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Lu SL, Yang WC, Chang YC, Chao CC, Liang CH, Chiang PL, Lin V, Lu JT, Hsu FM. Automated Detection, Segmentation, and Tracking of Brain Metastases in Repeated Courses of Stereotactic Radiosurgery Using Integrated Artificial Intelligence. Int J Radiat Oncol Biol Phys 2023; 117:e476. [PMID: 37785511 DOI: 10.1016/j.ijrobp.2023.06.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Salvage stereotactic radiosurgery (SRS) for distant brain metastases has been demonstrated as a safe and effective approach for intracranial recurrences after initial SRS. However, accurate tumor detection and segmentation among responding tumors within the irradiated parenchyma can be challenging. The requirement for the registration and reference to the previous course of SRS is very time-consuming and suffers significant inter and intra-reader variability. Artificial intelligence (AI)-assisted system has been proven to improve the accuracy and efficiency in the clinical flow of de-novo SRS. We hypothesize that an integrated AI system can facilitate an automated tumor contouring process for repeated SRS. MATERIALS/METHODS Three patients who underwent their third course of SRS to brain metastases were selected for the pioneering works. They have had two sessions of SRS with a mean lesion number of 4 and 3.7, respectively. VBrain, an FDA-approved brain tumor management AI platform, was used to co-registered serial MR scans and automatically identify, track, and contour brain metastases for each course of SRS. The AI also indicated new lesions and treated lesions for each course. Three radiation oncologists experienced in brain SRS contoured the gross tumor volumes (GTVs) of the third course of SRS in two reader modes (assisted then unassisted) with a memory washout period of one week between each section. The segmentation ground truth was established through consensus among the three experts. Lesion-wise sensitivity, contouring accuracy, and consuming time were compared between the two contouring modes. RESULTS In each patient, there were 15, 11, and 9 metastases, with a median diameter of 4.72 (95% CI: 4.05, 6.91) mm. The mean lesion-wise sensitivity was 96.96±2.47% with AI assistance and 76.90 ± 7.10% without assistance. There were two false-positive lesions in the assisted read, resulting in a low average false-positive rate of 0.67 per patient, while no false positive for the unassisted mode. AI assistance improved contouring accuracy. The median Dice similarity coefficient (DSC) was 0.71 (95% CI: 0.55, 0.87) for assisted contouring and 0.65 (95% CI: 0.46, 0.85) for unassisted contouring. We also use average Hausdorff distance (HD) to measure segmentation results. The mean HD was 0.72± 0.13 mm versus 0.73±0.08 mm for the two contouring modes (p = 0.02) Furthermore, the median contouring time per case was significantly shorter with AI assistance than without assistance (20.8 minutes vs. 29.8 minutes; p < 0.001), corresponding to a 43.2% time-saving. CONCLUSION Our results suggest that the integration of an AI-based system into repeated brain SRS can significantly improve the accuracy and efficiency of tumor detection and segmentation. This approach has the potential to streamline the treatment planning process for salvage SRS.
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Affiliation(s)
- S L Lu
- Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - W C Yang
- Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | | | | | | | | | - V Lin
- Vysioneer Inc., Cambridge, MA
| | - J T Lu
- Vysioneer Inc., Cambridge, MA
| | - F M Hsu
- Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
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Lin V, Tsouchnika A, Allakhverdiiev E, Rosen AW, Gögenur M, Clausen JSR, Bräuner KB, Walbech JS, Rijnbeek P, Drakos I, Gögenur I. Training prediction models for individual risk assessment of postoperative complications after surgery for colorectal cancer. Tech Coloproctol 2022; 26:665-675. [PMID: 35593971 DOI: 10.1007/s10151-022-02624-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/13/2022] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The occurrence of postoperative complications and anastomotic leakage are major drivers of mortality in the immediate phase after colorectal cancer surgery. We trained prediction models for calculating patients' individual risk of complications based only on preoperatively available data in a multidisciplinary team setting. Knowing prior to surgery the probability of developing a complication could aid in improving informed decision-making by surgeon and patient and individualize surgical treatment trajectories. METHODS All patients over 18 years of age undergoing any resection for colorectal cancer between January 1, 2014 and December 31, 2019 from the nationwide Danish Colorectal Cancer Group database were included. Data from the database were converted into Observational Medical Outcomes Partnership Common Data Model maintained by the Observation Health Data Science and Informatics initiative. Multiple machine learning models were trained to predict postoperative complications of Clavien-Dindo grade ≥ 3B and anastomotic leakage within 30 days after surgery. RESULTS Between 2014 and 2019, 23,907 patients underwent resection for colorectal cancer in Denmark. A Clavien-Dindo complication grade ≥ 3B occurred in 2,958 patients (12.4%). Of 17,190 patients that received an anastomosis, 929 experienced anastomotic leakage (5.4%). Among the compared machine learning models, Lasso Logistic Regression performed best. The predictive model for complications had an area under the receiver operating characteristic curve (AUROC) of 0.704 (95%CI 0.683-0.724) and an AUROC of 0.690 (95%CI 0.655-0.724) for anastomotic leakage. CONCLUSIONS The prediction of postoperative complications based only on preoperative variables using a national quality assurance colorectal cancer database shows promise for calculating patient's individual risk. Future work will focus on assessing the value of adding laboratory parameters and drug exposure as candidate predictors. Furthermore, we plan to assess the external validity of our proposed model.
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Affiliation(s)
- V Lin
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark.
| | - A Tsouchnika
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - E Allakhverdiiev
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - A W Rosen
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - M Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - J S R Clausen
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - K B Bräuner
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - J S Walbech
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - P Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - I Drakos
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - I Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebækvej 1, 4600, Køge, Denmark
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Liu Y, van Beekhuizen S, Heeg B, Lin V. 851P Treatment efficacy for adults with relapsed or refractory acute lymphoblastic leukemia: A systematic literature review (SLR). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ward J, Shum M, Bertino E, Lin V, Kuruvadi V, Heineman T. Efficacy and safety of pegvorhyaluronidase alfa (PEGPH20; PVHA) and pembrolizumab (pembro) combination therapy in patients (Pts) with stage III/IV non-small cell lung cancer (NSCLC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz437.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Brumwell A, Noyes E, Kulkarni S, Lin V, Becerra MC, Yuen CM. A rapid review of treatment literacy materials for tuberculosis patients. Int J Tuberc Lung Dis 2018; 22:336-341. [PMID: 29471913 DOI: 10.5588/ijtld.17.0363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess available treatment literacy materials for patients undergoing treatment for tuberculosis (TB). DESIGN We conducted a rapid review by searching the US Centers for Disease Control's Find TB Resources website and the websites of health departments and TB-focused organizations. We included English-language documents intended to educate TB patients about anti-tuberculosis treatment. We evaluated the format, readability, and content of documents, and audience. We defined 12 essential content elements based on those previously identified as facilitating human immunodeficiency virus treatment literacy. RESULTS Of the 205 documents obtained, 45 were included in our review. The median reading grade level was 7 (IQR 5-8). The median number of essential content elements present was 6 (IQR 4-8), with the most comprehensive document containing 11 of the 12 elements. Only two documents were written for children with TB or their care givers, and two for patients with drug-resistant TB. Many documents contained paternalistic and non-patient-centered language. CONCLUSION We found few examples of comprehensive, patient-centered documents. Work is needed to achieve consensus as to the essential elements of TB treatment literacy and to create additional materials for children, patients with drug-resistant TB, and those with lower literacy levels.
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Affiliation(s)
- A Brumwell
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - E Noyes
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - S Kulkarni
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - V Lin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - M C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - C M Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Wallace J, Pitts M, Liu C, Lin V, Hajarizadeh B, Richmond J, Locarnini S. More than a virus: a qualitative study of the social implications of hepatitis B infection in China. Int J Equity Health 2017; 16:137. [PMID: 28764768 PMCID: PMC5540563 DOI: 10.1186/s12939-017-0637-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/26/2017] [Indexed: 02/08/2023] Open
Abstract
Background China has the largest absolute number of people living with hepatitis B with up to 300,000 people estimated to die each year from hepatitis B related diseases. Despite advances in immunisation, clinical management, and health policy, there is still a lack of accessible and affordable health care for people with hepatitis B. Through in-depth interviews, this study identifies the personal, social and economic impact of living with hepatitis B and considers the role of stigma and discrimination as barriers to effective clinical management of the disease. Methods Semi-structured qualitative interviews were held with 41 people living with hepatitis B in five Chinese cities. Participants were recruited through clinical and non-government organisations providing services to people with hepatitis B, with most (n = 32) being under the age of 35 years. Results People living with hepatitis B experience the disease as a transformative intergenerational chronic infection with multiple personal and social impacts. These include education and employment choices, economic opportunities, and the development of intimate relationships. While regulations reducing access to employment and education for people with hepatitis B have been repealed, stigma and discrimination continue to marginalise people with hepatitis B. Conclusions Effective public policy to reduce morbidity and mortality associated with hepatitis B needs to address the lived impact of hepatitis B on families, employment and educational choices, finances, and social marginalisation.
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Affiliation(s)
- J Wallace
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Victoria, 3000, Australia.
| | - M Pitts
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Victoria, 3000, Australia
| | - C Liu
- China Health Program, La Trobe University, Melbourne, Australia
| | - V Lin
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - B Hajarizadeh
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Victoria, 3000, Australia.,The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, Australia
| | - J Richmond
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Victoria, 3000, Australia
| | - S Locarnini
- Victorian Infectious Diseases Reference Laboratory, Director, WHO Regional Reference Laboratory for Hepatitis B, Doherty Institute, Melbourne, Australia
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Hebert J, Hua G, Moshen-Pour S, Liu W, Azar M, Dhir S, Shiu A, Lin V. Comparative Healthcare Systems Program: Inspiring changes in public
health through first-hand experiences of the Quebec and Taiwanese health
systems. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Fernandes J, Ribeiro S, Garrido P, Sereno J, Costa E, Reis F, Santos-Silva A, Hirata M, Tashiro Y, Aizawa K, Endo K, Fujimori A, Morikami Y, Okada S, Kumei M, Mizobuchi N, Sakai M, Claes K, Di Giulio S, Galle J, Guerin A, Kiss I, Suranyi M, Winearls C, Wirnsberger G, Farouk M, Manamley N, Addison J, Herlitz H, Visciano B, Nazzaro P, Riccio E, Del Rio A, Mozzillo GR, Pisani A, Gupta A, Ikizler TA, Lin V, Guss C, Pratt RD, Stewart VM, Anthoney A, Blenkin S, Ahmed S, Yasumoto M, Tsuda A, Ishimura E, Ohno Y, Ichii M, Nakatani S, Mori K, Fukumoto S, Uchida J, Emoto M, Nakatani T, Inaba M, Joki N, Tanaka Y, Kubo S, Asakawa T, Hase H, Ikeda M, Inaguma D, Sakaguchi T, Shinoda T, Koiwa F, Negi S, Yamaka T, Shigematsu T, Inaguma D, Suranyi MG, Claes K, Di Giulio S, Galle J, Kiss I, Winearls C, Wirnsberger G, Farouk M, Manamley N, Addison J, Herlitz H, Guerin A, Groenendaal-Van De Meent D, Den Adel M, Rijnders S, Essers H, Golor G, Haffner S, Schaddelee M, Hirata M, Tashiro Y, Yogo K, Aizawa K, Endo K, Choukroun G, Hannedouche T, Kessler M, Laville M, Levannier M, Mignon F, Rostaing L, Rottembourg J, Jeon J, Park Y, Karanth S, Prabhu R, Bairy M, Nagaraju SP, Bhat A, Kosuru S, Parthasarathy R, Kamath S, Prasad HK, Kallurwar KP, Nishida H, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, Wan Q, Cana Ruiu DC, Ashcroft R, Brown C, Williams J, Mikhail A. CKD ANAEMIA. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Locatelli F, Choukroun G, Fliser D, Moecks J, Wiggenhauser A, Gupta A, Swinkels DW, Lin V, Guss C, Pratt R, Carrilho P, Martins AR, Alves M, Mateus A, Gusmao L, Parreira L, Assuncao J, Rodrigues I, Stamopoulos D, Mpakirtzi N, Afentakis N, Grapsa E, Zitt E, Sturm G, Kronenberg F, Neyer U, Knoll F, Lhotta K, Weiss G, Robinson BM, Larkina M, Bieber B, Kleophas W, Li Y, Locatelli F, McCullough K, Nolen JG, Port FK, Pisoni RL, Kalicki RM, Uehlinger DE, Ogawa C, Kanda F, Tomosugi N, Maeda T, Kuji T, Fujikawa T, Shino M, Shibata K, Kaneda T, Nishihara M, Satta H, Kawata SI, Koguchi N, Tamura K, Hirawa N, Toya Y, Umemura S, Chanliau J, Martin H, Stamatelou K, Gonzalez-Tabares L, Manamley N, Farouk M, Addison J, Donck J, Schneider A, Gutjahr-Lengsfeld L, Ritz E, Scharnagl H, Gelbrich G, Pilz S, Macdougall IC, Wanner C, Drechsler C, Kuntsevich V, Charen E, Kobena D, Sheth N, Siktel H, Levin NW, Winchester JF, Kotanko P, Kaysen G, Kuragano T, Kida A, Yahiro M, Nanami M, Nagasawa Y, Hasuike Y, Nakanishi T, Stamopoulos D, Mpakirtzi N, Dimitratou V, Griveas I, Lianos E, Grapsa E, Sasaki Y, Yamazaki S, Fujita K, Kurasawa M, Yorozu K, Shimonaka Y, Suzuki N, Yamamoto M, Zwiech R, Szczepa ska J, Bruzda-Zwiech A, Rao A, Gilg J, Caskey F, Kirkpantur A, Balci MM, Turkvatan A, Afsar B, Alkis M, Mandiroglu F, Kim YO, Yoon SA, Kim YS, Choi SJ, Min JW, Cheong MA, Hasuike Y, Kida A, Oue M, Yamamoto K, Kimura T, Fukao W, Yahiro M, Kaibe S, Nanami M, Nakanishi T, Djuric PS, Ikonomovski J, Tosic J, Jankovic A, Majster Z, Stankovic Popovic V, Dimkovic N, Aicardi Spalloni V, Del Vecchio L, Longhi S, Violo L, La Milia V, Pontoriero G, Locatelli F, Shino M, Kuji T, Fujikawa T, Toya Y, Umemura S, Macdougall I, Rumjon A, Mangahis E, Goldstein L, Ryzlewicz T, Becker F, Kilgallon W, Fukasawa M, Otake Y, Yamagishi T, Kamiyama M, Kobayashi H, Takeda M, Toida T, Sato Y, Fujimoto S. DIALYSIS ANAEMIA. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lu K, Lin V, Yu T, Weng H. UP-3.010: Sweet Enzyme, Phosphoglycerate Kinase: A Potential Therapeutic Target in Urothelial Caner of Urinary Bladder. Urology 2009. [DOI: 10.1016/j.urology.2009.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Guo XH, Tian XY, Pan YS, Yang XH, Wu SY, Wang W, Lin V. Managerial attitudes on the development of health promoting hospitals in Beijing. Health Promot Int 2007; 22:182-90. [PMID: 17495993 DOI: 10.1093/heapro/dam010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 11/14/2022] Open
Abstract
In 2002, the Beijing Committee for Disease Prevention launched guidelines based on the Ottawa Charter for Health Promotion on health promoting hospitals (HPHs). HPH pilot projects were then initiated, on a voluntary basis, in 44 Beijing hospitals. Evaluations have been undertaken to assess the impacts of the pilot project. This article outlines this HPH project, its development and evaluation and reports on the attitudes and contribution of hospital management as determined by questionnaires and interviews from 281 managerial employees from 106 Beijing hospitals (93 from pilot hospitals and 188 from control). The results of the evaluation indicate that long-term health promotion planning and health promotion specialized funds have been better established in pilot hospitals than in the control group and also that the concept of HPH is better understood by managerial staff in pilot hospitals than by those in control hospitals. The main perceived barriers faced in the development of HPH are shortages of funds, personnel, time management and professional skills. To further develop HPHs in China, effort needs to be made to ensure that hospital leaders and management are considered first. If managerial staff have an appropriate understanding of the concept and principles of HPH, then it is more likely that health promotion activities can be introduced into the daily workings of hospitals, and the necessary funds, personnel and training on health promotion skills be provided.
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Affiliation(s)
- X H Guo
- Department of Epidemiology and Health Statistics, School of Public Health and Family Medicine, Capital Medical University, Beijing 100 069, People's Republic of China
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Choi BCK, Frank J, Mindell JS, Orlova A, Lin V, Vaillancourt ADMG, Puska P, Pang T, Skinner H, Marsh M, Mokdad AH, Yu SZ, Lindner MC, Sherman G, Barreto SM, Green LW, Svenson LW, Sainsbury P, Yan Y, Zhang ZF, Zevallos JC, Ho SC, de Salazar LM. 260: Vision for a Global Registry of Anticipated Public Health Studies (GRAPHS). Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s65c] [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: 11/13/2022] Open
Affiliation(s)
- B C K Choi
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - J Frank
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - J S Mindell
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - A Orlova
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - V Lin
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | | | - P Puska
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - T Pang
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - H Skinner
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - M Marsh
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - A H Mokdad
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - S-Z Yu
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - M C Lindner
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - G Sherman
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - S M Barreto
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - L W Green
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - L W Svenson
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - P Sainsbury
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - Y Yan
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - Z-F Zhang
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - J C Zevallos
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - S C Ho
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
| | - L M de Salazar
- Public Health Agency of Canada, Ottawa, Ontario, K1A 1B4
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Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is mainly a stromal process, showing an increased ratio of stromal to epithelial elements, a collagen type III downregulation, and a collagen types I and IV upregulation. Little is known about elastin gene expression in BPH tissues due to difficulties related to extensive alternative splicing of the elastin gene. Therefore, we analyzed and quantified elastin gene expression in BPH. METHODS A competitive reverse transcriptase-polymerase chain reaction (competitive RT-PCR) quantitative technique was used, and a quantitative elastin mRNA analysis with normal (n = 10) and BPH (n = 12) tissues was performed with two newly designed elastin primers. Small tissue samples (4-8 mg) were homogenized and sonicated, and cDNA was synthesized from mRNA using a RT reaction. Various target (wild-type) elastin cDNAs with unknown concentrations were competitively coamplified with known serial dilutions of the control mutant template, differing from the target cDNA by a short deletion. Gel fractions and computerized densitometry, were performed and cDNA concentration was calculated by linear regression. RESULTS The primers identified in our study (BOB-1 and BOB-2) accurately amplified a consistent length of the elastin cDNA, avoiding areas of alternative splicing. The average elastin mRNA concentration in BPH tissues was 53 attomole/mg +/- 11.6 vs. 140.6 attomole/mg +/- 19.6 in normal prostatic tissue (P = 0.019). The variation within every sample was less than 10%. CONCLUSIONS Our observations suggest a significant downregulation (70%) of the elastin mRNA gene in the transition zone of BPH patients.
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Affiliation(s)
- B Djavan
- Department of Urology, University of Vienna, Vienna, Austria.
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Abstract
Nerve conduction studies continue to be an important tool in the evaluation of peripheral nerve disorders but have come under increased scrutiny because of heightened cost control in health care service delivery. In selected clinical settings, automated nerve conduction studies may be a useful clinical tool replacing conventional testing, but existing instruments are limited and have not generally been accepted into clinical practice. Further advancements in nerve conduction automation may be possible by incorporating expert system approaches into nerve conduction measurement and control algorithms. Using fuzzy logic techniques to duplicate the reasoning strategies of experienced electrodiagnostic clinicians, a software controller was developed to automatically perform sensory nerve conduction studies. The fuzzy logic system successfully performed 88% of 97 sensory studies in a mixed group of normal and patient populations. Sensory nerve action potential latency and amplitude measures obtained with automated testing were the same as determined by clinicians. Failures were related to design limitations of the controller, noise, and artifact. The high negative predictive value and sensitivity of fuzzy logic based testing suggest that its utility is in minimizing the need for unnecessary conventional electrodiagnostic studies in patients with normal nerve function. Fuzzy logic appears to be a useful approach to nerve conduction automation that can model expert reasoning and judgment.
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Affiliation(s)
- A Gitter
- University of Texas, Health Science Center at San Antonio, Rehabilitation Medicine, Texas 78284-7398, USA
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Djavan B, Lin V, Kaplan EP, Richier JC, Shariat S, Marberger M, McConnell JD. Decreased elastin gene expression in noncompliant human bladder tissue: a competitive reverse transcriptase-polymerase chain reaction analysis. J Urol 1998; 160:1658-62. [PMID: 9783926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE In low capacity noncompliant fibrotic bladders, as seen in patients with myelomeningocele, elevated storage pressures ultimately can lead to renal damage. Earlier studies have described an increased deposition of extracellular matrix protein, especially type III collagen, in the detrusor muscle. We analyzed elastin gene expression and quantified elastin gene alteration in the obstructed bladder, correlating urodynamically measured compliance with elastin messenger ribonucleic acid (mRNA) concentration. MATERIALS AND METHODS Using a reverse transcriptase-polymerase chain reaction quantitative technique elastin mRNA can be reliably measured in 5 to 8 mg. samples of bladder tissue. We compared tissue samples from patients with urodynamically demonstrated noncompliant bladders (less than 10 cc/cm. water) to a control group with normal bladder compliance (greater than 20 cc/cm. water). Tissue samples were homogenized and sonicated, and complementary deoxyribonucleic acid (cDNA) was synthetized from mRNA using reverse transcriptase. Wild type and mutant elastin cDNA were synthetized, and target elastin cDNA with unknown concentration was competitively co-amplified with known serial dilutions of the mutant template (competitive polymerase chain reaction). Computerized densitometry allowing cDNA concentration measurement was performed and competitive reverse transcriptase-polymerase chain reaction was repeated at least twice for every sample. RESULTS Elastin mRNA concentration ranged from 27.6 to 63.2 attomole per mg. in noncompliant bladders compared to 62 to 190 attomole per mg. in controls. The variation within the same sample was less than 10%. There was a statistically significant difference between mean plus or minus standard deviation elastin cDNA concentration in noncompliant bladders (37.48 attomole per mg. +/- 12.06) and controls (119.63+/-41.01 attomole per mg.). CONCLUSIONS A significant decrease in elastin mRNA matches the decreased deposition of elastic fibers noted in previous immunohistochemical studies. Our data suggest that this decrease is mainly due to a transcriptional down regulation of the elastin gene in noncompliant bladders.
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Affiliation(s)
- B Djavan
- Department of Urology, University of Vienna, Austria
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Adams T, Lin V. Partnership in public health. World Health Forum 1998; 19:246-52. [PMID: 9786045] [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: 02/09/2023]
Abstract
In Australia the States, Territories, Federal Government, nongovernmental organizations and the community all contribute to public health development. Efforts are being made to build a partnership between them to improve efficiency and effectiveness.
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Affiliation(s)
- T Adams
- Australian National University, Canberra ACT, Australia
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Ng EH, Ji CY, Tan PH, Lin V, Soo KC, Lee KO. Altered serum levels of insulin-like growth-factor binding proteins in breast cancer patients. Ann Surg Oncol 1998; 5:194-201. [PMID: 9527274 DOI: 10.1007/bf02303854] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Insulin-like growth factor 1 (IGF-1) has mitogenic properties for breast cancer cell lines and has been proposed to be an important factor in breast carcinogenesis. We hypothesized that differences in IGF-1 or its binding proteins might increase susceptibility to breast cancer. This case-control study was designed to investigate whether patients with breast cancer have altered levels of either IGF-1 or its intermediary modulatory proteins, the IGF binding proteins (BP). METHODS Serum was collected from 90 patients (63 with breast cancer and 27 with benign breast disease) after an overnight fast and before surgery. IGF-1, BP1, and BP3 levels were determined by immunoradiometric assays. In a subset of 66 patients, Western ligand blots were also performed for a semiquantitative measurement of functioning BP levels. A forward stepwise logistic regression model to adjust for other confounding variables (age, menopausal status, parity, age at menarche, use of oral contraceptives, history of breast biopsy, family history of breast cancer, hormone replacement therapy, and body-mass index) was used in the multivariate analysis. RESULTS Serum IGF-1 levels were similar in cases and controls. However, levels of BP3 (p < 0.001), BP4 (p < 0.01), and BP1 (p < 0.05) were significantly associated with risk of breast cancer. The level of BP3 was the most significant factor predictive of breast cancer. The odds ratio for breast cancer in women with BP3 levels >2066 ng/ml was 0.18 (95% CI, 0.05-0.55). Correspondingly, women with BP1 levels higher than 39 ng/ml had an odds ratio of 0.21 (95% CI, 0.07-0.68) for breast cancer. When considering only cancer patients (n = 63), decreasing levels of BP4 (p < 0.01) and increasing levels of BP1 (p < 0.02) were significantly associated with progesterone receptor positivity (PR+) in the tumor. The odds ratio of PR+ in patients with BP1 levels higher than 34 ng/ml was 7.49 (95% CI, 1.5-37.4). Better grade of tumor (well and moderately differentiated) was observed in patients with higher levels of BP3 (p < 0.03). CONCLUSIONS Distinct differences in BP profiles exist among patients with breast cancer and also among those with high-grade, hormonal receptor-negative tumors. These findings suggest that the bioavailability of IGF-1 as mediated by its binding proteins may participate in both breast carcinogenesis and selection of more aggressive breast carcinomas.
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Affiliation(s)
- E H Ng
- Department of Surgery, Singapore General Hospital, Republic of Singapore
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Lin V. Resource review. Investing in health research and development: report of the ad hoc committee on health research relating to future intervention options. World Health Organization, Geneva, 1996. Health Promot Int 1997. [DOI: 10.1093/heapro/12.4.331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Browning C, Hilfinger JM, Rainier S, Lin V, Hedderwick S, Smith M, Markovitz DM. The sequence and structure of the 3' arm of the first stem-loop of the human immunodeficiency virus type 2 trans-activation responsive region mediate Tat-2 transactivation. J Virol 1997; 71:8048-55. [PMID: 9311903 PMCID: PMC192170 DOI: 10.1128/jvi.71.10.8048-8055.1997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 02/05/2023] Open
Abstract
Human immunodeficiency virus type 2 (HIV-2) causes AIDS, but generally after a much longer asymptomatic period than that which follows infection with HIV-1. At the molecular level, HIV-2 is much more closely related to the simian immunodeficiency viruses than to HIV-1 and our previous studies have demonstrated that HIV-2 and HIV-1 enhancer stimulation is mediated by different sets of cellular proteins following T-cell activation. Similar to HIV-1, HIV-2 encodes a transactivating protein, Tat, which appears to be necessary for viral replication and stimulates viral transcriptional initiation and/or elongation. While Tat-1 binds to the RNA of the trans-activation responsive (TAR) region of HIV-1 and HIV-2, cellular factors that bind to the RNA transcript are also necessary for Tat to function in vivo. Since almost all previous investigations of cellular cofactors for Tat had focused on HIV-1, we undertook studies aimed at understanding the interaction between the TAR RNA region of the HIV-2 promoter (TAR-2) and cellular proteins. By using extension inhibition analysis (toeprinting) and RNA electrophoretic mobility shift assays, we demonstrated binding of a nuclear factor(s) in T cells to the base of the promoter-proximal stem-loop structure. Mutational analysis of this region revealed that both the sequence of the 3' arm and the stem structure itself are important for activation of the promoter by Tat-2. In contrast, the structure is necessary for activation of TAR-2 by Tat-1 but the sequence is less important. These results suggest that a cellular factor interacts with the 3' arm of the proximal stem-loop structure of TAR-2 and mediates Tat-2-induced increases in the level of HIV-2 transcripts.
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Affiliation(s)
- C Browning
- Department of Microbiology and Immunology, University of Michigan Medical Center, Ann Arbor 48109-0642, USA
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Abstract
BACKGROUND It has been proposed that clones of tumor cells acquire higher metastatic potential as a result of specific genetic alterations. This study was designed to determine the role of the c-met protooncogene in systemic spread by comparing the loss of the c-met protooncogene between primary and metastatic breast carcinomas. METHODS Only patients who had not received chemotherapy or radiotherapy in the preceding 6 months were included in this study. Histologically proven malignant tissue was obtained from the primary tumor, involved nodes, and distant metastatic and recurrent tumors of patients with breast carcinomas. Allelic loss of the c-met protooncogene in tumor tissue was determined by Southern blotting using a polymerase chain reaction-generated 347-bp human met-H probe. Restriction digestion was performed using Taq I and Msp I, with the patient's lymphocyte DNA as controls. RESULTS Of 52 patients, lymphocyte DNA from 36 patients was heterozygous for the c-met protooncogene (69% informative). Forty-six tumors from these 36 patients were analyzed. Four of 30 primary tumors (13%) showed allelic loss of c-met. Of the nine nodal metastases examined, three (33%) showed allelic loss of the c-met protooncogene. Of seven distant metastatic breast tumors or recurrent disease, two (29%) showed allelic loss (both in patients with skin metastasis in the chest wall). CONCLUSIONS Allelic loss of the c-met protooncogene was detected in both primary (13%) and metastatic sites (31%) of breast cancer. Although a higher proportion of allelic loss of c-met was noted in nodal and distant/recurrent disease, the difference when compared with the primary tumor was not statistically significant. These findings indicate a limited role of the c-met protooncogene in breast cancer metastases.
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Affiliation(s)
- E H Ng
- Department of Surgery, Singapore General Hospital, Singapore
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Affiliation(s)
- S T Cochran
- Department of Radiological Sciences, University of California, School of Medicine, Los Angeles 90095-1721, USA
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Abstract
OBJECTIVES This study sought to demonstrate that health status varies markedly in different parts of China. METHODS The main source of data was statistics compiled by the Chinese Ministry for Public Health for 1978 to 1990 regarding causes of death. However, because mortality statistics in China are based on localities that have the capacity to provide data, they are not entirely representative. The international classification of disease categories was also used, together with anatomically based disease descriptions. Rates were calculated using the 1982 and 1990 population censuses. RESULTS Death rates differ markedly between urban and rural areas. Deaths due to infectious diseases, respiratory diseases, pregnancy and childbirth, and injuries and poisoning are much higher in rural areas; those due to pertussis, dysentery, typhoid, hepatitis, rabies, and anthrax are much more common in the apparently poorer provinces. Schistosomiasis remains a major problem in some provinces. Goiter and cretinism are still major diseases in many parts of China, especially those areas with iodine deficiency. CONCLUSIONS Cause-of-death patterns in Chinese cities are similar to those of industrially developed countries such as Australia, Japan, and the United States. Such patterns in the poorer rural areas are much more typical of those of developing countries.
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Affiliation(s)
- J S Lawson
- School of Health Services Management, University of New South Wales, Kensington, Australia
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Abstract
With very limited resources, China has developed perhaps the world's largest network of health care services. The health status of its peoples has risen dramatically during the past 40 years. The reasons for these achievements are complex and include an ideology of equity for all citizens, the near universal availability of adequate food, education, housing, jobs, and transport, and the universal availability of accessible and affordable treatment and preventive health services. Despite these achievements China is facing new problems. These include the aging of the population, continued growth of the population leading to ever increasing demands on all sectors of the economy including health services, urban-rural inequalities, low productivity in the health services, lack of legal safeguards for health protection, a continued burden of infectious and endemic diseases, weak infrastructure for prevention and primary health care, and an increasing burden of chronic diseases associated with tobacco smoking and atherosclerotic circulatory diseases and trauma due to traffic accidents and occupational hazards. Decentralized management, financial incentives for health workers, privatization of medical practitioners, health legislation, and changes to health insurance arrangements have been introduced as a means of addressing the issues. The outcomes have been uneven, with little or no improvements in some problems and good progress in others. Changes in the health system appear to be reflecting not only health reform measures but also general economic reforms.
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Affiliation(s)
- P L Yang
- School of Health Services Management, University of New South Wales, Kensington, Australia
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Sassoon D, Lyons G, Wright WE, Lin V, Lassar A, Weintraub H, Buckingham M. Expression of two myogenic regulatory factors myogenin and MyoD1 during mouse embryogenesis. Nature 1989; 341:303-7. [PMID: 2552320 DOI: 10.1038/341303a0] [Citation(s) in RCA: 545] [Impact Index Per Article: 15.6] [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: 01/01/2023]
Abstract
MyoD1 and myogenin are muscle-specific proteins which can convert non-myogenic cells in culture to differentiated muscle fibres, implicating them in myogenic determination. The pattern of expression of MyoD1 and myogenin during the early stages of muscle formation in the mouse embryo in vivo and in limb-bud explants cultured in vitro, indicates that they may have different functions in different types of muscle during development.
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Affiliation(s)
- D Sassoon
- Department of Molecular Biology, Pasteur Institute, Paris, France
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