1
|
Cornish EE, Wickremasinghe S, Mehta H, Lim L, Sandhu SS, Nguyen V, Gillies MC, Fraser-Bell S. Aflibercept monotherapy versus aflibercept with targeted retinal laser to peripheral retinal ischemia for diabetic macular oedema (LADAMO). Eye (Lond) 2023; 37:3417-3422. [PMID: 37069239 PMCID: PMC10630305 DOI: 10.1038/s41433-023-02525-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/21/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE We tested the hypothesis that targeted retinal laser photocoagulation (TPRP) to peripheral retinal ischaemia reduces the overall burden of aflibercept injections when treating diabetic macular oedema (DMO) over a 24-month period. METHODS Prospective, double-masked, multicentre, randomised controlled trial in Australia comparing aflibercept monotherapy, following a treat-and-extend protocol, or combination therapy of aflibercept and TPRP for DMO. The aflibercept monotherapy group received placebo laser. The primary outcome measure was the mean number of intravitreal aflibercept injections for each group at 24 months. Secondary outcome included: mean change in central macular thickness (CMT) and vision at trial completion, the proportion of eyes whose DMO resolved and the mean injection treatment interval. Ocular and systemic adverse events were recorded. RESULTS We enrolled 48 eyes of 47 patients; 27 eyes were randomised to combination therapy (aflibercept and TPRP) and 21 to aflibercept monotherapy. Thirty-two eyes (67%) completed the 2-year study. The number of intravitreal treatments given were similar for combination therapy (10.5 (SD 5.8) and monotherapy (11.8 (SD5.6)) (P = 0.44). The mean visual improvement (+4.0 (-1.8, 9.8) and +7.8 (2.6, 12.9) letters, P = 0.32), mean decrease in CMT (-154 (-222,-87) µm and -152 (-218,-86) µm, P = 0.96), proportion of eyes with CMT < 300 µm (48% and 67%; P = 0.50) and safety outcomes were similar in both the combination and monotherapy treatment groups (respectively). CONCLUSIONS Laser to areas of ischaemic peripheral retina does not reduce the burden of intravitreal aflibercept injections when treating diabetic macular oedema.
Collapse
Grants
- Consultant - Allergan, Bayer, Novartis, Roche
- Consultant - Bayer, Novartis, AbbVie, Speaker fees - Bayer, AbbVie
- Allergan (Allergan Inc.)
- Personal fees - Bayer, Consultant - Allergan, Novartis, Bayer Expert testimony - Bayer
Collapse
Affiliation(s)
- E E Cornish
- Save Sight Institute, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.
| | - S Wickremasinghe
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, VIC, Australia
| | - H Mehta
- Save Sight Institute, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
- Ophthalmology Department, Royal Free London, NHS Foundation Trust, London, United Kingdom
| | - L Lim
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, VIC, Australia
| | - S S Sandhu
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, VIC, Australia
| | - V Nguyen
- Save Sight Institute, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - M C Gillies
- Save Sight Institute, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - S Fraser-Bell
- Save Sight Institute, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
2
|
Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
Collapse
|
3
|
Lim L, Hulsebosch SE, Gilor C, Reagan KL, Kopecny L, Maggiore AD, Phillips KL, Kass PH, Vernau W, Nelson RW. Re-evaluation of the low-dose dexamethasone suppression test in dogs. J Small Anim Pract 2023; 64:12-20. [PMID: 36089334 DOI: 10.1111/jsap.13553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aims to re-evaluate the low-dose dexamethasone suppression test 8-hour cortisol cut-point for the diagnosis of hypercortisolism in dogs using a solid-phase, competitive chemiluminescent enzyme immunoassay. MATERIALS AND METHODS Twenty-seven client-owned dogs with naturally occurring hypercortisolism and 30 healthy control dogs were prospectively recruited. Performance of the low-dose dexamethasone suppression test was assessed using sensitivity, specificity and a receiver operating characteristic curve compared to a clinical diagnosis of hypercortisolism including response to treatment. RESULTS Twenty-four dogs were diagnosed with pituitary-dependent hypercortisolism and three with adrenal-dependent hypercortisolism. In 30 healthy control dogs, 8-hour post-dexamethasone cortisol concentrations ranged from 5.5 to 39 nmol/L. A receiver operating characteristic curve curve constructed from the 8-hour post-dexamethasone cortisol concentrations of hypercortisolism and control dogs demonstrated that the most discriminatory cut-point was more than 39 nmol/L with sensitivity of 85.2% (95% confidence interval, 67.5% to 94.1%) and specificity of 100% (95% confidence interval, 88.7% to 100.0%) and an area under the curve of 0.963. CLINICAL SIGNIFICANCE The optimal cut-point of more than 36 nmol/L proposed by this study is similar to the currently accepted 8-hour cortisol concentration cut-point for diagnosing hypercortisolism when using a solid-phase, competitive chemiluminescent enzyme immunoassay.
Collapse
Affiliation(s)
- L Lim
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California, USA
| | - S E Hulsebosch
- Department of Medicine & Epidemiology, University of California-Davis, Davis, California, USA
| | - C Gilor
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - K L Reagan
- Department of Medicine & Epidemiology, University of California-Davis, Davis, California, USA
| | - L Kopecny
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California, USA
| | - A D Maggiore
- Department of Medicine & Epidemiology, University of California-Davis, Davis, California, USA
| | - K L Phillips
- Department of Surgical & Radiological Sciences, University of California-Davis, Davis, California, USA
| | - P H Kass
- Department of Population Health and Reproduction, University of California-Davis, Davis, California, USA
| | - W Vernau
- Department of Pathology, Microbiology & Immunology, University of California-Davis, Davis, California, USA
| | - R W Nelson
- Department of Medicine & Epidemiology, University of California-Davis, Davis, California, USA
| |
Collapse
|
4
|
Kandiah N, Soo SA, Lim L, Leow YJ, Vipin A, Ng KP. Development and Validation of a Cognitive Evaluation tool for Multilingual Populations: The Visual Cognitive Assessment Test (VCAT). Alzheimers Dement 2022. [DOI: 10.1002/alz.066969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nagaendran Kandiah
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore Singapore
- ISTAART member (ID: ) singapore 100018066163 Singapore
| | - See Ann Soo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore Singapore
| | - Levinia Lim
- National Neuroscience Institute Singapore Singapore
| | - Yi Jin Leow
- Lee Kong Chian School of Medicine Singapore Singapore
| | - Ashwati Vipin
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore Singapore
| | - Kok Pin Ng
- National Neuroscience Institute Singapore Singapore
- Lee Kong Chian School of Medicine Singapore Singapore
| |
Collapse
|
5
|
Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
Collapse
Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
Collapse
|
7
|
McIntyre C, McLeod M, Tutt T, Petersen A, Lepori-Bui N, Patel S, Monterola G, Siddiqui A, Villar K, Tran C, Bainter C, Pham T, Diaz N, Lim L, Dibian Z, Wang L, Meyer E. Process Development and Manufacturing: GROWING A CELL THERAPY FACILITY TO SUPPORT SPONSORED CLINICAL TRIALS AND COMMERCIAL CELL THERAPY PRODUCTS. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
8
|
Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
Collapse
Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Vipin A, Satish V, Saffari SE, Koh W, Lim L, Silva E, Nyu MM, Choong TM, Chua E, Lim L, Ng ASL, Chiew HJ, Ng KP, Kandiah N. Dementia in Southeast Asia: influence of onset-type, education, and cerebrovascular disease. Alzheimers Res Ther 2021; 13:195. [PMID: 34847922 PMCID: PMC8630908 DOI: 10.1186/s13195-021-00936-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Southeast Asia represents 10% of the global population, yet little is known about regional clinical characteristics of dementia and risk factors for dementia progression. This study aims to describe the clinico-demographic profiles of dementia in Southeast Asia and investigate the association of onset-type, education, and cerebrovascular disease (CVD) on dementia progression in a real-world clinic setting.
Methods
In this longitudinal study, participants were consecutive series of 1606 patients with dementia from 2010 to 2019 from a tertiary memory clinic from Singapore. The frequency of dementia subtypes stratified into young-onset (YOD; <65 years age-at-onset) and late-onset dementia (LOD; ≥65 years age-at-onset) was studied. Association of onset-type (YOD or LOD), years of lifespan education, and CVD on the trajectory of cognition was evaluated using linear mixed models. The time to significant cognitive decline was investigated using Kaplan-Meier analysis.
Results
Dementia of the Alzheimer’s type (DAT) was the most common diagnosis (59.8%), followed by vascular dementia (14.9%) and frontotemporal dementia (11.1%). YOD patients accounted for 28.5% of all dementia patients. Patients with higher lifespan education had a steeper decline in global cognition (p<0.001), with this finding being more pronounced in YOD (p=0.0006). Older patients with a moderate-to-severe burden of CVD demonstrated a trend for a faster decline in global cognition compared to those with a mild burden.
Conclusions
There is a high frequency of YOD with DAT being most common in our Southeast Asian memory clinic cohort. YOD patients with higher lifespan education and LOD patients with moderate-to-severe CVD experience a steep decline in cognition.
Collapse
|
10
|
Aldibekova G, Abdrakhmanova S, Lim L, Panaviene V, Starosvetova Е. [ASSESSMENT OF PHYSICAL DEVELOPMENT OF PRESCHOOL CHILDREN OF THE REPUBLIC OF KAZAKHSTAN AND RETROSPECTIVE ANALYSIS OVER THE LAST 50 YEARS]. Georgian Med News 2021:45-51. [PMID: 34749322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose - study of the physical development of preschool children, taking into account gender characteristics and comparison with identical data from the study of 1968, 1972, 1986, 2000s. Object of the research: 968 children aged 3-6 years, living in the central, southern and northern regions of the country, who underwent an anthropometric study using standard instruments. Also, the results were compared with the research data from 1968, 1972, 1986, 2000s. The body weight of boys 3-5 years old significantly exceeded that of girls (р<0.05). A significant difference in body length is obvious only at the age of 4 (р<0.05). The lengths of the arms and legs did not differ in both sexes, except for the length of the arms in 5-year-old boys with a significant predominance (p<0.05). On average, boys of the studied ages had higher body length indicators than girls (p>0,05). When conducting a comparative analysis of the body length and body weight of children in Kazakhstan with the WHO standards, there were no significant differences. At the same time, the head circumference of 3-year-old boys and 3-4-year-old girls exceeds the identical indicators according to WHO (р<0.05). This fact is possibly related to the climatic, ethnic and social-everyday characteristics of the children. The latter, once again indicates the need to develop regional standards, since WHO standards are likely to be a guideline. A comparative analysis of the basic indicators of the physical development of children over the period from 1968 to 2019 demonstrates a gradual increase in somatometric indicators in most age groups. The physical development of preschool children in the Republic of Kazakhstan at the present stage is quite harmonious. A retrospective analysis of the physical development of children aged 3-6 years over the past 50 years has shown a significant increase in body length, without a significant increase in body weight in modern children, which indicates the ongoing process of acceleration with a tendency to asthenization.
Collapse
Affiliation(s)
- G Aldibekova
- 1Non-profit Joint Stock Company «Astana Medical University», Nur-Sultan; 2Corporate funddation University Medical Center «National Research Center for Maternal and Child health», Nur-Sultan, Kazakhstan
| | - S Abdrakhmanova
- 1Non-profit Joint Stock Company «Astana Medical University», Nur-Sultan; Kazakhstan
| | - L Lim
- 1Non-profit Joint Stock Company «Astana Medical University», Nur-Sultan; Kazakhstan
| | - V Panaviene
- 3Vilnius University, Faculty of Medicine, Lithuania
| | - Е Starosvetova
- 1Non-profit Joint Stock Company «Astana Medical University», Nur-Sultan; Kazakhstan
| |
Collapse
|
11
|
Jalali A, Gard G, Banks S, Dunn C, Wong HL, Wong R, Lee M, Gately L, Loft M, Shapiro JD, Kosmider S, Tie J, Ananda S, Yeung JM, Jennens R, Lee B, McKendrick J, Lim L, Khattak A, Gibbs P. Initial experience of TAS-102 chemotherapy in Australian patients with Chemo-refractory metastatic colorectal cancer. Curr Probl Cancer 2021; 46:100793. [PMID: 34565601 DOI: 10.1016/j.currproblcancer.2021.100793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
For patients with refractory metastatic colorectal cancer (mCRC) treatment with Trifluridine/Tipiracil, also known as TAS-102, improves overall survival. This study aims to investigate the efficacy and safety of TAS-102 in a real-world population from Victoria, Australia. A retrospective analysis of prospectively collected data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry was undertaken. The characteristics and outcomes of patients receiving TAS-102 were assessed and compared to those enrolled in the registration study (RECOURSE). Across 13 sites, 107 patients were treated with TAS-102. The median age was 60 years (range: 31-83), compared to 63 for RECOURSE. Comparing registry TAS-102-treated and RECOURSE patients, 75% vs 100% were ECOG performance status 0-1, 74% vs 79% had initiated treatment more than 18 months from diagnosis of metastatic disease and 36% vs 49% were RAS wild-type. Median time on treatment was 10.4 weeks (range: 1.7-32). Median progression-free survival (PFS) was 3.3 months compared to 2 months in RECOURSE, while median overall survival was the same at 7.1 months. Two patients (2.3%) had febrile neutropenia and there were no treatment-related deaths, where TAS-102 dose at treatment initiation was at clinician discretion.TRACC registry patients treated with TAS-102 were younger than those from the RECOURSE trial, with similar overall survival observed. Less strict application of RECIST criteria and less frequent imaging may have contributed to an apparently longer PFS.
Collapse
Affiliation(s)
- A Jalali
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Latrobe Regional Hospital, VIC, Australia.
| | - G Gard
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - S Banks
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - C Dunn
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - H L Wong
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia
| | - R Wong
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Eastern Health, VIC, Australia; Eastern Health Clinical School, Monash University, VIC, Australia
| | - M Lee
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Eastern Health, VIC, Australia; Eastern Health Clinical School, Monash University, VIC, Australia
| | - L Gately
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - M Loft
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - J D Shapiro
- Department of Medical Oncology, Cabrini Hospital, VIC, Australia
| | - S Kosmider
- Department of Medical Oncology, Western Health, VIC, Australia
| | - J Tie
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia
| | - S Ananda
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia; Department of Medical Oncology, Epworth Health, VIC, Australia
| | - J M Yeung
- Department of Surgery, Western Health, University of Melbourne, VIC, Australia; Western Health Chronic Disease Alliance, Western Health, VIC, Australia
| | - R Jennens
- Department of Medical Oncology, Epworth Health, VIC, Australia
| | - B Lee
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia; Department of Medical Oncology, Northern Health, VIC, Australia
| | - J McKendrick
- Department of Medical Oncology, Eastern Health, VIC, Australia; Department of Medical Oncology, Epworth Health, VIC, Australia
| | - L Lim
- Department of Medical Oncology, Eastern Health, VIC, Australia
| | - A Khattak
- Department of Medical Oncology, Fiona Stanley Hospital, WA, Australia
| | - P Gibbs
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia
| |
Collapse
|
12
|
Ng KP, Chiew HJ, Hameed S, Ting SKS, Ng A, Soo SA, Wong BYX, Lim L, Yong ACW, Mok VCT, Rosa‐Neto P, Dominguez J, Kim S, Hsiung GYR, Ikeda M, Miller BL, Gauthier S, Kandiah N. Frontotemporal dementia and COVID-19: Hypothesis generation and roadmap for future research. Alzheimers Dement (N Y) 2021; 6:e12085. [PMID: 33490361 PMCID: PMC7810128 DOI: 10.1002/trc2.12085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 01/21/2023]
Abstract
The COVID-19 pandemic has caused tremendous suffering for patients with dementia and their caregivers. We conducted a survey to study the impact of the pandemic on patients with mild frontotemporal dementia (FTD). Our preliminary findings demonstrate that patients with FTD have significant worsening in behavior and social cognition, as well as suffer greater negative consequences from disruption to health-care services compared to patients with AD. The reduced ability to cope with sudden changes to social environments places patients with FTD at increased vulnerability to COVID-19 infection as well as to poorer clinical and social outcomes. Caregivers of FTD patients also demonstrate high burden during crisis situations. A proportion of patients with FTD benefitted from use of web-based interactive platforms. In this article, we outline the priority areas for research as well as a roadmap for future collaborative research to ensure greatest benefit for patients with FTD and their caregivers.
Collapse
Affiliation(s)
- Kok Pin Ng
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - Hui Jin Chiew
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Shahul Hameed
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - Simon Kang Seng Ting
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - Adeline Ng
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - See Ann Soo
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | | | - Levinia Lim
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Alisa C. W. Yong
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Vincent C. T. Mok
- Gerald Choa Neuroscience CentreLui Che Woo Institute of Innovative MedicineDepartment of Medicine and TherapeuticsPrince of Wales HospitalFaculty of MedicineThe Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina
| | - Pedro Rosa‐Neto
- Translational Neuroimaging LaboratoryMcGill University Research Centre for Studies in AgingAlzheimer’s Disease Research UnitDouglas Research InstituteLe Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Ouest‐de‐l'Île‐de‐MontréalDepartment of Neurology and Neurosurgery, Psychiatry and Pharmacology and TherapeuticsMcGill UniversityMontrealCanada
| | | | - SangYun Kim
- Department of NeurologySeoul National University College of Medicine and Clinical Neuroscience Center of Seoul National University Bundang HospitalSeongnam‐siKorea
| | - G. Y. Robin Hsiung
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Manabu Ikeda
- Department of PsychiatryGraduate School of Medicine, Osaka UniversityOsakaJapan
| | - Bruce L. Miller
- Memory and Aging CenterDepartment of NeurologyUniversity of CaliforniaSan FranciscoSan FranciscoCaliforniaUSA
| | - Serge Gauthier
- Translational Neuroimaging LaboratoryMcGill University Research Centre for Studies in AgingAlzheimer’s Disease Research UnitDouglas Research InstituteLe Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Ouest‐de‐l'Île‐de‐MontréalDepartment of Neurology and Neurosurgery, Psychiatry and Pharmacology and TherapeuticsMcGill UniversityMontrealCanada
| | - Nagaendran Kandiah
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| |
Collapse
|
13
|
Lim L, Galvin S. R35 Early Experiences of Thoracoscopic Parathyroid Gland Resection in New Zealand. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
14
|
Pai M, Likitjaroen Y, Lim L, Ryoo N, Chiu P, Hsu J, Suzuki K, Chang Y, Kandiah N, Kim S. Posterior cortical atrophy syndrome: Asian study. Alzheimers Dement 2020. [DOI: 10.1002/alz.044452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ming‐Chyi Pai
- Medical College and Hospital National Cheng Kung University Tainan Taiwan
- Institute of Gerontology National Cheng Kung University Tainan Taiwan
| | | | - Levinia Lim
- National Neuroscience Institute Singapore Singapore
| | - Nayoung Ryoo
- Seoul National University Bundang Hospital Seongnam Korea
| | - Pai‐Yi Chiu
- Show Chwan Memorial Hospital Changhua Taiwan
| | - Jung‐Lung Hsu
- Chang Gung Memorial Hospital Linkou Medical Center Taoyuan Taiwan
| | - Kyoko Suzuki
- Tohoku University Graduate School of Medicine Sendai Japan
| | | | | | - SangYun Kim
- Alzheimer's Disease All Biomarker Research Group Seoul National University Bundang Hospital Seongnam Korea
| |
Collapse
|
15
|
Lim L, Wong B, Vipin A, Silva E, Lay Hoon Lim L, Vanessa Chua E, Yuen Oi Choong T, Mei NM, Chiew HJ, Hameed S, Seng Ting SK, Lyn Ng AS, Ng KP, Kandiah N. Posterior cortical atrophy in Southeast Asia: Clinical and biomarker profile. Alzheimers Dement 2020. [DOI: 10.1002/alz.044223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Levinia Lim
- National Neuroscience Institute Singapore Singapore
| | | | | | | | | | | | | | - Nyu Mei Mei
- National Neuroscience Institute Singapore Singapore
| | | | | | | | | | - Kok Pin Ng
- McGill University Research Centre for Studies in Aging Verdun QC Canada
| | | |
Collapse
|
16
|
Choong TYO, Yong TT, Satish V, Wilbur KZH, Mei NM, Lim L, Silva E, Kandiah N. OWOW! Six years on, what have we learned? Experience and perspectives on a cognitive interventional programme for persons with dementia. Alzheimers Dement 2020. [DOI: 10.1002/alz.045977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Ting Ting Yong
- University of Newcastle, UK United Kingdom United Kingdom
| | | | | | - Nyu Mei Mei
- National Neuroscience Institute Singapore Singapore
| | - Levinia Lim
- National Neuroscience Institute Singapore Singapore
| | | | | |
Collapse
|
17
|
Lim L, Nam K, Bahk J, Jeon Y. The relationship between intraoperative cerebral oximetry and postoperative delirium in patients undergoing off-pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2020. [DOI: 10.1053/j.jvca.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
18
|
Koh W, Lim L, Low A, Wong B, Lim L, Silva E, Ng KP, Kandiah N. Development and validation of a brief visual based cognitive screening tool for dementia: the Visual Cognitive Assessment Test short-form (VCAT-S). J Neurol Neurosurg Psychiatry 2020; 91:1122-1123. [PMID: 32732390 DOI: 10.1136/jnnp-2020-323106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/19/2020] [Accepted: 06/22/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Wilbur Koh
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Audrey Low
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Benjamin Wong
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Linda Lim
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Eveline Silva
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore .,Duke-NUS Medical School, Singapore
| |
Collapse
|
19
|
Wong BYX, Yong TT, Lim L, Tan JY, Ng ASL, Ting SKS, Hameed S, Ng KP, Zhou JH, Kandiah N. Medial Temporal Atrophy in Amyloid-Negative Amnestic Type Dementia Is Associated with High Cerebral White Matter Hyperintensity. J Alzheimers Dis 2020; 70:99-106. [PMID: 31177215 DOI: 10.3233/jad-181261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Non-amyloid mechanisms behind neurodegeneration and cognition impairment are unclear. Cerebrovascular disease (CVD) may play an important role in suspected non-Alzheimer's pathophysiology (SNAP), especially in Asia. OBJECTIVE To examine the association between CVD and medial temporal lobe atrophy (MTA) in amyloid-β negative patients with mild amnestic type dementia. METHODS Thirty-six mild dementia patients with complete neuropsychological, cerebrospinal fluid (CSF) biomarker, and neuroimaging information were included. Only patients with clinically significant MTA were recruited. Patients were categorized based on their CSF Aβ levels. Neuroimaging and neuropsychological variables were analyzed. RESULTS Despite comparable MTA between Aβ positive and negative patients, Aβ-negative patients had significantly greater white matter hyperintensities (WMH; Total Fazekas Rating) than their Aβ-positive counterparts (6.42 versus 4.19, p = 0.03). A larger proportion of Aβ-negative patients also had severe and confluent WMH. Regression analyses controlling for baseline characteristics yielded consistent results. CONCLUSION Our findings demonstrate that MTA is associated with greater CVD burden among Aβ-negative patients with amnestic type dementia. CVD may be an important mechanism behind hippocampal atrophy. This has implications on clinical management strategies, where measures to reduce CVD may slow neurodegeneration and disease progression.
Collapse
Affiliation(s)
| | - Ting Ting Yong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Jayne Yi Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Adeline Su Lyn Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | | | - Shahul Hameed
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Juan Helen Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
20
|
Lim L, Kozhanov V, Lim N, Abdrakhmanova S, Aldibekova G. [RETROSPECTIVE ANALYSIS OF THE STATE OF PHYSICAL DEVELOPMENT OF SCHOOLCHILDREN FOR THE LAST 60 YEARS ACCORDING TO DATA ALMATY CITY]. Georgian Med News 2020:47-55. [PMID: 32242844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The physical development of children is one of the main criteria for the health status of the child population, reflecting the influence of endogenous and exogenous factors. Dynamic study of schoolchildren's physical development allows one to determine the characteristics of the formations of their morphofunctional parameters and then influence the health of the whole population. The study of the orientation of time shifts in physical development has an important predictive preventive component and is the basis for updating regional standards every 5-10 years. Objective - to identify the main trends in the physical development of schoolchildren in Kazakhstan according to anthropometric measurements among schoolchildren of Almaty over the past 60 years (1956, 1972(2), 1983, 1989, 2005, 2017). Object of study: 13136 schoolchildren of 7-16 years old, various general education institutions (schools) of Almaty, who studied in 1956, in 1972, in 1983, in 1989, in 2005, and in 2017, which were used to carry out transverse and longitudinal studies of physical development using a standardized anthropometric method using standard tools. A comparative analysis of the basic indicators of physical development (length and body weight), conducted between 1956 and 2017, shows a pronounced tendency to increase them across all ages. The largest increase in basic body size in both boys and girls was in the period from 1956 to 1972 (p <0.05). Later, until 2005, stabilization and even slowing down of the observed processes of increasing somatometric indicators was noted. The economic crisis that swept the country in the 1990 led to a significant decrease in the mass-growth indicators in children of both sexes in 2005. The results of a 2017 study indicate a "new round of acceleration" of modern children of Kazakhstan of both sexes. A retrospective study of the physical development of schoolchildren, conducted in Kazakhstan over the past 60 years, showed a pronounced tendency to increase the basic mass and growth indicators, especially in males, and the acceleration of the period of puberty. In modern schoolchildren, there was a change in the timing of the annual "crosses" of growth curves at an earlier age period. For children of Kazakhstan in the new millennium, a decrease in the degree of correlative connections between length and body weight is characteristic, which indicates their disharmonious development.
Collapse
Affiliation(s)
- L Lim
- 1Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
| | - V Kozhanov
- 1Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
| | - N Lim
- 2Nazarbayev University, Nur-Sultan, Kazakhstan
| | - S Abdrakhmanova
- 1Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
| | - G Aldibekova
- 1Scientific Center of Pediatrics and Pediatric Surgery, Almaty; 2Nazarbayev University, Nur-Sultan, Kazakhstan
| |
Collapse
|
21
|
Tu H, Xu C, Tong-Li C, Offin M, Razavi P, Schapira E, Namakydoust A, Lee A, Pavlakis N, Clarke S, Diakos C, Chan D, Myers M, Makhnin A, Jain H, Martinez A, Iqbal Z, Adamski A, Li H, Hernandez J, Watford S, Hosseini A, Shaffer T, Lim L, Li M, Drilon A, Ladanyi M, Arcila M, Rusch V, Jones D, Rudin C, Rimner A, Isbell J, Li B. P1.01-122 A Clinical Utility Study of Plasma DNA Next Generation Sequencing Guided Treatment of Uncommon Drivers in Advanced Non-Small-Cell Lung Cancers. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
22
|
Pekker I, Lim L, Simon J, Gormley M, Li Z, Pollak J, Potts K, Watford S, Posey J, Chan P, Urtishak K, Garg K, Hosseini A, Li M. Analytical performance of the resolution-HRD plasma assay used to identify mCRPC patients with biallelic disruption of DNA repair genes for treatment with niraparib. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz257.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Lim L, Cho Y, Lee HC, Choi EK, Park S, Yu J, Nam K, Kim T, Jeon Y. The attenuated effect of remote ischemic conditioning on tissue oxygen saturation and heart rate variability in the patient undergoing cardiac surgery: a pilot study. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
24
|
Abstract
OBJECTIVE We aimed to evaluate the prevalence of depressive and anxiety symptoms and mental health literacy (MHL) in outpatients with or without cancer in Singapore. METHODS Oncology outpatients and outpatients without cancer (controls) were assessed for severity of anxiety and depressive symptoms (using the Hospital Anxiety and Depression Scale) and MHL regarding major depressive disorder and generalised anxiety disorder in terms of diagnosis, aetiology, treatment, and attitudes toward mental health services. RESULTS A total of 89 oncology outpatients and 61 controls were recruited. Those with primary and secondary education had significantly lower MHL scores than those with university education (p = 0.001). Oncology outpatients and controls were comparable in terms of anxiety (13.5% vs 9.8%, p = 0.5), depression (2.2% vs 1.6%, p > 0.99), and total MHL score (7.94 vs 9.13, p = 0.102). CONCLUSIONS MHL is comparable between oncology outpatients and controls and is positively associated with education level.
Collapse
Affiliation(s)
- S H Poon
- Department of Psychiatry, Singapore General Hospital, Singapore
| | - F Q Wang
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - J Goh
- Department of Psychiatry, Singapore General Hospital, Singapore
| | - Y H Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - L Lim
- Department of Psychiatry, Singapore General Hospital, Singapore
| |
Collapse
|
25
|
Abstract
Cerebrovascular disease (CVD) contributes to spatial navigation deficits; however, the everyday outcomes of this association remain unexplored. We investigated whether CVD was a risk for getting lost behavior (GLB) in elderly with mild cognitive impairment (MCI) and mild Alzheimer disease (AD). Getting lost behavior was assessed using a semistructured clinical interview and was associated with white matter lesions (WMLs) in patients with MCI. Specifically, right occipital WMLs increased the odds of GLB by 12 times (P = .03) and right temporal WMLs increased the odds of GLB by 4 times (P = .01), regardless of age, gender, global cognitive impairment, and occipital or medial temporal gray matter atrophy. Hypertension increased the risk of GLB in MCI by contributing to the burden of WMLs. White matter lesions were not associated with GLB in mild AD. Our findings suggest that interventions aimed at reducing GLB in prodromal dementia may involve preventing WMLs by optimizing hypertension control.
Collapse
Affiliation(s)
- Chathuri Yatawara
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Russell Chander
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Juan Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
26
|
Raffetin A, Belkacem A, Bounhiol A, Diallo K, Schemoul J, Paoletti G, Lim L, Medina F, Caraux-Paz P, Patey O. Être ou ne pas être une borréliose de Lyme ? Une approche pluridisciplinaire pour un diagnostic plus juste et un parcours de soin personnalisé. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Koh J, Lim W, Neoh J, Hescham S, Blokland A, Chan Y, Temel Y, Lim L, Wu E. Pacemaker in the aged brain: From molecular profiling to memory enhancement. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
28
|
Schmid P, Pinder S, Wheatley D, Zummit C, Macaskill EJ, Hu J, Price R, Bundred N, Hadad S, Shia A, Sarker SJ, Lim L, Mousa K, O'Brien C, Wilson TR, Lackner MR, Gendreau S, Gazinska P, Korbie D, Trau M, Mainwaring P, Thompson A, Purushotham A. Abstract P2-08-02: Interaction of PIK3CA mutation subclasses with response to preoperative treatment with the PI3K inhibitor pictilisib in patients with estrogen receptor-positive breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Although preclinical data suggest that combining PI3K inhibitors with endocrine therapy may overcome resistance, results from randomized clinical trials have failed to identify a subgroup of patients that derive a substantial benefit. This preoperative window study assessed whether adding the PI3K inhibitor pictilisib can increase the anti-tumor effects of anastrozole in primary breast cancer and aimed to identify the most appropriate patient population for combination therapy.
Methods: In this randomized, open-label, phase 2 study, 167 postmenopausal women with newly diagnosed, operable, ER-positive, HER2-negative breast cancers were recruited. Participants were randomly allocated (2:1, favoring the combination) to two-weeks of preoperative treatment with anastrozole 1 mg once daily or the combination of anastrozole 1mg with pictilisib 260 mg once daily. The primary endpoint was inhibition of tumor cell proliferation, as measured by change in Ki-67 protein expression between tumor samples taken before and at the end of treatment. Secondary endpoints include induction of apoptosis (Caspase3) and safety. Comprehensive biomarkers analyses included targeted NGS of a comprehensive cancer panel of >400 genes (Ampliseq Comprehensive Cancer panel), copy number variation analyses, and pre- and post-treatment reverse-phase protein arrays (RPPA) and RNA profiling (NanoString nCounter platform).
Results:There was significantly greater geometric mean Ki67 suppression of 82.5% (90% CI, 78.3%-85.8%) for the combination vs 70.7% (61.0%-78.0%) for anastrozole [geometric mean ratio (combination/ anastrozole) 0.60 (0.58-0.85);p=0.01]. Higher baseline Ki67, Luminal B status and/or negative PR status were associated with increased benefit from adding pictilisib. A significant interaction was observed between PIK3CA mutation subtypes [helical domain mutations (HD), kinase domain mutations (KD), wildtype (WT)] and mean Ki67 suppression; the combination/anastrozole geometric mean ratio of Ki67 suppression was 0.48 (0.27-0.84; p=0.02) for patients with HD mutations and 0.63 (0.39–1.0; p=0.05) for patients with PIK3Ca WT, compared to 1.17 (0.57–2.41; p=0.64) for patients with KD mutations. This was largely due to patients with HD mutations showing a particularly poor response to anastrozole alone [mean Ki67 suppression 53.9% (9.5%-76.5%)], that was reversed by the addition of pictilisib [mean Ki-67 suppression 78.1% (71.0%-83.4%)]. On the other hand, patients with KD mutations responded well to anastrozole alone [mean Ki-67 suppression 77.7% (57.0%-88.4%)] and showed no benefit from the addition of pictilisib [mean Ki-67 suppression 73.9% (59.8%-83.0%)]. There was no significant difference in induction of apoptosis between treatment groups. Comprehensive pre- and post-treatment biomarkers analyses will be presented.
Conclusions: Adding pictilisib to anastrozole significantly increases the anti-proliferative response to preoperative treatment with anastrozole. A significant interaction was observed between PIK3CA mutation subtypes, with patients with helical domain mutations showing a particularly poor response to anastrozole alone that was reversed by the addition of pictilisib.
Citation Format: Schmid P, Pinder S, Wheatley D, Zummit C, Macaskill EJ, Hu J, Price R, Bundred N, Hadad S, Shia A, Sarker S-J, Lim L, Mousa K, O'Brien C, Wilson TR, Lackner MR, Gendreau S, Gazinska P, Korbie D, Trau M, Mainwaring P, Thompson A, Purushotham A. Interaction of PIK3CA mutation subclasses with response to preoperative treatment with the PI3K inhibitor pictilisib in patients with estrogen receptor-positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-02.
Collapse
Affiliation(s)
- P Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S Pinder
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - D Wheatley
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - C Zummit
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - EJ Macaskill
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - J Hu
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - R Price
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - N Bundred
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S Hadad
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - A Shia
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S-J Sarker
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - L Lim
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - K Mousa
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - C O'Brien
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - TR Wilson
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - MR Lackner
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S Gendreau
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - P Gazinska
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - D Korbie
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - M Trau
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - P Mainwaring
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - A Thompson
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - A Purushotham
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| |
Collapse
|
29
|
Lim L, Zhang A, Lim L, Choong TM, Silva E, Ng A, Kandiah N. High Caregiver Burden in Young Onset Dementia: What Factors Need Attention? J Alzheimers Dis 2019; 61:537-543. [PMID: 29171995 DOI: 10.3233/jad-170409] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is an increase in prevalence of young onset dementia (YOD). The specific problems among YOD patients and levels of caregiver burden (CB) in this group warrants further evaluation. OBJECTIVE To evaluate and compare level of CB in YOD and late onset dementia (LOD). Also, we sought to understand the specific factors, such as neuropsychiatric symptoms, that may affect the levels of caregiver burden in the YOD group. METHODS Patient-caregiver dyads with YOD and LOD were recruited from a tertiary neurology center. Levels of CB between YOD and LOD were compared among 183 patient-caregiver dyads. CB was quantified using the Zarit Burden Inventory (ZBI). Neuropsychological evaluations as well as the Neuropsychiatric Inventory were performed. Factors that influenced level of CB in YOD group was investigated with regression analyses. RESULTS There were 57 YOD and 126 LOD dyads. Caregivers of YOD subjects reported significantly higher levels of burden compared to caregivers of LOD subjects (ZBI: 17.3 versus 13.94; p = 0.015). 52.6% of YOD caregivers reported a high caregiver burden. When compared to caregivers of LOD, the odds of a caregiver of YOD reporting high caregiver burden was 2.34 (95% CI: 1.22-4.49: p = 0.010). YOD dyads with a high caregiver burden had significantly higher neuropsychiatric inventory scores. Risk factors for high caregiver burden in YOD included family history of dementia and behavioral symptoms including disinhibited behavior, delusions, and apathy. CONCLUSION Targeted support for caregivers of patients with YOD is needed to address the higher CB in this group.
Collapse
Affiliation(s)
- Linda Lim
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Angeline Zhang
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Eveline Silva
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Adeline Ng
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke-NUS, Graduate Medical School, Singapore
| |
Collapse
|
30
|
Chander RJ, Foo H, Yong T, Lim L, Tan J, Wen MC, Ng A, Hameed S, Ting S, Zhou J, Kandiah N. Serial position effects differ between Alzheimer's and vascular features in mild cognitive impairment. Aging (Albany NY) 2018; 10:3866-3880. [PMID: 30540261 PMCID: PMC6326682 DOI: 10.18632/aging.101678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/18/2018] [Indexed: 04/25/2023]
Abstract
Individuals with mild cognitive impairment (MCI) exhibit varying serial position effect (SPE) performances. The relationship between SPE performance in word list recall and clinical, genetic, and neuroimaging features of MCI requires elucidation. 119 MCI and 68 cognitively normal (CN) participants underwent cognitive assessment, apolipoprotein E (ApoE) genotyping, and volumetric MRI brain scans processed via voxel-based morphometry. A 10-word recall task was used to assess SPE performance in relation to recency and primacy recall. MCI participants were classified as having Good SPE performance (high primacy and recency, Good SPE) or Poor SPE performance (low primacy only, LP-SPE; low recency only, LR-SPE; or both low, Low SPE). Poor SPE participants had reduced grey matter (GM) volumes and increased white matter hyperintensities (WMH) volumes. Participants with LP-SPE demonstrated reduced hippocampal GM volumes and were more likely to be ApoE ε4 carriers. LR-SPE was associated with higher WMH volumes. Presence of both greater WMH volumes and ApoE ε4 resulted in Low SPE. LP-SPE MCI participants had features typical of Alzheimer's disease. LR-SPE MCI was associated with increased WMH volumes, likely representing vascular pathology. SPE profiles are associated with distinct clinical patterns of MCI pathophysiology and could have potential as a clinical marker.
Collapse
Affiliation(s)
- Russell Jude Chander
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Heidi Foo
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Tingting Yong
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Jayne Tan
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
- Department of Neurology, Singapore General Hospital, Singapore 169856, Singapore
| | - Ming-Ching Wen
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Adeline Ng
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
| | - Shahul Hameed
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
- Department of Neurology, Singapore General Hospital, Singapore 169856, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Simon Ting
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
- Department of Neurology, Singapore General Hospital, Singapore 169856, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Juan Zhou
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
| |
Collapse
|
31
|
Ng KP, Chiew HJ, Lim L, Rosa-Neto P, Kandiah N, Gauthier S. The influence of language and culture on cognitive assessment tools in the diagnosis of early cognitive impairment and dementia. Expert Rev Neurother 2018; 18:859-869. [DOI: 10.1080/14737175.2018.1532792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Pedro Rosa-Neto
- Alzheimer’s Disease Research Unit, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Serge Gauthier
- Alzheimer’s Disease Research Unit, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| |
Collapse
|
32
|
Liew K, Bartolo C, O'Reilly M, Lim L. Targeting antimicrobial stewardship in hospitalised patients with community-acquired pneumonia within 24 h of admission. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
33
|
Low A, Lim L, Hoon Lim LL, Wong B, Silva E, Ng KP, Kandiah N. P3‐468: CONSTRUCT VALIDITY OF THE VISUAL COGNITIVE ASSESSMENT TEST (VCAT): AN INTERNATIONAL LANGUAGE‐NEUTRAL COGNITIVE SCREENING TOOL. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Audrey Low
- National Neuroscience InstituteSingaporeSingapore
| | - Levinia Lim
- National Neuroscience InstituteSingaporeSingapore
| | | | | | | | - Kok Pin Ng
- McGill University Research Centre for Studies in AgingVerdunQCCanada
| | | |
Collapse
|
34
|
Lim L, Yong TT, Wong B, Lyn Ng AS, Ting S, Hameed S, Ng KP, Kandiah N. P2‐465: THE ROLE OF COMPREHENSIVE INVESTIGATION IN THE DIAGNOSTIC WORK‐UP OF YOUNGER PATIENTS WITH COGNITIVE IMPAIRMENT. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Levinia Lim
- National Neuroscience InstituteSingaporeSingapore
| | | | | | | | - Simon Ting
- National Neuroscience InstituteSingaporeSingapore
| | | | - Kok Pin Ng
- McGill University Research Centre for Studies in AgingVerdunQCCanada
| | | |
Collapse
|
35
|
Yong TT, Yuen Oi Choong TM, Lim L, Silva E, Kandiah N. P4‐139: EVALUATION OF COGNITIVE ENHANCEMENT AND COGNITIVE STIMULATION PROGRAMMES FOR ASIAN PATIENTS WITH MILD COGNITIVE IMPAIRMENT OR MILD DEMENTIA. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Levinia Lim
- National Neuroscience InstituteSingaporeSingapore
| | | | | |
Collapse
|
36
|
Lim L, Wong B, Yong TT, Lyn Ng AS, Ting S, Hameed S, Kandiah N. P1‐489: THE ADDITIVE VALUE OF NEUROPSYCHOLOGICAL EVALUATION, NEUROIMAGING, APOE GENOTYPING AND CEREBROSPINAL FLUID Aβ/TAU EVALUATION IN THE DIAGNOSIS OF YOUNG‐ONSET DEMENTIA. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Levinia Lim
- National Neuroscience InstituteSingaporeSingapore
| | | | | | | | - Simon Ting
- National Neuroscience Institute (SGH Campus)SingaporeSingapore
| | | | | |
Collapse
|
37
|
Lim L, Faisal W, Wuttke M, Chong G. Causes of death in a cohort of early stage colorectal cancer patients at a regional centre in Australia. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
38
|
Chander RJ, Lim L, Handa S, Hiu S, Choong A, Lin X, Singh R, Oh D, Kandiah N. Atrial Fibrillation is Independently Associated with Cognitive Impairment after Ischemic Stroke. J Alzheimers Dis 2018; 60:867-875. [PMID: 28922154 DOI: 10.3233/jad-170313] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND While atrial fibrillation (AF) is an important risk factor for ischemic strokes and mild cognitive impairment (MCI) in Alzheimer's disease, the association between AF and post-stroke cognitive impairment (PSCI), and the factors mediating this association, is unclear. OBJECTIVE To investigate the role of AF in PSCI, especially in relation to other markers of cerebrovascular disease. METHODS 445 subjects with mild ischemic stroke without pre-stroke cognitive decline were assessed 3-6 months post-stroke for cognitive deficits. MRIs were reviewed by trained raters for acute infarct characteristics, global cortical atrophy, white matter hyperintensities, cerebral microbleeds, and intracranial stenosis. Logistic regression analysis was used to identify factors independently associated with PSCI. Subjects were also categorized according to paroxysmal (pAF) or persistent/chronic AF (p/cAF), and presence or absence of AF or large cortical infarcts (LCI) to study cognitive trends. RESULTS 80 (18.0%) subjects had AF. 76.3% of AF subjects and 42.7% of subjects without AF had PSCI. The odds ratio (OR) of AF in developing PSCI was 2.31 (95% CI: 1.12-4.75; p = 0.035), after correcting for other risk factors. pAF subjects and AF subjects with LCIs had higher ORs for PSCI. AF subjects performed worse in neuropsychological tasks associated with global cognition, episodic memory, and executive function. CONCLUSION AF is a significant risk factor for PSCI, even after correcting for AF-related infarcts. Other mechanisms, such as hypoperfusion, microhemorrhages, and neuroinflammation, may be at play. All stroke patients with AF, regardless of the type of infarction, should be closely monitored for PSCI.
Collapse
Affiliation(s)
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Sagarika Handa
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Shaun Hiu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Angeline Choong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Xuling Lin
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Daniel Oh
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
39
|
Hart H, Lim L, Mehta MA, Simmons A, Mirza KAH, Rubia K. Altered fear processing in adolescents with a history of severe childhood maltreatment: an fMRI study. Psychol Med 2018; 48:1092-1101. [PMID: 29429419 PMCID: PMC6088776 DOI: 10.1017/s0033291716003585] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 12/08/2016] [Accepted: 12/15/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children with a history of maltreatment suffer from altered emotion processing but the neural basis of this phenomenon is unknown. This pioneering functional magnetic resonance imaging (fMRI) study investigated the effects of severe childhood maltreatment on emotion processing while controlling for psychiatric conditions, medication and substance abuse. METHOD Twenty medication-naive, substance abuse-free adolescents with a history of childhood abuse, 20 psychiatric control adolescents matched on psychiatric diagnoses but with no maltreatment and 27 healthy controls underwent a fMRI emotion discrimination task comprising fearful, angry, sad happy and neutral dynamic facial expressions. RESULTS Maltreated participants responded faster to fearful expressions and demonstrated hyper-activation compared to healthy controls of classical fear-processing regions of ventromedial prefrontal cortex (vmPFC) and anterior cingulate cortex, which survived at a more lenient threshold relative to psychiatric controls. Functional connectivity analysis, furthermore, demonstrated reduced connectivity between left vmPFC and insula for fear in maltreated participants compared to both healthy and psychiatric controls. CONCLUSIONS The findings show that people who have experienced childhood maltreatment have enhanced fear perception, both at the behavioural and neurofunctional levels, associated with enhanced fear-related ventromedial fronto-cingulate activation and altered functional connectivity with associated limbic regions. Furthermore, the connectivity adaptations were specific to the maltreatment rather than to the developing psychiatric conditions, whilst the functional changes were only evident at trend level when compared to psychiatric controls, suggesting a continuum. The neurofunctional hypersensitivity of fear-processing networks may be due to childhood over-exposure to fear in people who have been abused.
Collapse
Affiliation(s)
- H. Hart
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - L. Lim
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - M. A. Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A. Simmons
- NIHR Biomedical Research Centre at South London and Maudsley Foundation NHS Trust and King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - K. Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
40
|
Kurtys E, Lim L, Man F, Volpe A, Fruhwirth G. In vivo tracking of CAR-T by [ 18 f]BF 4 - PET/CT in human breast cancer xenografts reveals differences in CAR-T tumour retention. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Mavaddat N, Sadler E, Lim L, Williams K, Warburton E, Kinmonth AL, Mant J, Burt J, McKevitt C. Perceptions of self-rated health among stroke survivors: a qualitative study in the United Kingdom. BMC Geriatr 2018; 18:81. [PMID: 29609550 PMCID: PMC5879795 DOI: 10.1186/s12877-018-0765-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/12/2018] [Indexed: 11/15/2022] Open
Abstract
Background Self-rated health predicts health outcomes independently of levels of disability or mood. Little is known about what influences the subjective health experience of stroke survivors. Our aim was to investigate stroke survivors’ perceptions of self-rated health, with the intention of informing the design of interventions that may improve their subjective health experience. Methods We conducted semi-structured interviews with a purposive sample of 28 stroke survivors recruited from a stroke unit and follow-up outpatient clinic, 4–6 months after stroke, to explore what factors are perceived to be part of self-rated health in the early stages of recovery. Qualitative data were analysed using a thematic analysis approach to identify underlying themes. Results Participants’ accounts show that stroke survivors’ perceptions of self-rated health are multifactorial, comprising physical, psychological and social components. Views on future recovery after stroke play a role in present health experience and are shaped by psychosocial resources that are influenced by past experiences of ill-health, dispositional outlook such as degree of optimism, a sense of control and views on ageing. Conclusions Severity of physical limitations alone does not influence perceptions of self-rated health among stroke survivors. Self-rated health in stroke survivors is a multidimensional construct shaped by changes in health status occurring after the stroke, individual characteristics and social context. Understanding the factors stroke survivors themselves associate with better health will inform the development of effective approaches to improve rehabilitation and recovery after stroke.
Collapse
Affiliation(s)
- N Mavaddat
- Division of General Practice, School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia. .,Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK.
| | - E Sadler
- Health Service & Population Research Department, King's Improvement Science and Centre for Implementation Science, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - L Lim
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - K Williams
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - E Warburton
- Department of Clinical Neurosciences, University of Cambridge, Neurology Unit, R3, Box 83, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - A L Kinmonth
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - J Mant
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - J Burt
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, UK
| | - C McKevitt
- School of Population Health Sciences, King's College London, Addison House, London, SE1 1UL, UK
| |
Collapse
|
42
|
Abstract
BACKGROUND Childhood abuse is associated with abnormalities in brain structure and function. Few studies have investigated abuse-related brain abnormalities in medication-naïve, drug-free youth that also controlled for psychiatric comorbidities by inclusion of a psychiatric control group, which is crucial to disentangle the effects of abuse from those associated with the psychiatric conditions. METHODS Cortical volume (CV), cortical thickness (CT) and surface area (SA) were measured in 22 age- and gender-matched medication-naïve youth (aged 13-20) exposed to childhood abuse, 19 psychiatric controls matched for psychiatric diagnoses and 27 healthy controls. Both region-of-interest (ROI) and whole-brain analyses were conducted. RESULTS For the ROI analysis, the childhood abuse group compared with healthy controls only, had significantly reduced CV in bilateral cerebellum and reduced CT in left insula and right lateral orbitofrontal cortex (OFC). At the whole-brain level, relative to healthy controls, the childhood abuse group showed significantly reduced CV in left lingual, pericalcarine, precuneus and superior parietal gyri, and reduced CT in left pre-/postcentral and paracentral regions, which furthermore correlated with greater abuse severity. They also had increased CV in left inferior and middle temporal gyri relative to healthy controls. Abnormalities in the precuneus, temporal and precentral regions were abuse-specific relative to psychiatric controls, albeit at a more lenient level. Groups did not differ in SA. CONCLUSIONS Childhood abuse is associated with widespread structural abnormalities in OFC-insular, cerebellar, occipital, parietal and temporal regions, which likely underlie the abnormal affective, motivational and cognitive functions typically observed in this population.
Collapse
Affiliation(s)
- L Lim
- Department of Child & Adolescent Psychiatry,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - H Hart
- Department of Child & Adolescent Psychiatry,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - M Mehta
- Department of Neuroimaging,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - A Worker
- Department of Neuroimaging,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - A Simmons
- Department of Neuroimaging,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - K Mirza
- Department of Child & Adolescent Psychiatry,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - K Rubia
- Department of Child & Adolescent Psychiatry,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| |
Collapse
|
43
|
Abstract
Facial Osteotomy techniques have evolved enormously over the past 20 years providing significant and often life-changing benefits to our dental patients with skeletal malocclusions. Advancements in technology and refined surgical techniques have resulted in improvements in surgical outcomes, a reduction in post-operative complications and a quicker recovery for today's patients undergoing orthognathic surgery. This paper aims to an update on the contemporary approach to the correction of skeletal malocclusions with facial osteotomies.
Collapse
Affiliation(s)
- L Lim
- Sydney University and Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Oral and Facial Surgery, Chatswood, New South Wales, Australia
| | - A A Heggie
- Section of Oral & Maxillofacial Surgery, Royal Children's Hospital of Melbourne, Parkville, Melbourne, Australia
| |
Collapse
|
44
|
Lim L, Ng TP, Ong AP, Tan MP, Cenina AR, Gao Q, Ng A, Kandiah N. A novel language-neutral Visual Cognitive Assessment Test (VCAT): validation in four Southeast Asian countries. Alzheimers Res Ther 2018; 10:6. [PMID: 29370825 PMCID: PMC6389153 DOI: 10.1186/s13195-017-0333-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/18/2017] [Indexed: 02/06/2023]
Abstract
Background Cognitive screeners are imperative for early diagnosis of dementia. The Visual Cognitive Assessment Test (VCAT) is a language-neutral, visual-based test which has proven useful for a multilingual population in a single-center study. However, its performance utility is unknown in a wider and more diverse Southeast Asian cohort. Methods We recruited 164 healthy controls (HC) and 120 cognitively impaired (CI) subjects- 47 mild cognitive impairment (MCI) and 73 mild Alzheimer’s disease (AD) dementia participants, from four countries between January 2015 and August 2016 to determine the usefulness of a single version of the VCAT, without translation or adaptation, in a multinational, multilingual population. The VCAT was administered along with established cognitive evaluation. Results The VCAT, without local translation or adaptation, was effective in discriminating between HC and CI subjects (MCI and mild AD dementia). Mean (SD) VCAT scores for HC and CI subjects were 22.48 (3.50) and 14.17 (5.05) respectively. Areas under the curve for Montreal Cognitive Assessment (0.916, 95% CI 0.884–0.948) and the VCAT (0.905, 95% CI 0.870–0.940) in discriminating between HCs and CIs were comparable. The multiple languages used to administer VCAT in four countries did not significantly influence test scores. Conclusions The VCAT without the need for language translation or cultural adaptation showed satisfactory discriminative ability and was effective in a multinational, multilingual Southeast Asian population.
Collapse
Affiliation(s)
- Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore
| | - Anam Paulus Ong
- Faculty of Medicine, Department of Neurology, Hasan Sadikin Hospital, Padjadjaran University, Kota Bandung, Jawa Barat, Indonesia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | - Alvin Rae Cenina
- Department of Neurosciences, Philippine General Hospital, University of the Philippines, Manila, Philippines.,Department of Neurosciences, Asian Hospital and Medical Center, Manila, Philippines
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore
| | - Adeline Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore. .,Duke-NUS, Graduate Medical School, Singapore, Singapore.
| |
Collapse
|
45
|
Offen S, Bart N, Hungerford S, Lim L, Feneley M, Kathir K, Winlaw D, Jabbour A, Kotlyar E, Hayward C, Muthiah K, MacDonald P. Connecting the Dots: VF Arrest Secondary to Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Syndrome. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Yatawara C, Lee DR, Lim L, Zhou J, Kandiah N. Getting Lost Behavior in Patients with Mild Alzheimer's Disease: A Cognitive and Anatomical Model. Front Med (Lausanne) 2017; 4:201. [PMID: 29201866 PMCID: PMC5696332 DOI: 10.3389/fmed.2017.00201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/02/2017] [Indexed: 01/23/2023] Open
Abstract
Background Getting lost behavior (GLB) in the elderly is believed to involve poor top-down modulation of visuospatial processing, by impaired executive functions. However, since healthy elderly and elderly with Alzheimer's disease (AD) experience a different pattern of cognitive decline, it remains unclear whether this hypothesis can explain GLB in dementia. Objective We sought to identify whether poor executive functions and working memory modulate the relationship between visuospatial processing and prevalence of GLB in healthy elderly and patients with AD. Complementary to this, we explored whether brain regions critical for executive functions modulate the relationship between GLB and brain regions critical for visuospatial processing. Method Ninety-two participants with mild AD and 46 healthy age-matched controls underwent neuropsychological assessment and a structural MRI. GLB was assessed using a semistructured clinical interview. Path analysis was used to explore interactions between visuospatial deficits, executive dysfunction/working memory, and prevalence of GLB, in AD and controls independently. Results For both healthy controls and patients with mild AD, visuospatial processing deficits were associated with GLB only in the presence of poor working memory. Anatomically, GLB was associated with medial temporal atrophy in patients with mild AD, which was not strengthened by low frontal gray matter (GM) volume as predicted. Instead, medial temporal atrophy was more strongly related to GLB in patients with high frontal GM volumes. For controls, GLB was not associated with occipital, parietal, medial temporal, or frontal GM volume. Conclusion Cognitively, a top-down modulation deficit may drive GLB in both healthy elderly and patients with mild AD. This modulation effect may be localized in the medial temporal lobe for patients with mild AD. Thus, anatomical substrates of GLB in mild AD may not follow the typical top-down modulation mechanisms often reported in the healthy aging population. Implications advance therapeutic practices by highlighting the need to target both working memory and visuospatial deficits simultaneously, and that anatomical substrates of GLB may be disease specific.
Collapse
Affiliation(s)
- Chathuri Yatawara
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Daryl Renick Lee
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Juan Zhou
- Duke-NUS Medical School, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
47
|
Lim L, Yong TT, Chander RJ, Ting S, Hameed S, Lyn Ng AS, Kandiah N. [P1–568]: YOUNG‐ONSET DEMENTIA IN A SOUTHEAST ASIAN POPULATION FROM SINGAPORE: CLINICAL AND BIOMARKER CHARACTERIZATION. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Levinia Lim
- National Neuroscience InstituteSingaporeSingapore
| | | | | | - Simon Ting
- National Neuroscience InstituteSingaporeSingapore
| | - Shahul Hameed
- National Neuroscience InstituteSingaporeSingapore
- Duke‐NUS GMS/NeurologySingaporeSingapore
| | | | - Nagaendran Kandiah
- National Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Graduate Medical SchoolSingaporeSingapore
| |
Collapse
|
48
|
Yong TT, Chander RJ, Foo HE, Lim L, Tat Ng AY, Tan L, Kandiah N. [P1–390]: VOXEL‐BASED MORPHOMETRIC COMPARISON STUDY OF MILD COGNITIVE IMPAIRMENT IN ALZHEIMER's DISEASE AND PARKINSON's DISEASE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | - Levinia Lim
- National Neuroscience InstituteSingaporeSingapore
| | | | - Louis Tan
- National Neuroscience InstituteSingaporeSingapore
| | | |
Collapse
|
49
|
Yuen Oi Choong T, Deocariza Guevarra AC, Silva E, Lim L, Yong TT, Mei NM, Hui Zhang AS, Lay Hoon Lim L, Vanessa Chua E, Kandiah N. [P4–320]: A MULTIDOMAIN STRUCTURED COGNITIVE STIMULATION PROGRAMME FOR ASIAN PATIENTS WITH MILD DEMENTIA: THE OWOW! PROGRAMME. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Levinia Lim
- National Neuroscience InstituteSingaporeSingapore
| | | | - Nyu Mei Mei
- National Neuroscience InstituteSingaporeSingapore
| | | | | | | | | |
Collapse
|
50
|
Chander RJ, Foo HE, Yong TT, Lim L, Tan JY, Wen MC, Zhou J, Kandiah N. [P3–468]: POOR SERIAL POSITION EFFECT PERFORMANCE IS CORRELATED WITH REDUCED CORTICAL AND HIPPOCAMPAL VOLUMES IN MILD COGNITIVE IMPAIRMENT. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | - Levinia Lim
- National Neuroscience InstituteSingaporeSingapore
| | - Jayne Yi Tan
- National Neuroscience InstituteSingaporeSingapore
| | | | - Juan Zhou
- Agency for Science, Technology and ResearchSingaporeSingapore
- Duke‐NUS Graduate Medical SchoolSingaporeSingapore
| | - Nagaendran Kandiah
- National Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Graduate Medical SchoolSingaporeSingapore
| |
Collapse
|