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Wang L, Hong PJ, May C, Rehman Y, Oparin Y, Hong CJ, Hong BY, AminiLari M, Gallo L, Kaushal A, Craigie S, Couban RJ, Kum E, Shanthanna H, Price I, Upadhye S, Ware MA, Campbell F, Buchbinder R, Agoritsas T, Busse JW. Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials. BMJ 2021; 374:n1034. [PMID: 34497047 DOI: 10.1136/bmj.n1034] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the benefits and harms of medical cannabis and cannabinoids for chronic pain. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, AMED, PsycInfo, CENTRAL, CINAHL, PubMed, Web of Science, Cannabis-Med, Epistemonikos, and trial registries up to January 2021. STUDY SELECTION Randomised clinical trials of medical cannabis or cannabinoids versus any non-cannabis control for chronic pain at ≥1 month follow-up. DATA EXTRACTION AND SYNTHESIS Paired reviewers independently assessed risk of bias and extracted data. We performed random-effects models meta-analyses and used GRADE to assess the certainty of evidence. RESULTS A total of 32 trials with 5174 adult patients were included, 29 of which compared medical cannabis or cannabinoids with placebo. Medical cannabis was administered orally (n=30) or topically (n=2). Clinical populations included chronic non-cancer pain (n=28) and cancer related pain (n=4). Length of follow-up ranged from 1 to 5.5 months. Compared with placebo, non-inhaled medical cannabis probably results in a small increase in the proportion of patients experiencing at least the minimally important difference (MID) of 1 cm (on a 10 cm visual analogue scale (VAS)) in pain relief (modelled risk difference (RD) of 10% (95% confidence interval 5% to 15%), based on a weighted mean difference (WMD) of -0.50 cm (95% CI -0.75 to -0.25 cm, moderate certainty)). Medical cannabis taken orally results in a very small improvement in physical functioning (4% modelled RD (0.1% to 8%) for achieving at least the MID of 10 points on the 100-point SF-36 physical functioning scale, WMD of 1.67 points (0.03 to 3.31, high certainty)), and a small improvement in sleep quality (6% modelled RD (2% to 9%) for achieving at least the MID of 1 cm on a 10 cm VAS, WMD of -0.35 cm (-0.55 to -0.14 cm, high certainty)). Medical cannabis taken orally does not improve emotional, role, or social functioning (high certainty). Moderate certainty evidence shows that medical cannabis taken orally probably results in a small increased risk of transient cognitive impairment (RD 2% (0.1% to 6%)), vomiting (RD 3% (0.4% to 6%)), drowsiness (RD 5% (2% to 8%)), impaired attention (RD 3% (1% to 8%)), and nausea (RD 5% (2% to 8%)), but not diarrhoea; while high certainty evidence shows greater increased risk of dizziness (RD 9% (5% to 14%)) for trials with <3 months follow-up versus RD 28% (18% to 43%) for trials with ≥3 months follow-up; interaction test P=0.003; moderate credibility of subgroup effect). CONCLUSIONS Moderate to high certainty evidence shows that non-inhaled medical cannabis or cannabinoids results in a small to very small improvement in pain relief, physical functioning, and sleep quality among patients with chronic pain, along with several transient adverse side effects, compared with placebo. The accompanying BMJ Rapid Recommendation provides contextualised guidance based on this body of evidence. SYSTEMATIC REVIEW REGISTRATION: https://osf.io/3pwn2.
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Affiliation(s)
- Li Wang
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Patrick J Hong
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Curtis May
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yasir Rehman
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yvgeniy Oparin
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Chris J Hong
- Department of Otolaryngology - Head &Neck Surgery, University of Toronto, Toronto, Canada
| | - Brian Y Hong
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mahmood AminiLari
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lucas Gallo
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alka Kaushal
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Samantha Craigie
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Rachel J Couban
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Elena Kum
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Ira Price
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Suneel Upadhye
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark A Ware
- Alan Edwards Pain Management Unit, McGill University Health Centre; and Department of Family Medicine and Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rachelle Buchbinder
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventative Medicine, Monash University; and Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Jason W Busse
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
- Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
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Hong CJ, Giannopoulos AA, Hong BY, Witterick IJ, Irish JC, Lee J, Vescan A, Mitsouras D, Dang W, Campisi P, de Almeida JR, Monteiro E. Clinical applications of three‐dimensional printing in otolaryngology–head and neck surgery: A systematic review. Laryngoscope 2019; 129:2045-2052. [DOI: 10.1002/lary.27831] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Chris J. Hong
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Andreas A. Giannopoulos
- Cardiac Imaging Computed Tomography/Positron Emission Tomography/Magnetic Resonance Imaging, Department of Nuclear MedicineUniversity Hospital Zurich Zurich Switzerland
| | - Brian Y. Hong
- Division of Plastic and Reconstructive Surgery, Department of SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Ian J. Witterick
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Jonathan C. Irish
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - John Lee
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Allan Vescan
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Dimitrios Mitsouras
- Faculty of MedicineUniversity of Ottawa Ottawa Ontario Canada
- Applied Imaging Science Lab, Department of RadiologyBrigham and Women's Hospital, Harvard Medical School Boston Massachusetts U.S.A
| | - Wilfred Dang
- Department of Diagnostic RadiologyUniversity of Ottawa Ottawa Ontario Canada
| | - Paolo Campisi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
| | - Eric Monteiro
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto Toronto Ontario Canada
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Wang L, Hong BY, Kennedy SA, Chang Y, Hong CJ, Craigie S, Kwon HY, Romerosa B, Couban RJ, Reid S, Khan JS, McGillion M, Blinder V, Busse JW. Predictors of Unemployment After Breast Cancer Surgery: A Systematic Review and Meta-Analysis of Observational Studies. J Clin Oncol 2018; 36:1868-1879. [PMID: 29757686 DOI: 10.1200/jco.2017.77.3663] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose Breast cancer surgery is associated with unemployment. Identifying high-risk patients could help inform strategies to promote return to work. We systematically reviewed observational studies to explore factors associated with unemployment after breast cancer surgery. Methods We searched MEDLINE, EMBASE, CINAHL, and PsycINFO to identify studies that explored risk factors for unemployment after breast cancer surgery. When possible, we pooled estimates of association for all independent variables reported by more than one study. Results Twenty-six studies (46,927 patients) reported the association of 127 variables with unemployment after breast cancer surgery. Access to universal health care was associated with higher rates of unemployment (26.6% v 15.4%; test of interaction P = .05). High-quality evidence showed that unemployment after breast cancer surgery was associated with high psychological job demands (odds ratio [OR], 4.26; 95% CI, 2.27 to 7.97), childlessness (OR, 1.30; 95% CI, 1.11 to 1.53), lower education level (OR, 1.15; 95% CI, 1.05 to 1.25), lower income level (OR, 1.46; 95% CI, 1.24 to 1.73), cancer stage II, III or IV (OR, 1.43; 95% CI, 1.13 to 1.82), and mastectomy versus breast-conserving surgery (OR, 1.18; 95% CI, 1.07 to 1.30). Moderate-quality evidence suggested an association with high physical job demands (OR, 2.11; 95%CI, 1.52 to 2.93), African-American ethnicity (OR, 1.89; 95% CI, 1.21 to 2.96), and receipt of chemotherapy (OR, 1.95; 95% CI, 1.36 to 2.79). High-quality evidence demonstrated no significant association with part-time hours, blue-collar work, tumor size, positive lymph nodes, or receipt of radiotherapy or endocrine therapy; moderate-quality evidence suggested no association with age, marital status, or axillary lymph node dissection. Conclusion Addressing high physical and psychological job demands may be important in reducing unemployment after breast cancer surgery.
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Affiliation(s)
- Li Wang
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian Y Hong
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean A Kennedy
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yaping Chang
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chris J Hong
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samantha Craigie
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Henry Y Kwon
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Beatriz Romerosa
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rachel J Couban
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Susan Reid
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James S Khan
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael McGillion
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Victoria Blinder
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jason W Busse
- Li Wang, Yaping Chang, Samantha Craigie, Rachel J. Couban, Susan Reid, Michael McGillion, and Jason W. Busse, McMaster University, Hamilton; Sean A. Kennedy and Chris J. Hong, University of Toronto, Toronto; Brian Y. Hong, University of Ottawa, Ottawa, Ontario, Canada; Li Wang, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Henry Y. Kwon, Wayne State University School of Medicine, Detroit, MI; Beatriz Romerosa, University Hospital of Toledo, Toledo, Spain; James S. Khan, Stanford University, Palo Alto, CA; and Victoria Blinder, Memorial Sloan Kettering Cancer Center, New York, NY
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Lee DJ, Chin CJ, Hong CJ, Perera S, Witterick IJ. Outpatient versus inpatient thyroidectomy: A systematic review and meta-analysis. Head Neck 2017; 40:192-202. [PMID: 29120517 DOI: 10.1002/hed.24934] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/08/2017] [Accepted: 07/20/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Outpatient thyroidectomy has gained popularity due to improved resource utilization. METHODS We conducted a systematic review and meta-analysis using MEDLINE, EMBASE, CINAHL, Web of Science, and the Cochrane library. We included all studies examining the outcomes of outpatient thyroidectomy as compared with those of inpatient thyroidectomy. Risk of bias was assessed using the Newcastle-Ottawa scale. Postoperative complications (hematoma, hypocalcemia, and recurrent laryngeal nerve injury) and readmission/reintervention rates were compared. RESULTS After screening 1665 records, 10 nonrandomized observational studies were included. There were fewer complication rates in the outpatient group than the inpatient group (relative risk [RR] 0.56; 95% confidence interval [CI] 0.37-0.83). There was no difference in readmission/reintervention rates (RR 0.60; 95% CI 0.33-1.09). CONCLUSION The results suggest outpatient thyroidectomy may be as safe as inpatient thyroidectomy in appropriately selected patients. The results are limited by high risk of bias. Well-designed prospective studies are necessary to further assess the safety of outpatient thyroidectomy.
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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Christopher J Chin
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie Medicine New Brunswick, St. John, New Brunswick, Canada
| | - Chris J Hong
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Stefan Perera
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
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Hong CJ, Monteiro E, Badhiwala J, Lee J, de Almeida JR, Vescan A, Witterick IJ. Open versus endoscopic septoplasty techniques: A systematic review and meta-analysis. Am J Rhinol Allergy 2017; 30:436-442. [PMID: 28124656 DOI: 10.2500/ajra.2016.30.4366] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Septal deviation is a condition of high prevalence, which ranges from 22% in newborns to 90% in adults. Surgical intervention is frequently considered in the management of patients with symptoms. Although many surgeons prefer either the endoscopic or the open approach to septoplasty, there is an ongoing debate regarding comparative outcomes between the two approaches. OBJECTIVE The purpose of this study was to systematically review the literature and provide pooled summary estimates to evaluate the efficacy and safety of open versus endoscopic septoplasty techniques. METHODS This study was registered with PROSPERO (CRD42014010730). MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science, and The Cochrane Central Registry for Randomized Trials were searched for relevant studies by using the following keywords in varying combinations: "nasal septum," "nasal obstruction," "nasal cartilages," "nose," "nose diseases," "surgery," "nasal/septal deviation," and "septoplasty." All the studies that compared open versus endoscopic septoplasty techniques for the management of symptomatic septal deviation were considered. Two reviewers independently extracted data by using a preestablished extraction form and performed quality assessment by using the Jadad and Newcastle Ottawa Scales. Weighted pooled estimates were calculated and reported, along with relative risks and 95% confidence intervals. RESULTS Fourteen studies met our inclusion criteria. When comparing open versus endoscopic septoplasty techniques, there was significant improvement in postoperative symptoms (i.e., nasal obstruction, headaches) (p < 0.05) in the endoscopic septoplasty group. There also were significantly fewer complications associated with the endoscopic septoplasty technique (p < 0.05). Based on the quality assessment, included studies were deemed at a moderate-to-high risk of bias. CONCLUSION Our analysis indicated that endoscopic septoplasty may have some advantages over open septoplasty. However, our findings should be taken with caution given the poor quality of included studies.
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Affiliation(s)
- Chris J Hong
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Hong CJ, Caulley L, Kohlert S, Graham GE, McMillan HJ, Michaud J, Vaccani JP. Congenital Trismus From Brainstem Dysgenesis: Case Report and Review of Literature. Pediatrics 2016; 138:peds.2015-4605. [PMID: 27255150 DOI: 10.1542/peds.2015-4605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 11/24/2022] Open
Abstract
Trismus refers to any condition inducing limited mouth opening and may present as a result of acquired or congenital pathology. We present the case of a newborn who presented with severe, congenital trismus due to brainstem dysgenesis. We describe the course of his investigations, and a multidisciplinary approach to the management of his care and follow-up. To our knowledge, this is one of the earliest reported cases of congenital trismus attributable to brainstem dysgenesis. A literature review was conducted to provide an overview of the differential pathogenesis as it presents in congenital cases and discuss the complexity of managing congenital trismus due to brainstem dysgenesis in a neonate and infant.
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Affiliation(s)
- Chris J Hong
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Caulley
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada; and
| | - Scott Kohlert
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada; and
| | | | | | | | - Jean-Philippe Vaccani
- Otolaryngology-Head and Neck Surgery, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Hong CJ, Tsang AC, Quinn JG, Bonaparte JP, Stevens A, Kilty SJ. Anti-IgE monoclonal antibody therapy for the treatment of chronic rhinosinusitis: a systematic review. Syst Rev 2015; 4:166. [PMID: 26581392 PMCID: PMC4652338 DOI: 10.1186/s13643-015-0157-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 02/04/2015] [Accepted: 11/09/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Several options are available for the treatment of chronic rhinosinusitis (CRS), but disease control remains elusive for many patients. Recently, literature has emerged describing anti-IgE monoclonal antibody as a potential therapy for CRS. However, its effectiveness and safety are not well known. The purpose of this systematic review was to assess the effectiveness and safety of anti-IgE therapy and to identify evidence gaps that will guide future research for the management of CRS. METHODS Methodology was registered with PROSPERO (No. CRD42014007600). A comprehensive search was performed of standard bibliographic databases, Google Scholar, and clinical trials registries. Only randomized controlled trials assessing anti-IgE therapy in adult patients for the treatment of CRS were included. Two independent reviewers extracted data using a pre-defined extraction form and performed quality assessment using the Cochrane risk of bias tool and the GRADE framework. RESULTS Two studies met our inclusion criteria. When comparing anti-IgE therapy to placebo, there was a significant difference in Lund-McKay score (p = 0.04) while no difference was seen for percent opacification on computed tomography (CT). At 16 weeks, treatment led to a decrease in clinical polyp score. No significant difference was seen with regard to quality of life (Total Nasal Symptom Severity (TNSS), p < 0.21; Sinonasal Outcome Test 20 (SNOT-20), p < 0.60), and no serious complications were reported in either trial. Based on the quality assessment, studies were deemed to be of moderate risk of bias and a low overall quality of evidence. CONCLUSIONS There is currently insufficient evidence to determine the effectiveness of anti-IgE monoclonal antibody therapy for the treatment of CRS.
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Affiliation(s)
- Chris J Hong
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Adrian C Tsang
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Jason G Quinn
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, Canada.
| | - James P Bonaparte
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, 737 Parkdale Ave., Room 459, Ottawa, Ontario, K1Y 1J8, Canada.
| | - Adrienne Stevens
- Center for Practice Changing Research, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada. .,Department of Clinical Epidemiology, University of Ottawa, Ottawa, ON, Canada.
| | - Shaun J Kilty
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, 737 Parkdale Ave., Room 459, Ottawa, Ontario, K1Y 1J8, Canada.
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8
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Badhiwala JH, Hong CJ, Nassiri F, Hong BY, Riva-Cambrin J, Kulkarni AV. Treatment of posthemorrhagic ventricular dilation in preterm infants: a systematic review and meta-analysis of outcomes and complications. J Neurosurg Pediatr 2015; 16:545-555. [PMID: 26314206 DOI: 10.3171/2015.3.peds14630] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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] [Indexed: 11/06/2022]
Abstract
OBJECT The optimal clinical management of intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilation (PHVD)/posthemorrhagic hydrocephalus (PHH) in premature infants remains unclear. A common approach involves temporary treatment of hydrocephalus in these patients with a ventriculosubgaleal shunt (VSGS), ventricular access device (VAD), or external ventricular drain (EVD) until it becomes evident that the patient needs and can tolerate permanent CSF diversion (i.e., ventriculoperitoneal shunt). The present systematic review and meta-analysis aimed to provide a robust and comprehensive summary of the published literature regarding the clinical outcomes and complications of these 3 techniques as temporizing measures in the management of prematurity-related PHVD/PHH. METHODS The authors searched MEDLINE, EMBASE, CINAHL, Google Scholar, and the Cochrane Library for studies published through December 2013 on the use of VSGSs, VADs, and/or EVDs as temporizing devices for the treatment of hydrocephalus following IVH in the premature neonate. Data pertaining to patient demographic data, study methods, interventions, and outcomes were extracted from eligible articles. For each of the 3 types of temporizing device, the authors performed meta-analyses examining 6 outcomes of interest, which were rates of 1) obstruction; 2) infection; 3) arrest of hydrocephalus (i.e., permanent shunt independence); 4) mortality; 5) good neurodevelopmental outcome; and 6) revision. RESULTS Thirty-nine studies, representing 1502 patients, met eligibility criteria. All of the included articles were observational studies; 36 were retrospective and 3 were prospective designs. Nine studies (n = 295) examined VSGSs, 24 (n = 962) VADs, and 9 (n = 245) EVDs. Pooled rates of outcome for VSGS, VAD, and EVD, respectively, were 9.6%, 7.3%, and 6.8% for obstruction; 9.2%, 9.5%, and 6.7% for infection; 12.2%, 10.8%, and 47.3% for revision; 13.9%, 17.5%, and 31.8% for arrest of hydrocephalus; 12.1%, 15.3%, and 19.1% for death; and 58.7%, 50.1%, and 56.1% for good neurodevelopmental outcome. CONCLUSIONS This study provides robust estimates of outcomes for the most common temporizing treatments for IVH in premature infants. With few exceptions, the range of outcomes was similar for VSGS, VAD, and EVD.
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Affiliation(s)
- Jetan H Badhiwala
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto
| | - Chris J Hong
- Faculty of Medicine, University of Ottawa, Ontario, Canada; and
| | - Farshad Nassiri
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto
| | - Brian Y Hong
- Faculty of Medicine, University of Ottawa, Ontario, Canada; and
| | - Jay Riva-Cambrin
- Division of Pediatric Neurosurgery, Primary Children's Hospital, Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Abhaya V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto
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9
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Biernacka JM, Sangkuhl K, Jenkins G, Whaley RM, Barman P, Batzler A, Altman RB, Arolt V, Brockmöller J, Chen CH, Domschke K, Hall-Flavin DK, Hong CJ, Illi A, Ji Y, Kampman O, Kinoshita T, Leinonen E, Liou YJ, Mushiroda T, Nonen S, Skime MK, Wang L, Baune BT, Kato M, Liu YL, Praphanphoj V, Stingl JC, Tsai SJ, Kubo M, Klein TE, Weinshilboum R. The International SSRI Pharmacogenomics Consortium (ISPC): a genome-wide association study of antidepressant treatment response. Transl Psychiatry 2015; 5:e553. [PMID: 25897834 PMCID: PMC4462610 DOI: 10.1038/tp.2015.47] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/01/2015] [Indexed: 12/21/2022] Open
Abstract
Response to treatment with selective serotonin reuptake inhibitors (SSRIs) varies considerably between patients. The International SSRI Pharmacogenomics Consortium (ISPC) was formed with the primary goal of identifying genetic variation that may contribute to response to SSRI treatment of major depressive disorder. A genome-wide association study of 4-week treatment outcomes, measured using the 17-item Hamilton Rating Scale for Depression (HRSD-17), was performed using data from 865 subjects from seven sites. The primary outcomes were percent change in HRSD-17 score and response, defined as at least 50% reduction in HRSD-17. Data from two prior studies, the Pharmacogenomics Research Network Antidepressant Medication Pharmacogenomics Study (PGRN-AMPS) and the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, were used for replication, and a meta-analysis of the three studies was performed (N=2394). Although many top association signals in the ISPC analysis map to interesting candidate genes, none were significant at the genome-wide level and the associations were not replicated using PGRN-AMPS and STAR*D data. The top association result in the meta-analysis of response represents SNPs 5′ upstream of the neuregulin-1 gene, NRG1 (P = 1.20E - 06). NRG1 is involved in many aspects of brain development, including neuronal maturation and variations in this gene have been shown to be associated with increased risk for mental disorders, particularly schizophrenia. Replication and functional studies of these findings are warranted.
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Affiliation(s)
- J M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA,Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. E-mail:
| | - K Sangkuhl
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - G Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - R M Whaley
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - P Barman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - A Batzler
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - R B Altman
- Department of Genetics, Stanford University, Stanford, CA, USA,Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - V Arolt
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - J Brockmöller
- Department of Clinical Pharmacology, University Göttingen, Göttingen, Germany
| | - C H Chen
- Department of Psychiatry, Taipei Medical University-Shuangho Hospital, New Taipei City, Taiwan
| | - K Domschke
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - D K Hall-Flavin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - C J Hong
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - A Illi
- Department of Psychiatry, School of Medicine, University of Tampere, Tampere, Finland
| | - Y Ji
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - O Kampman
- Department of Psychiatry, School of Medicine, University of Tampere, Tampere, Finland,Department of Psychiatry, Seinäjoki Hospital District, Seinäjoki, Finland
| | - T Kinoshita
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - E Leinonen
- Department of Psychiatry, School of Medicine, University of Tampere, Tampere, Finland,Department of Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Y J Liou
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - T Mushiroda
- RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - S Nonen
- Department of Pharmacy, Hyogo University of Health Sciences, Hyogo, Japan
| | - M K Skime
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - L Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - B T Baune
- Department of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - M Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Y L Liu
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - V Praphanphoj
- Center for Medical Genetics Research, Rajanukul Institute, Department of Mental Health, Ministry of Public Health Bangkok, Bangkok, Thailand
| | - J C Stingl
- Research Division Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - S J Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - M Kubo
- RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - T E Klein
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - R Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
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10
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Abstract
Aesthetic surgery is known for its prolific introduction of new techniques, devices, and products. The implementation of any aesthetic innovation, however, may inadvertently expose patients to potential complications and adverse events. How do we decide whether a new technique or technology is superior-in both safety and effectiveness-compared with prevailing interventions? In this paper, we present some basic steps anchored in evidence-based surgery that aesthetic surgeons need to pursue in the adoption of a new technique, technology, or product. These steps include: (1) gaining familiarity with and understanding the levels of evidence; (2) performing an effective literature search; (3) formulating a critical appraisal of an article; (4) making the decision to adopt or reject; (5) recognizing the need for continued assessment; (6) acknowledging the need for education and credentialing; and (7) translation of the gathered knowledge. We hope that this paper will foster critical thinking and reduce the reliance on "photographic evidence" in aesthetic surgery literature.
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Affiliation(s)
- Achilleas Thoma
- Dr Thoma is a Clinical Professor, Division of Plastic Surgery, Department of Surgery, McMaster University; Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University; and Director, Surgical Outcomes Research Center, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Ms. Kaur is a PhD Student, School of Rehabilitation Sciences; Research Coordinator, Division of Plastic Surgery, Department of Surgery; and Research Coordinator, Surgical Outcomes Research Center, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Mr. Hong is an MD Candidate, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr Li is a Resident, Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Manraj Nirmal Kaur
- Dr Thoma is a Clinical Professor, Division of Plastic Surgery, Department of Surgery, McMaster University; Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University; and Director, Surgical Outcomes Research Center, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Ms. Kaur is a PhD Student, School of Rehabilitation Sciences; Research Coordinator, Division of Plastic Surgery, Department of Surgery; and Research Coordinator, Surgical Outcomes Research Center, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Mr. Hong is an MD Candidate, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr Li is a Resident, Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Chris J Hong
- Dr Thoma is a Clinical Professor, Division of Plastic Surgery, Department of Surgery, McMaster University; Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University; and Director, Surgical Outcomes Research Center, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Ms. Kaur is a PhD Student, School of Rehabilitation Sciences; Research Coordinator, Division of Plastic Surgery, Department of Surgery; and Research Coordinator, Surgical Outcomes Research Center, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Mr. Hong is an MD Candidate, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr Li is a Resident, Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yu Kit Li
- Dr Thoma is a Clinical Professor, Division of Plastic Surgery, Department of Surgery, McMaster University; Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University; and Director, Surgical Outcomes Research Center, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Ms. Kaur is a PhD Student, School of Rehabilitation Sciences; Research Coordinator, Division of Plastic Surgery, Department of Surgery; and Research Coordinator, Surgical Outcomes Research Center, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Mr. Hong is an MD Candidate, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr Li is a Resident, Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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11
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Hong CJ, Tsang AC, Quinn J, Bonaparte J, Stevens A, Kilty SJ. Anti-Ige monoclonal antibody therapy for the treatment of chronic rhinosinusitis: a systematic review. Allergy Asthma Clin Immunol 2014. [PMCID: PMC4304038 DOI: 10.1186/1710-1492-10-s2-a19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Affiliation(s)
- Chris J Hong
- Faculty of Medicine (Hong), University of Ottawa, Ottawa, Ont.; Department of Ophthalmology and Vision Sciences (Trope), University of Toronto, Toronto, Ont
| | - Graham E Trope
- Faculty of Medicine (Hong), University of Ottawa, Ottawa, Ont.; Department of Ophthalmology and Vision Sciences (Trope), University of Toronto, Toronto, Ont.
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13
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Hong CJ, Trope GE, Buys YM, Robinson BE, Jin YP. Does government assistance improve utilization of eye care services by low-income individuals? Can J Ophthalmol 2014; 49:320-5. [DOI: 10.1016/j.jcjo.2014.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 03/06/2014] [Accepted: 03/16/2014] [Indexed: 10/25/2022]
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14
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Liu HC, Chi CW, Ko SY, Wang HC, Hong CJ, Lin KN, Wang PN, Liu TY. Cholinesterase inhibitor affects the amyloid precursor protein isoforms in patients with Alzheimer's disease. Dement Geriatr Cogn Disord 2005; 19:345-8. [PMID: 15785036 DOI: 10.1159/000084561] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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] [Accepted: 11/01/2004] [Indexed: 11/19/2022] Open
Abstract
An altered platelet ratio of amyloid precursor protein (APP) isoforms might be a diagnostic, predictive, or therapeutic marker for Alzheimer's disease (AD). Our purpose was to test the hypothesis that this ratio might serve as a therapeutic marker for AD patients treated with the cholinesterase inhibitor, galantamine. Thirty-nine patients (mean age 76.6 +/- 9.4 years) with AD were treated with galantamine for 12 weeks. Patients were evaluated at baseline, 4 and 12 weeks by cognitive testing along with a determination of their platelet APP isoform ratio. Western blotting was performed to calculate the APP isoform ratio. At the end of the treatment, cognitive scores significantly improved, and the ratio of the high-molecular-weight (130 kDa) isoform to the low-molecular-weight (110-106 kDa) isoforms increased. These results suggest that cholinesterase inhibition might be involved in APP processing.
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Affiliation(s)
- H C Liu
- Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan
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15
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Wang PN, Liu HC, Liu TY, Chu A, Hong CJ, Lin KN, Chi CW. Estrogen-metabolizing gene COMT polymorphism synergistic APOE epsilon4 allele increases the risk of Alzheimer disease. Dement Geriatr Cogn Disord 2005; 19:120-5. [PMID: 15591802 DOI: 10.1159/000082663] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [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] [Accepted: 06/04/2004] [Indexed: 11/19/2022] Open
Abstract
Alzheimer disease (AD) is a polygenic multifactorial disorder. Several studies suggested that the neuroprotective effect of estrogen was based on an APOE-dependent mechanism. The goals of the current study were to determine if the genes involved in estrogen metabolism were linked to the risk of AD and find out if there was an interaction between estrogen-metabolizing gene polymorphisms and the APOE epsilon4 allele in the risk of prevalent AD. We investigated 66 patients with AD and 86 age- and gender-matched normal subjects. The polymorphisms of APOE and estrogen-metabolizing genes CYP17, CYP1A1 and COMT were examined. No association was found between each estrogen-metabolizing gene polymorphism and AD. However, the COMT HH genotype and APOE epsilon4 allele had a synergistic effect on the risk of AD. Taking subjects with epsilon4-epsilon4-/HH- as reference, the risk of developing AD in subjects with one epsilon4 allele (epsilon4+epsilon4-/HH-) was 2.6 (95% confidence interval, CI, 0.7- 9.1); however, the risk in subjects with both HH and one epsilon4 (epsilon4+epsilon4-/HH+) increased to 3.6 (95% CI 1.2-10.6). The subjects with homozygous epsilon4 still had the highest risk in developing AD (odds ratio 6.6, 95% CI 0.6-69.6). The p value of the linear trend test for this regression model was 0.004. It is possible that a high metabolism of estrogen by COMT may have reduced the protective effect of estrogen in AD. Further studies to clarify this interaction may improve our understanding of the generic risks for AD.
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Affiliation(s)
- P N Wang
- The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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16
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Chang JB, Wang PN, Chen WT, Liu CY, Hong CJ, Lin KN, Liu TY, Chi CW, Liu HC. ApoEε4 allele is associated with incidental hallucinations and delusions in patients with AD. Neurology 2004; 63:1105-7. [PMID: 15452311 DOI: 10.1212/01.wnl.0000138612.24301.32] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Of 135 patients with Alzheimer disease (AD), 56 without psychiatric symptoms at the first visit were followed for a mean period of 51.9 +/- 10.3 months to identify incident psychiatric symptoms. The hazard ratios of ApoE epsilon4 allele in developing psychiatric symptoms were calculated by Cox regression hazard analyses. The presence of the ApoE epsilon4 allele carried a 19.0-fold risk for developing hallucinations and a 3.4-fold risk for delusions.
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Affiliation(s)
- J B Chang
- Department of Neurology, National Yang-Ming University School of Medicine, Taipei County, Taiwan
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17
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Hong CJ, Cheng CY, Shu LRR, Yang CY, Tsai SJ. Association study of the dopamine and serotonin transporter genetic polymorphisms and methamphetamine abuse in Chinese males. J Neural Transm (Vienna) 2003; 110:345-51. [PMID: 12658362 DOI: 10.1007/s00702-002-0790-8] [Citation(s) in RCA: 30] [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: 10/26/2022]
Abstract
The dopamine transporter (DAT) and the serotonin transporter (5-HTT) play important roles in methamphetamine (METH) dependence because they are the target of METH action. For this study, the association between the DAT and 5-HTT polymorphisms and METH dependence were investigated for a Chinese-male sample population. The investigated polymorphisms included those of the DAT 3'-variable number tandem repeat, the 5-HTT gene promoter and a 5-HTT variable number tandem repeat polymorphisms. No significant difference was demonstrated for genotype or allele frequency, when comparing METH dependent and control cases for the DAT and the 5-HTT polymorphisms. The findings of this study suggest that these polymorphisms do not play major roles in METH dependence in the Chinese-male population.
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Affiliation(s)
- C J Hong
- Department of Psychiatry, Veterans General Hospital-Taipei, and
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18
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Wu WH, Huo SJ, Cheng CY, Hong CJ, Tsai SJ. Association study of the 5-HT(6) receptor polymorphism (C267T) and symptomatology and antidepressant response in major depressive disorders. Neuropsychobiology 2002; 44:172-5. [PMID: 11702016 DOI: 10.1159/000054938] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [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: 11/19/2022]
Abstract
The serotonergic neurotransmitter system has been implicated in the pathogenesis of major depressive disorder (MDD). Of the 14 human serotonin (5-HT) receptors, the 5-HT(6) receptor may be a candidate for the study of MDD because of its relative abundance in certain limbic areas and its high affinity to several antidepressants. The present study tested the hypothesis that a 5-HT(6) genetic polymorphism (C267T) is associated with the clinical manifestations of, and/or antidepressant response in, MDD. The Hamilton Depression Rating Scale was used to assess 57 MDD patients before antidepressant treatment, with 34 patients completing the 4-week treatment and evaluation. The results of the association study provide that the 5-HT(6) C267T genetic variant does not play a major role in producing the clinical manifestations or antidepressant response for MDD patients. Further study with a functional 5-HT(6) polymorphism is needed to explore the role of 5-HT(6) in the pathogenesis of MDD.
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Affiliation(s)
- W H Wu
- Division of Psychiatry, Cheng Hsin Rehabilitation and Medical Center, Veterans General Hospital-Taipei, Taiwan, ROC
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19
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Abstract
There exists considerable evidence implicating abnormalities of the alpha (alpha)-adrenergic system in the development of Alzheimer disease (AD). We propose to investigate potential correlations between the presence or otherwise of alpha-adrenoceptor polymorphisms and the presence of AD. We studied the polymorphisms of the alpha1a- and the alpha2a-adrenoceptor genes in 142 AD patients and 98 normal controls. The result demonstrated that none of the alpha2a-adrenoceptor genotypes was associated with increased susceptibility to AD. However, there was a trend that the frequency of the C allele of the alpha1a-adrenoceptor was elevated and an excess of the CC genotype (90.1%) was found in the subjects with AD in comparison with the controls (78.6%). This association was unrelated to the apolipoprotein E genotypes. The hypothesis that the alpha1a-adrenoceptor gene may be implicated in the pathogenesis of AD may deserve further study.
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Affiliation(s)
- C J Hong
- Department of Psychiatry, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan, Republic of China
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20
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Abstract
The p53 tumor-suppressor gene, encoding a phosphoprotein, is a key element in maintaining genomic stability and cell apoptosis. It is also implicated in nervous-system development. In order to examine the role of the p53 gene for the pathogenesis of schizophrenic disorders, patients (n=155) and control subjects (n=168) were genotyped for the p53-Pro72Arg polymorphism. The results demonstrated no association with schizophrenia and/or age of onset for this polymorphism.
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Affiliation(s)
- H J Chiu
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC
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21
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Tsai SJ, Wang YC, Hong CJ. Association study between cannabinoid receptor gene (CNR1) and pathogenesis and psychotic symptoms of mood disorders. ACTA ACUST UNITED AC 2001; 105:219-21. [PMID: 11353438 DOI: 10.1002/ajmg.1259] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cannabis can induce mood change and sometimes psychotic symptoms in normal persons. In brain, the main active ingredient of cannabis acts via the cannabinoid CB1 receptor (CNR1) which is located on chromosome 6q14-15. Linkage studies have suggested the presence of a bipolar disorder susceptibility locus on chromosome 6q. In this population based association study, we tested the hypothesis that a microsatellite polymorphism in the promoter region of the CNR1 gene confers susceptibility to mood disorders and psychotic features. We genotyped the CNR1 gene is 154 mood disorder patients and 165 normal controls. The results showed that the triplet repeat polymorphism in the promoter region of the CNR1 gene was not likely to be involved in the pathogenesis or in the psychotic symptoms of mood disorders.
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Affiliation(s)
- S J Tsai
- Department of Psychiatry, Veterans General Hospital-Taipei, Taipei, Taiwan ROC.
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22
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Hong CJ, Yu YW, Lin CH, Cheng CY, Tsai SJ. Association analysis for NMDA receptor subunit 2B (GRIN2B) genetic variants and psychopathology and clozapine response in schizophrenia. Psychiatr Genet 2001; 11:219-22. [PMID: 11807413 DOI: 10.1097/00041444-200112000-00007] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is known that a syndrome resembling schizophrenia is produced by the N-methyl-d-aspartate receptor antagonists. It has also been demonstrated that the level of an ionotropic N-methyl-d-aspartate 2B subunit (GRIN2B) of the glutamate receptor tends to increase after subchronic administration of clozapine, suggesting that GRIN2B may play an active role in the pathogenesis of schizophrenia and the function of clozapine medication. We studied 100 schizophrenic patients, investigating the associations for the GRIN2B genetic variants, and psychiatric symptoms and clozapine response. No significant differences were demonstrated comparing these three groups in terms of the baseline Brief Psychiatric Rating Scale (BPRS) score (P = 0.441). The percentage of patients scoring within 20% of baseline BPRS after clozapine treatment was similar for the three genotype groups (P = 0.132). A marginally higher mean clozapine dosage was revealed, however, for patients bearing the 2664C/C genotype (P = 0.013). Although replication of this research is required to confirm the results, an association for the GRIN2B C2664T polymorphism and clozapine treatment is suggested from our findings, which may assist in the prediction of optimal dosage for schizophrenic patients.
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Affiliation(s)
- C J Hong
- Department of Psychiatry, Veterans General Hospital-Taipei, Taiwan, ROC
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23
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Abstract
The guanine nucleotide-binding proteins (G proteins), heterotrimers consisting of alpha, beta and gamma subunits, convey signals initiated by the activation of many neurotransmitter receptors. Evidence for involvement of the G proteins in mood disorders relies on the effects of mood stabilizers and antidepressants on G protein function. In addition, abnormalities in the expression of G proteins have been demonstrated in mood disorder patients. Therefore, we tested the hypothesis that a functional polymorphism (C825T) in the G protein beta3 gene subunit (GNB3) confers susceptibility to mood disorders. A population-based association study was utilized, and GNB3 was genotyped for 144 mood disorder patients and 153 normal controls. The results reveal that it is not likely that the C825T polymorphism in the GNB3 gene subunit is involved in mood disorder pathogenesis. Further studies of the associations between other G protein subunits and mood disorder are needed to fully elaborate the involvement of this protein in mood disorders.
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Affiliation(s)
- C N Lin
- Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan, ROC
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Liao DL, Yeh YC, Chen HM, Chen H, Hong CJ, Tsai SJ. Association between the Ser9Gly polymorphism of the dopamine D3 receptor gene and tardive dyskinesia in Chinese schizophrenic patients. Neuropsychobiology 2001; 44:95-8. [PMID: 11490179 DOI: 10.1159/000054924] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [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: 11/19/2022]
Abstract
It has been suggested that dopamine D3 receptor (DRD3) may have important implications for antipsychotic-induced tardive dyskinesia (TD). Previous studies have demonstrated an association between a serine to glycine polymorphism in the first exon of the DRD3 gene and TD; however, the results have been inconsistent. Therefore, we have replicated these studies using a Chinese sample population. A total of 115 schizophrenic patients from chronic wards were assessed for TD severity using the Abnormal Involuntary Movements Scale (AIMS) and were subsequently genotyped for the DRD3 polymorphism. The mean AIMS score for patients carrying the heterozygote (DRD3(ser-gly)) was significantly greater than for those with the homozygotes (DRD3(ser-ser) and DRD3(gly-gly)). Our results are in line with a previous report, the results of which suggest that the presence of the DRD3(ser-gly) genotype may be a risk factor for the development of TD in patients treated with antipsychotics.
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Affiliation(s)
- D L Liao
- Department of Psychiatry, Executive Yuan Department of Health, Pali Psychiatric Hospital, Taipei, Taiwan, ROC
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25
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Liou YJ, Lai IC, Hong CJ, Liu HC, Liu TY, Tsai SJ. Association analysis of the partially duplicated alpha7 nicotinic acetylcholine receptor genetic variant and Alzheimer's disease. Dement Geriatr Cogn Disord 2001; 12:301-4. [PMID: 11455129 DOI: 10.1159/000051273] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/19/2022] Open
Abstract
Changes in the nicotinic acetylcholine receptors (nAChRs) have been demonstrated for Alzheimer's disease (AD). Of these receptors, the alpha7 nAChRs, which are abundant on hippocampal interneurons, have been implicated in the cytotoxic role of the beta-amyloid. Increased mRNA levels of alpha7 nAChR in the peripheral lymphocytes and hippocampus of AD patients have been reported. We tested the hypothesis that the allelic variant, 2bp deletion, of the partially duplicated alpha7 nAChR gene confers susceptibility to Alzheimer's disease. The -2bp polymorphism was examined in 120 patients with AD and 98 normal controls. The distribution of the partially duplicated alpha7 nAChR genotypes (p = 0.372) and alleles (p = 0.465) did not differ significantly for AD patients and controls. This negative finding suggests that the partially duplicated alpha7 nAChR genetic polymorphism contributes no major effect to the development of AD. However, we suggest that the other genetic variation of the alpha7 nAChR gene, related to AD or the associated symptomatology, merits further investigation.
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Affiliation(s)
- Y J Liou
- Department of Psychiatry, Veterans General Hospital-Taipei, #201, Shih-Pai Road Sec. 2, 11217, Taipei, Taiwan, ROC
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26
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Abstract
BACKGROUND Apolipoprotein E (apoE) is present in a variety of biochemically different amyloid deposits, including Alzheimer's disease, systemic amyloidosis and primary cutaneous amyloidosis (PCA). Among the three closely related alleleic forms of apoE, the epsilon4 allele is linked to Alzheimer's disease. Apolipoprotein A-I (apoA-I), another apolipoprotein, is also found in senile plaques of Alzheimer's disease and in amyloid of aortic atherosclerotic plaques. Furthermore, apoA-I has recently been found to be associated with hereditary cutaneous and cardiac amyloidosis. OBJECTIVES To determine whether the apoE epsilon4 allele is associated with increased risk of PCA and whether apoE and apoA-I are present in PCA and common secondary cutaneous amyloidosis (SCA) (i.e. basal cell carcinoma, Bowen's disease and seborrhoeic keratosis). METHODS We examined the apoE genotype in 57 Chinese patients with PCA and 58 normal healthy control subjects of similar age. In addition, immunohistochemical staining was performed to determine the localization of apoE and apoA-I in skin tissues from 15 patients with SCA and 15 with PCA. RESULTS The frequency of the epsilon4 allele in the PCA group was not significantly higher than that in the control group (8.8% vs. 6.9%, P > 0.05). ApoE was present in amyloid deposits in both PCA and SCA, but apoA-I was not detected in these cutaneous amyloid deposits. CONCLUSIONS ApoE is also a component of amyloid deposits in SCA. Although the genetic susceptibility of certain apoE isoforms may not be a crucial factor in the development of PCA and, although apoA-I is not associated with amyloid deposits of PCA and SCA, the role of apolipoproteins in amyloidogenesis deserves further scrutiny.
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Affiliation(s)
- Y T Chang
- Department of Dermatology, Taipei Veterans General Hospital and National Yang-Ming University, Shih-Pai, Taipei 112, Taiwan
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27
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Lin CH, Yu YW, Chen TJ, Tsa SJ, Hong CJ. Association analysis for dopamine D2 receptor Taq1 polymorphism with P300 event-related potential for normal young females. Psychiatr Genet 2001; 11:165-8. [PMID: 11702060 DOI: 10.1097/00041444-200109000-00010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
P300 has been demonstrated abnormal for a variety of neuropsychiatric disorders, and heritability has been proposed. We analyzed the event-related potentials for three DRD2 genotype groups in 134 normal young females. The results demonstrate that there is no association for DRD2 genotype and P300 components. Our negative findings in normal subjects suggest association demonstrated for P300 latency and the DRD2 allele may be disease dependent.
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Affiliation(s)
- C H Lin
- Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan, ROC
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28
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Abstract
BACKGROUND Depressive patients are more likely to smoke than the general population and nicotine was found to reduce the incidence and severity of depressive symptoms in many studies. These findings suggest that nicotinic acetylcholine receptors (nAChRs) may be implicated in major depressive disorder. We tested the hypothesis that the allelic variant, 2 bp deletion, of the partially duplicated alpha7 nAChR gene confers susceptibility to major depressive disorder. METHODS We genotyped alpha7 nAChR in 72 patients with major depressive disorder and 103 normal controls. RESULTS The distribution of the partially duplicated alpha7 nAChR genotypes (P=0.027) and alleles (P=0.037) suggests a modest difference between depressive patients and controls. LIMITATIONS The -2 bp allele is thought to be present only in the duplicated exon 6, and the impact of the partially duplicated alpha7 nAChR and its -2 bp variant remain to be determined. CONCLUSIONS The -2 bp allele of partially duplicated alpha7 nAChR may have an influence on the risk for development of major depressive disorder. The levels of significance achieved are modest and the findings must be replicated in other studies.
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Affiliation(s)
- I C Lai
- Department of Psychiatry, Veterans General Hospital, No. 201 Shih-Pai Road, Sec. 2, 11217 Taipei, Taiwan, ROC
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29
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Abstract
Angiotensin-converting enzyme (ACE) is a key enzyme in the renin-angiotensin system and can modulate dopamine turnover in the midbrain. Previous studies have revealed changes in the central ACE levels for schizophrenic patients, possibly related to the polydipsia commonly demonstrated for chronic schizophrenia. An insertion (I)/deletion (D) polymorphism of the ACE gene has been associated with ACE levels. Therefore, we elected to investigate the ACE I/D polymorphism for 124 schizophrenic patients and 117 control subjects. No significant differences for the genotype distribution or the allele frequency were revealed comparing controls and schizophrenic patients. The ACE genotypes were not associated with onset age or psychiatric symptoms for the schizophrenic cases. A modest association was revealed for this ACE polymorphism and polydipsia diagnosis for these patients. Using bearers of the D allele as baseline, the ratio for I/I homozygote was 2.31 (95% CI 0.95-5.65). This association needs further replication as it may have implications for the pathogenesis and the treatment of polydipsia for schizophrenic patients.
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Affiliation(s)
- W C Ouyang
- Section of Geriatric Psychiatry, Provisional Chia-Nan Psychiatric Center, Tainan, Taiwan, ROC
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30
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Tsai SJ, Hong CJ, Liu TY, Cheng CY, Liu HC. Association study for a functional serotonin transporter gene polymorphism and late-onset Alzheimer's disease for Chinese patients. Neuropsychobiology 2001; 44:27-30. [PMID: 11408789 DOI: 10.1159/000054910] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/19/2022]
Abstract
Two recent studies have demonstrated an association for a deletion/insertion polymorphism within the promoter region of the serotonin transporter gene (5-HTTLPR), and Alzheimer's disease (AD). According to these studies, subjects with the short variant of the 5-HTTLPR gene are at increased risk for AD; however, this finding has not been confirmed by other workers. To evaluate the role of the 5-HTTLPR gene in susceptibility for AD, we conducted an association study for this polymorphism in a Chinese population. No significant differences were determined for genotype distribution or allele frequencies, comparing AD patients and normal controls. Even dividing the population into subgroups according to the presence of the APOE epsilon4 allele, no differences for genotype or allele frequencies were determined, comparing patients and controls. These results suggest that it is unlikely that the 5-HTTLPR polymorphism plays a substantial role in conferring susceptibility to AD.
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Affiliation(s)
- S J Tsai
- Department of Psychiatry, Veterans General Hospital-Taipei, Taipei, Taiwan, ROC
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31
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Liu HC, Hong CJ, Liu CY, Lin KN, Tsai SJ, Liu TY, Chi CW, Wang PN. Association analysis of the 5-HT6 receptor polymorphism C267T with depression in patients with Alzheimer's disease. Psychiatry Clin Neurosci 2001; 55:427-9. [PMID: 11442897 DOI: 10.1046/j.1440-1819.2001.00886.x] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A significant increase of 267C allele of the 5-HT(6) receptor gene has been reported in patients with Alzheimer's disease (AD). Because a deficit in serotonergic neurotransmission is involved in major depression, we tried to find out whether 267C allele is associated with depressive disorders in AD. A psychiatrist interviewed all AD patients and their caregivers for evidence of depression using a Chinese version of the Standard Clinical Interview for DSM-III-R. The difference in the 5-HT(6) genotype or allele distributions between the AD patients with depressive disorders (n = 25) and those without (n = 120) was not significant.
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Affiliation(s)
- H C Liu
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
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32
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Abstract
alpha(1)-Antichymotrypsin (ACT) gene has been suggested as a susceptibility factor for Parkinson's disease (PD) and might be related to the onset of PD. We replicated these findings in a Chinese population. The results demonstrated that the ACT genotypic and allelic distributions showed no significant differences between the PD patient and the control groups. The age at onset was younger in the heterozygotes than in the homozygotes (p = 0.042). We suggest that the ACT polymorphism might play some role in the pathogenesis of PD, especially in the onset.
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Affiliation(s)
- Y C Wang
- Section of Psychiatry, Yu-Li Veterans Hospital, Hualien, Taiwan, ROC
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33
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Abstract
Schizophrenic disorders are equally distributed for both sexes; however, later onset, milder psychopathology and better outcome are associated with the female gender. This sex difference is thought to be partly due to the estrogen system. Recent studies have determined that estrogen receptor alpha subtype (ER alpha) genetic polymorphisms may affect the expression of ER alpha, and are associated with Alzheimer's disease. For this study, we investigated the association of ER alpha polymorphisms for 125 schizophrenic patients and 142 control subjects. No significant differences for genotype distribution or allele frequency were revealed comparing controls and schizophrenic patients. The ER alpha genotypes were not associated with onset age, psychiatric symptoms or outcome for schizophrenic cases. With new research highlighting the prominent role of sex hormones in neurological and psychological dysfunction, further study is needed to explore the genetic effect of the sex hormone receptor gene on susceptibility mental disorders and associations with different phenotypes.
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Affiliation(s)
- W C Ouyang
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC
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34
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Yu YW, Tsai SJ, Yang KH, Lin CH, Chen MC, Hong CJ. Evidence for an association between polymorphism in the serotonin-2A receptor variant (102T/C) and increment of N100 amplitude in schizophrenics treated with clozapine. Neuropsychobiology 2001; 43:79-82. [PMID: 11174050 DOI: 10.1159/000054871] [Citation(s) in RCA: 35] [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: 11/19/2022]
Abstract
Using event-related potentials (ERPs), a reduction in the auditory N100, N200 and P300 amplitude has been found in schizophrenic patients and may represent some pathophysiological deficit. Therefore, we investigated whether the genetic variant of the serotonin-2A receptor is associated with ERP change after clozapine treatment in schizophrenic patients. Ninety-nine schizophrenic patients were included in the study. The results demonstrated that patients with 102C/C genotype have higher N100 amplitude than other patients after clozapine treatment. Our findings suggested that serotonin-2A receptor polymorphism may relate to clozapine response in schizophrenic patients. An objective and reliable tool like ERPs to assess patients' treatment response may afford more consistent results in pharmacogenetic studies.
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Affiliation(s)
- Y W Yu
- Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan, ROC
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35
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Tsai SJ, Wang YC, Yu Younger WY, Lin CH, Yang KH, Hong CJ. Association analysis of polymorphism in the promoter region of the alpha2a-adrenoceptor gene with schizophrenia and clozapine response. Schizophr Res 2001; 49:53-8. [PMID: 11343863 DOI: 10.1016/s0920-9964(00)00127-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There exists considerable evidence implicating the alpha (alpha) adrenergic system in the superior therapeutic effects of clozapine for the treatment of schizophrenia, as also its associated adverse hypersalivation side effect. It would seem plausible for variants of the adrenoceptors to be associated with the clozapine response. The present study tested the hypothesis that a biallelic polymorphism in the promoter region of the alpha2a-adrenoceptor gene confers susceptibility to schizophrenia, and is associated with a clozapine-induced (favorable) therapeutic response and/or a clozapine-induced hypersalivation. Ninety-seven treatment-resistant schizophrenic patients were assessed using the Brief Psychiatric Rating Scale before and after clozapine treatment. The results of clozapine treatment demonstrated that the alpha2a-adrenoceptor gene variants did not play a major role in the susceptibility, hypersalivation adverse effect or clozapine response of patients with schizophrenia. The polymorphism of the alpha2a-adrenoceptor gene investigated is not likely to play a major role in the pathogenesis of schizophrenic disorders or clozapine response, although the hypothesis that these genes are implicated in the cognitive deficit and polydipsia associated with schizophrenic disorders may, however, still warrant further study.
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Affiliation(s)
- S J Tsai
- Department of Psychiatry, Veterans General Hospital-Taipei, Taipei, Taiwan, ROC.
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36
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Abstract
The human tryptophan hydroxylase (TPH) gene, the rate-limiting enzyme in serotonin biosynthesis, was localized on human chromosome 11p14-p15.3. Variation within intron 7 of the TPH gene was found to influence serotonin metabolism in the brain. To explore the possible role of TPH in the pathogenesis of schizophrenic disorders, we genotyped the TPH A218C polymorphism in 196 schizophrenic patients and 251 controls. The results demonstrated that genotype distribution was significantly different between schizophrenic patients and control subjects (P=0.002). No association was found between TPH genotypes and suicidal history in schizophrenic patients (P=0.239). The positive finding in this study suggests that the TPH 218A allele is a risk factor for schizophrenic disorders or is in linkage disequilibrium with the putative schizophrenia susceptibility locus in Han Chinese population.
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Affiliation(s)
- C J Hong
- Department of Psychiatry, Veterans General Hospital-Taipei, Taipei, Taiwan, ROC.
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37
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Abstract
The anticipation phenomenon is an important aspect in several genetic disorders in which the age at onset (AAO) decreases and the severity of illness increases in successive generations. This phenomenon has been reported in several schizophrenic family studies, and expanded repeat mutations are implicated. In the present study, we investigate the anticipation phenomenon in Chinese schizophrenic families. We compare the AAO between two generations of 38 unilinear schizophrenic families. Intergenerational comparisons show that the AAO was significantly earlier in the offspring generation (mean AAO, 22.2 years) than that in the parental generation (mean AAO, 31.0 years) (P < 0.001). When only including the offspring generation who married, the AAO difference between the two generations was not significant (28.4 years vs 31.0 years, P = 0.151). Our findings suggest that a selection bias in the parental group might greatly impact the study of anticipation in schizophrenia. Other unavoidable biases associated with these analyses are discussed in the text.
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Affiliation(s)
- C H Lin
- Kai-Suan Psychiatric Hospital, Kaohsiung, Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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38
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Abstract
Clozapine-induced weight gain may impair health and affect patient compliance. The aim of this study is to investigate the relationship between the genetic variants of the serotonin system and clozapine-induced body weight change (BWC). Ninety-three treatment-resistant schizophrenic patients were weighed monthly for 4 months during clozapine treatment. At the conclusion of treatment, patients had gained an average of 2.4 kg body weight, with BWC ranging from -17.5 to +12.9 kg. The levels of the serotonin transporter variants, serotonin 2A, serotonin 2C and serotonin 6, demonstrated no statistically significant relationship to BWC. Patients with a lower initial body mass index demonstrated a greater weight gain associated with clozapine treatment. Further exploration of the neurotransmitters implicated in the antipsychotic-induced BWC is important in order to reduce the morbidity and noncompliance associated with weight gain.
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Affiliation(s)
- C J Hong
- Department of Psychiatry, Veterans General Hospital-Taipei, no. 201, Shih-Pal Road, Sec. 2, 11217, Taipei, Taiwan, ROC
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39
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Hong CJ, Yu YW, Lin CH, Song HL, Lai HC, Yang KH, Tsai SJ. Association study of apolipoprotein E epsilon4 with clinical phenotype and clozapine response in schizophrenia. Neuropsychobiology 2001; 42:172-4. [PMID: 11096331 DOI: 10.1159/000026689] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Schizophrenic patients with the apolipoprotein E (APOE = gene; apoE = protein) epsilon4 allele exhibited lower psychosis scores than patients without the epsilon4 allele in previous reports. The present study tested the hypothesis that the APOE epsilon4 allele confers association with the clinical manifestations of schizophrenia or clozapine response. A total of 95 schizophrenic patients who were treatment resistant were included in the study. The results demonstrated that the presence of the APOE epsilon4 allele did not influence the response to clozapine in schizophrenic patients, neither was the baseline psychopathology related to the APOE epsilon4 allele. Given the multiple functions of the apoE protein in the brain, further study of the influence of APOE on CNS medication response is needed.
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Affiliation(s)
- C J Hong
- Department of Psychiatry, Veterans General Hospital-Taipei, Taipei, Taiwan, ROC
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40
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Tsai SJ, Wang YC, Hong CJ. Allelic variants of the alpha1a adrenoceptor and the promoter region of the alpha2a adrenoceptor and temperament factors. Am J Med Genet 2001; 105:96-8. [PMID: 11425010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Human personality traits are partially determined by genes. It has been suggested that the reward-dependence dimension assessed by the Tridimensional Personality Questionnaire (TPQ) is related to the central noradrenergic system. Our population-based association study tested the hypothesis that genetic variants of the adrenoceptor are associated with this personality trait. The alpha1a- and the alpha2a-adrenoceptor genotypes were determined for 198 healthy Han Chinese who had completed the TPQ. We found no significant differences for TPQ personality-factor scores, including reward dependence and its subscales, for subjects showing different adrenoceptor genotypes. Our negative findings suggest that polymorphisms of the alpha1a adrenoceptor and of the promoter region of the alpha2a-adrenoceptor have no major effect on the reward-dependence personality trait as assessed by TPQ.
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Affiliation(s)
- S J Tsai
- Department of Psychiatry, Veterans General Hospital-Taipei, Taiwan, Republic of China.
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41
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Liou YJ, Tsai SJ, Hong CJ, Wang YC, Lai IC. Association analysis of a functional catechol-o-methyltransferase gene polymorphism in schizophrenic patients in Taiwan. Neuropsychobiology 2001; 43:11-4. [PMID: 11150892 DOI: 10.1159/000054858] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [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: 11/19/2022]
Abstract
The catechol-O-methyltransferase (COMT) gene was thought to be a candidate gene for schizophrenia because of its role in inactivating dopamine. This study examined the relationship between a functional polymorphism (val158met) of the COMT gene, schizophrenia and its associated behaviors. One hundred and ninety-eight Chinese schizophrenic patients and 188 controls were genotyped by polymerase chain reaction restriction fragment length polymorphism. Of the schizophrenic patients, 72 had a history of violence and 62 had a history of suicide attempts. The results failed to show significant association between val158met polymorphism and schizophrenia, violence or suicide. However, our results showed a significant difference in age at disease onset among different genotypes (F = 5.501, p = 0.005).
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Affiliation(s)
- Y J Liou
- Department of Psychiatry, Veterans General Hospital-Taipei, Taipei, Taiwan, ROC
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42
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Abstract
Nicotine acetylcholine receptors (nAChRs) are implicated in the pathogenesis of schizophrenia because the prevalence of smoking among schizophrenic patients is extraordinarily high, and nicotine has been demonstrated to improve some psychophysiological dysfunction in schizophrenics. In addition, recent studies have suggested linkage of the alpha(7) nAChR gene region in families of schizophrenics. In a population-based association study, we tested the hypothesis that the allelic variant, with a 2-bp deletion, of the human alpha(7) nAChR gene confers susceptibility to schizophrenic disorders. We genotyped alpha(7) nAChR in 146 patients with schizophrenic disorders and 151 controls. The results showed no significant difference in genotype or allele frequencies between schizophrenic patients and control subjects. This suggests that alpha(7) nAChR 2-bp deletion plays no major role in the pathogenesis of schizophrenic disorders. Other nAChR variants in schizophrenic disorders may need further investigation.
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Affiliation(s)
- I C Lai
- Department of Psychiatry, Veterans General Hospital-Taipei, Taipei, Taiwan, ROC
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43
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Abstract
Serotonergic dysfunction is implicated in Alzheimer's disease (AD) on the basis of studies of serotonin and its metabolite in postmortem specimens and CSF. There were also reports on association of a tryptophan hydroxylase (TPH) intron 7 variant and CSF 5-hydroxyindoleacetic acid concentrations. These suggested TPH might be a candidate to study for possible involvement in AD. Using a case-control association approach, we studied the TPH polymorphism in 150 subjects with AD and 100 controls. There were no significant differences in genotype or allele frequencies between controls and AD patients. The negative findings suggested that this TPH polymorphism has no major effect on the development of AD. However, the genetic variation of the TPH gene related to the symptomatology of AD deserves further investigation.
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Affiliation(s)
- Y C Wang
- Section of Psychiatry, Yu-Li Veterans Hospital, Hualien, Taiwan, ROC
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44
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Yu YW, Lin CH, Chen SP, Hong CJ, Tsai SJ. Intelligence and event-related potentials for young female human volunteer apolipoprotein E epsilon4 and non-epsilon4 carriers. Neurosci Lett 2000; 294:179-81. [PMID: 11072144 DOI: 10.1016/s0304-3940(00)01569-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [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: 11/19/2022]
Abstract
The apolipoprotein E (APOE) epsilon4 allele is associated with late-onset Alzheimer's disease and cognitive function in aging normal populations. To study the effect of the presence of the epsilon4 allele on cognitive function, we compared intelligence-test scores and component values for event-related potentials for epsilon4 and non-epsilon4 carriers in a group of 134 young females. The results demonstrate modest increases in performance intelligence quotient (IQ) and N100 amplitude for epsilon4 carriers (P=0.038 and 0.068, respectively). Our findings suggest that cognitive impairment, associated with the presence of the epsilon4 allele, is age-dependent and thus not probable for young women. The higher performance IQ scores demonstrated for epsilon4 carriers require further exploration.
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Affiliation(s)
- Y W Yu
- Yu's Psychiatric Clinic, Kaohsiung, Taiwan, ROC
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45
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Hsu JW, Wang YC, Lin CC, Bai YM, Chen JY, Chiu HJ, Tsai SJ, Hong CJ. No evidence for association of alpha 1a adrenoceptor gene polymorphism and clozapine-induced urinary incontinence. Neuropsychobiology 2000; 42:62-5. [PMID: 10940760 DOI: 10.1159/000026674] [Citation(s) in RCA: 22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Clozapine is an effective atypical antipsychotic that has high affinity for many neurotransmitter receptors. Among the adverse effects of clozapine, urinary incontinence is commonly found and is suggested to be caused by alpha-adrenergic blockade. We tested the hypothesis that clozapine-induced urinary incontinence is related to a genetic variant of the alpha(1a)-adrenoceptor. We also tested whether the alpha(1a)-receptor gene confers susceptibility to schizophrenic disorders. Our result indicated that the alpha(1a)-adrenoceptor gene polymorphism investigated plays no major role in the pathogenesis of schizophrenia or in clozapine-induced urinary incontinence. Considering the superior effects of clozapine and its potent adrenergic antagonistic effects, it is of interest to investigate the association between this polymorphism and the treatment response.
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Affiliation(s)
- J W Hsu
- Section of Psychiatry, Yu-Li Veterans Hospital, National Yang-Ming University, Veterans General Hospital-Taipei, Taiwan, ROC
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46
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Tsai SJ, Hong CJ, Yu YW, Lin CH, Song HL, Lai HC, Yang KH. Association study of a functional serotonin transporter gene polymorphism with schizophrenia, psychopathology and clozapine response. Schizophr Res 2000; 44:177-81. [PMID: 10962219 DOI: 10.1016/s0920-9964(99)00170-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Serotonin is implicated in the pathogenesis of schizophrenia. Following serotonin release, the serotonin transporter (5-HTT) is the major determinant of serotonin inactivation. The present study tested the hypothesis that a biallelic polymorphism in the 5' regulatory region of the 5-HTT gene (5-HTTLPR) confers susceptibility to schizophrenia, association with the clinical manifestations of schizophrenia or clozapine response. 90 treatment-resistant schizophrenic patients were assessed using the Brief Psychiatric Rating Scale before and after clozapine treatment. The results demonstrated that the 5-HTTLPR variants did not play a major role in the susceptibility, clinical manifestations or clozapine response in schizophrenia.
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Affiliation(s)
- S J Tsai
- Department of Psychiatry, Veterans General Hospital Taipei, Taipei, Taiwan
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47
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Abstract
Cannabis can induce schizophrenic-like symptoms in healthy individuals. A principal active ingredient of cannabis, delta-9-tetrahydrocannabinol, acts in the brain on a specific receptor, termed the cannabinoid receptor 1 (CNR1). The human gene for CNR1 is mapped to chromosome 6q14-15, and linkage studies have produced evidence for a schizophrenia-susceptibility locus in this region. To explore a possible role for CNR1 in the pathogenesis of schizophrenic disorders, we used an association study to genotype the CNR1 polymorphism for 127 schizophrenic patients and 146 control subjects. The results demonstrate no association between CNR1 genotypes and schizophrenic disorders (P = 0.409), with these negative findings suggesting that, for Chinese populations, the (AAT)n triplet repeat in the promoter region of the CNR1 gene is not directly involved in the pathogenesis of schizophrenic disorders.
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Affiliation(s)
- S J Tsai
- Department of Psychiatry, Veterans General Hospital-Taipei, Taiwan.
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Abstract
Schizophrenic disorders are complex genetic disorders and may involve multiple genes of small effect. The presence of apolipoprotein E (apoE) is associated with several neuropsychiatric disorders. Previous studies on apoE genotype distribution in schizophrenia have reported conflicting findings. We studied the genotype frequencies in a large group of schizophrenic patients. The genotype distribution was significantly different between the schizophrenic patients and the control subjects. Persons who were sigma3 carriers have an increased risk of schizophrenia. This result suggests that apoE isoforms may play a functional role in the pathogenesis of schizophrenic disorders. Some possible mechanisms regarding the effect of apoE on the development of schizophrenia are discussed.
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Affiliation(s)
- J Y Chen
- Section of Psychiatry, Yu-Li Veterans Hospital, Taipei, Taiwan, ROC
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Lee DW, Liu HC, Liu TY, Chi CW, Hong CJ. No association between butyrylcholinesterase K-variant and Alzheimer disease in Chinese. Am J Med Genet 2000; 96:167-9. [PMID: 10893490] [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: 02/17/2023]
Abstract
Increased butyrylcholinesterase (BChE) activity has been reported to be associated with the formation of amyloid plaques and neurofibrillary tangles and may consequently be involved in the pathogenesis of Alzheimer disease (AD). Because the catalytic activity of BChE-K variant is reduced by one-third compared with non-variant, we speculated that BChE-K variant has a protective effect on AD. However, Lehmann et al. [1997] reported a synergistic effect between the genes for BChE-K variant and apolipoprotein E (ApoE) epsilon 4, which increases the risk for late onset AD. In the present study, we tested 89 Chinese AD patients and 101 Chinese controls and found no evidence of association between BCHE-K and AD of either early or late onset (age > 65 years). No evidence of a synergistic effect was found between the BCHE-K variant and APOE epsilon 4 in this study. Our data suggest that BChE-K variant has no modifying effect on the pathogenesis of AD. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:167-169, 2000.
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Affiliation(s)
- D W Lee
- Department of Psychiatry, Veterans General Hospital-Taipei, Taipei, Taiwan
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