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Mak JWY, Sun Y, Limsrivilai J, Abdullah M, Kaibullayeva J, Balderramo D, Vergara BI, Paudel MS, Banerjee R, Hilmi I, Ali RAR, Wei SC, Ng KK, Altuwaijri M, Kelly P, Yamamoto-Furusho JK, Kotze PG, Ahuja V, Chong VH, Dao HV, Abbey Y, Ching JYL, Ho A, Chan AKW, Bernstein CN, Gearry RB, Abreu M, Rubin DT, Dotan I, Hracs L, Kaplan GG, Ng SC. Development of the global inflammatory bowel disease visualization of epidemiology studies in the 21 st century (GIVES-21). BMC Med Res Methodol 2023; 23:129. [PMID: 37231405 DOI: 10.1186/s12874-023-01944-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND There is a rapid increase in the incidence of inflammatory bowel diseases (IBD) in newly industrialized countries, yet epidemiological data is incomplete. We herein report the methodology adopted to study the incidence of IBD in newly industrialized countries and to evaluate the effect of environmental factors including diet on IBD development. METHODS Global IBD Visualization of Epidemiology Studies in the 21st Century (GIVES-21) is a population-based cohort of newly diagnosed persons with Crohn's disease and ulcerative colitis in Asia, Africa, and Latin America to be followed prospectively for 12 months. New cases were ascertained from multiple sources and were entered into a secured online system. Cases were confirmed using standard diagnostic criteria. In addition, endoscopy, pathology and pharmacy records from each local site were searched to ensure completeness of case capture. Validated environmental and dietary questionnaires were used to determine exposure in incident cases prior to diagnosis. RESULTS Through November 2022, 106 hospitals from 24 regions (16 Asia; 6 Latin America; 2 Africa) have joined the GIVES-21 Consortium. To date, over 290 incident cases have been reported. All patients have demographic data, clinical disease characteristics, and disease course data including healthcare utilization, medication history and environmental and dietary exposures data collected. We have established a comprehensive platform and infrastructure required to examine disease incidence, risk factors and disease course of IBD in the real-world setting. CONCLUSIONS The GIVES-21 consortium offers a unique opportunity to investigate the epidemiology of IBD and explores new clinical research questions on the association between environmental and dietary factors and IBD development in newly industrialized countries.
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Affiliation(s)
- Joyce W Y Mak
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yang Sun
- The First Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | | | | | - Jamilya Kaibullayeva
- Research Institute of Cardiology and Internal Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | | | | | - Rupa Banerjee
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Ida Hilmi
- University of Malaya, Kuala Lumpur, Malaysia
| | | | - Shu Chen Wei
- National Taiwan University Hospital, Taipei, Taiwan
| | - Ka Kei Ng
- Conde S. Januário Hospital, Macao SAR, China
| | - Mansour Altuwaijri
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | | | | | - Vineet Ahuja
- All India Institute of Medical Sciences, Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | | | - Jessica Y L Ching
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Agnes Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alicia K W Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Maria Abreu
- Department of Medicine, University of Miami Miller School of Medicine, Florida, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah-Tikva, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lindsay Hracs
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Siew C Ng
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Ng KK, Hui YH, Chu KS, Kung BT, Au-Yong TK. Metformin Discontinuation for 48 Hours Reduces Intestinal Fluorodeoxyglucose Uptake in 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. Hong Kong Journal of Radiology 2021. [DOI: 10.12809/hkjr2117186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- KK Ng
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Hong Kong
| | - YH Hui
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Hong Kong
| | - KS Chu
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Hong Kong
| | - BT Kung
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Hong Kong
| | - TK Au-Yong
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Hong Kong
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Siu BW, Fistein EC, Leung HW, Chan LS, Yan CK, Lai AC, Yuen KK, Ng KK. Compulsory Admission in Hong Kong: Balance between Paternalism and Patient Liberty. East Asian Arch Psychiatry 2018; 28:122-128. [PMID: 30563948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In Hong Kong, compulsory admission is governed by the Mental Health Ordinance Section 31 (detention of a patient under observation), Section 32 (extension of period of detention for such a patient), Section 36 (detention of certified patients), and the sections in Part IV for hospital order, transfer order, and removal order. Mental health professionals adopt both legal criteria and practice criteria for compulsory admission. The present study discusses the harm principle, the patient's decision-making capacity, the multi-axial framework for compulsory admission, and the balance between paternalism and patient liberty.
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Affiliation(s)
- B Wm Siu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - E C Fistein
- School of Clinical Medicine, University of Cambridge, United Kingdom
| | - H W Leung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - L Sy Chan
- Department of Forensic Psychiatry and Old Age Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - C K Yan
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - A Ch Lai
- Head of the Socioanthropology Department, School of Medical Sciences, National University of Asunción (Santa Rosa Campus), Santa Rosa del Aguaray, Paraguay
| | - K K Yuen
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - K K Ng
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
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Kow FP, Adlina B, Sivasangari S, Punithavathi N, Ng KK, Ang AH, Ong LM. The impact of music guided deep breathing exercise on blood pressure control - A participant blinded randomised controlled study. Med J Malaysia 2018; 73:233-238. [PMID: 30121686] [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: 06/08/2023]
Abstract
INTRODUCTION As pharmacological treatment of hypertension has become a burden worldwide, the study looked into nonpharmacological ways of reducing blood pressure. The objective was to determine if music guided, slow and deep breathing will reduce the blood pressure among patients with hypertension in eight weeks. METHODS A participant blinded, multi-centre, randomised controlled trial was conducted in which the participants in the intervention group (IG) practiced deep breathing exercise guided by sound cues and those in the control group (CG) listened to the music. The primary end point was reduction in blood pressure at eight weeks. RESULTS 87 patients, 46 males and 41 females with mean age of 61.1 years were recruited and 93.1% of them successfully completed the study. There was significant reduction in systolic and diastolic Blood Pressure from baseline by 8 weeks in both groups. The reduction in Mean systolic blood pressure (SBP) in the control arm was 10.5mmHg compared to 8.3mmHg (p<0.001) in intervention group. Diastolic blood pressure (DBP) reduction in control and intervention groups were 5.2 mmHg (p<0.001) and 5.6 mmHg (p<0.001) respectively. The absolute difference in SBP reduction from baseline in IG & CG was -2.2 (95%CI: -7.8 to 3.5) and DBP was -0.4 (95%CI: -2.9 to 3.6). However, blood pressure reduction between the two groups was not significant. CONCLUSIONS Both listening to music and deep breathing exercise were associated with a clinically significant reduction in SBP and DBP. However, deep breathing exercise did not augment the benefit of music in reducing BP.
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Affiliation(s)
- F P Kow
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia.
| | - B Adlina
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
| | - S Sivasangari
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
| | - N Punithavathi
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
| | - K K Ng
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
| | - A H Ang
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
| | - L M Ong
- Hospital Pulau Pinang, Clinical Research Centre, Georgetown, Pulau Pinang, Malaysia
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Sanagapalli S, Ko Y, Kariyawasam V, Ng SC, Tang W, de Silva HJ, Chen M, Wu K, Aniwan S, Ng KK, Ong D, Ouyang Q, Hilmi I, Simadibrata M, Pisespongsa P, Gopikrishna S, Leong RW. The association between new generation oral contraceptive pill and the development of inflammatory bowel diseases. Intest Res 2018; 16:409-415. [PMID: 30090040 PMCID: PMC6077300 DOI: 10.5217/ir.2018.16.3.409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/22/2018] [Accepted: 02/28/2018] [Indexed: 02/06/2023] Open
Abstract
Background/Aims To examine the association between use of oral contraceptive pills (OCPs) and the risk of developing inflammatory bowel diseases (IBD), in a modern cohort. Methods A prospective nested case-control study across sites in the Asia-Pacific region was conducted; involving female IBD cases and asymptomatic controls. Subjects completed a questionnaire addressing questions related to OCP use. Primary outcome was the risk of development of IBD of those exposed to OCP versus non-exposure. Secondary outcomes were development of Crohn's disease (CD) versus ulcerative colitis (UC), and whether age of first use of OCP use may be associated with risk of IBD. Results Three hundred and forty-eight female IBD cases (41% CD, median age: 43 years) and 590 female age-matched controls were recruited. No significant association was found between OCP use and the risk of IBD (odds ratio [OR], 1.65; 95% confidence interval, 0.77-3.13; P=0.22), CD (OR, 1.55) or UC (OR, 1.01). The lack of association persisted when results were adjusted for age and smoking. IBD cases commenced OCP use at a younger age than controls (18 years vs. 20 years, P=0.049). Conclusions In this large cohort of subjects from the Asia-Pacific region, we found a modest but not significantly increased risk of developing IBD amongst OCP users.
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Affiliation(s)
- Santosh Sanagapalli
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord NSW, Australia
| | - Yanna Ko
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord NSW, Australia
| | - Viraj Kariyawasam
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord NSW, Australia
| | - Siew C Ng
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Whitney Tang
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | | | - Minhu Chen
- The First Affiliated Hospital of Sun Yat Sen University, Guangzhou, China
| | - Kaichun Wu
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | | | - Ka Kei Ng
- Hospital Conde S Januario, Macau, China
| | - David Ong
- National University Hospital of Singapore, Singapore
| | - Qin Ouyang
- West China Hospital, Sichuan University, Chengdu, China
| | - Ida Hilmi
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | | | - Saranya Gopikrishna
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord NSW, Australia
| | - Rupert W Leong
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord NSW, Australia
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Siu BWM, Au-Yeung CCY, Chan AWL, Chan LSY, Yuen KK, Leung HW, Yan CK, Ng KK, Lai ACH, Davies S, Collins M. Validation of the "Security Needs Assessment Profile" for measuring the profiles of security needs of Chinese forensic psychiatric inpatients. Int J Law Psychiatry 2017; 54:61-66. [PMID: 28528124 DOI: 10.1016/j.ijlp.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/13/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
Mapping forensic psychiatric services with the security needs of patients is a salient step in service planning, audit and review. A valid and reliable instrument for measuring the security needs of Chinese forensic psychiatric inpatients was not yet available. This study aimed to develop and validate the Chinese version of the Security Needs Assessment Profile for measuring the profiles of security needs of Chinese forensic psychiatric inpatients. The Security Needs Assessment Profile by Davis was translated into Chinese. Its face validity, content validity, construct validity and internal consistency reliability were assessed by measuring the security needs of 98 Chinese forensic psychiatric inpatients. Principal factor analysis for construct validity provided a six-factor security needs model explaining 68.7% of the variance. Based on the Cronbach's alpha coefficient, the internal consistency reliability was rated as acceptable for procedural security (0.73), and fair for both physical security (0.62) and relational security (0.58). A significant sex difference (p=0.002) in total security score was found. The Chinese version of the Security Needs Assessment Profile is a valid and reliable instrument for assessing the security needs of Chinese forensic psychiatric inpatients.
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Affiliation(s)
- B W M Siu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - C C Y Au-Yeung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - A W L Chan
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - L S Y Chan
- Department of Forensic Psychiatry & Old Age Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - K K Yuen
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - H W Leung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - C K Yan
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - K K Ng
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - A C H Lai
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - S Davies
- Nottinghamshire Healthcare NHS Trust, UK.
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Guo T, Ng KK, Chiang HW, Ma MF, Lin Y, Qian JM. Duodenal Neuroendocrine Carcinoma Presenting with Disseminated Liver and Bone Metastases as the Primary Manifestation: Case Report and Literature Review. Cell Biochem Biophys 2016; 72:305-9. [PMID: 25564359 DOI: 10.1007/s12013-014-0430-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Neuroendocrine tumors are composed by a heterogeneous group of tumors with a wide range of morphologic, functional, and behavioral characteristics. These tumors are generally slow growing and behave in an indolent fashion. However, they have the potential to spread, especially for poorly differentiated neuroendocrine carcinomas, and when they do, they can be very aggressive, with high propensity for distant metastases, and difficult to treat with current modalities. As poorly differentiated neuroendocrine carcinomas rarely occur in extrapulmonary sites, to the best of our knowledge, this is the first case report of a poorly differentiated duodenal neuroendocrine carcinoma with diffuse liver and bone metastases as the primary manifestation. Despite receiving a trial of chemotherapeutic regimen, the patient had progressive intrahepatic cholestasis and died of subacute hepatic failure.
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Affiliation(s)
- Tao Guo
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Ka Kei Ng
- Department of Gastroenterology, Centro Hospitalar Conde de S. Januario (CHCSJ), Macao, China
| | - Hoi Wan Chiang
- Department of Gastroenterology, Centro Hospitalar Conde de S. Januario (CHCSJ), Macao, China
| | - Man Fei Ma
- Department of Gastroenterology, Centro Hospitalar Conde de S. Januario (CHCSJ), Macao, China
| | - Yi Lin
- Department of Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jia Ming Qian
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Ng SC, Zeng Z, Niewiadomski O, Tang W, Bell S, Kamm MA, Hu P, de Silva HJ, Niriella MA, Udara WSAAY, Ong D, Ling KL, Ooi CJ, Hilmi I, Lee Goh K, Ouyang Q, Wang YF, Wu K, Wang X, Pisespongsa P, Manatsathit S, Aniwan S, Limsrivilai J, Gunawan J, Simadibrata M, Abdullah M, Tsang SWC, Lo FH, Hui AJ, Chow CM, Yu HH, Li MF, Ng KK, Ching JYL, Chan V, Wu JCY, Chan FKL, Chen M, Sung JJY. Early Course of Inflammatory Bowel Disease in a Population-Based Inception Cohort Study From 8 Countries in Asia and Australia. Gastroenterology 2016; 150:86-95.e3; quiz e13-4. [PMID: 26385074 DOI: 10.1053/j.gastro.2015.09.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/26/2015] [Accepted: 09/05/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS The incidence of inflammatory bowel disease (IBD) is increasing in Asia, but little is known about disease progression in this region. The Asia-Pacific Crohn's and Colitis Epidemiology Study was initiated in 2011, enrolling subjects from 8 countries in Asia (China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, and Thailand) and Australia. We present data from this ongoing study. METHODS We collected data on 413 patients diagnosed with IBD (222 with ulcerative colitis [UC], 181 with Crohn's disease [CD], 10 with IBD unclassified; median age, 37 y) from 2011 through 2013. We analyzed the disease course and severity and mortality. Risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. RESULTS The cumulative probability that CD would change from inflammatory to stricturing or penetrating disease was 19.6%. The cumulative probabilities for use of immunosuppressants or anti-tumor necrosis factor agents were 58.9% and 12.0% for patients with CD, and 12.7% and 0.9% for patients with UC, respectively. Perianal CD was associated with an increased risk of anti-tumor necrosis factor therapy within 1 year of its diagnosis (hazard ratio, 2.97; 95% confidence interval, 1.09-8.09). The cumulative probabilities for surgery 1 year after diagnosis were 9.1% for patients with CD and 0.9% for patients with UC. Patients with CD and penetrating disease had a 7-fold increase for risk of surgery, compared with patients with inflammatory disease (hazard ratio, 7.67; 95% confidence interval, 3.93-14.96). The overall mortality for patients with IBD was 0.7%. CONCLUSIONS In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia was comparable with that of the West. Patients with CD frequently progress to complicated disease and have accelerated use of immunosuppressants. Few patients with early stage UC undergo surgery in Asia. Increasing our understanding of IBD progression in different populations can help optimize therapy and improve outcomes.
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Affiliation(s)
- Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China.
| | - Zhirong Zeng
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ola Niewiadomski
- St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Whitney Tang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Sally Bell
- St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Michael A Kamm
- St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Pinjin Hu
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | | | | | - David Ong
- National University Hospital of Singapore, Singapore, Singapore
| | | | | | - Ida Hilmi
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Khean Lee Goh
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Qin Ouyang
- West China Hospital, Sichuan University, Chengdu, China
| | - Yu Fang Wang
- West China Hospital, Sichuan University, Chengdu, China
| | - Kaichun Wu
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Xin Wang
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | | | | | | | | | - Jeffri Gunawan
- Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital
| | | | - Murdani Abdullah
- Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital
| | | | - Fu Hang Lo
- North District Hospital, Hong Kong, China
| | - Aric J Hui
- Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Chung Mo Chow
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | | | | | - Ka Kei Ng
- Hospital Conde S Januario, Macau, China
| | - Jessica Y L Ching
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Victor Chan
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Francis K L Chan
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Minhu Chen
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
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9
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Ng SC, Tang W, Leong RW, Chen M, Ko Y, Studd C, Niewiadomski O, Bell S, Kamm MA, de Silva HJ, Kasturiratne A, Senanayake YU, Ooi CJ, Ling KL, Ong D, Goh KL, Hilmi I, Ouyang Q, Wang YF, Hu P, Zhu Z, Zeng Z, Wu K, Wang X, Xia B, Li J, Pisespongsa P, Manatsathit S, Aniwan S, Simadibrata M, Abdullah M, Tsang SWC, Wong TC, Hui AJ, Chow CM, Yu HH, Li MF, Ng KK, Ching J, Wu JCY, Chan FKL, Sung JJY. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut 2015; 64:1063-71. [PMID: 25217388 DOI: 10.1136/gutjnl-2014-307410] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 08/25/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The rising incidence of inflammatory bowel disease in Asia supports the importance of environmental risk factors in disease aetiology. This prospective population-based case-control study in Asia-Pacific examined risk factors prior to patients developing IBD. DESIGN 442 incident cases (186 Crohn's disease (CD); 256 UC; 374 Asians) diagnosed between 2011 and 2013 from eight countries in Asia and Australia and 940 controls (frequency-matched by sex, age and geographical location; 789 Asians) completed an environmental factor questionnaire at diagnosis. Unconditional logistic regression models were used to estimate adjusted ORs (aOR) and 95% CIs. RESULTS In multivariate model, being breast fed >12 months (aOR 0.10; 95% CI 0.04 to 0.30), antibiotic use (aOR 0.19; 0.07 to 0.52), having dogs (aOR 0.54; 0.35 to 0.83), daily tea consumption (aOR 0.62; 0.43 to 0.91) and daily physical activity (aOR 0.58; 0.35 to 0.96) decreased the odds for CD in Asians. In UC, being breast fed >12 months (aOR 0.16; 0.08 to 0.31), antibiotic use (aOR 0.48; 0.27 to 0.87), daily tea (aOR 0.63; 0.46 to 0.86) or coffee consumption (aOR 0.51; 0.36 to 0.72), presence of hot water tap (aOR 0.65; 0.46 to 0.91) and flush toilet in childhood (aOR 0.71; 0.51 to 0.98) were protective for UC development whereas ex-smoking (aOR 2.02; 1.22 to 3.35) increased the risk of UC. CONCLUSIONS This first population-based study of IBD risk factors in Asia-Pacific supports the importance of childhood immunological, hygiene and dietary factors in the development of IBD, suggesting that markers of altered intestinal microbiota may modulate risk of IBD later in life.
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Affiliation(s)
- Siew C Ng
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Whitney Tang
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Rupert W Leong
- Bankstown and Concord Hospitals, Sydney, New South Wales, Australia
| | - Minhu Chen
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Yanna Ko
- Bankstown and Concord Hospitals, Sydney, New South Wales, Australia
| | - Corrie Studd
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Ola Niewiadomski
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Sally Bell
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael A Kamm
- St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia Imperial College London, London, UK
| | - H J de Silva
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | | | | | | | - David Ong
- National University Hospital of Singapore, Singapore, Singapore
| | - Khean Lee Goh
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Ida Hilmi
- University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Qin Ouyang
- West China Hospital, Sichuan University, Chengdu, China
| | - Yu-Fang Wang
- West China Hospital, Sichuan University, Chengdu, China
| | - PinJin Hu
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Zhenhua Zhu
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Zhirong Zeng
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Kaichun Wu
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Xin Wang
- Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Bing Xia
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jin Li
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | | | | | | | | | | | | | | | - Aric J Hui
- Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - Chung Mo Chow
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Ka Kei Ng
- Hospital Conde S Januario, Macau, China
| | - Jessica Ching
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Francis K L Chan
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Hong Kong, China
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10
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Fury MG, Sherman EJ, Rao SS, Wolden S, Smith-Marrone S, Mueller B, Ng KK, Dutta PR, Gelblum DY, Lee JL, Shen R, Kurz S, Katabi N, Haque S, Lee NY, Pfister DG. Phase I study of weekly nab-paclitaxel + weekly cetuximab + intensity-modulated radiation therapy (IMRT) in patients with stage III-IVB head and neck squamous cell carcinoma (HNSCC). Ann Oncol 2014; 25:689-694. [PMID: 24496920 PMCID: PMC4433511 DOI: 10.1093/annonc/mdt579] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/27/2013] [Accepted: 12/10/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is a clinical need to improve the efficacy of standard cetuximab + concurrent intensity-modulated radiation therapy (IMRT) for patients with locally and/or regionally advanced HNSCC. Taxanes have radiosensitizing activity against HNSCC, and nab-paclitaxel may offer therapeutic advantage in comparison with other taxanes. PATIENTS AND METHODS This was a single-institution phase I study with a modified 3 + 3 design. Four dose levels (DLs) of weekly nab-paclitaxel were explored (30, 45, 60, and 80 mg/m(2)), given with standard weekly cetuximab (450 mg/m(2) loading dose followed by 250 mg/m(2) weekly) and concurrent IMRT (total dose, 70 Gy). RESULTS Twenty-five eligible patients (20 M, 5 F) enrolled, with median age 58 years (range, 46-84 years). Primary tumor sites were oropharynx, 19 (10 human papillomavirus [HPV] pos, 8 HPV neg, 1 not done); neck node with unknown primary, 2; larynx 2; and oral cavity and maxillary sinus, 1 each. Seven patients had received prior induction chemotherapy. Maximum tolerated dose (MTD) was exceeded at DL4 (nab-paclitaxel, 80 mg/m(2)) with three dose-limiting toxicities (DLTs) (grade 3 neuropathy, grade 3 dehydration, with grade 3 mucositis grade 3 anemia) among five assessable patients. There was only one DLT (grade 3 supraventricular tachycardia) among six patients at DL3 (nab-paclitaxel, 60 mg/m(2)), and this was deemed the MTD. Among 23 assessable patients, the most common ≥ g3 AEs were lymphopenia 100%, functional mucositis 65%, and pain in throat/oral cavity 52%. At a median follow-up of 33 months, 2-year failure-free survival (FFS) is 65% [95% confidence interval (CI) 42% to 81%] and 2-year overall survival (OS) is 91% (95% CI 69-97). CONCLUSION The recommended phase II dose for nab-paclitaxel is 60 mg/m(2) weekly when given standard weekly cetuximab and concurrent IMRT. This regimen merits further study as a nonplatinum alternative to IMRT + cetuximab alone. CLINICALTRIALSGOV ID NCT00736619.
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MESH Headings
- Aged
- Aged, 80 and over
- Albumins/adverse effects
- Albumins/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Phytogenic/adverse effects
- Antineoplastic Agents, Phytogenic/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/radiotherapy
- Cetuximab
- Chemoradiotherapy
- Combined Modality Therapy/adverse effects
- ErbB Receptors/antagonists & inhibitors
- Female
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/radiotherapy
- Humans
- Male
- Maximum Tolerated Dose
- Middle Aged
- Neoplasm Staging
- Paclitaxel/adverse effects
- Paclitaxel/therapeutic use
- Radiotherapy, Intensity-Modulated
- Squamous Cell Carcinoma of Head and Neck
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Affiliation(s)
| | | | | | | | | | - B Mueller
- Radiation Oncology, MSKCC Regional Network Affiliate, Sleepy Hollow
| | | | - P R Dutta
- Radiation Oncology, MSKCC Regional Network Affiliate, Rockville Center
| | | | - J L Lee
- Radiation Oncology, MSKCC Regional Network Affiliate, Commack, USA
| | - R Shen
- Epidemiology and Biostatistics
| | | | | | - S Haque
- Radiology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York
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11
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Ng SC, Tang W, Ching JY, Wong M, Chow CM, Hui AJ, Wong TC, Leung VK, Tsang SW, Yu HH, Li MF, Ng KK, Kamm MA, Studd C, Bell S, Leong R, de Silva HJ, Kasturiratne A, Mufeena MNF, Ling KL, Ooi CJ, Tan PS, Ong D, Goh KL, Hilmi I, Pisespongsa P, Manatsathit S, Rerknimitr R, Aniwan S, Wang YF, Ouyang Q, Zeng Z, Zhu Z, Chen MH, Hu PJ, Wu K, Wang X, Simadibrata M, Abdullah M, Wu JC, Sung JJY, Chan FKL. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study. Gastroenterology 2013; 145:158-165.e2. [PMID: 23583432 DOI: 10.1053/j.gastro.2013.04.007] [Citation(s) in RCA: 533] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/14/2013] [Accepted: 04/02/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. METHODS We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. RESULTS We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P < .001). CONCLUSIONS We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations.
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Affiliation(s)
- Siew C Ng
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Whitney Tang
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jessica Y Ching
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - May Wong
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Chung Mo Chow
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | - A J Hui
- Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - T C Wong
- North District Hospital, Hong Kong, China
| | | | | | | | | | - Ka Kei Ng
- Hospital Conde S Januario, Macau, China
| | - Michael A Kamm
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | - Corrie Studd
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | - Sally Bell
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | - Rupert Leong
- Bankstown and Concord Hospitals, Sydney, Australia
| | | | | | - M N F Mufeena
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | | | - Poh Seng Tan
- National University Hospital of Singapore, Singapore
| | - David Ong
- National University Hospital of Singapore, Singapore
| | - Khean L Goh
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ida Hilmi
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | | | - Yu Fang Wang
- West China Hospital, Sichuan University, Chengdu, China
| | - Qin Ouyang
- West China Hospital, Sichuan University, Chengdu, China
| | - Zhirong Zeng
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Zhenhua Zhu
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Min Hu Chen
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Pin Jin Hu
- The First Affiliated Hospital of San Yat Sen University, Guangzhou, China
| | - Kaichun Wu
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Shaanxi, China
| | - Xin Wang
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Shaanxi, China
| | | | | | - Justin Cy Wu
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Francis K L Chan
- Institute of Digestive Disease, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
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12
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Low WHH, Seet W, A S R, Ng KK, H J, Dan SP, Teng CL, Lee VKM, Chua SS, M Y FA, T K, Chee WSS, Goh PP, M Z, Lim TO. Community-based cardiovascular Risk Factors Intervention Strategies (CORFIS) in managing hypertension: A pragmatic non-randomised controlled trial. Med J Malaysia 2013; 68:129-135. [PMID: 23629558] [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: 06/02/2023]
Abstract
BACKGROUND Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evaluate the effectiveness of a Community-Based Cardiovascular Risk Factors Intervention Strategies (CORFIS) in the management of hypertension in primary care. METHODS This is a pragmatic, non-randomized controlled trial. Seventy general practitioners (GPs) were selected to provide either CORFIS (44 GPs) or conventional care (26 GPs) for 6 months. A total of 486 hypertensive patients were recruited; 309 were in the intervention and 177 in the control groups. Primary outcome was the proportion of hypertensive patients who achieved target blood pressure (BP) of <140/90mmHg (for those without diabetes mellitus) and <130/80mmHg (with diabetes mellitus). Secondary outcomes include change in the mean/median BP at 6-month as compared to baseline. RESULTS The proportion of hypertensive patients who achieved target BP at 6-month was significantly higher in the CORFIS arm (69.6%) as compared to the control arm (57.6%), P=0.008. Amongst those who had uncontrolled BP at baseline, the proportion who achieved target BP at 6-month was also significantly higher in the CORFIS arm (56.6%) as compared to the control arm (34.1%), p<0.001. There was no difference in the patients who had already achieved BP control at baseline. There were significant reductions in SBP in the CORFIS arm (median -9.0mmHg; -60 to 50) versus control (median -2mmHg; -50 to 48), p=0.003; as well as in DBP (CORFIS arm: median -6.0mmHg; ranged from -53 to 30 versus control arm: median 0.0mmHg; ranged from -42 to 30), p<0.001. CONCLUSIONS Patients who received CORFIS care demonstrated significant improvements in achieving target BP.
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Affiliation(s)
- W H H Low
- Clinical Research Center, Clinical Epidemiology Unit, 1st Floor MMA House, 124, Jalan Pahang, Kuala Lumpur 53000 Malaysia.
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13
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Chen CY, Chang HP, Ng KK, Wang CC, Lai CH, Chao A. Long-term disease-free survival in three ovarian cancer patients with a single relapse. EUR J GYNAECOL ONCOL 2012; 33:321-3. [PMID: 22873111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Recurrent ovarian cancer with long-term survival is uncommon and often associated with poor prognosis. We report three cases of patients with advanced ovarian cancer who have achieved long-term disease-free survival following a single prior relapse. Case 1 relapsed with a localized bulky tumor and received a complete surgical resection and chemotherapy. Case 2 had a persistent central pelvic tumor after debulking surgery and second-line chemotherapy, and yet achieved excellent control with concurrent chemoradiation to the true pelvis. Case 3 relapsed with paraaortic lymph node metastasis and probable lung metastasis (subsequently negated by positron emission tomography) and received chemotherapy alone. These three patients have since remained disease-free for 13, 12, and seven years, respectively, since their first relapse. We conclude that select patients can obtain long-term disease-free survival after the first relapse by accurate restaging and aggressive multimodality treatment.
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Affiliation(s)
- C Y Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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14
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Tam TKW, Ng KK, Lau CM, Lai TC, Lai WY, Tsang LCY. Faecal occult blood screening: knowledge, attitudes, and practice in four Hong Kong primary care clinics. Hong Kong Med J 2011; 17:350-357. [PMID: 21979470] [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: 05/31/2023] Open
Abstract
OBJECTIVES. To assess primary care patients for their awareness, knowledge, and attitude towards colorectal cancer and screening, to report on the uptake of faecal occult blood test screening and the results of screening, and explore predictors of screening uptake. DESIGN. Cross-sectional study. SETTING. Four primary care clinics in Hong Kong. PATIENTS. A total of 1664 patients aged 50 to 74 years attending the clinics in the period July 2006 to July 2007. MAIN OUTCOME MEASURES. Percentage of subjects who were aware that colorectal cancer is common and curable at an early stage, and who knew that faecal occult blood test or colonoscopy is useful for screening; relevant knowledge score; uptake rate of faecal occult blood testing; rate of testing positive; and factors predicting uptake. RESULTS. A total of 1645 questionnaires were collected. In all, 89% (95% confidence interval, 88-91%) were aware that colorectal cancer is common, 95% (94-96%) believed faecal occult blood test and colonoscopy are useful for screening, and 58% (56-61%) achieved a knowledge score of 50% or above. The uptake rate of the faecal occult blood test was 35%. Uptake was higher among those with a positive family history (odds ratio=1.57; 95% confidence interval, 1.08-2.27; P=0.02), those who were more aware that colorectal cancer is common (1.86; 1.29-2.69; P=0.001), and that colorectal cancer is potentially curable at an early stage (1.76; 1.32-2.36; P=0.0001). Rate of testing positive was 2.1% (95% confidence interval, 0.9-3.3%); no colorectal cancer was detected and the neoplasia detection rate (for cancers and adenomas) was 5.1 per 1000 subjects screened. CONCLUSIONS. Patients were aware that colorectal cancer is common in our community, and faecal occult blood test or colonoscopy is useful for screening. The uptake of screening was low, though relatively higher for those with a positive family history and greater awareness of the high frequency and potential for cure of colorectal cancer. Faecal occult blood test positivity rate was 2.1%, and neoplasia detection rate 5.1 per 1000 screened.
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Affiliation(s)
- Tammy K W Tam
- Primary Care Research Team, Professional Development and Quality Assurance, Department of Health, Hong Kong.
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15
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Poh BK, Mancer K, Goh D, Lim T, Ng V, Ng KK, Ng FC. PlasmaKinetic™ (bipolar) transurethral resection of prostate: a prospective trial to study pathological artefacts, surgical parameters and clinical outcomes. Singapore Med J 2011; 52:336-339. [PMID: 21633766] [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: 05/30/2023]
Abstract
INTRODUCTION The aims of the study were to compare the degree of cautery artefacts in prostatic chips between monopolar and PlasmaKinetic™ transurethral resection of prostate (TURP), and to determine if there is any difference in the intraoperative and post surgical parameters between them. METHODS After institutional review board approval, patients were prospectively enrolled to undergo PlasmaKinetic™ TURP. Their parameters were compared with those of the historical monopolar TURP controls. All histological specimens were reviewed by a single senior pathologist. RESULTS 46 patients were recruited to undergo PlasmaKinetic™ TURP. The resection time was significantly longer for the bipolar group compared to the monopolar group (50.2 versus 36.7 min, p-value is 0.001). The speed of resection (resection weight/time) was lower for the bipolar group (0.45 versus 0.56 g/min, p-value is 0.017). More irrigant was used for the bipolar group (21.2 versus 15.6 litres, p-value is 0.001) intraoperatively. There was no statistically significant difference in terms of intraoperative drop in haemoglobin and serum sodium change between the two groups. There seems to be a lesser degree of cautery artefacts in the PlasmaKinetic™ group than the monopolar group (42.17 versus 45.07 microns); however, this was not statistically significant (p-value is 0.452). CONCLUSION Bipolar TURP seems to result in a lesser degree of cautery artefacts when compared to conventional monopolar TURP, albeit statistically insignificant, compared to monopolar TURP. TURP also resulted in a longer resection time and increased irrigant use, but no difference in blood loss and serum sodium levels.
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Affiliation(s)
- B K Poh
- Department of Urology, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
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Chan CYZ, Lam CH, Lam DY, Lee LY, Ng KK, Wong ML. A qualitative study on HPV vaccination from a nursing perspective in Hong Kong. Asian Pac J Cancer Prev 2011; 12:2539-2545. [PMID: 22320952] [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: 05/31/2023] Open
Abstract
OBJECTIVE To identify the perception on human papillomavirus (HPV) vaccination among female nursing students in Hong Kong. DATA SOURCES Data were collected through focus group discussions and semi-structured in-depth interviews. All participants (n=28) were female nursing students of a university in Hong Kong. Tape recordings of individual interviews and focus group discussions were transcribed verbatim in Chinese, translated into English, and analyzed according to Colaizzi's phenomenological analysis. STUDY DESIGN Four major themes emerged from the data: nursing students' understanding about HPV vaccine, nursing students' attitude on HPV vaccine, nursing students' perspective on HPV vaccination promotion, and nursing role on HPV vaccination. CONCLUSIONS Government should take initiative in promotion with vaccine suppliers. The awareness and knowledge of HPV and HPV vaccination among women should be increased in order to raise the positive attitude of women towards HPV vaccination and prevention of cervical cancer. Health professionals should work together on HPV promotion among women and increase the HPV vaccination rates. Moreover, further studies regarding attitude and awareness of HPV vaccination among women in different age groups are needed in order to identify more associated factors affecting their perceptions towards HPV vaccination.
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Affiliation(s)
- C Y Z Chan
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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17
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Chok KS, Ng KK, Poon RT, Lo CM, Fan ST. Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg 2009; 96:81-7. [PMID: 19065644 DOI: 10.1002/bjs.6358] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this retrospective study was to determine the impact of postoperative complications on the long-term outcome of curative liver resection for hepatocellular carcinoma (HCC). METHODS A total of 863 patients who had curative resection of HCC from December 1989 to December 2004 were included in the analysis. Median follow-up was 35.6 months. RESULTS Some 288 patients (33.4 per cent) developed postoperative complications. The hospital mortality rate was 5.3 per cent (46 patients). Multiple logistic regression analysis showed that older age and massive intraoperative blood loss were related to a significantly higher complication rate. Demographics of patients with and without postoperative complications were comparable. The former had significantly more blood loss (median 1.1 versus 0.7 litres; P < 0.001) and required more transfused blood (P < 0.001). The overall survival rates of patients without complications at 1, 3, 5 and 10 years were 83.6, 62.8, 51.5 and 32.1 per cent respectively. Corresponding rates for those with complications were 67.8, 52.4, 41.5 and 26.6 per cent (P = 0.004). Cox proportional hazard model analysis revealed that the presence of postoperative complications was independently associated with poor overall survival. CONCLUSION Postoperative complications can affect overall long-term survival after resection of HCC.
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Affiliation(s)
- K S Chok
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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Ng KK, Poon RT, Lam CM, Yuen J, Tso WK, Fan ST. Efficacy and safety of radiofrequency ablation for perivascular hepatocellular carcinoma without hepatic inflow occlusion. Br J Surg 2006; 93:440-7. [PMID: 16470712 DOI: 10.1002/bjs.5267] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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: 12/13/2022]
Abstract
BACKGROUND The role of radiofrequency ablation (RFA) for perivascular (up to 5 mm from the major intrahepatic portal vein or hepatic vein branches) hepatocellular carcinoma (HCC) is unclear because of possible incomplete tumour ablation and potential vascular damage. This study aimed to evaluate the safety and efficacy of RFA for perivascular HCC without hepatic inflow occlusion. METHODS Between May 2001 and November 2003, RFA using an internally cooled electrode was performed on 52 patients with perivascular HCC (group 1) through open (n = 39), percutaneous (n = 9), laparoscopic (n = 2) and thoracoscopic (n = 2) approaches. Hepatic inflow occlusion was not applied during the ablation procedure. The perioperative and postoperative outcomes were compared with those of 90 patients with non-perivascular HCC (group 2) treated by RFA during the same period. RESULTS The morbidity rate was similar between groups 1 and 2 (25 versus 28 per cent; P = 0.844). One patient in group 1 (2 per cent) and two in group 2 (2 per cent) had developed thrombosis of major intrahepatic blood vessels on follow-up computed tomography scan. There were no significant differences between groups 1 and 2 in mortality rate (2 versus 0 per cent; P = 0.366), complete ablation rate for small HCC (92 versus 98 per cent; P = 0.197), local recurrence rate (11 versus 9 per cent; P = 0.762) and overall survival (1-year: 86 versus 87 per cent; 2-year: 75 versus 75 per cent; P = 0.741). CONCLUSION RFA without hepatic inflow occlusion is a safe and effective treatment for perivascular HCC.
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Affiliation(s)
- K K Ng
- Centre for the Study of Liver Disease, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China.
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Tam TKW, Lau CM, Tsang LCY, Ng KK, Ho KS, Lai TC. Epidemiological study of diabetic retinopathy in a primary care setting in Hong Kong. Hong Kong Med J 2005; 11:438-44. [PMID: 16340019] [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: 05/05/2023] Open
Abstract
OBJECTIVES To estimate the prevalence and risk factors of diabetic retinopathy in type 2 diabetic patients, and to investigate the difference in retinopathy progression in patients with normal fundi or established retinopathy at baseline and the risk factors implicated in the progression. DESIGN Retrospective community-based study. SETTING Ten primary care clinics in Hong Kong. PATIENTS Type 2 diabetic patients; subsidiary analysis included subjects with more than one screening event. MAIN OUTCOME MEASURES Patient demographics, baseline prevalence, and risk factors of diabetic retinopathy; progression of retinopathy in patients with normal fundi and established retinopathy at baseline, and the associated risk factors. RESULTS A total of 6165 patients were recruited from January 1998 to May 2004. Primary analysis included 4423 patients with good-quality retinal photographs. The mean age of the patients was 60.36 years (standard deviation, 10.80 years; range, 28-94 years), the mean duration of diabetes was 4.71 years (standard deviation, 4.67 years; range, 0.1-40.6 years), and the mean level of glycated haemoglobin was 7.47% (standard deviation, 1.44%). The prevalence of retinopathy at baseline was 28.4%. Subsidiary analysis showed progression to sight-threatening retinopathy was more common in the group with baseline retinopathy than that without (7.9% vs 0.7%), and occurred at a faster rate (mean, 1.5 [range, 0.5-3.0] vs 2.0 [1.0-4.2] years). Logistic regression revealed that the level of glycated haemoglobin was positively associated with both the onset (P<0.001) and progression of retinopathy (P=0.03). CONCLUSION Optimal glycaemic control is important for reducing sight-threatening retinopathy. Close observation is required for patients with established retinopathy as progression occurs more rapidly.
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Affiliation(s)
- T K W Tam
- Professional Development and Quality Assurance, Department of Health, 2/F Ngautaukok Jockey Club Clinic, 60 Ting On Street, Hong Kong.
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Ng KK, Fan ST. General surgery review. M. A. Makary (ed.). 209 × 278 mm. Pp. 386. 2004. Ladner-Drysdale: Washington, DC. $74.95. Br J Surg 2005. [DOI: 10.1002/bjs.5072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- K K Ng
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - S T Fan
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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Chen MY, Ng KK, Ma SY, Wu TI, Chang TC, Lai CH. False-positive fluorine-18 fluorodeoxy-D-glucose positron emission tomography imaging caused by retained gauze in a woman with recurrent ovarian cancer: a case report. EUR J GYNAECOL ONCOL 2005; 26:451-3. [PMID: 16122202] [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: 05/04/2023]
Abstract
We report a case of a 47-year-old woman with a false-positive [18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) result caused by retained gauze during resection of liver metastasis for a Stage IV ovarian cancer at primary cytoreductive surgery. She achieved complete remission and remained free of progression for seven years. Owing to elevation of CA-125, computed tomography and PET studies were performed, and both showed two potentially resectable lesions. One was located ventral to the diaphragmatic surface of the left hepatic lobe and the other was around the gauze at the right hepatorenal fossa. During surgical intervention, the left supraheptic tumor was excised and the gauze with surrounding granulation was removed. However, the former proved to be recurrent ovarian cancer with the latter proven false-positive. This case demonstrates that PET results should be interpreted with caution in differentiating a benign inflammatory process from malignant abnormalities, especially in regions with a high probability of granulomatous lesions.
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Affiliation(s)
- M Y Chen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Abstract
Combined hepatocellular-cholangiocarcinoma (HCC-CC) is a rare primary liver tumour. We report a carrier of both HBV and HCV presenting with intermittent abdominal pain, fever, chillness and elevated á-fetoprotein (AFP) of 1197 ng/ml. Computed tomography showed an irregular hypodense mass in the left lateral segment of the liver with vague contrast enhancement and multiple regional lymphadenopathy. Hepatic angiogram showed that the mass was hypovascular and the left portal vein was occluded with a tapered end. Percutaneous ultrasound-guided core needle biopsy of the liver yielded HCC-CC. We suggest that HCC-CC should be considered in hypovascular liver tumours with striking elevation of serum AFP and multiple regional lymphadenopathy.
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Affiliation(s)
- C H Toh
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
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Tam TKW, Cheng LPK, Lau DMW, Lai TC, Lai WY, Ng KK, Ng MY, Kong CW, Tsang LCY. The prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting: cross-sectional study. Hong Kong Med J 2004; 10:307-11. [PMID: 15479958] [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: 04/30/2023] Open
Abstract
OBJECTIVES To determine the prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting, and to study the association between various risk factors and the presence of microalbuminuria. DESIGN Cross-sectional community-based study. SETTING Four primary care clinics, Hong Kong. PATIENTS All patients with type II diabetes mellitus who regularly attended the clinics between May 2002 and March 2003. MAIN OUTCOME MEASURES Patients' demographic data, the proportion with microalbuminuria (measured using a spot urine test), and the association between this condition and risk factors for diabetic nephropathy (via correlation and multivariable logistic regression analysis). RESULTS The mean age of the 1161 patients in the sample population was 58.0 years. The mean duration of diabetes mellitus was 5.7 years, and the mean level of glycated haemoglobin was 7.4%. A total of 13.4% of the patients had microalbuminuria. Having the condition was significantly associated with advanced age, female sex, poor glycaemic control, and coexisting hypertension in both correlation and regression analyses. No significant association with ever smoking was found. CONCLUSION Early screening for incipient diabetic nephropathy and aggressive management of modifiable risk factors in a primary care setting may be important in optimising the renal outcome of patients with type II diabetes mellitus.
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Affiliation(s)
- T K W Tam
- Professional Development and Quality Assurance, Department of Health, 2/F Ngautaukok Jockey Club Clinic, 60 Ting On Street, Ngautaukok, Hong Kong.
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Abstract
BACKGROUND Declining fertility of couples from the fourth decade of life is largely attributable to the drop in female fertility. However, increasing numbers of men, whose fertility theoretically lasts until death, are seeking fertility treatment at older ages, yet there is little information on sperm production and function past the age of 50 years. The few studies of such older men have examined men attending fertility clinics, and therefore willing to provide semen samples, but the participation bias of such recruitment hinders extrapolation to the unselected general male population. METHODS We have taken the opportunity to study a convenience sample of 55 healthy, non-infertile men ranging in age from 52 to 79 years old who provided semen samples as part of a prostate cancer screening project. They were compared with a control group (n = 409) of younger (< 52 years) men from among 567 volunteers screened as potential sperm donors for an artificial insemination program. RESULTS Older men had lower semen volume (mean semen volume 1.8 versus 3.2 ml; P < 0.0001) and total sperm output (median 74 versus 206 million sperm per ejaculate; P < 0.0001), whereas sperm density (median 64 versus 73 million sperm/ml; P = 0.12) was non-significantly decreased. Older men had more abnormal sperm morphology with decreasing numbers of normal forms (mean 14% versus 25%; P < 0.0001) and reduced vitality (mean 51% versus 80%; P < 0.0001), as well as increased numbers of cytoplasmic droplets (median 1 versus 0; P < 0.0001) and sperm tail abnormalities (30% versus 17%; P < 0.0001). Sperm head or neck abnormalities were no different between the groups. CONCLUSIONS While neither study group may be representative of the general male population, these findings suggest that sperm production, reflected in sperm output but not sperm density, as well as sperm morphology and viability are diminished in this population of healthy, non-infertile older men.
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Affiliation(s)
- K K Ng
- Department of Urology, Concord Hospital, Sydney NSW 2139, Australia
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Wan YL, Ko SF, Ng KK, Cheung YC, Lui KW, Wong HF. Role of CT-guided core needle biopsy in the diagnosis of a gossypiboma: case report. ACTA ACUST UNITED AC 2004; 29:713-5. [PMID: 15185035 DOI: 10.1007/s00261-004-0172-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 11/28/2003] [Accepted: 01/07/2004] [Indexed: 10/26/2022]
Abstract
A 66-year-old woman with previous hysterectomy had dysuria and vaginal spotting for 1 month. Computed tomography showed a heterogeneous presacral mass with eccentric calcification. Biopsies of the bladder and vagina and transrectal biopsy of the pelvic mass yielded only inflammation. T2-weighted magnetic resonance images revealed a heterogeneous mass with wavy hypointensities. Computed tomographically guided biopsy targeting at the calcified area disclosed thread-like materials, thus confirming the diagnosis of gossypiboma.
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Affiliation(s)
- Y L Wan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Linkou, School of Medicine, Chang Gung University, 5 Fusing Road, Taoyuan Hsien, Taiwan, Republic of China.
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Fong YK, Ho SH, Peh OH, Ng FC, Lim PHC, Quek PLC, Ng KK. Extracorporeal shockwave lithotripsy and intracorporeal lithotripsy for proximal ureteric calculi--a comparative assessment of efficacy and safety. Ann Acad Med Singap 2004; 33:80-3. [PMID: 15008569] [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 Extracorporeal shockwave lithotripsy (ESWL) is the treatment modality of choice of many urologists for proximal ureteric calculi. In this study, we compared the efficacy and safety of ESWL versus ureteroscopy with holmium laser lithotripsy for the treatment of this group of stones. MATERIALS AND METHODS Between May 1999 and October 2000, 50 patients had ESWL and another 51 patients underwent ureteroscopy with holmium laser lithotripsy for proximal ureteric calculi. The two groups were similar in age, sex ratio and stone size. ESWL was performed with the Dornier Compact lithotriptor whereas holmium laser lithotripsy was performed via retrograde ureteric access with a Wolf 7.5 Fr semirigid ureteroscope. RESULTS Ureteroscopy with holmium laser lithotripsy was significantly better in terms of the mean procedure time (56 min in ESWL; 25 min in ureteroscopy; P < 0.001) and the 1-month stone free rate (50% in ESWL; 80% in ureteroscopy; P = 0.001). The 3-month stone free rate was also higher for ureteroscopy (78% in ESWL; 90% in ureteroscopy) but this difference was not statistically significant (P = 0.09). Minor complications of steinstrasse (6%) occurred in ESWL and proximal stone migration (8%) occurred during ureteroscopy. CONCLUSION Ureteroscopy with holmium laser lithotripsy is a viable and safe alternative to ESWL for the management of proximal ureteric calculi.
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Affiliation(s)
- Y K Fong
- Department of Urology, Changi General Hospital, Singapore.
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Abstract
BACKGROUND The purpose of this study was to investigate the regenerative potential of hyaline cartilage in a neocartilage graft implant with the aid of MR cartilage imaging using a rabbit model. METHODS Surgical osteochondral defects were created in the femoral condyles of 30 mature New Zealand rabbits. The findings of neocartilage in autologous cartilage grafts packed into osteochondral defects were compared with control group of no implant to the osteochondral defect. The outcome of the implantations was correlated with histologic and MR cartilage imaging findings over a 3-month interval. RESULTS Neocartilage grafts packed into osteochondral defects showed regeneration of hyaline cartilage at the outer layer of the implant using MR cartilage imaging. Fibrosis of fibrocartilage developed at the outer layer of the autologous cartilage graft together with an inflammatory reaction within the osteochondral defect. CONCLUSION This animal study provides evidence of the regenerative ability of hyaline cartilage in neocartilage transplants to repair articular cartilage.
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Affiliation(s)
- C F Tan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Linkou Medical Center, 5 Fu Hsing Street, Kwei Shen, Tauyuan, Taiwan ROC.
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Ng KK, Lam CM, Poon RT, Law WL, Seto CL, Fan ST. Radiofrequency ablation as a salvage procedure for ruptured hepatocellular carcinoma. Hepatogastroenterology 2003; 50:1641-3. [PMID: 14571805] [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: 04/27/2023]
Abstract
Spontaneous rupture of hepatocellular carcinoma is a distinct presentation causing acute abdomen. Different treatment approaches have been advocated including emergency hepatectomy, initial hemostasis by hepatic artery ligation or transarterial embolization and second-stage hepatectomy. Unrecognized ruptured hepatocellular carcinoma during laparotomy is often encountered in countries where the incidence of hepatocellular carcinoma is low. Radiofrequency ablation is a new localized thermal ablative technique for the treatment of unresectable hepatic tumors including hepatocellular carcinoma. We report a case where radiofrequency ablation was used as a salvage procedure for ruptured hepatocellular carcinoma during emergency laparotomy.
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Affiliation(s)
- K K Ng
- Department of Surgery, Centre for the Study of Liver Disease, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
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Ng KK, Cheng YF, Lui KW, Wan YL, Wai YY, Tan CF, Cheung YC, Chen YM. Application of GD-enhanced renal allograft MR angiography for evaluation of posttransplantation complications. Transplant Proc 2003; 35:307-8. [PMID: 12591414 DOI: 10.1016/s0041-1345(02)03963-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- K K Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taipei, Taiwan
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Ng KK, Lim HCP, Ng FC, Li MK, Consigliere D, Chia SJ, Moorthy P, Munisamy M. The use of sildenafil in patients with erectile dysfunction in relation to diabetes mellitus--a study of 1,511 patients. Singapore Med J 2002; 43:387-90. [PMID: 12507022] [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: 02/28/2023]
Abstract
Erectile dysfunction (ED) seriously impairs the quality of life. Patients with diabetes mellitus (DM) are prone to ED due to various factors, including vasculopathy, neuropathy and sex hormone abnormalities. This is a retrospective study involving 1,511 patients taking sildenafil. Patients with DM have significantly more comorbidities like hypertension and ischaemic heart disease. They are also more likely to be on medications which may affect erectile function, including various antihypertensive drugs. 77.9% of patients with DM reported success with sildenafil, as compared to 86.5% of patients without DM. A significant number of patients with DM require a higher dose of sildenafil as compared to those without DM.
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Affiliation(s)
- K K Ng
- Department of Urology, Changi General Hospital, Singapore 529889.
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Teh HS, Lin MBK, Tsou IYY, Khoo TK, Lim PHC, Ng FC, Chin CM, Peh SOH, Ho SH, Ng KK, Fong YK. Penile colour duplex ultrasonography as a screening tool for venogenic erectile dysfunction. Ann Acad Med Singap 2002; 31:165-9. [PMID: 11957552] [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: 02/24/2023]
Abstract
INTRODUCTION Vasculogenic impotence is one of the major causes of erectile dysfunction. Cavernosometry and cavernosography is traditionally the gold standard for evaluation of venogenic impotence. However, it is invasive and there are potentially significant complications. Penile colour flow Doppler imaging (PCDI) is non-invasive and can be used to assess venous incompetence. MATERIALS AND METHODS One hundred and sixty-eight patients were referred for PCDI assessment from March 1998 to February 2001. Forty-three of these also had cavernosogram and cavernosometry done and were included in the study. RESULTS The sensitivity was 93.9%, the specificity was 90.0%, the accuracy was 93.0% with a negative predictive value of 81.8% and a positive predictive value of 96.9%. Kappa value of 0.81 was obtained, indicating excellent agreement between PCDI and cavernosogram and cavernometry. CONCLUSIONS Penile colour flow Doppler imaging is accurate in the assessment of venogenic erectile dysfunction. It can replace cavernometry and cavernosogram as a screening tool. Cavernometry and cavernosogram should only be done in cases when PCDI suggests venogenic impotence, and when surgery is contemplated.
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Affiliation(s)
- H S Teh
- Department of Radiology, Changi General Hospital, 2, Simei Street 3, Singapore 529889.
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Abstract
The 1.8 A crystal structure of 7-hydroxycoumarin (7-HC) bound to chymotrypsin reveals that this inhibitor forms a planar cinnamate acyl-enzyme complex. The phenyl ring of the bound inhibitor forms numerous van der Waals contacts in the S1 pocket of the enzyme, with the p-hydroxyl group donating a hydrogen bond to the main-chain oxygen atom of Ser217, and the o-hydroxyl group forming a water-mediated hydrogen bond with the carbonyl oxygen of Val227. The structure of the acyl-enzyme complex suggests that the mechanism of inhibition of 7-HC involves nucleophilic attack by the Ser195 O(gamma) atom on the carbonyl carbon atom of the inhibitor, accompanied by the breaking of the 2-pyrone ring of the inhibitor, and leading to the formation of a cinnamate acyl-enzyme derivative via a tetrahedral transition state. Comparisons with structures of photoreversible cinnamates bound to chymotrypsin reveal that although 7-HC interacts with the enzyme in a similar fashion, the binding of 7-HC to chymotrypsin takes place in a productive conformation in contrast to the photoreversible cinnamates. In summary, the 7-HC-chymotrypsin complex provides basic insight into the inhibition of chymotrypsin by natural coumarins and provides a structural basis for the design of more potent mechanism-based inhibitors against a wide range of biologically important chymotrypsin-like enzymes.
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Affiliation(s)
- U Ghani
- International Centre for Chemical Sciences, H. E. J. Research Institute of Chemistry, University of Karachi, Karachi, 75270, Pakistan
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Tan CF, Yen PS, Wong HF, Ng KK, Wan YL. The value of dynamic enhanced MRI in the early diagnosis of hip pain in patients having received marrow transplantation. Transplant Proc 2001; 33:3670-1. [PMID: 11750561 DOI: 10.1016/s0041-1345(01)02582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- C F Tan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital & Chang Gung University, Taoyuan, Taiwan.
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Sim S, Rosenzweig KE, Schindelheim R, Ng KK, Leibel SA. Induction chemotherapy plus three-dimensional conformal radiation therapy in the definitive treatment of locally advanced non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2001; 51:660-5. [PMID: 11597806 DOI: 10.1016/s0360-3016(01)01666-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate our institution's experience using chemotherapy in conjunction with three-dimensional conformal radiation therapy (3D-CRT). METHODS AND MATERIALS From 1991 to 1998, 152 patients with Stage III non-small-cell lung cancer (NSCLC) were treated with 3D-CRT at Memorial Sloan-Kettering Cancer Center. A total of 137 patients (90%) were surgically staged with either thoracotomy or mediastinoscopy. The remainder were staged radiographically. Seventy patients were treated with radiation therapy alone, and 82 patients received induction chemotherapy before radiation. The majority of chemotherapy-treated patients received a platinum-containing regimen. Radiation was delivered with a 3D conformal technique using CT-based treatment planning. The median dose in the radiation alone group was 70.2 Gy, while in the combined modality group, it was 64.8 Gy. RESULTS The median follow-up time was 30.5 months among survivors. Stage IIIB disease was present in 36 patients (51%) in the radiation-alone group and 57 patients (70%) in the combined-modality group. Thirty-nine patients had poor prognostic factors (KPS < 70 or weight loss > 5%), and they were equally distributed between the two groups. The median survival times for the radiation-alone and the combined-modality groups were 11.7 months and 18.1 months, respectively (p = 0.001). The 2-year rates of local control in the radiation-alone and combined-modality groups were 35.4% and 43.1%, respectively (p = 0.1). Grade 3 or worse nonhematologic toxicity occurred in 20% of the patients receiving radiation alone and in 16% of those receiving chemotherapy and radiation. Overall, there were only 4 cases of Grade 3 or worse esophagitis. CONCLUSION Despite more Stage IIIB patients in the combined-modality group, the addition of chemotherapy to 3D-CRT produced a survival advantage over 3D-CRT alone in Stage III NSCLC without a concomitant increase in toxicity. Chemotherapy thus appears to be beneficial, even in patients who are receiving higher doses of radiation therapy than are typically given with conventional techniques. Because locoregional failure remains a major challenge in patients with advanced disease, 3D-CRT in conjunction with chemotherapy may allow safe treatment to the dose levels required to further enhance local control.
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Affiliation(s)
- S Sim
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Affiliation(s)
- T F Tong
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China
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Chou HH, Wang CC, Lai CH, Hong JH, Ng KK, Chang TC, Tseng CJ, Tsai CS, Chang JT. Isolated paraaortic lymph node recurrence after definitive irradiation for cervical carcinoma. Int J Radiat Oncol Biol Phys 2001; 51:442-8. [PMID: 11567819 DOI: 10.1016/s0360-3016(01)01628-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [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: 11/24/2022]
Abstract
PURPOSE To evaluate the clinical features of isolated paraaortic lymph node (PALN) recurrence after definitive radiotherapy, and analyze the prognostic factors and effect of salvage treatment. METHODS AND MATERIALS Of a total 876 patients who received pelvic radiotherapy after the diagnosis of primary cervical carcinoma, 26 were found to have isolated PALN recurrence as the first recurrent site, and these patients enrolled in this study. Only those with primary-site carcinoma controlled and who were free of other distant metastases were eligible. Nineteen of the 26 patients accepted salvage therapy. Fourteen patients accepted concurrent chemoradiation (CCRT), 1 accepted radiation to the paraaortic region, and 4 accepted chemotherapy alone. Clinical parameters evaluated included tumor markers (SCC and CEA) and image studies. RESULTS Seven of the 26 patients were alive and disease-free. All 7 survivors had salvage treatment with radiation to the paraaortic region and concurrent cisplatin-based chemotherapy. None of the patients receiving chemotherapy or radiation alone enjoyed long-term, disease-free survival. The 5-year survival rate for isolated PALN recurrence of the 14 patients who accepted salvage concurrent chemoradiation (CCRT) was 51.2%. The presence of a clinical symptom at the time of PALN recurrence was analyzed. Seven of the 12 asymptomatic patients and none of the 14 symptomatic patients survived without disease after salvage treatment. The SCC levels at recurrence showed a statistically significant relationship to disease-free survival. CONCLUSIONS An SCC level of < or = 4 ng/ml and a lack of symptoms at the time of recurrence were good prognostic factors in isolated PALN recurrence after primary radiation therapy. In addition to concurrent CCRT, periodical surveillance with tumor markers and imaging studies allowed early detection and salvage of those patients.
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Affiliation(s)
- H H Chou
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Lui KW, Wong HF, Cheung YC, See LC, Ng KK, Kong MS, Wan YL. Air enema for diagnosis and reduction of intussusception in children: clinical experience and fluoroscopy time correlation. J Pediatr Surg 2001; 36:479-81. [PMID: 11227001 DOI: 10.1053/jpsu.2001.21604] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [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: 12/12/2022]
Abstract
PURPOSE The objective of this study was to correlate the fluoroscopy time with radiologic outcome in the pneumoreduction of intussusception in children. METHODS From September 1995 to December 1997, a prospective analysis of 181 cases of pediatric intussusception with pneumoreduction without sedation was done. A receiver operating characteristic curve of fluoroscopy time was drawn for correlation with radiologic outcome. RESULTS The overall success and failure rates of pneumoreduction were 84% and 16%, respectively. Three patients (1.6%) experienced colon perforation. The mean fluoroscopy time was 2.8 +/- 1.7 minutes in successful procedure and 4.9 +/- 2.8 minutes in failed procedures (P < 0.001). Analysis of the receiver operating characteristic curve of fluoroscopy time indicates that 4 minutes fluoroscopy time was a good critical point in differentiating successful and failed cases. In those 18 patients who had successful reduction with fluoroscopy times of more than 4 minutes, 4 patients had clinical symptoms for more than 1 day and 14 patients less than 1 day. One of those 4 patients required operation 1 day later because of peritonitis caused by necrosis of terminal ileum. Two patients had high fever in the next 2 days and recovered after antibiotic treatment. CONCLUSIONS Pneumoreduction is a good method in treatment of intussusception with high successful rate. Four minutes is the critical point of procedure. Reduction with greater than 4 minutes in those patients having illness more than 1 day might not benefit and have more complications.
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Affiliation(s)
- K W Lui
- First Department of Diagnostic Radiology, Chang Gung Medical Center, Chang Gung University, Tao-Yuan Hsien, Taiwan
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Tseng JH, Hung CF, Ng KK, Wan YL, Yeh TS, Chiu CT. Icteric-type hepatoma: magnetic resonance imaging and magnetic resonance cholangiographic features. Abdom Imaging 2001; 26:171-7. [PMID: 11178695 DOI: 10.1007/s002610000136] [Citation(s) in RCA: 25] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We evaluated the imaging features of magnetic resonance imaging (MRI) and magnetic resonance cholangiography (MRC) of icteric-type hepatoma and correlated these with the findings of endoscopic retrograde cholangiography (ERC), percutaneous cholangiography, and surgery. METHODS Thirteen patients with viral hepatitis complicated by cirrhosis of the liver and obstructive jaundice underwent MRC and dynamic MRI. Five patients received percutaneous transhepatic cholangiography and drainage; one of these patients also underwent resection of the left hepatic lobe. Another patient received MRC followed by thrombectomy and T-tube insertion. ERC and endoscopic nasobiliary drainage were performed in another patient for bile diversion. RESULTS Primary liver tumors and dilatation of biliary system were demonstrated in all patients. No capsule formation could be found in any primary liver tumors. MRI showed the simultaneous presence of an intraluminal tumor in the portal trunk and common hepatic duct in eight patients. Three different MRC features were found: (a) an oval defect in the hilar bile duct(s) with dilated intrahepatic ducts (n = 9), (b) dilated intrahepatic ducts with missing major bile ducts (n = 2), and (c) localized stricture of the hilar bile duct(s) (n = 2). CONCLUSION The presence of one or more of the following features in multiplanar MRI and MRC help to identify this rare, specific type of hepatocellular carcinoma: (a) the presence of an intraluminal tumor in both the portal trunk and the common hepatic duct, (b) enhancement of the intraluminal tumor in the common hepatic duct on the arterial phase, (c) type I MRC feature, and (d) hemobilia, blood clot within the gallbladder, and/or type II MRC feature.
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Affiliation(s)
- J H Tseng
- Department of Diagnostic Radiology, Chang-Gung Memorial Hospital, 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
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Chang TC, Jain S, Ng KK, Hsueh S, Tsai CS, Chen HL, Chang CN. Cerebellar metastasis from papillary serous adenocarcinoma of the ovary mimicking Ménière's disease. A case report. J Reprod Med 2001; 46:267-9. [PMID: 11304872] [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: 02/19/2023]
Abstract
BACKGROUND In rare cases, cerebellar metastasis originating in serous papillary adenocarcinoma of the ovary can mimick Ménière's disease. CASE A 51-year-old woman, with complete remission after optimal maximal debulking and chemotherapy for an International Federation of Gynecology and Obstetrics IIIc primary ovarian carcinoma, presented with nausea, vomiting, vertigo and headache 18 months after surgery. Investigations revealed a solitary cerebellar cystic mass, 4.6 x 4.0 x 3.2 cm. Gross total excision of the cerebellar lesion followed by brain irradiation resulted in complete resolution of her symptoms. Histology showed a metastatic tumor consistent with the primary ovarian carcinoma. CONCLUSION In an atypical presentation in patients with metastatic ovarian carcinoma, thorough investigations should be done to rule out or confirm brain metastasis, which can be aggressively managed to prevent serious consequences and improve outcome.
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Affiliation(s)
- T C Chang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Change Gung Memorial Hospital Linkou Medical Center and Chang Gung Medical College, Taoyuan, Taiwan.
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Downey RJ, Ng KK. The management of non-small-cell lung cancer with oligometastases. Chest Surg Clin N Am 2001; 11:121-32, ix. [PMID: 11253594] [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: 02/19/2023]
Abstract
The standard care for patients with non-small-cell lung cancer is chemotherapy of supportive care, with surgery being reserved for palliation of symptoms; however, there is a small group of patients with a finite number of extrathoracic metastases (oligometastases) who may experience improved survival by resection of their metastases and the primary site, with or without systemic treatment. This article summarizes the theoretic basis for resection of metastatic lung cancer, reviews the available data addressing management of disease metastatic to the lung, brain, and adrenal glands, and outlines a model for a future clinical trial to investigate the area further.
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Affiliation(s)
- R J Downey
- Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Affiliation(s)
- C F Tan
- Department of Diagnostic Radiology, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Affiliation(s)
- C F Tan
- Department of Diagnostic Radiology, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Toyota E, Ng KK, Sekizaki H, Itoh K, Tanizawa K, James MN. X-ray crystallographic analyses of complexes between bovine beta-trypsin and Schiff base copper(II) or iron(III) chelates. J Mol Biol 2001; 305:471-9. [PMID: 11152605 DOI: 10.1006/jmbi.2000.4303] [Citation(s) in RCA: 32] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To establish the structural basis underlying the activity of a novel series of metal-chelate trypsin inhibitors, the structures of p-amidinosalicylidene-l-alaninato(aqua)copper(II) (1a), m-amidinosalicylidene-l-alaninato(aqua)copper(II) (1b), bis(p-amidinosalicylidene-l-alaninato)iron(III) (2a), and bis(m-amidinosalicylidene-l-alaninato)iron(III) (2b) bound to bovine beta-trypsin were studied by X-ray crystallography. The amidinium group of the inhibitor donates hydrogen bonds to Asp189, Gly219 and Ser190, as seen before in trypsin-benzamidine complexes. The copper(II) ion of 1a is situated away from trypsin's catalytic triad residues, and is octahedrally coordinated by a Schiff base and three water molecules. In contrast, the copper(II) ion of 1b is situated close to the catalytic triad and adopts a square pyramidal coordination geometry. The iron(III) ion of 2a is octahedrally coordinated by two Schiff base ligands and, like the copper(II) ion of 1a, is situated away from the catalytic triad. The p-amidinophenyl ring of a second Schiff base ligand of 2a is directed toward a hydrophobic groove formed by Trp215 and Leu99. Finally, the iron(III) ion of 2b appears to be replaced by magnesium(II), which is octahedrally coordinated by a Schiff base, Gln192 and two water molecules. One of the Schiff base ligands seen in the trypsin-2a complex or in the unbound form of 2b is replaced by water molecules and Gln192. His57 and Ser195 form water-mediated interactions with the magnesium(II) ion of 2b, and Ser195 also forms a hydrogen bond with the phenolic oxygen atom of the Schiff base ligand. These structures reveal a novel mode of interaction between metal-chelate inhibitors and serine proteases, thus providing a structural basis for the development of more potent inhibitors against a variety of trypsin-like enzymes.
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Affiliation(s)
- E Toyota
- Faculty of Pharmaceutical Sciences, Health Sciences University of Hokkaido, Ishikari-Tobestu, Hokkaido 061-0293, Japan
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Wang IK, Ng KK, Chen YM, Huang CC. Pyeloureteritis cystica: case report. Chang Gung Med J 2001; 24:62-7. [PMID: 11299979] [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: 02/19/2023]
Abstract
Pyeloureteritis cystica, characterized by multiple bubbly filling defects on urography and caused by inflammatory stimuli, is a rare disorder of the ureter. It commonly affects older people. Diagnosis is established by radiological studies. Antibiotics should be given if urinary tract infection is present. Up to now, no other specific treatment can be used to cure this disorder. We report a case of pyeloureteritis cystica associated with urinary tract infection and a ureteral stone in a young woman who presented with hematuria and bilateral flank pain. The pyeloureteritis cystica had a bead-like appearance on intravenous pyelogram and retrograde pyelogram as well as in magnetic resonance urography. The diagnosis and treatment of this disorder are discussed. Magnetic resonance urography can provide high-resolution of coronal images of the entire urinary tract without the use of contrast agents or ionizing radiation. However, the cost of the procedure is a major concern.
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Affiliation(s)
- I K Wang
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Chang Gung University, Taoyuan
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Lui KW, Yeow KM, Wan YL, Cheung YC, Ng KK, Tseng JH. Ultrasound guided puncture of the brachial artery for haemodialysis fistula angiography. Nephrol Dial Transplant 2001; 16:98-101. [PMID: 11209000 DOI: 10.1093/ndt/16.1.98] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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
BACKGROUND Arterio-venous (a-v) fistulae of haemodialysis patients frequently require function assessment by angiography. The purpose of the present study was to determine the efficacy and safety of ultrasound-guided transbrachial catheterization when a-v fistulae were evaluated. METHODS Between July 1996 and December 1997, 208 dialysis patients, whose a-v fistulae (arterial inflow < 50 ml/min or venous pressure > 150 mm Hg in three consecutive HD sessions) were at the wrist or elbow, underwent transbrachial angiography using an ultrasound-guided 20-gauge IA needle to evaluate fistula function. Procedure-related symptoms or complications were noted in 28 patients and these were analysed. RESULTS No apparent cases of vessel spasm or thrombosis were noted. Reported symptoms in 28 patients (13.5%) included local arm pain (3.3%), transient paresthesia (0.9%), mild ecchymosis (10.6%) and haematoma (0.9%). All complications were minor and none required surgical intervention. CONCLUSION Ultrasound-guided puncture of the brachial artery is a safe, reliable and effective procedure in skilled hands and should be the preferred means of catheterization whenever haemodialysis angiography is performed.
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Affiliation(s)
- K W Lui
- First Department of Diagnostic Radiology, Chang Gung Medical Center at Linkou, College of Medicine, Chang Gung University, Taiwan
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Ng KK, Ng PW, Tsang KL. Clinical characteristics of adult epilepsy patients in the 1997 Hong Kong epilepsy registry. Chin Med J (Engl) 2001; 114:84-7. [PMID: 11779444] [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: 02/23/2023] Open
Abstract
OBJECTIVE To study the clinical characteristics of 2952 patients with epilepsy who had received drug treatment from the neurology outpatient clinics of eight major hospitals in Hong Kong. METHODS Retrospective review of outpatient records. RESULTS 1601 (54.3%) males and 1351 (45.7%) females with a median age of 35.8 years (range, 10-94.8) were studied. Seizure types included generalized tonic-clonic in 80.7% of patients, complex partial in 28.3%, simple partial in 14.4%, atypical absence in 2.6% and myoclonic in 1.4%, and 30.4% of patients had more than one seizure type. EEG, CT brain, MRI brain and neuropsychological evaluation were obtained in 81.2%, 61.7%, 17.0% and 2.2% of patients, respectively. The etiology of epilepsy was cryptogenic in 59.9%, symptomatic in 35.1% and idiopathic in 3.9%; the commonest were intracranial infection, cerebral vascular disease, cranial trauma and perinatal insult. Phenytoin, carbamazepine and valproate were the most frequently used drugs and 25.9% of patients were taking more than two drugs. 48.3% of patients had active seizures in the past six months and 26.4% were considered to have unsatisfactory control of their epilepsy. Medical refractoriness of epilepsy was associated with a history of perinatal insult, intracranial infection, congenital brain malformation, intracranial neoplasm, cerebral vascular disease, hippocampal sclerosis, mental retardation and a history of status epilepticus (P < 0.05). CONCLUSION In this local cohort of adult patients with epilepsy under specialist care, there were a considerable number of patients falling into the category of cryptogenic epilepsy. Risk factors associated with medical refractoriness are similar to previous studies.
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Affiliation(s)
- K K Ng
- Division of Neurology, Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, China.
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Ng KK, Fung SY, Chow LW. Practice of breast self-examination among high risk Chinese women in Hong Kong. Chin Med J (Engl) 2000; 113:1100-3. [PMID: 11776145] [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: 02/23/2023] Open
Abstract
BACKGROUND The incidence of breast cancer in Hong Kong is increasing and breast self-examination (BSE) as a screening tool is becoming more popular, especially among first-degree relatives (FDR) of breast cancer victims. BSE may be more applicable to Chinese women as their breast size is smaller. This study explores the BSE practice in this group of women. METHODS A cross sectional study was conducted by sending questionnaires to 330 FDR of breast cancer patients treated in the Department of Surgery, University of Hong Kong. BSE behavior was studied with respect to its frequency, awareness, completeness and confidence of practice. RESULTS 110 subjects returned the questionnaires with a response rate of 33%. The mean age of the respondent was 37 years. Only 57 women (52%) were practicers. The practicers have a stronger BSE awareness (P < 0.01) and a lower mean score on thought barriers (P = 0.002) than the non-practicers. 40% of the practicers gain their BSE knowledge through clinicians and their mean period of practice was 3.2 years. 68% of the practicers performed BSE completely. The overall confidence rate was 35%, but the rate was 43% among those who performed complete BSE. Thirteen factors possibly related to the completeness and rate of confidence of BSE examination were studied. The only factor that significantly determined completeness was the time spent for each examination (P = 0.002). The complete practicers required a longer time than the incomplete practicers (6.60 and 2.96 min, respectively). Women with a stronger BSE intention (P = 0.001) and a lower mean score on thought barriers (P = 0.001) performed the examination confidently. CONCLUSIONS Slightly over half of the FDR practice BSE. The majority perform a complete BSE but they are not confident in finding abnormalities. Women spending more time on BSE are associated with a higher rate of completeness. However, only those with a stronger BSE intention and lesser thought barriers are more confident in their practice.
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Affiliation(s)
- K K Ng
- Department of Surgery & Nursing Studies, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Abstract
This is a preliminary report of the quality of life of 9 people, 5 men and 4 women, in Hong Kong who underwent temporal lobectomy for seizure control. The Chinese version of World Health Organization Quality of Life Measure Abbreviated Version, validated in Hong Kong, was used as the outcome measure. Analysis suggested that the quality of life of these participants after successful temporal lobectomy was poorer than that of 157 healthy controls in the physical and psychological domains as measured. This suggests that other factors in addition to achieving complete seizure control play significant roles in promoting the quality of life of such patients.
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Affiliation(s)
- A Ho
- Department of Psychology, The University of Hong Kong, Hong Kong
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Lee MP, Chan JW, Ng KK, Li PC. Clinical manifestations of tuberculosis in HIV-infected patients. Respirology 2000; 5:423-6. [PMID: 11192558] [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: 02/19/2023]
Abstract
OBJECTIVE The purpose of the present study was to evaluate the impact of HIV infection on the clinical presentation of tuberculosis. METHODOLOGY We retrospectively studied the impact of HIV infection on the clinical presentation of tuberculosis. A total of 60 consecutive patients co-infected with HIV and tuberculosis were identified. RESULTS Majority were male (88.3%) and the most common transmission category was heterosexual contact (80%). Most were in the advanced stage of HIV infection; 93% had CD4 cell count less than 200/mm3. Concerning the site of tuberculosis involvement, 37% had pulmonary involvement alone, 13% had extrapulmonary disease involving one single site, 50% had both pulmonary and extrapulmonary involvement. Fifteen (25%) patients also met the criteria of disseminated tuberculosis, who had a significantly lower mean CD4 cell count than those with pulmonary involvement alone (mean 40 vs 102; P = 0.048). Chest radiographs comprised a wide spectrum of manifestations. A considerable proportion had primary pulmonary tuberculosis pattern (38%) and normal radiographs (8.5%). CONCLUSIONS Our patients generally had advanced HIV infection; 93% of those had CD4 lymphocyte count < 200/mm3. Extrapulmonary involvement and disseminated disease were common. Radiographic manifestations of pulmonary tuberculosis were often 'atypical' due to the greater proportion of primary tuberculosis among our patients.
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Affiliation(s)
- M P Lee
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
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Affiliation(s)
- C F Hung
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, People's Republic of China
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