Chau TN, Lai ST, Chan FK, Sung JJ. Lamivudine treatment for fulminant hepatic failure due to acute exacerbation of chronic hepatitis B infection. Aliment Pharmacol Ther 2001; 15:1737-44. [PMID: 11683687 DOI: 10.1046/j.1365-2036.2001.01107.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [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] [Indexed: 01/16/2023]
Abstract
BACKGROUND Exacerbation of chronic hepatitis B infection can lead to fulminant hepatic failure with a mortality of up to 90%. AIM To evaluate the efficacy of lamivudine in the treatment of this subgroup of patients. METHODS Twenty-four patients with exacerbation of chronic hepatitis B infection and fulminant hepatic failure were treated with lamivudine, 100 mg daily. Hepatitis A, C, D and human immunodeficiency virus co-infections and hepatocellular carcinoma were excluded. RESULTS The median age was 53 years (range, 24-77 years) with a male predominance of 20:4. Seventeen patients were hepatitis B e antigen positive. Mean hepatitis B virus DNA was 2079 Meq/mL. Eight patients (33%) survived (group A). Thirteen patients died and three patients received liver transplantation (67%) (group B). Baseline laboratory results were comparable between the two groups, including serum albumin, bilirubin, alanine aminotransferase, prothrombin time and creatinine. Group B patients had significantly more comorbid illnesses at baseline and more complications, including sepsis and renal failure, compared with group A patients. Six out of eight survivors (75%) had full hepatitis B e antigen seroconversion, but this was not sustained in four patients. CONCLUSIONS Lamivudine may be useful in treating patients with fulminant hepatic failure due to exacerbation of chronic hepatitis B. Hepatitis B e antigen seroconversion was less durable in this subgroup of patients and long-term therapy may be required.
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Affiliation(s)
- S W Tsang
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, New Territories, Hong Kong, China.
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Wong WR, Tsai CY, Shih SR, Chan HL. Association of pityriasis rosea with human herpesvirus-6 and human herpesvirus-7 in Taipei. J Formos Med Assoc 2001; 100:478-83. [PMID: 11579614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND AND PURPOSE Pityriasis rosea (PR) is a common papulosquamous skin disease with unknown etiology. The possible relationship of PR with human herpesvirus infection (HHV) has been extensively studied. This study used the polymerase chain reaction (PCR) to investigate the presence of human herpesvirus 6 and 7 (HHV-6 and HHV-7) in 41 PR patients from two hospitals in Northern Taiwan. The epidemiologic features of PR in patients were also studied. METHODS A total of 41 PR patients (11 males, 30 females) were enrolled in this study from April 1999 to March 2000. PCR of skin biopsy specimens from 24 PR patients was used to identify the existence of HHV-6 and HHV-7. Viral culture from PR biopsy specimens was also performed. Blood from these patients was sampled for Venereal Disease Research Laboratory tests. Skin biopsies from 20 age- and sex-matched controls with other skin diseases were also subjected to PCR study. RESULTS The ages of the 41 PR patients ranged from 8 to 62 years. An increased incidence (17/41) of PR episodes was observed during the spring. Both HHV-6 and HHV-7 DNA was below the limit of detection in all biopsy specimens from patients and healthy controls. Viral culture for HHV was negative in all patients. CONCLUSION The epidemiologic features of PR in this series are comparable to other studies except for an exaggerated female predominance (male:female ratio 1:2.7). Our data indicate a lack of association between HHV-6 and HHV-7 infection and PR.
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Affiliation(s)
- W R Wong
- Department of Dermatology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan
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Abstract
Two patients presenting with chronic pigmented purpuric dermatosis (CPPD) on the dorsum of both feet were found to show granulomatous inflammation superimposed on the pathological changes of CPPD. Two similar cases have been reported from Japan. The unique clinicopathological features of this group of patients suggest that they have a rare granulomatous variant of CPPD.
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Affiliation(s)
- W R Wong
- Department of Dermatology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei 105, Taiwan.
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40
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Affiliation(s)
- C Y Tsai
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan
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Lin PL, Wang YP, Chou YM, Chan HL, Huang HH. Lack of intravenous lidocaine effects on HRV changes of tracheal intubation during induction of general anesthesia. Acta Anaesthesiol Sin 2001; 39:77-82. [PMID: 11475179] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Intravenous lidocaine has been widely used for suppressing the autonomic activation from tracheal intubation during induction of general anesthesia. Conventionally, researches of its effectiveness through assessment of heart rate and blood pressure changes obtained by common clinical methods result in the conclusions deduced of much controversy. Heart rate variability is a noninvasive measurement of autonomic regulation and is suitable for the study of this subject. METHODS 36 ASA class I-II patients undergoing general anesthesia were divided into 3 groups. Besides induction agents, intravenous lidocaine was given 5 min before tracheal intubation in group A, 3 min before intubation in group B and nothing in group C. HRV spectral powers were measured at awake state, anesthetized state before tracheal intubation and anesthetized state after tracheal intubation by time frequency spectral analysis method and comparison was made between the three groups. RESULTS The HRV spectral power in high frequency (HF) and mid-frequency (MF) power bands and their ratios (MF/HF) were not significantly different among the 3 groups during the 3 observation periods. CONCLUSIONS There was no evidence to indicate the effectiveness of intravenous lidocaine on the autonomic regulation during tracheal intubation under the influence of induction agents used in general anesthesia.
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Affiliation(s)
- P L Lin
- Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan S. Rd., Taipei, Taiwan
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Yuen P, Chan HL, Lee YS. Sézary syndrome in a Malay--case report and literature review. Singapore Med J 2001; 42:224-7. [PMID: 11513062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Sézary syndrome is a rare form of primary cutaneous T cell lymphoma. It is a distinct systemic variant of mycosis fungoides, marked by erythroderma, lymphadenopathy and circulating cerebriform lymphocytes in the peripheral blood. We report a case of Sézary syndrome in a 61-year-old Malay man with a five-year history of indurated plaques, ulcers and tumours on the head and trunk, with characteristic findings on physical examination, skin biopsy, electron microscopy, immunophenotyping and peripheral blood film. A literature review on Sézary syndrome is presented.
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Affiliation(s)
- P Yuen
- Department of Medicine, National University Hospital, Singapore
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Hu J, Li G, Chan HL, Choy CL. A standing wave-type noncontact linear ultrasonic motor. IEEE Trans Ultrason Ferroelectr Freq Control 2001; 48:699-708. [PMID: 11381693 DOI: 10.1109/58.920696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this study, a novel standing wave-type noncontact linear ultrasonic motor is proposed and analyzed. This linear ultrasonic motor uses a properly controlled ultrasonic standing wave to levitate and drive a slider. A prototype of the motor was constructed by using a wedge-shaped aluminum stator, which was placed horizontally and driven by a multilayer PZT vibrator. The levitation and motion of the slider were observed. Assuming that the driving force was generated by the turbulent acoustic streaming in the boundary air layer next to the bottom surface of the slider, a theoretical model was developed. The calculated characteristics of this motor were found to agree quite well with the experimental results. Based on the experimental and theoretical results, guidelines for increasing the displacement and speed of the slider were obtained. It was found that increasing the stator vibration displacement, or decreasing the gradient of the stator vibration velocity and the weight per unit area of the slider, led to an increase of the slider displacement. It was also found that increasing the amplitude and gradient of the stator vibration velocity, or decreasing the weight per unit area of the slider and the driving frequency, gave rise to an increase of the slider speed. There exists an optimum roughness of the bottom surface of the slider at which the slider speed has a maximum.
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Affiliation(s)
- J Hu
- Center for Smart Materials and Department of Applied Physics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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Chan HL, Wu JC, Chan FK, Choi CL, Ching JY, Lee YT, Leung WK, Lau JY, Chung SC, Sung JJ. Is non-Helicobacter pylori, non-NSAID peptic ulcer a common cause of upper GI bleeding? A prospective study of 977 patients. Gastrointest Endosc 2001; 53:438-42. [PMID: 11275883 DOI: 10.1067/mge.2001.112840] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-Helicobacter pylori, non-NSAID ulcer is relatively common in Western countries. Whether it is a significant problem in the Orient is unclear. The aim of this study was to investigate the incidence of non-H pylori, non-NSAID ulcers presenting with GI bleeding. METHODS A prospective study was done of 1675 consecutive patients presenting with upper GI bleeding over a period of 12 months. Upper endoscopy was performed with biopsy specimens taken from the antrum and body of the stomach for a biopsy urease test (BUT) and histology for detection of H pylori. Exposure to nonsteroidal anti-inflammatory drugs (NSAID) or aspirin within 4 weeks of hospitalization was carefully scrutinized. A 6-week course of treatment with an H2-receptor antagonist was prescribed for patients who did not use an NSAID and had a negative BUT result. Follow-up endoscopy was performed to confirm H pylori status with a BUT and histology. Positive histology at either initial or follow-up endoscopy was used as the standard for diagnosing H pylori infection. RESULTS Among 977 patients who were found to have ulcer bleeding, 434 (44%) had exposure to aspirin or an NSAID. Of the 543 non-NSAID users, 431 (79.4%) had a positive BUT and 112 (20.6%) were BUT negative on initial endoscopy. Eighty-nine of 112 patients who were NSAID negative, BUT negative returned for follow-up endoscopy. Forty-nine of 89 (55.1%) were found to have a positive BUT and positive histology at follow-up endoscopy. Only 40 of 977 (4.1%) patients admitted with ulcer bleeding were confirmed to have non-H pylori, non-NSAID ulcers. CONCLUSIONS Non-H pylori, non-NSAID bleeding ulcer is uncommon. A negative BUT is unreliable for exclusion of H pylori infection during the acute phase of ulcer bleeding.
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Affiliation(s)
- H L Chan
- Departments of Medicine and Therapeutics, Surgery, and Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
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Chan FK, Chung SC, Suen BY, Lee YT, Leung WK, Leung VK, Wu JC, Lau JY, Hui Y, Lai MS, Chan HL, Sung JJ. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med 2001; 344:967-73. [PMID: 11274623 DOI: 10.1056/nejm200103293441304] [Citation(s) in RCA: 480] [Impact Index Per Article: 20.9] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many patients who have had upper gastrointestinal bleeding continue to take low-dose aspirin for cardiovascular prophylaxis or other non-steroidal antiinflammatory drugs (NSAIDs) for musculoskeletal pain. It is uncertain whether infection with Helicobacter pylori is a risk factor for bleeding in such patients. METHODS We studied patients with a history of upper gastrointestinal bleeding who were infected with H. pylori and who were taking low-dose aspirin or other NSAIDs. We evaluated whether eradication of the infection or omeprazole treatment was more effective in preventing recurrent bleeding. We recruited patients who presented with upper gastrointestinal bleeding that was confirmed by endoscopy. Their ulcers were healed by daily treatment with 20 mg of omeprazole for eight weeks or longer. Then, those who had been taking aspirin were given 80 mg of aspirin daily, and those who had been taking other NSAIDs were given 500 mg of naproxen twice daily for six months. The patients in each group were then randomly assigned separately to receive 20 mg of omeprazole daily for six months or one week of eradication therapy, consisting of 120 mg of bismuth subcitrate, 500 mg of tetracycline, and 400 mg of metronidazole, all given four times daily, followed by placebo for six months. RESULTS We enrolled 400 patients (250 of whom were taking aspirin and 150 of whom were taking other NSAIDs). Among those taking aspirin, the probability of recurrent bleeding during the six-month period was 1.9 percent for patients who received eradication therapy and 0.9 percent for patients who received omeprazole (absolute difference, 1.0 percent; 95 percent confidence interval for the difference, -1.9 to 3.9 percent). Among users of other NSAIDs, the probability of recurrent bleeding was 18.8 percent for patients receiving eradication therapy and 4.4 percent for those treated with omeprazole (absolute difference, 14.4 percent; 95 percent confidence interval for the difference, 4.4 to 24.4 percent; P=0.005). CONCLUSIONS Among patients with H. pylori infection and a history of upper gastrointestinal bleeding who are taking low-dose aspirin, the eradication of H. pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding. Omeprazole is superior to the eradication of H. pylori in preventing recurrent bleeding in patients who are taking other NSAIDs.
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Affiliation(s)
- F K Chan
- Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
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Yeo W, Chan PK, Chan HL, Mo FK, Johnson PJ. Hepatitis B virus reactivation during cytotoxic chemotherapy-enhanced viral replication precedes overt hepatitis. J Med Virol 2001. [DOI: 10.1002/jmv.2060] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Zhang QQ, Chan HL, Ploss B, Choy CL. PCLT/P (VDF-TrFE) nanocomposite pyroelectric sensors. IEEE Trans Ultrason Ferroelectr Freq Control 2001; 48:154-160. [PMID: 11367782 DOI: 10.1109/58.895925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Thin composite films consisting of 12 vol% of nanosized lanthanum and calcium-modified lead titanate (PCLT) powder embedded in a vinylidene fluoride-trifluoroethylene copolymer [P(VDF-TrFE)] matrix were deposited on silicon (Si) substrates to form pyroelectric sensors with three different configurations. The influences of a thermal buffer layer and back etching of the silicon substrate on the current and voltage responsivities of the sensors were investigated theoretically and experimentally. The specific detectivity of the sensors was also calculated from the measured voltage responsivity and noise.
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Affiliation(s)
- Q Q Zhang
- Department of Applied Physics, Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong.
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Abstract
OBJECTIVES HBeAg-negative patients constitute approximately 70% of all chronic hepatitis B virus (HBV) infections in Southeast Asia, and some of these patients continue to suffer from active disease. We aimed to study the risk of hepatitis relapse in chronic HBV-infected patients with negative HBeAg and the predictor(s) of relapses. METHODS This was a retrospective analysis of patients carrying HBsAg but lacking HBeAg. Patients recruited were required to have been followed for > or = 12 months with a minimum of three blood samples available for analysis. Patient demographic data, liver biochemistry, and HBV serology were analyzed in relation to relapses of hepatitis. Relapse was defined as an abrupt elevation of ALT > 200 IU/L or > 3-fold previous levels, whichever was higher. RESULTS In a period of 3 months, 317 patients seen at the Hepatitis Clinic at the Prince of Wales Hospital in Hong Kong were recruited. The median duration of follow-up was 34 months. On initial consultation, 111 (35.0%) patients had elevated ALT (>60 IU/L). Overall, 57 (18.0%) patients developed at least one relapse, including 37 (33.3%) patients with elevated ALT and 20 (9.7%) patients with normal ALT at the first visit. Multiple logistic regression analysis showed that elevated ALT level at first presentation (odds ratio 4.17, 95% confidence interval 2.24-7.75) and male gender (odds ratio 2.83, 95% confidence interval 1.23-6.49) were the two independent factors associated with a higher risk of hepatitis relapse. The sensitivity, specificity, and positive and negative predictive values of a single ALT test for hepatitis relapse were 64.9%, 71.5%, 33.3%, and 90.3%, respectively. CONCLUSIONS HBeAg-negative HBV carriers with normal ALT levels have a low risk of hepatitis relapse.
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Affiliation(s)
- H L Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin
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Chan HL. Recognizing and preventing adverse drug reactions: with particular reference to drug eruptions. Singapore Med J 2000; 41:519-20. [PMID: 11284607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Wang YH, Huang TS, Lin JL, Hwang JJ, Chan HL, Lai JS, Tseng YZ. Decreased autonomic nervous system activity as assessed by heart rate variability in patients with chronic tetraplegia. Arch Phys Med Rehabil 2000; 81:1181-4. [PMID: 10987159 DOI: 10.1053/apmr.2000.6300] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the alterations of autonomic nervous functions and sympathovagal balance of the subjects with spinal cord injuries (SCIs) in different levels by heart rate variability analysis. DESIGN Prospective, observational study. SETTING All participants were recruited from the outpatient clinic from National Taiwan University Hospital, which is a tertiary referral center. PARTICIPANTS Thirty-one patients with traumatic chronic complete SCI (more than 6 months): 14 with paraplegia (Group A), and 17 with tetraplegia (Group B). MAIN OUTCOME MEASURES Heart rate variability assessed by 24-hour Holter monitoring. RESULTS Two patients in Group A and 1 in Group B were excluded from final data analysis because of poor recording data. Two time domain variables, the standard deviation (SD) of all normal RR intervals (SDNN) and the mean of the SDs of all normal RR intervals for all 5-minute intervals (SDNNi), over 24 hours were decreased in Group B. All time domain variables, SDNN, SDNNi, root mean square of the successive normal RR interval difference (rMSSD), and the percentage of RR intervals differing >50msec from the preceding one (pNN50), were decreased during the nighttime recordings (all p < .05) in Group B. The very-low-frequency, low-frequency (LF), and high-frequency (HF) components of the power spectrum of the RR intervals were also decreased in Group B (p < .05), irrespective of the daytime and nighttime recordings. The LF-to-HF ratio did not differ significantly in these two groups, indicating the maintained sympathovagal balance in the chronic SCI patients. CONCLUSION These findings suggested that the autonomic nervous system activity was depressed in the patients with chronic tetraplegia, but the autonomic nervous system still maintained homeostasis.
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Affiliation(s)
- Y H Wang
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei
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