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Shi LH, Lam SH, So H, Chan CY, Li TK, Szeto CC, Tam LS. Inflammation is associated with incident hypertension in patients with axial spondyloarthritis: A longitudinal cohort study. Clin Exp Hypertens 2023; 45:2205056. [PMID: 37139811 DOI: 10.1080/10641963.2023.2205056] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To elucidate the risk factors for the development of incident hypertension (IHT) in patients with axial spondyloarthritis (axSpA). METHODS We conducted a retrospective cohort study in axSpA patients who were recruited from 2001 to 2019 from a university clinic in Hong Kong. Patients with HT and/or anti-hypertensive drug use at baseline were excluded. They were followed until the end of 2020. The outcome was IHT, defined by a diagnosis and a prescription for an antihypertensive drug. Baseline and time-varying Cox regression analyses adjusting for age, sex, and body mass index (BMI), were used to assess the relationship between drug use, inflammatory burden, and IHT. RESULTS Four hundred and thirteen patients [age: 34(25-43) years, male: 319 (77.2%)] were recruited. After a median follow-up of 12 (6-17) years, 58 patients (14%) developed IHT (IHT+group). Among all the baseline variables, disease duration and delay in diagnosis were the independent predictors for IHT based on the Cox regression model. In the multivariate Cox regression analysis, baseline disease duration, delay in diagnosis and time-varying ESR levels were independent predictors associated with an increased risk of IHT. IHT risk was significantly increased in patients with disease duration >5 years. The use of anti-inflammatory drugs was not associated with the development of IHT. CONCLUSION Higher inflammatory burden as reflected by a longer disease duration, delay diagnosis and higher ESR levels, were predictors associated with IHT after adjusting for traditional CV risk factors. These data support routine screening for hypertension in axSpA patients, especially those with longer disease duration.
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Affiliation(s)
- Lin-Hong Shi
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Science (LiHS), The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Steven H Lam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ho So
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Crystal Y Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Science (LiHS), The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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So H, Chow E, Cheng IT, Lau SL, Li TK, Szeto CC, Tam LS. Telemedicine for follow-up of systemic lupus erythematosus during the 2019 coronavirus pandemic: A pragmatic randomized controlled trial. J Telemed Telecare 2023:1357633X231181714. [PMID: 37357745 DOI: 10.1177/1357633x231181714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Patients with systemic lupus erythematous were vulnerable to severe coronavirus disease 2019 infection and the negative impact of disrupted healthcare delivery. Telemedicine has been a popular alternative to standard in-person care during the pandemic despite the lack of evidence. METHODS This was a 1-year pragmatic randomized-controlled trial. Patients followed at the lupus nephritis clinic were randomized to either telemedicine or standard follow-up in a 1:1 ratio. Patients in the telemedicine group were followed up via videoconferencing. Standard follow-up group patients continued conventional in-person outpatient care. The primary outcome of the study was the proportion of patients in low disease activity after 1 year. Secondary outcomes included cost-of-illness, safety, and various patient-reported outcomes. RESULTS From 6/2020 to 12/2021, 144 patients were randomized and 141 patients (telemedicine: 70, standard follow-up: 71) completed the study. At 1 year, 80.0% and 80.2% of the patients in the telemedicine group and standard follow-up group were in lupus low disease activity state or complete remission, respectively (p = 0.967). Systemic lupus erythematous disease activity indices, number of flares and frequency of follow-ups were also similar. There were no differences in the cost-of-illness, quality of life or mental health scores. However, significantly more patients in the telemedicine group (41.4% vs 5.6%; p < 0.001) required switch of mode of follow-up and higher proportion of them had hospitalization during the study period (32.9% vs 15.5%; p = 0.016). Being in the telemedicine group or not in low disease activity at baseline were the independent predictors of hospitalization (odds ratio: 2.6; 95% confidence interval: 1.1-6.1, odds ratio: 2.7, 95% confidence interval: 1.1-6.7, respectively) in the post hoc analysis. CONCLUSIONS In patients with systemic lupus erythematous, telemedicine predominant follow-up resulted in similar 1-year disease control compared to standard care. However, it needed to be complemented by in-person visits, especially in patients with unstable disease.
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Affiliation(s)
- Ho So
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Evelyn Chow
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Isaac T Cheng
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sze-Lok Lau
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tena K Li
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
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Yue J, Wong PCH, Zhang Y, Peng F, Griffith JF, Xu J, Xiao F, Li TK, Hung V, Qin L, Tam LS. A novel visceral adiposity index predicts bone loss in female early rheumatoid arthritis patients detected by HR-pQCT. Sci Rep 2023; 13:2471. [PMID: 36774444 PMCID: PMC9922327 DOI: 10.1038/s41598-023-29505-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/06/2023] [Indexed: 02/13/2023] Open
Abstract
The purpose of this prospective study is to compare the Chinese visceral adiposity index (CVAI) between early rheumatoid arthritis (ERA) patients and healthy controls; and to assess the relationship between CVAI and the bone microstructure using high-resolution peripheral quantitative computed tomography (HR-pQCT) in ERA patients. 104 female ERA and 100 age-, gender- and BMI-matched healthy controls were recruited for the comparison of CVAI. All ERA patients were prospectively followed for 1 year. HR-pQCT scan of the distal radius, tibia and second metacarpal head were performed at baseline and after one-year. ERA patients were divided into two sub-groups according to the median CVAI value (65.73) (low CVAI and high CVAI groups). CVAI in the ERA group was significantly higher than the controls group (p = 0.01). At baseline, the high CVAI group had a higher ESR level (p = 0.004) while the cortical volumetric bone mineral density (vBMD) was lower (at both the distal radius and tibia, all p < 0.05) compared to the low CVAI group. Linear regression analysis revealed that a higher baseline CVAI was an independent predictor of a lower cortical vBMD at month 12 (distal radius: B = - 0.626, p = 0.022, 95%CI - 1.914 to - 0.153; tibia: B = - 0.394, p = 0.003, 95%CI - 1.366 to - 0.290); and a greater reduction in trabecular vBMD (tibia: B = 0.444, p = 0.001, 95%CI 0.018-0.063; distal radius: B = 0.356, p = 0.008, 95%CI 0.403-0.063). In summary, CVAI is an independent predictor of trabecular bone loss in female patients with ERA, which may be augmented by a chronic inflammatory state in patients with visceral dysfunction of fat metabolism.Trial registration: http://Clinicaltrial.gov no: NCT01768923, 16/01/2013.
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Affiliation(s)
- Jiang Yue
- Department of Endocrinology and Metabolism, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Priscilla C H Wong
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ying Zhang
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Peng
- Department of Laboratory Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiankun Xu
- Bone Quality and Health Center, Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Fan Xiao
- Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Vivian Hung
- Bone Quality and Health Center, Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling Qin
- Bone Quality and Health Center, Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Shi LH, Lam SH, So H, Li EK, Li TK, Szeto CC, Tam LS. High inflammatory burden predicts cardiovascular events in patients with axial spondyloarthritis: a long-term follow-up study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221122401. [PMID: 36105413 PMCID: PMC9465578 DOI: 10.1177/1759720x221122401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Axial spondyloarthritis (axSpA) patients are at higher risk of cardiovascular (CV) disease (CVD) than the general population, partly due to consequences of inflammation or its treatment. But relationship between inflammation in axSpA and cardiovascular events (CVE) is unknown. Objectives To examine whether inflammatory burden over time can predict CVE independent of baseline CV risk factors in axSpA patients. Design A cohort analysis was performed in patients who had been recruited since January 2001. The primary outcome was a first CVE occurring between January 2001 and December 2020. Methods Three CVD risk scores were computed at baseline. The performance of the original and modified (*1.5 multiplication factor) CV risk algorithms were assessed. Time-varying Cox proportional hazard models and Kaplan-Meier survival analysis were used to assess whether inflammatory burden (Bath ankylosing spondylitis disease activity index [BASDAI] and inflammatory markers), nonsteroidal anti-inflammatory drugs (NSAIDs) and disease modifying antirheumatic drugs (DMARDs) can predict the development of first CVE. Results 463 patients (35 [26-45] years, male: 360 [77.8%]) were recruited. After a median follow-up of 12 (7-19) years, 61 patients (13.2%) experienced a first CVE. Traditional/modified CV risk scores underestimated CV risk. Erythrocyte sedimentation rate (ESR) ⩾ 20 mm/h was associated with a significantly higher risk of CVE during follow-up (HR: 2.07, 95%CI [1.10, 3.98], p = 0.008). Active disease as indicated by a rising BASDAI also showed positive trend towards a higher risk of developing CVE over time. After adjusting for CV risk scores in the multivariable models, high ESR level (ESR ⩾ 20 mm/h) over time remained significantly associated with a higher risk of developing CV events. Conclusion Increased inflammatory burden as reflected by elevated ESR levels (ESR ⩾ 20) was associated with increased risk of CVE, while the use of NSAIDs and DMARDs were not.
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Affiliation(s)
- Lin-Hong Shi
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Steven H Lam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ho So
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Edmund K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories 999077, Hong Kong
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So H, Chow E, Cheng IT, Lau SL, Li TK, Szeto CC, Tam LS. Use of telemedicine for follow-up of lupus nephritis in the COVID-19 outbreak: The 6-month results of a randomized controlled trial. Lupus 2022; 31:488-494. [PMID: 35254169 PMCID: PMC8902321 DOI: 10.1177/09612033221084515] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective This study aimed to evaluate the short-term patient satisfaction, compliance, disease control, and infection risk of telemedicine (TM) compared with standard in-person follow-up (FU) for patients with lupus nephritis (LN) during the COVID-19 pandemic. Method This was a single-center open-label randomized controlled study. Consecutive patients followed at the LN clinic were randomized to either TM or standard FU (SF) group in a 1:1 ratio. Patients in the TM group received FU via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared and presented. Results From June to December 2020, 122 patients were randomized (TM: 60, SF: 62) and had at least 2 FUs. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the two groups except a higher physician global assessment score (PGA) in the TM group. After a mean FU of 19.8 ± 4.5 weeks, the overall patient satisfaction score was higher in the TM group. More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%; p = .049) with higher baseline PGA (OR = 1.17; 95% CI, 1.08–1.26) being the independent predictor. The proportions of patients remained in LLDAS were similar in the two groups (TM: 75.0% vs SF: 74.2%, p = .919). None of the patients had COVID-19. Conclusions TM FU resulted in better patient satisfaction and similar short-term disease control in patients with LN compared to standard care. However, it was associated with more hospitalizations and might need to be complemented by in-person visits especially in patients with higher PGA.
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Affiliation(s)
- Ho So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Evelyn Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Isaac T Cheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Sze-Lok Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
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So H, Chow E, Cheng IT, Lau SL, Li TK, Szeto CC, Tam LS. Factors Associated With Use of Telemedicine for Follow-Up of SLE in the COVID-19 Outbreak. Front Med (Lausanne) 2021; 8:790652. [PMID: 34966764 PMCID: PMC8710609 DOI: 10.3389/fmed.2021.790652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the factors associated with telemedicine (TM) use for follow-up of Systemic Lupus Erythematous (SLE) patients in the COVID-19 pandemic. Methods: This was a single-centered cross-sectional study conducted in Hong Kong. Consecutive patients followed up at the lupus nephritis clinic were contacted for their preference in changing the coming consultation to TM in the form of videoconferencing. The demographic, socioeconomic, and disease data of the first 140 patients opted for TM and 140 control patients preferred to continue standard in-person follow-up were compared. Results: The mean age of all the participants was 45.6 ± 11.8 years, and the disease duration was 15.0 ± 9.2 years. The majority of them were on prednisolone (90.0%) and immunosuppressants (67.1%). The mean SLEDAI-2k was 3.4 ± 2.4, physician global assessment (PGA) was 0.46 ± 0.62 and Systemic Lupus International Collaborating Clinics (SLICC) damage index was 0.97 ± 1.23. A significant proportion of the patients (72.1%) had 1 or more comorbidities. It was found that patients with higher mean PGA (TM: 0.54 ± 0.63 vs. control: 0.38 ± 0.59, p = 0.025) and family monthly income > USD 3,800 (TM: 36.4% vs. control: 23.6%; p = 0.028) preferred TM, while full-time employees (TM: 40.0% vs. control: 50.7%; p = 0.041) preferred in-person follow-up. These predictors remained significant in the multivariate analysis after adjusting for age and gender. No other clinical factors were found to be associated with the preference of TM follow-up. Conclusion: When choosing the mode of care delivery between TM and physical clinic visit for patients with SLE, the physician-assessed disease activity and patient's socio-economic status appeared to be important.
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Affiliation(s)
- Ho So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Evelyn Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Isaac T Cheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sze-Lok Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tena K Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Sun YL, Sun L, Li TK, Lyu SG, Lu XH. [Efficacy of two-lung ventilation with different tidal volume assisted by CO 2 pneumothorax for airway management in patients undergoing radical resection of esophageal cancer using combined laparoscopic and thoracoscopic approach]. Zhonghua Yi Xue Za Zhi 2021; 101:2787-2791. [PMID: 34551495 DOI: 10.3760/cma.j.cn112137-20210118-00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the efficacy of two-lung ventilation with different tidal volume assisted by CO2 pneumothorax for airway management in patients undergoing radical esophagectomy using combined thoracoscopic and laparoscopic approach. Methods: One hundred and eighty patients undergoing radical esophagectomy using combined thoracoscopy and laparoscopy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University between February and September 2019 were randomly divided into three groups (group V1, V2, V3, n=60) according to the tidal volume (TV) used. The TVs of group V1-V3 were 4, 5, 7 ml/kg during thoracoscopic surgery, respectively. All the patients were intubated with a single-lumen endotracheal tube and underwent two-lung ventilation assisted by continuous positive pressure CO2 pneumothorax in group V1, V2 and V3, with the CO2 pressure of 10 mmHg (1 mmHg=0.133 kPa) and the frequency of 20 times/min. Mean arterial pressure (MAP) and heart rate (HR) were recorded before thoracoscopic surgery (T1), 30 minutes after thoracoscopic surgery (T2), at the end of thoracoscopic surgery (T3), after thoracoscopic surgery and 30 minutes after two-lung intermittent positive pressure ventilation, respectively. The results of arterial blood gas were collected at T1, T2, T3 and T4. Recovery time from anesthesia, consciousness recovery time, and lung collapse condition were recorded. Results: At T2, the value of MAP in group V1 was (81±10) mmHg, which was higher than those of group V2 [(69±7) mmHg] and group V3 [(71±8) mmHg], with a statistically significant difference (F=9.270, P<0.05). Meanwhile, at T2, the value of HR in group V1 was (83±7) times/min, which was higher than those of group V2 [(68±6) times/min] and group V3 [(71±7) times/min], and there was a statistically significant difference (F=23.460, P<0.05). However, at T2, the values of arterial partial pressure of oxygen (PaO2) in three groups were (262±16), (249±16) and (241±20) mmHg, respectively, with no statistically significant difference (F=1.929, P>0.05). At T3, the value of arterial partial pressure of carbon dioxide (PaCO2) in group V3 was (46±5) mmHg, which was lower than those of group V1 [(63±9) mmHg] and V2 [(62±10) mmHg], with a statistically significant difference (F=20.890, P<0.05). Moreover, at T3, the value of pH in group V3 was (7.35±0.04), which was higher than those of group V1 (7.28±0.04) and V2 (7.32±0.04), and there was a statistically significant difference (F=9.309, P<0.05). Additionally, the satisfaction rates of lung collapse in group V3 was 57.1%, which was lower than those of group V1 (94.7%) and group V2 (96.3%), with a statistically significant difference (χ²=7.601, P<0.05). There was no statistical significance in the time of awakening and consciousness recovery among three groups (F=1.020 and 1.110, both P>0.05). Conclusion: The two-lung ventilation with 5 ml/kg tidal volume assisted by CO2 pneumothorax has advantages in terms of hemodynamics and surgical field exposure, and is more suitable as the appropriate dose for respiratory management in patients undergoing radical resection of esophageal cancer using combined thoracoscopic and laparoscopic approach.
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Affiliation(s)
- Y L Sun
- Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - L Sun
- Department of Anesthesiology, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen 518000, China
| | - T K Li
- Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - S G Lyu
- Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - X H Lu
- Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
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Cheng IT, Wong KT, Li EK, Wong PCH, Lai BT, Yim IC, Ying SK, Kwok KY, Li M, Li TK, Lee JJ, Lee AP, Tam LS. Comparison of carotid artery ultrasound and Framingham risk score for discriminating coronary artery disease in patients with psoriatic arthritis. RMD Open 2021; 6:rmdopen-2020-001364. [PMID: 32973102 PMCID: PMC7539857 DOI: 10.1136/rmdopen-2020-001364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/13/2020] [Accepted: 09/05/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives This study aimed to assess the performance of carotid ultrasound (US) parameters alone or in combination with Framingham Risk Score (FRS) in discriminating patients with psoriatic arthritis (PsA) with and without coronary artery disease (CAD). Methods Ninety-one patients with PsA (56 males; age: 50±11 years, disease duration: 9.4±9.2 years) without overt cardiovascular (CV) diseases were recruited. Carotid intima-media thickness (cIMT), the presence of plaque and total plaque area (TPA) was determined by high-resolution US. CAD was defined as the presence of any coronary plaque on coronary CT angiography (CCTA). Obstructive-CAD (O-CAD) was defined as >50% stenosis of the lumen. Results Thirty-five (38%) patients had carotid plaque. Fifty-four (59%) patients had CAD (CAD+) and 9 (10%) patients had O-CAD (O-CAD+). No significant associations between the presence of carotid plaque and CAD were found. However, cIMT and TPA were higher in both the CAD+ and O-CAD+ group compared with the CAD− or O-CAD− groups, respectively. Multivariate logistic regression analysis revealed that mean cIMT was an independent explanatory variable associated with CAD and O-CAD, while maximum cIMT and TPA were independent explanatory variables associated with O-CAD after adjusting for covariates. The optimal cut-offs for detecting the presence of CAD were FRS >5% and mean cIMT at 0.62 mm (AUC: 0.71; sensitivity: 67%; specificity: 76%), while the optimal cut-offs for detecting the presence of O-CAD were FRS >10% in combination with mean cIMT at 0.73 mm (AUC: 0.71; sensitivity: 56%; specificity: 85%). Conclusion US parameters including cIMT and TPA may be considered in addition to FRS for CV risk stratification in patients with PsA.
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Affiliation(s)
- Isaac T Cheng
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Ka Tak Wong
- Diagnostic and Interventional Radiology, Prince of Wales Hospital, Hong Kong
| | - Edmund K Li
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | | | | | | | - Shirley K Ying
- Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | | | - Martin Li
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Jack J Lee
- School of Public Health Division of Biostatistics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong
| | - Alex P Lee
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
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Lam SH, So H, Cheng IT, Li EK, Wong P, Li TK, Lee APW, Tam LS. Association of C-reactive protein and non-steroidal anti-inflammatory drugs with cardiovascular events in patients with psoriatic arthritis: a time-dependent Cox regression analysis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211027712. [PMID: 34262622 PMCID: PMC8252335 DOI: 10.1177/1759720x211027712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022] Open
Abstract
Aims: Psoriatic arthritis (PsA) is associated with accelerated atherosclerosis due to underlying inflammation. Whether inflammatory burden and drugs used to suppress inflammation over time are associated with cardiovascular (CV) events remained unclear. This study aims to examine the time-varying effect of C-reactive protein (CRP) levels and the use of drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) and disease modifying anti-rheumatic drugs, on the risk of CV events independent of traditional CV risk factors in PsA patients. Methods: A retrospective cohort analysis was performed in patients with PsA who were recruited from 2008 to 2015 and followed until the end of 2019. The outcome was occurrence of a first CV event. Framingham risk score (FRS) was used to quantify the traditional CV risk. Cox proportional hazard models with time-varying CRP levels and drugs used were analysed to identify the risk factors for CV events in PsA patients. Results: Two hundred patients with PsA [median age: 47.5 (40.0–56.0); male: 119 (59.5%)] were recruited. After a mean follow-up of 8.8 ± 3.8 years, 30 (15%) patients developed a first CV event. The multivariable Cox regression model showed that time-varying CRP level [hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.00–1.04] and NSAIDs exposure (HR 0.38, 95% CI 0.15–0.96) were significantly associated with CV events after adjusting for baseline FRS (HR 5.06, 95% CI 1.84–13.92). Conclusion: Increased inflammatory burden as reflected by elevated CRP level was associated with increased risk of CV events, while the risk was significantly reduced with NSAIDs use in PsA patients.
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Affiliation(s)
- Steven H Lam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Ho So
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Isaac T Cheng
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edmund K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Priscilla Wong
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Alex Pui-Wai Lee
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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So H, Cheng IT, Lau SL, Chow E, Lam T, Hung VW, Li EK, Griffith JF, Lee VW, Shi L, Huang J, Kwok KY, Yim CW, Li TK, Lo V, Lee J, Lee JJW, Qin L, Tam LS. Effects of RANKL inhibition on promoting healing of bone erosion in rheumatoid arthritis using HR-pQCT: a 2-year, randomised, double-blind, placebo-controlled trial. Ann Rheum Dis 2021; 80:981-988. [PMID: 33811034 DOI: 10.1136/annrheumdis-2021-219846] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/21/2021] [Accepted: 03/18/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the effects of denosumab on erosion healing at 2-4 metacarpophalangeal (MCP) head as determined by high-resolution peripheral quantitative CT (HR-pQCT) in patients with rheumatoid arthritis (RA) with stable disease. METHODS This was a randomised, placebo-controlled, double-blind study. Patients with RA with disease activity score 28 joints (DAS28) ≤5.1 were randomised (1:1) to subcutaneous denosumab 60 mg or placebo once every 6 months for 24 months. The primary outcome was erosion healing at MCP 2-4 on HR-pQCT at 12 months. The effects of denosumab on erosion and joint space parameters on HR-pQCT and radiographs, disease activity and health assessment questionnaire-disability index (HAQ-DI) were also examined. RESULTS At 24 months, HR-pQCT images were analysed in 98 patients. One-third of the patients achieved sustained low disease activity throughout the study. At 12 months, changes in erosion parameters on HR-pQCT were similar between the two groups. At 24 months, new erosions (19% vs 9%, p=0.009) and erosion progression (18% vs 8%, p=0.019) were more common in the placebo group than the denosumab group. Erosion healing was seen in a significantly higher proportion of patients in the denosumab group (20% vs 6%, p=0.045) at 24 months. No significant changes in joint space parameters on HR-pQCT, van der Heijde-Sharp erosion score, DAS28 and HAQ-DI were observed in the two groups at 12 and 24 months. CONCLUSION Although no differences in erosion parameters were observed at 12 months, denosumab was more efficacious than placebo in erosion repair on HR-pQCT after 24 months. TRIAL REGISTRATION NUMBER NCT03239080.
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Affiliation(s)
- Ho So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Isaac T Cheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sze-Lok Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Evelyn Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tommy Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vivian W Hung
- Bone Quality and Health Centre of the Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Edmund K Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vivian W Lee
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Junbin Huang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kitty Yan Kwok
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Cheuk-Wan Yim
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vincent Lo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jolie Lee
- Department of Medicine, Tai Po Hospital, Hong Kong, Hong Kong
| | - Jack Jock-Wai Lee
- Division of Biostatistics, The Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ling Qin
- Bone Quality and Health Centre of the Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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11
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Sun YL, Sun L, Li TK, Lyu SG, Bai Y, Li XT, Lu XH. [Application of different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy]. Zhonghua Yi Xue Za Zhi 2021; 101:630-635. [PMID: 33685044 DOI: 10.3760/cma.j.cn112137-20200628-01963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To observe the application of three different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy. Methods: one hundred and eighty patients undergoing combined thoracoscopic and laparoscopic esophagectomy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University from February to September 2019 were randomly divided into three groups which include: double-lumen endotracheal intubation group (group S,n=60),single-lumen endotracheal intubation group (group D,n=60) and Coopdech occlusion of bronchial catheter combined with a single-lumen endotracheal intubation group (group C,n=60). The arterial blood samples were collected immediately after endotracheal intubation (T0), 30 min after artificial pneumothorax (single lung ventilation) (T1), 30 min after artificial pneumothorax (double lung ventilation) (T2), and 30 min after extubation (T3) to detect arterial blood gas. Patients' heart rate (HR), blood oxygen partial pressure (PaO2), blood carbon dioxide partial pressure (PaCO2) and airway pressure(Paw) were recorded at T0-T3.Completion time of endotracheal intubation, carbon dioxide intrathoracic inflation pressure, degree of lung collapse and incidence of postoperative 3-day pneumonia in three groups were recorded. The bronchoalveolar lavage fluid (BALF) of patients at T0, T2 and the end of the operation (T4) were collected to detect the levels of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) in BALF by enzyme-linked immunosorbent assay (ELISA). Results: A total of 14 patients were excluded during the operation, of which 9 cases lasted longer than 6 hours, 3 cases had arrhythmia during the operation and 2 cases lasted less than 1 hour. Finally, 56 cases in group S, 54 cases in group D and 56 cases in group C completed the experiment. The satisfaction rates of lung collapse in group S, group D and group C were 85.7% (48/56), 100.0% (54/54), 89.2% (50/56), respectively, with no statistically significant difference (χ²=1.308, P>0.05). The intrathoracic inflation pressure of carbon dioxide in group D was (10.2±2.2) mmHg (1 mmHg=0.133 kPa), which was higher than (5.1±3.4) mmHg in group S and (5.6±3.1) mmHg in group C, the difference was statistically significant (F=-9.303, P<0.05). The incidence of postoperative 3-day pneumonia in group D was 14.8%, which was lower than 39.3% in group S and 17.8% in group C, the difference was statistically significant (χ²=8.300, P<0.05). At T4, the value of TNF-α in group D was (122.4±4.4) ng/L, which was lower than that in group S and group C, (257.9±6.3) and (185.8±5.6) ng/L, with statistically significant difference (F=69.020, P<0.05). At T4, the value of IL-6 in group D was (175.4±4.9) ng/L, which was lower than that of patients in group S and group C, (289.6±6.8) and (226.2±4.4) ng/L, with statistically significant difference (F=59.750, P<0.05). At T4, the value of IL-8 in group D was (303.1±7.2) ng/L, which was lower than in group S and group C, (595.4±22.1) and (436.8±10.9) ng/L, with statistically significant difference (F=55.359, P<0.05). Conclusion: All the three endotracheal intubations can produce satisfactory ventilation effect in the combined thoracoscopic and laparoscopic esophagectomy, however, single-lumen endotracheal intubation has less effect on lung injury.
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Affiliation(s)
- Y L Sun
- Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China
| | - L Sun
- Department of Anesthesiology, Cancer Hospital, Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen 518000, China
| | - T K Li
- Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China
| | - S G Lyu
- Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China
| | - Y Bai
- Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China
| | - X T Li
- Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China
| | - X H Lu
- Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China
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Cheng IT, Li EK, Wong PC, Law MY, Yim IC, Lai BT, Ying SK, Kwok KY, Li M, Li TK, Lee JJ, Szeto CC, Yan BP, Lee AP, Tam LS. Treat to target and prevention of subclinical atherosclerosis in psoriatic arthritis-which target should we choose? Rheumatology (Oxford) 2020; 59:2881-2892. [PMID: 32087023 DOI: 10.1093/rheumatology/keaa025] [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] [Received: 10/19/2019] [Revised: 01/10/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE PsA patients who achieved sustained minimal disease activity (sMDA) had less subclinical atherosclerosis progression. The vascular effects of achieving other potential treatment targets, including the PsA Disease Activity Score (PASDAS) and the Disease Activity in PsA (DAPSA) score, remained uncertain. This study aimed to compare the vascular effects of achieving different treatment targets in PsA patients. METHOD This is a post hoc analysis of a 2 year treat-to-target study aimed at MDA. A total of 101 consecutive PsA patients without overt cardiovascular disease were recruited. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. Low disease activity (LDA) was defined as MDA, DAPSA ≤14 or PASDAS ≤3.2. Sustained disease control was defined as achieving these targets at each visit from month 12 until month 24. RESULTS Ninety patients [52 male (57.8%), age 50 years (s.d. 11)] who completed 24 months of follow-up were included in this analysis. A total of 44%, 48% and 45% of patients achieved sustained DAPSA LDA (sDAPDA-LDA), sustained PASDAS LDA (sPASDAS-LDA) and sMDA, respectively. Patients who achieved sMDA had significantly less progression of carotid intima-media thickness than those who did not (P = 0.031). Using multivariate analysis, achieving sMDA and sPASDAS-LDA had a protective effect on plaque progression, less increase in total plaque area, reduced mean intima-media thickness and reduced augmentation index after adjusting for covariates. In contrast, no significant differences in the progression of vascular parameters were demonstrated between patients who did or did not achieve sDAPSA-LDA. CONCLUSION Achieving sMDA/sDASPAS-LDA, but not sDAPSA-LDA, was associated with a protective effect in subclinical atherosclerosis and arterial stiffness progression. A multidimensional domain of disease control might be better in minimizing cardiovascular risk in PsA.
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Affiliation(s)
- Isaac T Cheng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edmund K Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Priscilla C Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Mei Yan Law
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Isaac C Yim
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong
| | - Billy T Lai
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong
| | - Shirley K Ying
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Kitty Y Kwok
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Martin Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jack J Lee
- Division of Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Alex P Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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13
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Lam SHM, Cheng IT, Li EK, Wong P, Lee J, Yip RML, Yim CW, Ying SK, Li M, Li TK, Lee APW, Tam LS. DAPSA, carotid plaque and cardiovascular events in psoriatic arthritis: a longitudinal study. Ann Rheum Dis 2020; 79:1320-1326. [PMID: 32737113 DOI: 10.1136/annrheumdis-2020-217595] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/24/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine whether Disease Activity in Psoriatic Arthritis (DAPSA) reflecting the inflammatory component of psoriatic arthritis (PsA) can predict cardiovascular (CV) events independent of traditional CV risk factors and subclinical carotid atherosclerosis. METHODS A cohort analysis was performed in patients with PsA who had been followed since 2006. The outcome of interest was first CV event. Four different CV disease (CVD) risk scores and DAPSA were computed at baseline. The presence of carotid plaque (CP) and carotid intima-media thickness (CIMT) was also determined in a subgroup of patients using high-resolution ultrasound. The association between DAPSA, CVD risk scores, CP, CIMT and the occurrence of CV events was assessed using Cox proportional hazard models. RESULTS 189 patients with PsA (mean age: 48.9 years; male: 104 (55.0%)) were recruited. After a median follow-up of 9.9 years, 27 (14.3%) patients developed a CV event. Higher DAPSA was significantly associated with an increased risk of developing CV events (HR: 1.04, 95% CI (1.01 to 1.08), p=0.009). The association remained significant after adjusting for all CV risk scores in the multivariable models. In the subgroup analysis, 154 patients underwent carotid ultrasound assessment and 23 (14.9%) of them experienced a CV event. CP was associated with increased risk of developing CV events after adjusting for three CV risk scores and DAPSA, with HR ranging from 2.35 to 3.42. CONCLUSION Higher DAPSA and the presence of CP could independently predict CVD events in addition to traditional CV risk scores in patients with PsA.
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Affiliation(s)
- Steven Ho Man Lam
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Isaac T Cheng
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Edmund K Li
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Priscilla Wong
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jolie Lee
- Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong, Hong Kong
| | - Ronald Man-Lung Yip
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Cheuk-Wan Yim
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Shirley K Ying
- Department of Medicine, Princess Margaret Hospital, Hong Kong, China
| | - Martin Li
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tena K Li
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Alex Pui-Wai Lee
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, New Territories, Hong Kong
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Wu D, Griffith JF, Lam SHM, Wong P, Yue J, Shi L, Li EK, Cheng IT, Li TK, Hung VW, Qin L, Tam LS. Comparison of bone structure and microstructure in the metacarpal heads between patients with psoriatic arthritis and healthy controls: an HR-pQCT study. Osteoporos Int 2020; 31:941-950. [PMID: 31938819 DOI: 10.1007/s00198-020-05298-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/10/2020] [Indexed: 01/01/2023]
Abstract
UNLABELLED Human cadaveric study has indicated that the metacarpal head (MCH) is intracapsular in location. We hypothesized that exposure to the intra-articular inflammatory milieu in psoriatic arthritis (PsA) will lead to bone loss in the MCH. INTRODUCTION To compare the bone structure and microstructure in the MCH between patients with PsA and healthy controls by high-resolution peripheral quantitative CT (HR-pQCT), and to ascertain factors associated with bone loss in PsA patients. METHODS Sixty-two PsA patients without joint destruction and 62 age-, gender-, and body mass index-matched healthy subjects underwent HR-pQCT imaging of the second and third MCH (MCH 2&3). The number and volume of bone erosion and enthesiophytes, as well as volumetric bone mineral density (vBMD) and microstructure at the MCH 2&3, were recorded. Correlation analysis and multivariable linear regression models were used to determine the association of demographic and disease-specific variables with compromised bone structure and microstructure in PsA. RESULTS At the MCH 2&3, bone erosion (p = 0.003) and enthesiophyte (p = 0.000) volumes in PsA patients were significantly larger than healthy controls. In PsA patients, older age was associated with a larger erosion and enthesiophyte volume. Concerning the mean vBMD and microstructure at the MCH 2&3, PsA patients had significantly lower mean vBMD (average vBMD - 6.9%, trabecular vBMD - 8.8%, peri-trabecular vBMD - 7.7%, meta-trabecular vBMD - 9.8%), trabecular bone volume fraction (- 8.8%), and trabecular thickness (- 8.1%) compared with control subjects. Multivariable regression analysis revealed that older age and a higher C-reactive protein level were associated with trabecular bone loss. CONCLUSIONS PsA patients had a higher burden of bone damages (erosions and enthesiophytes) and trabecular bone loss compared with healthy control at the MCH. Inflammation contributed to the deterioration in trabecular microstructure in these patients.
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Affiliation(s)
- D Wu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - J F Griffith
- Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - S H M Lam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - P Wong
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - J Yue
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - L Shi
- Research Centre for Medical Image Computing, Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - E K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - I T Cheng
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - T K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - V W Hung
- Bone Quality and Health Centre of the Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - L Qin
- Bone Quality and Health Centre of the Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - L-S Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Wang C, Zhu GY, Lu J, Chen L, Wang Y, Li JC, Li TK, Guo JH. [Efficacy of a novel fully covered radioactive stent for advanced esophageal and gastric cardia cancer: a retrospective controlled study]. Zhonghua Yi Xue Za Zhi 2019; 99:3687-3693. [PMID: 31874491 DOI: 10.3760/cma.j.issn.0376-2491.2019.47.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the feasibility, safety, and efficacy of a novel fully covered radioactive stent for the treatment of advanced esophageal and gastric cardia cancer. Methods: Data of 122 patients, who underwent esophageal radioactive stent placement for advanced esophageal or gastric cardia cancer between January 2012 and September 2017 in Zhongda Hospital, were retrospectively analyzed. Patients were divided into the novel stent group (n=59; 45 males, 14 females; mean age 73±10 years old) and the conventional stent group (n=63; 51 males, 12 females; mean age 72±9 years old), according to the types of radioactive stents. No significant difference was found between the two groups in baseline characteristics (all P>0.05). Outcomes were measured in terms of technical success, dysphagia score, stent restenosis, stent migration, major complications, and overall survival. Results: The technical success rate was 98.3% in the novel stent group, and 100.0% in the conventional stent group (P=0.484) . The dysphagia scores 3 days after surgery decreased from 3.27±0.45 and 3.37±0.49 to 1.25±0.66 and 1.32±0.50, respectively (all P<0.01), and the variances were comparable (P=0.709). Compared with conventional stents, novel stents were significantly associated with a decreased in the rate of stent restenosis, 11.9% vs 27.0%; cause-specific hazard ratio 0.387, 95%CI 0.160-0.934 (P=0.035); sub-distributional hazard ratio 0.401, 95%CI 0.167-0.963 (P=0.041), while the stent migration rate was statistically comparable (13.6% vs 6.3%, P=0.181). There was no significant difference between the novel stent group and the conventional stent group in major complications (all P>0.05), including moderate-severe chest pain (22.0% vs 25.4%), hemorrhage (11.9% vs 11.1%), fistula formation (1.7% vs 4.8%), and aspiration pneumonia (5.1% vs 6.3%). The median overall survival was 146(95%CI 115-177) days in the novel stent group, and 147(95%CI 98-196) days in the conventional stent group, and no significant difference was found (P=0.967). Conclusions: In patients with advanced esophageal or gastric cardia cancer,placement of a novel fully covered radioactive stent is safe and effective. This novel stent can relieve dysphagia rapidly and prevent stent restenosis effectively.
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Affiliation(s)
- C Wang
- Department of Interventional Radiology & Vascular Surgery, Zhongda Hospital, Southeast University, Nanjing, 210009, China
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Wu D, Griffith JF, Lam SHM, Wong PCH, Shi L, Li EK, Cheng IT, Li TK, Hung VW, Qin L, Tam LS. Progressive structural bone changes and their relationship with treatment in patients with psoriatic arthritis: a longitudinal HR-pQCT study. Arthritis Res Ther 2019; 21:265. [PMID: 31801610 PMCID: PMC6894233 DOI: 10.1186/s13075-019-2043-3] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background Although the short-term effects of tumor necrosis factor alpha (TNF-α) and interleukin-17A (IL-17A) inhibition on the structural changes in psoriatic arthritis (PsA) using high-resolution peripheral quantitative computed tomography (HR-pQCT) have been reported, no studies have investigated the long-term structural changes in PsA patients receiving routine care. We reported longitudinal changes of erosions and enthesiophytes using HR-pQCT and their relationship with treatments in PsA patients over a 5-year period. Methods HR-pQCT examination at the second and third metacarpal heads (MCH2 and MCH3) was performed in 60 PsA patients at baseline and after 5 years. The size of each individual lesion was quantified. Erosion and enthesiophyte progression were defined as change exceeding the smallest detectable change (SDC). Results A total of 108 bone erosions and 99 enthesiophytes were detected at baseline. Three new bone erosions but no new enthesiophytes were evident at 5 years. A significant increase in mean (±SD) erosion (0.58 ± 1.50 mm3, P < 0.001) and enthesiophyte (0.47 ± 0.76 mm3, P < 0.001) volume was observed. Erosion and enthesiophyte progression were found in 37/111 (33.3%) and 50/99 (50.5%) lesions, respectively. During this 5-year period, 26 (43%) out of the 60 patients achieved sustained Disease Activity index for PSoriatic Arthritis (DAPSA) low disease activity (LDA) (SDL group, defined as achieving DAPSA-LDA at both baseline and 5 years). Fourteen (23%) out of 60 patients received a TNF inhibitor throughout the 5-year period (TNFi group). Fewer erosions progressed (12/51 [23.5%] vs 25/60 [41.7%], P = 0.047) and the increased in enthesiophyte volume was significantly less (0.28 ± 0.67 vs 0.61 ± 0.80 mm3, P = 0.048) in the SDL group than in the non-SDL group. However, no significant difference between the TNFi and non-TNFi groups was detected in terms of the change in volume or progression of bone erosion and enthesiophyte. Conclusion Damage accrual in terms of bone erosion and enthesiophyte was observed in PsA patients over a period of 5 years despite receiving routine clinical care. Nonetheless, sustained control of disease activity may be able to prevent these bony damages.
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Affiliation(s)
- Dongze Wu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Steven H M Lam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Priscilla C H Wong
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Shi
- Research Centre for Medical Image Computing, Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Edmund K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Isaac T Cheng
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Vivian W Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Yue J, Lau TCK, Griffith JF, Xu J, Xiao F, Shi L, Wang D, Wong PCH, Li EK, Tam LP, Li M, Li TK, Mak WY, Hung V, Qin L, Tam L. Circulating miR‐99b‐5p as a novel predictor of erosion progression on high‐resolution peripheral quantitative computed tomography in early rheumatoid arthritis: A prospective cohort study. Int J Rheum Dis 2019; 22:1724-1733. [PMID: 31273939 DOI: 10.1111/1756-185x.13644] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/02/2019] [Accepted: 05/29/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Jiang Yue
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
- Department of Medicine & Therapeutics The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Terrence C. K. Lau
- Department of Biomedical Sciences City University of Hong Kong Hong Kong China
| | - James F. Griffith
- Department of Imaging and Interventional Radiology The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Jiankun Xu
- Department of Orthopedics & Traumatology The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Fan Xiao
- Department of Imaging and Interventional Radiology The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Lin Shi
- Department of Imaging and Interventional Radiology The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Priscilla C. H. Wong
- Department of Medicine & Therapeutics The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Edmund K. Li
- Department of Medicine & Therapeutics The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Lydia P. Tam
- Department of Medicine & Therapeutics The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Martin Li
- Department of Medicine & Therapeutics The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Tena K. Li
- Department of Medicine & Therapeutics The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Wah Yan Mak
- Department of Medicine & Therapeutics The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Vivian Hung
- Department of Orthopedics & Traumatology The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Ling Qin
- Department of Orthopedics & Traumatology The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
| | - Lai‐Shan Tam
- Department of Medicine & Therapeutics The Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong China
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Zhong YM, Zhang Q, Li TK, Pan T, Guo JH. [The experiment study of endovascular denervation in treatment of cancer pain]. Zhonghua Yi Xue Za Zhi 2019; 99:1814-1818. [PMID: 31207694 DOI: 10.3760/cma.j.issn.0376-2491.2019.23.013] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the feasibility and safety of endovascular denervation (EDN) with a multi-electrode radiofrequency ablation catheter on beagles. Methods: A total of 18 beagles, (10.2±1.1) kg,of either gender,were provided by the Animal Center of Southeast University (SYXK (Su) 2016-0013). They were divided equally into three groups:the instant euthanizing group, the long-term follow-up group and the sham operation group. Beagles in the instant euthanizing group were euthanized immediately after EDN. Beagles in the long-term follow-up group were euthanized three months after EDN. Beagles in the sham operation group underwent sham operation and were euthanized three months later. Blood biochemistry was measured at baseline, and immediately, 15 days, 30 days and 90 days after the surgery. Computerized tomographic (CT) angiography was determined before the surgery and 60 days after the surgery. Digital subtraction angiography (DSA) was determined 90 days after the surgery. Histopathologic analyses were used to identify the changes of arterial wall and neuron cells. Results: Beagles in the long-term follow-up group and the sham operation group all underwent EDN successfully without accidental death. No abdominal aortic perforation and peripheral tissue necrosis were found at Necropsy. No vascular injuries were found by CTA and DSA in each group. There was no statistical difference in hematological analyses, 90 days after the surgery:white blood cell:(12.5±1.5)×10(9)/L vs (13.2±0.7)×10(9)/L, P=0.275; red blood cell:(7.0±0.6)×10(9)/L vs (6.3±0.4)×10(9)/L, P=0.089; total bilirubin:(2.9±0.4) μmol/L vs (3.0±0.6) μmol/L, P=0.681; glutamic-pyruvic transaminase:(40±11) U/L vs (37±6) U/L, P=0.168; glutamic oxalocetie transaminase:(51±11) U/L vs (48±9) U/L, P=0.221; urea nitrogen:(7.2±1.2) mmol/L vs (6.9±0.8) mmol/L, P=0.505; creatinine:(60±9) μmol/L vs (59±9) μmol/L, P=0.81; prothrombin time:(7.2±0.7) s vs (7.0±0.7) s, P=0.719. Histopathological analyses showed that there were hypercellular appearance of nerve bundle and thickened perineurium in EDN groups, while normal perineurium around nerve bundle in the sham operation group. Conclusion: EDN could be applied in beagles safely and feasibly.
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Affiliation(s)
- Y M Zhong
- School of Medicine, Southeast University, Nanjing 210009, China
| | - Q Zhang
- Ceneter of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - T K Li
- School of Medicine, Southeast University, Nanjing 210009, China
| | - T Pan
- Ceneter of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - J H Guo
- Ceneter of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
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Sun YL, Bai Y, Li TK, Lü SG, Wang L, Lu XH. [Effect of single lumen endobronchial tube and double lumen endobronchial tube on ventilation and lung injury in patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy]. Zhonghua Yi Xue Za Zhi 2019; 97:2194-2197. [PMID: 28763898 DOI: 10.3760/cma.j.issn.0376-2491.2017.28.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effect of the single lumen endobronchial tube and the double lumen endobronchial tube on ventilation and lung injury in patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy. Methods: Sixty patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy were divided into single lumen endobronchial tube group (D group, n=30) and double lumen endobronchial tube group (S, n=30) according to the random number table. Blood samples were harvested at the moment of tracheal intubation (T(0)), after artificial pneumothorax (one lung ventilation) 30 min (T(1)), after artificial pneumothorax (one lung ventilation) 90 min (T(2)), artificial pneumothorax over (double lung ventilation) 30 min (T(3)) and after extubation 30 min (T(4)) for arterial blood gas analysis. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO(2)), oxygen tension (PaO(2)), carbon dioxide partial pressure (PaCO(2)) and airway pressure (PAW) were recorded at T(0)-T(4). The incidences of pneumonia of two groups were record at 3 days after operation. Results: There were no obvious differences in HR, MAP, SpO(2), PaO(2), PaCO(2) between two groups at T(0)-T(4) (P>0.05). Compared with T(0), the levels of HR and PaO(2) were increased remarkably at T(1)-T(3) (P<0.05), the levels of PaCO(2) were increased remarkably at T(1)-T(4) (P<0.01), and the levels of Paw were increased remarkably at T(1)-T(3) (P<0.01). Compared with S group, the levels of Paw were decreased remarkably at T(1)-T(2) (29.5±3.7 vs 21.3±2.1, P=0.001; 30.7±4.8 vs 20.3±2.3, P=0.001). There were no obvious differences in the levels of TNF-α, IL-6, IL-8 in Bronchoalveolar Lavage Fluid (BALF) between two groups at T(0) (P>0.05). Compared with T(0), the levels of TNF-α, IL-6, IL-8 in BALF were increased remarkably at T(3), T(5) (P<0.05). Compared with S group, the levels of TNF-α, IL-6, IL-8 in D group in BALF were decreased remarkably at T(3), T(5) (P<0.05). Compared with S group, the incidence of pneumonia in D group were decreased remarkably at 3 days after operation (4(13.3%) vs 11(36.7%), P=0.017). Conclusion: The ventilation effect of the single lumen endobronchial tube on lung injury for patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy is the same as that of the double lumen endobronchial tube, however the single lumen endobronchial tube has less injury on the lung.
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Affiliation(s)
- Y L Sun
- Department of Anesthesiology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
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Cheng IT, Shang Q, Li EK, Wong PC, Kun EW, Law MY, Yip RM, Yim IC, Lai BT, Ying SK, Kwok KY, Li M, Li TK, Zhu TY, Lee JJ, Chang MM, Szeto CC, Yan BP, Lee AP, Tam LS. Effect of Achieving Minimal Disease Activity on the Progression of Subclinical Atherosclerosis and Arterial Stiffness: A Prospective Cohort Study in Psoriatic Arthritis. Arthritis Rheumatol 2019; 71:271-280. [PMID: 30144299 DOI: 10.1002/art.40695] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/21/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the effects of achieving minimal disease activity (MDA) on the progression of subclinical atherosclerosis and arterial stiffness in patients with psoriatic arthritis (PsA). METHODS A total of 101 consecutive patients with PsA were recruited for this prospective cohort study. All patients received protocolized treatment targeting MDA for a period of 2 years. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. The primary outcome measure was the effect of achieving MDA at 12 months (MDA group) on the progression of subclinical atherosclerosis over a period of 24 months. Secondary objectives were to compare the changes in arterial stiffness markers over 24 months between the MDA and non-MDA groups, as well as the changes in subclinical atherosclerosis and arterial stiffness markers in patients who achieved MDA at each visit from month 12 through month 24 (sustained MDA [sMDA]). RESULTS Ninety PsA patients (mean ± SD age 50 ± 11 years, 58% male [n = 52]) who completed 24 months of follow-up were included in this analysis. Fifty-seven patients (63%) had achieved MDA at 12 months. Subclinical atherosclerosis and arterial stiffness outcomes were similar between the MDA and non-MDA groups. Forty-one patients (46%) achieved sMDA. As shown by multivariate analysis, achieving sMDA had a protective effect on plaque progression (odds ratio 0.273 [95% confidence interval 0.088-0.846], P = 0.024), and less of an increase in total plaque area, mean intima-media thickness, and augmentation index values after adjustment for covariates. CONCLUSION Our results support the recommendation that once MDA is achieved, it should ideally be maintained for a prolonged period in order to prevent progression of carotid atherosclerosis and arterial stiffness in patients with PsA.
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Affiliation(s)
- Isaac T Cheng
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Qing Shang
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edmund K Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Priscilla C Wong
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | | | - Mei Yan Law
- Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | | | | | | | | | | | - Martin Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tracy Y Zhu
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jack J Lee
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Mimi M Chang
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk-Chun Szeto
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Bryan P Yan
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Alex P Lee
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Shen J, Griffith JF, Zhu TY, Tang P, Kun EW, Lee VK, Yip RM, Kwok KY, Ying SK, Ho CT, Lau SL, Pui MO, Li TK, Lau EY, Lee JJ, Qin L, Tam LS. Bone Mass, Microstructure, and Strength Can Discriminate Vertebral Fracture in Patients on Long-Term Steroid Treatment. J Clin Endocrinol Metab 2018; 103:3340-3349. [PMID: 29982545 DOI: 10.1210/jc.2018-00490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/27/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Measurement of areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA) was able to predict fracture risk. High-resolution peripheral quantitative computed tomography (HR-pQCT) yields additional information about volumetric bone mineral density (vBMD), microarchitecture, and strength that may increase our understanding of fracture susceptibility. OBJECTIVE To ascertain whether vBMD, microarchitecture, and estimated bone strength derived from HR-pQCT can discriminate vertebral fractures in patients with glucocorticoid-induced osteoporosis (GIOP) independent of aBMD. DESIGN A cross-sectional case-control study. SETTING Seven regional hospitals in Hong Kong. PATIENTS A total of 110 patients on long-term glucocorticoids with vertebral fracture, determined radiographically, and 110 patients on long-term glucocorticoids without fracture. MAIN OUTCOME MEASURES We assessed vBMD, microarchitecture, and bone strength; aBMD; and fracture risk assessment tool (FRAX). RESULTS Patients with vertebral fracture had lower total vBMD and a thinner cortex at the distal tibia after adjustment for age, sex, and aBMD or FRAX. In the antiresorptive treatment-naive subgroup, patients with vertebral fracture also had lower total vBMD at both the distal radius and the tibia after adjustment for covariates. Lower total vBMD and a thinner cortex were also noticed in the nonosteoporotic or FRAX score of <10% subgroups with vertebral fracture and were also associated with increasing prevalence of vertebral fracture. CONCLUSION Patients with GIOP and vertebral fracture have a significant reduction in total vBMD and cortical thinning independent of aBMD and FRAX. These changes may help identify high-risk patients in the subgroups currently considered to have low fracture risk as assessed by DXA or FRAX.
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Affiliation(s)
- Jiayun Shen
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
| | - Tracy Y Zhu
- Bone Quality and Health Center, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Peggy Tang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
| | - Emily W Kun
- Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong
| | - Violet K Lee
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Ronald M Yip
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong
| | - Kitty Y Kwok
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Shirley K Ying
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Carmen T Ho
- Department of Medicine, Tung Wah Hospital, Hong Kong
| | - Sze-Lok Lau
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Michelle O Pui
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Eleven Y Lau
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Jack J Lee
- Division of Biostatistics, The Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Ling Qin
- Bone Quality and Health Center, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
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Shen J, Lam SH, Shang Q, Wong CK, Li EK, Wong P, Kun EW, Cheng IT, Li M, Li TK, Zhu TY, Lee JJW, Chang M, Lee APW, Tam LS. Underestimation of Risk of Carotid Subclinical Atherosclerosis by Cardiovascular Risk Scores in Patients with Psoriatic Arthritis. J Rheumatol 2017; 45:218-226. [DOI: 10.3899/jrheum.170025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/22/2022]
Abstract
Objective.To test the performances of established cardiovascular (CV) risk scores in discriminating subclinical atherosclerosis (SCA) in patients with psoriatic arthritis.Methods.These scores were calculated: Framingham risk score (FRS), QRISK2, Systematic COronary Risk Evaluation (SCORE), 10-year atherosclerotic cardiovascular disease risk algorithm (ASCVD) from the American College of Cardiology and the American Heart Association, and the European League Against Rheumatism (EULAR)–recommended modified versions (by 1.5 multiplication factor, m-). Carotid intima-media thickness > 0.9 mm and/or the presence of plaque determined by ultrasound were classified as SCA+.Results.We recruited 146 patients [49.4 ± 10.2 yrs, male: 90 (61.6%)], of whom 142/137/128/118 patients were eligible to calculate FRS/QRISK2/SCORE/ASCVD. Further, 62 (42.5%) patients were SCA+ and were significantly older, with higher systolic blood pressure and higher low-density lipoprotein cholesterol (all p < 0.05). All CV risk scores were significantly higher in patients with SCA+ [FRS: 7.8 (3.9–16.5) vs 2.7 (1.1–7.8), p < 0.001; QRISK2: 5.5 (3.1–10.2) vs 2.9 (1.2–6.3), p < 0.001; SCORE: 1 (0–2) vs 0 (0–1), p < 0.001; ASCVD: 5.6 (2.6–12.4) vs 3.4 (1.4–6.1), p = 0.001]. The Hosmer-Lemeshow test revealed moderate goodness of fit for the 4 CV scores (p ranged from 0.087 to 0.686). However, of the patients with SCA+, those identified as high risk were only 44.1% (by FRS > 10%), 1.8% (QRISK2 > 20%), 10.9% (SCORE > 5%), and 43.6% (ASCVD > 7.5%). By applying the EULAR multiplication factor, 50.8%/14.3%/14.5%/54.5% of the patients with SCA+ were identified as high risk by m-FRS/m-QRISK2/m-SCORE/m-ASCVD, respectively. EULAR modification increased the sensitivity of FRS and ASCVD in discriminating SCA+ from 44% to 51%, and 44% to 55%, respectively.Conclusion.All CV risk scores underestimated the SCA+ risk. EULAR–recommended modification improved the sensitivity of FRS and ASCVD only to a moderate level.
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Li TK, Zhu GY, Li WM, Lu J, Wang C, Pan TF, Wang Y, Guo JH. [Implantation of the irradiation stent system intoportal vein: studies on normal beagles]. Zhonghua Yi Xue Za Zhi 2017; 97:2458-2462. [PMID: 28835050 DOI: 10.3760/cma.j.issn.0376-2491.2017.31.016] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the feasibility and safety of the irradiation stent system in portal vein on normal beagles. Methods: A portal vein irradiation stent system was composed of an Iodine-125 seeds-carrier and a conventional stent.Twenty beagle dogs were randomly assigned to receive treatment with a conventional stent (5 beagle dogs) or an irradiation stent system (15 beagle dogs in three groups received 11.1, 22.2, 33.3 MBq radioactivity, n=5 in each dose group). Follow-up methods included blood biochemical test, color Doppler sonographyand CT scan at 0, 15, 30, 60, and 120 days after implantation of irradiation stent system.Pathological tissues were obtained from sacrificed beagle dogs on the 120th day. Results: The portal vein irradiation stent systems and the conventional stents were successfully deployed into the targeted portal vein segment in all beagles, none was dislodged during the deployment or the follow-up period.Differences of blood biochemical indexes and portal vein flow volume measured by color Doppler sonography were not significant (P>0.05). Stent systems were morphologically intact and patent.None of the peripheral organs had hemorrhage, necrosis or perforation.Pathological tissues revealed that the systems were surrounded by fibrous tissues and a few inflammatory cells, but with no significant differences in all groups. Conclusion: It indicates that portal veinirradiation stent system is safe in all dose groups, and it is feasible to design a special irradiation stent system for each patient according to the size of the portal vein tumor thrombus.
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Affiliation(s)
- T K Li
- Department of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Southeast University, Nanjing 210009, China
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Yue J, Griffith JF, Xiao F, Shi L, Wang D, Shen J, Wong P, Li EK, Li M, Li TK, Zhu TY, Hung VW, Qin L, Tam LS. Repair of Bone Erosion in Rheumatoid Arthritis by Denosumab: A High-Resolution Peripheral Quantitative Computed Tomography Study. Arthritis Care Res (Hoboken) 2017; 69:1156-1163. [PMID: 27768831 DOI: 10.1002/acr.23133] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To compare the bone healing effects of denosumab and alendronate in female rheumatoid arthritis (RA) patients by high-resolution peripheral quantitative computed tomography. METHODS This is a post hoc analysis of a randomized controlled trial. Forty patients were randomized in a 1:1 ratio to receive either subcutaneous denosumab (60 mg) once or oral alendronate (70 mg) weekly for 6 months. The size of individual bone erosions and the presence and extent of erosion-associated sclerosis (marginal osteosclerosis) were measured in the second metacarpal head of the nondominant hand at baseline, 3 months, and 6 months. RESULTS Forty-two erosions were identified at baseline. After 6 months, the width, depth, and volume of erosion significantly decreased in the denosumab group (-0.23 mm, -0.16 mm, -0.91 mm3 , respectively; all P < 0.01), whereas these parameters significantly increased in the alendronate group (0.19 mm, 0.32 mm, and 1.38 mm3 , respectively; all P < 0.01; between-group differences, P < 0.01 for all). Quantitative analysis showed that the bone mineral density of the erosion margin significantly increased only after treatment by denosumab (19.75 mg/cm3 ; P < 0.05 for denosumab, and -5.44 mg/cm3 ; P = 0.51 for alendronate; P < 0.05 for between-group differences). CONCLUSION Inhibition of receptor activator of NF-κB ligand by denosumab can induce partial repair of erosions in patients with RA, while erosions continued to progress in patients treated with alendronate. Combining denosumab with disease-modifying antirheumatic drugs may be considered for RA patients with progressive bone erosions.
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Affiliation(s)
- Jiang Yue
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - James F Griffith
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Fan Xiao
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lin Shi
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Defeng Wang
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jiayun Shen
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Priscilla Wong
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edmund K Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Martin Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tracy Y Zhu
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Vivian W Hung
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Ling Qin
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Quan J, Li TK, Pang H, Choi CH, Siu SC, Tang SY, Wat NMS, Woo J, Johnston JM, Leung GM. Diabetes incidence and prevalence in Hong Kong, China during 2006-2014. Diabet Med 2017; 34:902-908. [PMID: 27859570 DOI: 10.1111/dme.13284] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 01/02/2023]
Abstract
AIMS To estimate recent secular changes in the incidence and prevalence of diabetes and pre-diabetes among Hong Kong Chinese adults, and thus show possible future trends for developing mainland China. METHODS Based on a complete census of the public sector health records of 6.4 million people from 2006 to 2014, diabetes cases were ascertained using different methods including the World Health Organization (WHO) 2011 guidelines (HbA1c , fasting plasma glucose and glucose tolerance test), American Diabetes Association (ADA) 2015 guidelines (plus random plasma glucose), and additionally recorded diagnosis codes and medication dispensation. Pre-diabetes was defined using ADA 2015 guidelines. RESULTS We identified 697 201 people with diabetes (54.2% were incident cases); and 1 229 731 people with diabetes or pre-diabetes. In 2014, the overall incidence of diabetes was 9.46 per 1000 person-years [95% confidence interval (CI): 9.38 to 9.54], and overall prevalence was 10.29% (95% CI: 10.27% to 10.32%). Incidence of diabetes decreased significantly from 2007 to 2014 (quadratic trend, P < 0.001). From 2006 to 2014, the prevalence of diabetes increased significantly in both sexes and across all age groups (quadratic trend, P < 0.001). The overall incidence of pre-diabetes in 2014 was 18.88 per 1000 person-years (95% CI: 18.76 to 18.99), and the overall prevalence of pre-diabetes was 8.90% (95% CI: 8.87% to 8.92%). CONCLUSIONS Similar to other developed western and Asian populations, diabetes (and pre-diabetes) incidence in Hong Kong Chinese appeared to have stabilized and there have been small declines during the period of observation. Ageing and survivorship will likely drive a continued increase in the prevalence of diabetes and pre-diabetes, albeit with a decelerating growth rate if past trends persist.
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Affiliation(s)
- J Quan
- Division of Health Economics, Policy and Management, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - T K Li
- Division of Health Economics, Policy and Management, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - H Pang
- Division of Health Economics, Policy and Management, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - C H Choi
- Queen Elizabeth Hospital, Hong Kong
| | - S C Siu
- Department of Medicine & Rehabilitation, Tung Wah Eastern Hospital, Hong Kong
| | | | | | - J Woo
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - J M Johnston
- Division of Health Economics, Policy and Management, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - G M Leung
- Division of Health Economics, Policy and Management, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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Abstract
Ras association domain family member 5 (RASSF5), a member of the Ras association domain family, induces cell apoptosis by phosphorylating FOXO3a, which triggers target gene BIM (pro-apoptotic factor) activation. MiR-214 is overexpressed in oral cancer tissue, indicating its possible involvement in oral cancer pathogenesis. Bioinformatics analysis has revealed a complimentary sequence between miR-214 and the 3'-UTR of RASSF5 mRNA. However, whether miR-124 regulates RASSF5 in oral cancer remains poorly understood. We aimed to investigate the role of miR-214 in RASSF5 expression regulation in oral cancer. Tumor and paracarcinoma tissues were obtained from 48 oral cancer patients to examine miR-214 and RASSF5 expression. The relationship between miR-214 and RASSF5 was investigated by dual luciferase reporter gene assay. Oral cancer KB cells were cultured in vitro and divided into inhibitor NC, miR-214 inhibitor, Scramble-pMD18, RASSF5-pMD18, and miR-214 inhibitor + RASSF5-pMD18 groups. Caspase 3 activity, cell apoptosis, and total protein expression were measured by spectrophotometry, flow cytometry, and western blot, respectively. MiR-214 expression was significantly increased, while that of RASSF5 decreased in oral cancer tumor tissues compared to paracarcinoma tissues. Luciferase assay showed that miR-214 suppressed RASSF5 expression by targeting its 3'-UTR. Down-regulation of miR-214 and/or enhancement of RASSF5 expression markedly increased FOXO3a phosphorylation, BIM expression, caspase 3 activity, and apoptosis. In conclusion, miR-214 expression was elevated and RASSF5 was down-regulated in oral cancer. Moreover, miR-214 regulated KB cell apoptosis through targeted inhibition of RASSF5 expression, FOXO3a phosphorylation, and BIM expression, suggesting its possible application as a novel therapeutic oral cancer target.
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Affiliation(s)
- T K Li
- Department of Stomatology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - K Yin
- Department of Stomatology, Xingtai People's Hospital of Hebei Medical University, Xingtai, Hebei, China
| | - Z Chen
- Department of Stomatology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Y Bao
- Department of Stomatology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - S X Zhang
- Department of Stomatology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Shen J, Wong KT, Cheng IT, Shang Q, Li EK, Wong P, Kun EW, Law MY, Yip R, Yim I, Ying S, Li M, Li TK, Wong CK, Zhu TY, Lee JJW, Chang M, Lee APW, Tam LS. Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease. Ann Rheum Dis 2017; 76:1237-1244. [PMID: 28052860 DOI: 10.1136/annrheumdis-2016-210390] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/15/2016] [Accepted: 12/17/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate coronary atherosclerosis in patients with psoriatic arthritis (PsA) and control subjects using coronary CT angiography (CCTA). METHODS Ninety consecutive patients with PsA (male: 56(62.2%); 50.3±11.1 years) were recruited. 240 controls (male: 137(57.1%); 49.6±10.7 years) without known cardiovascular (CV) diseases who underwent CCTA due to chest pain and/or multiple CV risk factors were recruited for comparison. RESULTS Patients with PsA and controls were matched in age, gender and traditional CV risk factors (all p>0.2). The prevalence of overall plaque (54(60%)/84(35%), p<0.001), calcified plaque (CP) (29(32%)/40(17%), p=0.002), mixed plaque (MP) (20(22%)/18(8%), p<0.001), non-calcified plaque (NCP) (39(43%)/53(22%), p<0.001) and combined MP/NCP (46(51%)/62(26%), p<0.001) were all significantly higher in patients with PsA. Three-vessel disease was diagnosed in 12(13%) patients with PsA and 7(3%) controls (p<0.001), while obstructive plaques (>50% stenosis) were observed in 8(9%) patients with PsA and 7(3%) controls (p=0.033). After adjusting for traditional CV risk factors, PsA remained an independent explanatory variable for all types of coronary plaques (OR: 2.730 to 4.064, all p<0.001). PsA was also an independent explanatory variable for three-vessel disease (OR: 10.798, p<0.001) and obstructive plaque (3.939, p=0.024). In patients with PsA, disease duration was the only disease-specific characteristic associated with more vulnerable plaques (MP/NCP) in multivariate analysis (1.063, p=0.031). The other independent explanatory variables were age ≥55 years (5.636, p=0.005) and male gender (8.197, p=0.001). CONCLUSIONS Patients with PsA have increased prevalence, burden and severity of coronary atherosclerosis as documented by CCTA. Longer disease duration was independently associated with the presence of vulnerable MP/NCP plaques in patients with PsA. TRIAL REGISTRATION NUMBER NCT02232321.
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Affiliation(s)
- Jiayun Shen
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ka-Tak Wong
- Department of Diagnostic and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Isaac T Cheng
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Qing Shang
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Edmund K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Priscilla Wong
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Emily W Kun
- Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong, Hong Kong
| | - Mei Yan Law
- Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong, Hong Kong
| | - Ronald Yip
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Isaac Yim
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
| | - Shirley Ying
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Martin Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chun-Kwok Wong
- Department of Chemical Pathology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tracy Y Zhu
- Bone Quality and Health Center of the Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jack Jock-Wai Lee
- Division of Biostatistics, The Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mimi Chang
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Alex Pui-Wai Lee
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Shen J, Shang Q, Li EK, Leung YY, Kun EW, Kwok LW, Li M, Li TK, Zhu TY, Yu CM, Tam LS. Cumulative inflammatory burden is independently associated with increased arterial stiffness in patients with psoriatic arthritis: a prospective study. Arthritis Res Ther 2015; 17:75. [PMID: 25890227 PMCID: PMC4384323 DOI: 10.1186/s13075-015-0570-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/20/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to examine whether the cumulative inflammatory burden is associated with an increase in arterial stiffness in a prospective cohort of psoriatic arthritis (PsA) patients. Methods In total, 72 PsA patients were followed for a median of 6.5 years. Cumulative inflammatory burden was represented by the cumulative averages of repeated measures of erythrocyte sedimentation rate (ca-ESR) and C-reactive protein (ca-CRP). Brachial-ankle pulse wave velocity (PWV) was measured at the last visit. We also included 47 healthy controls for PWV assessment. Results PWV was significantly higher in PsA patients compared with healthy controls after adjustment for age, gender and body weight (1466 ± 29 cm/s versus 1323 ± 38 cm/s, P = 0.008). PsA patients were divided into two groups based on whether their PWV value is ≥1450 cm/s (High PWV group, N = 38) or <1450 cm/s (Low PWV group, N = 34). The High PWV group had a significantly higher ca-ESR (29 (19 to 44) versus 18 (10 to 32) mm/1st hour, P = 0.005) and ca-CRP (0.7 (0.3 to 1.4) versus 0.4 (0.2 to 0.7) mg/dl, P = 0.029). Using regression analysis, high ca-ESR (defined as ≥75th percentile: 37 mm/1st hour) was associated with a higher likelihood of being in the High PWV group (odds ratio (OR): 9.455 (1.939 to 46.093), P = 0.005, adjusted for baseline clinical and cardiovascular risk factors; and 9.111 (1.875 to 44.275), P = 0.006, adjusted for last visit parameters). Conclusions Cumulative inflammatory burden, as reflected by ca-ESR, was associated with increased arterial stiffness in PsA patients even after adjustment for cardiovascular risk factors, emphasizing the important role of chronic inflammation in accelerating the development of cardiovascular risks in PsA patients.
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Affiliation(s)
- Jiayun Shen
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Qing Shang
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Edmund K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore, Singapore.
| | - Emily W Kun
- Department of Medicine and Geriatrics, Taipo Hospital, Taipo, Hong Kong, China.
| | - Lai-Wa Kwok
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Martin Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Tracy Y Zhu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Cheuk-Man Yu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Shen J, Shang Q, Wong CK, Li EK, Wang S, Li RJ, Lee KL, Leung YY, Ying KY, Yim CW, Kun EW, Leung MH, Li M, Li TK, Zhu TY, Yu SL, Kuan WP, Yu CM, Tam LS. IL-33 and soluble ST2 levels as novel predictors for remission and progression of carotid plaque in early rheumatoid arthritis: A prospective study. Semin Arthritis Rheum 2015; 45:18-27. [PMID: 25798875 DOI: 10.1016/j.semarthrit.2015.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 11/26/2014] [Accepted: 02/16/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To study the association between the baseline IL-33 and soluble ST2 (sST2) levels with disease remission and progression of carotid atherosclerosis in early rheumatoid arthritis (ERA) patients. METHODS A total of 98 ERA patients were enrolled. Disease activity and the presence of carotid plaque were evaluated at baseline and 12 months later. Plasma IL-33 and sST2 levels were determined using enzyme-linked immunosorbent assay kits. RESULTS Baseline IL-33 and sST2 levels were associated with inflammatory markers and cardiovascular (CV) risk factors. Overall, 44(45%), 18(18%), and 21(21%) patients achieved remission based on 28-joint disease activity score (DAS28), Boolean, and simplified disease activity score (SDAI) criteria at 12 months, respectively. Patients with detectable IL-33 at baseline were less likely to achieve DAS28 (P = 0.010) and SDAI remission (P = 0.021), while a lower baseline sST2 level was able to predict DAS28, Boolean, and SDAI remission (P = 0.005, 0.001, and <0.001, respectively). Using multivariate analysis, a lower baseline sST2 level independently predict Boolean (OR = 0.789; P = 0.005) and SDAI remission (0.812; P = 0.008). Regarding carotid atherosclerosis, 9/98(9.2%) patients had plaque progression at 12 months. Baseline IL-33 was detectable in 8/9(89%) and 42/83(51%) of patients with and without plaque progression respectively (P = 0.029). Baseline detectable IL-33 was an independent predictor for plaque progression after adjusting for traditional CV risk factors (P = 0.017). CONCLUSIONS Lower baseline sST2 levels independently predict disease remission and baseline detectable IL-33 independently predicts carotid plaque progression in ERA patients. This study suggests that inflammation induced by the IL-33/ST2 axis may play a significant role in the development of cardiovascular disease in RA.
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Affiliation(s)
- Jiayun Shen
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Qing Shang
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chun-Kwok Wong
- Department of Chemical Pathology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Edmund K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Shang Wang
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Rui-Jie Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Lai Lee
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Republic of Singapore
| | - King-Yee Ying
- Department of Medicine, Princess Margaret Hospital, Hong Kong, China
| | - Cheuk-Wan Yim
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Emily W Kun
- Department of Medicine and Geriatrics, Taipo Hospital, Hong Kong, China
| | - Moon-Ho Leung
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - Martin Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Tracy Y Zhu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Shui-Lian Yu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Woon-Pang Kuan
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk-Man Yu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Wang YXJ, Griffith JF, Deng M, Li TK, Tam LS, Lee VWY, Lee KKC, Li EK. Vertebral body corner oedema vs gadolinium enhancement as biomarkers of active spinal inflammation in ankylosing spondylitis. Br J Radiol 2012; 85:e702-8. [PMID: 22595499 DOI: 10.1259/bjr/29661937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To investigate the relative performance of T(2) weighted short tau inversion-recovery (STIR) and fat-suppressed T(1) weighted gadolinium contrast-enhanced sequences in depicting active inflammatory lesions in ankylosing spondylitis (AS). METHODS Whole-spine MRI was performed on 32 patients with AS, who participated in a clinical trial of infliximab treatment, by STIR and contrast-enhanced sequences at baseline and after 30 weeks. The AS spine MRI-activity (ASspiMRI-a) scoring method was used. The images from these two imaging techniques were evaluated separately by two independent readers. RESULTS For the pre-treatment lesion status, the intraclass correlation coefficients comparing STIR readings and contrast-enhanced readings were 0.69±0.23 for Reader 1 and 0.65±0.21 for Reader 2. At baseline, the mean ASspiMRI-a score was 15.4% and 17.7% higher for contrast-enhanced images than for STIR images for Reader 1 and Reader 2, respectively. After infliximab treatment, Reader 1 rated an ASspiMRI-a score reduction of 50.8±33.6% and 25.3±35.3% for STIR images and contrast-enhanced images, respectively, whereas Reader 2 rated an ASspiMRI-a score reduction of 42.4±50.4% and 32.9±35.6% for STIR images and contrast-enhanced images, respectively. CONCLUSION While both contrast-enhanced and STIR sequences showed sensitivity to change over a short period of time after infliximab treatment, these two sequences may reflect different disease mechanisms.
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Affiliation(s)
- Y-X J Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital,Shatin, Hong Kong, China.
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Tam LS, Li EK, Shang Q, Tomlinson B, Lee VW, Lee KK, Li M, Kuan WP, Li TK, Tseung L, Yip GWK, Freedman B, Yu CM. Effects of rosuvastatin on subclinical atherosclerosis and arterial stiffness in rheumatoid arthritis: a randomized controlled pilot trial. Scand J Rheumatol 2011; 40:411-21. [DOI: 10.3109/03009742.2011.586649] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Tam LS, Li EK, Shang Q, Tomlinson B, Li M, Leung YY, Kuan WP, Kwok LW, Li TK, Zhu Y, Kun EW, Yip G, Yu CM. Tumour necrosis factor alpha blockade is associated with sustained regression of carotid intima-media thickness for patients with active psoriatic arthritis: a 2-year pilot study. Ann Rheum Dis 2010; 70:705-6. [PMID: 20647274 DOI: 10.1136/ard.2010.131359] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Macdonald-Jankowski DS, Li TK. Keratocystic odontogenic tumour in a Hong Kong community: the clinical and radiological features. Dentomaxillofac Radiol 2010; 39:167-75. [PMID: 20203279 DOI: 10.1259/dmfr/30802198] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical and conventional radiological features of a consecutive series of cases of "keratocystic odontogenic tumour" (KCOT) affecting a Hong Kong Chinese community and to determine their outcome by follow-up. METHODS All cases were accompanied by appropriate radiography and were histopathologically confirmed. RESULTS 33 consecutive KCOTs were reviewed. 18 patients were male. The mean age at first presentation was 30.6 years. Swelling was the most frequent presenting symptom. Those patients first presenting with pain were significantly older, whereas those first presenting with a maxillary lesion were significantly younger. The maxilla and mandible were affected in 13 and 20 cases, respectively. KCOTs were most frequently confined to the posterior sextants of both jaws. KCOTs affecting the maxilla were mainly unilocular, whereas those affecting the mandible were multilocular. Patients with multilocular KCOTs were significantly older. Patients with KCOTs associated with root resorption were significantly older, whereas patients associated with unerupted teeth were significantly younger. 69% displaced teeth, 41% resorbed them and 56% were associated with unerupted teeth. All but two were followed up for at least 2 years. Three lesions recurred. CONCLUSIONS KCOTs in this community displayed some differences from those reported in the literature.
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Affiliation(s)
- D S Macdonald-Jankowski
- Division of Oral & Maxillofacial Radiology, Faculty of Dentistry, UBC, 2199 Wesbrook Mall, Vancouver V6T 1Z3, BC, Canada.
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MacDonald-Jankowski DS, Li TK. Orthokeratinized odontogenic cyst in a Hong Kong community: the clinical and radiological features. Dentomaxillofac Radiol 2010; 39:240-5. [PMID: 20395466 DOI: 10.1259/dmfr/36547074] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim was to evaluate the principal clinical and conventional radiological features of a consecutive series of cases of orthokeratinized odontogenic cyst (OOC) affecting a Hong Kong Chinese community and to determine the outcome by follow-up. METHODS All cases were accompanied by appropriate radiography and were confirmed by histopathology. RESULTS The clinical and conventional radiological presentations, differential diagnoses and outcomes of follow-up of five consecutive OOCs were reviewed. There were two males and three females. All affected the posterior sextant. The mean age at first presentation was 33.5 years. The mean of their period of prior awareness was 0.11 years. Swelling was the most frequent presenting symptom. All presented as well-defined corticated radiolucencies; three were unilocular and two were multilocular and all displayed expansion. This resulted in displacement and erosion of the lower border of the mandible in one case and the downward displacement past the lower border of a lateral cortex in two others. The inferior dental canal in each mandibular case exhibited both displacement and absence. The antrum was affected in a sole maxillary case. Four patients were followed up for a mean of 8.5 years. The fifth patient discharged himself shortly after surgery. No lesions recurred. CONCLUSIONS OOCs in this community displayed an expansile character, but did not recur after moderately long follow-up. The time between the prior awareness of their disease and their presentation for diagnosis and treatment was, so far, the shortest for any lesion affecting the jaw in this Hong Kong Chinese community.
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Affiliation(s)
- D S MacDonald-Jankowski
- Division of Oral & Maxillofacial Radiology, Faculty of Dentistry, University of British Columbia, Vancouver V6T 1Z3, BC, Canada.
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Li EK, Zhu TY, Tam LS, Hung VW, Griffith JF, Li TK, Li M, Wong KC, Leung PC, Kwok AW, Qin L. Bone microarchitecture assessment by high-resolution peripheral quantitative computed tomography in patients with systemic lupus erythematosus taking corticosteroids. J Rheumatol 2010; 37:1473-9. [PMID: 20472932 DOI: 10.3899/jrheum.091231] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We assessed the relationship between vertebral fracture and bone microarchitecture in patients with systemic lupus erythematosus (SLE) on chronic corticosteroid therapy using high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS Fifty-nine Chinese women with SLE taking corticosteroid were selected to participate in a cross-sectional study. Vertebral fracture was confirmed semiquantitatively by lateral radiographs of the thoracic and lumbar spine. Density and microarchitecture at the distal radius were measured with HR-pQCT. Areal bone mineral density (aBMD) at hip and lumbar spine was measured by dual-energy X-ray absorptiometry (DEXA). RESULTS Twelve patients had vertebral fractures. The aBMD of spine or hip did not differ between those with and without vertebral fractures. Measures by HR-pQCT revealed that patients with vertebral fractures had significantly lower level of average bone density (p = 0.007), cortical bone density (p = 0.029), trabecular bone density (p = 0.024), trabecular bone volume to tissue volume (p = 0.023), and trabecular thickness (p = 0.011) than those without vertebral fractures. Independent explanatory variables associated with higher risk of vertebral fractures were older age (p = 0.013) and lower average cortical bone density (p = 0.029). CONCLUSION Vertebral fracture in patients with SLE on chronic corticosteroid treatment was associated with alterations of bone density and microarchitectures measured by HR-pQCT and DEXA. However, alterations were more pronounced in measurements by HR-pQCT. Low cortical bone density and old age were significant predictors of vertebral fracture risk.
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Affiliation(s)
- Edmund K Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.
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Klingenberg CP, Wetherill L, Rogers J, Moore E, Ward R, Autti-Rämö I, Fagerlund Å, Jacobson SW, Robinson LK, Hoyme HE, Mattson SN, Li TK, Riley EP, Foroud T. Prenatal alcohol exposure alters the patterns of facial asymmetry. Alcohol 2010; 44:649-57. [PMID: 20060678 PMCID: PMC2891212 DOI: 10.1016/j.alcohol.2009.10.016] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 08/26/2009] [Accepted: 10/28/2009] [Indexed: 11/29/2022]
Abstract
Directional asymmetry, the systematic differences between the left and right body sides, is widespread in human populations. Changes in directional asymmetry are associated with various disorders that affect craniofacial development. Because facial dysmorphology is a key criterion for diagnosing fetal alcohol syndrome (FAS), the question arises whether in utero alcohol exposure alters directional asymmetry in the face. Data on the relative position of 17 morphologic landmarks were obtained from facial scans of children who were classified as either FAS or control. Shape data obtained from the landmarks were analyzed with the methods of geometric morphometrics. Our analyses showed significant directional asymmetry of facial shape, consisting primarily of a shift of midline landmarks to the right and a displacement of the landmarks around the eyes to the left. The asymmetry of FAS and control groups differed significantly and average directional asymmetry was increased in those individuals exposed to alcohol in utero. These results suggest that the developmental consequences of fetal alcohol exposure affect a wide range of craniofacial features in addition to those generally recognized and used for diagnosis of FAS.
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Affiliation(s)
- CP Klingenberg
- Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester M13 9PT, United Kingdom
| | - L Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - J Rogers
- Advanced Visualization Laboratory, University Information Technology Services at Indiana University, Indianapolis, IN 46202, USA
| | - E Moore
- St. Vincent Women's Hospital, Indianapolis, IN 46260, USA, Department of Anthropology, Indiana University School of Liberal Arts, Indianapolis, IN 46202, USA
| | - R Ward
- Department of Anthropology, Indiana University School of Liberal Arts, Indianapolis, IN 46202, USA
| | - I Autti-Rämö
- Department of Child Neurology, HUCH Hospital for Children and Adolescents, Helsinki, Finland; and Research Department, The Social Insurance Institution, Helsinki, Finland
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Å
Fagerlund
- Folkhälsan Research Center, Helsinki, Finland; and Psychology Department, Åbo Akademi University, Turku, Finland
| | - SW Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48207, USA
| | - LK Robinson
- State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14214, USA
| | - HE Hoyme
- Department of Pediatrics, Sanford School of Medicine of the University of South Dakota; and Sanford Children's Hospital, Sioux Falls, SD 57117, USA
| | - SN Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
| | - TK Li
- Department of Psychiatry, Duke University, Durham, NC, 27710, USA
| | - EP Riley
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
| | - T Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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MacDonald-Jankowski DS, Li TK. Ossifying fibroma in a Hong Kong community: the clinical and radiological features and outcomes of treatment. Dentomaxillofac Radiol 2009; 38:514-23. [DOI: 10.1259/dmfr/51064053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Li EK, Tam LS, Zhu TY, Li M, Kwok CL, Li TK, Leung YY, Wong KC, Szeto CC. Is combination rituximab with cyclophosphamide better than rituximab alone in the treatment of lupus nephritis? Rheumatology (Oxford) 2009; 48:892-8. [PMID: 19478041 DOI: 10.1093/rheumatology/kep124] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Edmund K Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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MacDonald-Jankowski DS, Li TK. Fibrous dysplasia in a Hong Kong community: the clinical and radiological features and outcomes of treatment. Dentomaxillofac Radiol 2009; 38:63-72. [DOI: 10.1259/dmfr/56740531] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tam LS, Shang Q, Li EK, Tomlinson B, Chu TTW, Li M, Leung YY, Kwok LW, Wong KC, Li TK, Yu T, Zhu TY, Kun EW, Yip GW, Yu CM. Subclinical carotid atherosclerosis in patients with psoriatic arthritis. ACTA ACUST UNITED AC 2008; 59:1322-31. [DOI: 10.1002/art.24014] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Tam LS, Wong A, Mok VCT, Zhu YE, Kwok LW, Li TK, Wong KC, Li EK. The relationship between neuropsychiatric, clinical, and laboratory variables and quality of life of Chinese patients with systemic lupus erythematosus. J Rheumatol 2008; 35:1038-1045. [PMID: 18464308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the role of neuropsychiatric (NP), clinical, and laboratory variables in influencing the health related quality of life (HRQOL) of Chinese patients with systemic lupus erythematosus (SLE). METHODS The Medical Outcomes Study Short Form-36 was applied in a cohort of 291 patients with SLE. At the time of HRQOL testing all patients underwent a clinical and laboratory evaluation together with measures of disease activity and damage. Patients also submitted to a battery of NP tests. RESULTS Using multivariate analysis, NP involvement-ever was associated with impairment of the general health subscale. Cerebrovascular disease and mononeuropathy were associated with impairment of the physical function subscale, while the latter was also associated with impairment of the role-emotional subscale. Cognitive impairment was associated with impairment of the mental health subscale. The Hospital Anxiety and Depression (HAD) depression score was associated with impairment of all the 8 subscales, physical, and mental summary scores. The HAD anxiety score was associated with impairment of predominantly mental function. Active arthritis, lower education level, and serum albumin levels were associated with impairment of predominantly physical function. Advancing age and damage were associated with impairment of both physical and mental function. Low hemoglobin level and female sex were associated with impairment of predominantly mental function. CONCLUSION NP involvement and low-grade inflammation as reflected by low serum albumin and hemoglobin concentrations were associated with impaired HRQOL in patients with SLE, independent of other sociodemographic and clinical variables.
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Affiliation(s)
- Lai-Shan Tam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Tam LS, Tomlinson B, Chu TTW, Li M, Leung YY, Kwok LW, Li TK, Yu T, Zhu YE, Wong KC, Kun EWL, Li EK. Cardiovascular risk profile of patients with psoriatic arthritis compared to controls--the role of inflammation. Rheumatology (Oxford) 2008; 47:718-23. [PMID: 18400833 DOI: 10.1093/rheumatology/ken090] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the distribution of traditional and novel risk factors of cardiovascular disease (CVD) in patients with PsA compared with healthy controls. METHODS We compared risk factors for CVD between 102 consecutive PsA patients and 82 controls, adjusting for BMI. We also assessed the role of inflammation on the CVD risk factor by using a BMI and high-sensitivity CRP (hsCRP)-adjusted model. RESULTS The BMI of PsA patients were significantly higher than healthy controls. After adjusting for the BMI, PsA patients still have a higher prevalence of diabetes mellitus (DM) [odds ratio (OR) 9.27, 95% CI 2.09, 41.09) and hypertension (OR 3.37, 95% CI 1.68, 6.72), but a lower prevalence of low high density lipoprotein (HDL) cholesterol (OR 0.16, 95% CI 0.07, 0.41). PsA patients have significantly increased systolic and diastolic blood pressures, insulin resistance and inflammatory markers (hsCRP and white cell count) compared to controls. PsA patients have higher HDL cholesterol and apolipoprotein (Apo) A1 levels; and lower total cholesterol (TC) and low density lipoprotein cholesterol levels; and a lower TC/HDL ratio. However, the Apo B level (P < 0.05), and the Apo B/Apo A1 ratio (P = 0.07) were higher in PsA patients. Further adjustment for hsCRP level rendered the differences in the prevalence of hypertension and DM; the TC, and sugar levels; and white cell count non-significant between the two groups; while the differences in other parameters remained significant. CONCLUSION These data support the hypothesis that PsA may be associated with obesity, hypertension, dyslipidaemia and insulin resistance because of the shared inflammatory pathway.
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Affiliation(s)
- L-S Tam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Tam LS, Leung PC, Li TK, Zhang L, Li EK. Acupuncture in the treatment of rheumatoid arthritis: a double-blind controlled pilot study. BMC Complement Altern Med 2007; 7:35. [PMID: 17980044 PMCID: PMC2174514 DOI: 10.1186/1472-6882-7-35] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 11/03/2007] [Indexed: 11/25/2022]
Abstract
Background In planning a randomized controlled trial of acupuncture, we conducted a pilot study using validated outcome measures to assess the feasibility of the protocol, and to obtain preliminary data on efficacy and tolerability of 3 different forms of acupuncture treatment as an adjunct for the treatment of chronic pain in patients with Rheumatoid arthritis (RA). Methods The study employs a randomized, prospective, double-blind, placebo-controlled trial to evaluate the effect of electroacupuncture (EA), traditional Chinese acupuncture (TCA) and sham acupuncture (Sham) in patients with RA. All patients received 20 sessions over a period of 10 weeks. Six acupuncture points were chosen. Primary outcome is the changes in the pain score. Secondary outcomes included the changes in the ACR core disease measures, DAS 28 score and the number of patients who achieved ACR 20 at week 10. Results From 80 eligible patients, 36 patients with mean age of 58 ± 10 years and disease duration of 9.3 ± 6.4 years were recruited. Twelve patients were randomized to each group. Twelve, 10 and 7 patients from the EA, TCA and Sham group respectively completed the study at 20 weeks (p < 0.03); all except one of the premature dropouts were due to lack of efficacy. At week 10, the pain score remained unchanged in all 3 groups. The number of tender joints was significantly reduced for the EA and TCA groups. Physician's global score was significantly reduced for the EA group and patient's global score was significantly reduced for the TCA group. All the outcomes except patient's global score remained unchanged in the Sham group. Conclusion This pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial, which in turn will help to clarify the existing evidence base on acupuncture for RA. Trial registration ClinicalTrials.gov NCT00404443
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Tam LS, Tomlinson B, Chu TT, Li TK, Li EK. Impact of TNF inhibition on insulin resistance and lipids levels in patients with rheumatoid arthritis. Clin Rheumatol 2007; 26:1495-8. [PMID: 17237906 DOI: 10.1007/s10067-007-0539-8] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Revised: 01/03/2007] [Accepted: 01/05/2007] [Indexed: 12/13/2022]
Abstract
Patients with rheumatoid arthritis (RA) have increased cardiovascular mortality. TNF-alpha is a critical mediator of inflammation and metabolic response in patients with RA. Increased insulin resistance and dyslipidemia were known risk factors in patients with active RA, however, the regulation of these metabolic parameters by TNF-alpha is poorly understood. Neutralization of TNF-alpha with infliximab offers a unique opportunity to study TNF-alpha-mediated regulation of these metabolic parameters in RA. The aim of the study was to assess the in vivo TNF-alpha-mediated regulation of insulin resistance and lipids levels in RA. Nineteen patients with active RA treated with infliximab were prospectively followed for 14 weeks. Plasma lipids levels and insulin resistance were measured at baseline, 6 and 14 weeks after infliximab treatment. At week 14, the disease activity (DAS-28 score) improved significantly (p < 0.000), with a significant reduction in both C-reactive protein (p = 0.007) and erythrocyte sedimentation rate (p = 0.006) levels. The body weight did not change during the study period. After infliximab treatment, insulin resistance improved as reflected by the significant reduction in the Homeostasis Model Assessment Index. Total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and apolipoprotein B (apoB) levels all increased significantly from baseline. Nonetheless, the atherogenic index, LDL-cholesterol/HDL-cholesterol ratio, and the LDL/apoB ratio remained unchanged. Infliximab improves insulin sensitivity and alters lipid profile in patients with active RA.
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Affiliation(s)
- Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
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Abstract
Depression, eating disorders, and carbohydrate craving are frequently seen in alcoholics or recovering alcoholics. Accordingly, these disorders may share some mediating pathways. It is now well-established that there is a genetic predisposition to alcoholism. Through genetic means, our laboratory has developed an animal model of alcoholism. Free-fed Wistar rats were selectively bred for the traits of alcohol-preference (the P line) and non-preference (the NP line). After more than 20 generations of selection, the lines show a stable difference of more than six-fold in voluntary ethanol consumption. We have now shown that the P line satisfies all the perceived requirements of an animal model of alcoholism. One major discovered difference between the P and the NP line is the lowered content of serotonin in certain brain regions of the P rats. Interestingly, fluoxetine curbs the alcohol-seeking behavior of the P rats; variation in the carbohydrate content of the diet, however, does not modify voluntary ethanol intake. The P rats are similar in body weight to the NP rats, but are more active in a novel environment than the NP rats.
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Tam LS, Griffith JF, Yu AB, Li TK, Li EK. Rapid improvement in rheumatoid arthritis patients on combination of methotrexate and infliximab: clinical and magnetic resonance imaging evaluation. Clin Rheumatol 2006; 26:941-6. [PMID: 16868816 DOI: 10.1007/s10067-006-0372-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 06/05/2006] [Accepted: 06/07/2006] [Indexed: 10/24/2022]
Abstract
The objectives of this study was to assess, using clinical and magnetic resonance imaging (MRI) criteria, the efficacy of combination infliximab therapy in patients with active rheumatoid arthritis (RA) refractory to methotrexate (MTX) treatment and to ascertain whether the changes in MRI parameters correlate with the clinical response. Four infusions of infliximab (3 mg/kg) at weeks 0, 2, 6, and 14 were added to a stable background dose of MTX in 19 patients with active disease. Clinical parameters were assessed before each infusion and at week 14. Dynamic contrast-enhanced MRI examination of the most severely affected wrist was performed at baseline and week 14. Synovitis severity, volume of synovitis, and synovial perfusion indices were evaluated. Significant improvement in all clinical disease activity parameters was seen at week 14 with reduction in C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and DAS28. Sixty-eight percent of patients achieved ACR20. MRI disease activity parameters also significantly decreased after treatment with reduction in grading of synovitis, volume of active synovitis, and perfusion enhancement slope. Significant positive correlations were seen between the baseline volume of synovitis and the pain score (r=0.65), patient global score (r=0.68), and health assessment questionnaire (HAQ) score (r=0.46). In conclusion, addition of infliximab to methotrexate rapidly reduces inflammation in longstanding patients with RA. Assessment of enhancing synovial volume and perfusion indices on serial MRI examination was helpful in documenting the effect of treatment over this short period.
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Affiliation(s)
- Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hongkong, People's Republic of China.
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Lê AD, Li Z, Funk D, Shram M, Li TK, Shaham Y. Increased vulnerability to nicotine self-administration and relapse in alcohol-naive offspring of rats selectively bred for high alcohol intake. J Neurosci 2006; 26:1872-9. [PMID: 16467536 PMCID: PMC6793634 DOI: 10.1523/jneurosci.4895-05.2006] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The prevalence of smoking in human alcoholics is substantially higher than in the general population, and results from twin studies suggest that a shared genetic vulnerability underlies alcohol and nicotine addiction. Here, we directly tested this hypothesis by examining nicotine-taking behavior in alcohol-naive offspring of alcohol-preferring (P) rats and alcohol-nonpreferring (NP) rats that had been selectively bred for high and low alcohol intake. The self-administration of intravenous nicotine (0.015-0.060 mg/kg per infusion) in P rats was more than twice than that of NP rats. Nicotine seeking induced by reexposure to nicotine cues in extinction tests was also substantially greater in P rats than in NP rats. In a subsequent relapse test, priming nicotine injections reinstated drug seeking in P rats but not NP rats. P rats also self-administered higher amounts of oral sucrose (1-20%) than NP rats, a finding consistent with previous reports. In contrast, self-administration of intravenous cocaine (0.1875-1.125 mg/kg per infusion) was remarkably similar in the P and NP rats; however, P-NP differences in cocaine seeking emerged in subsequent extinction and cocaine priming-induced reinstatement tests. In both cases, lever responding was higher in P rats than in NP rats. Thus, alcohol-naive offspring of rats genetically selected for high alcohol intake are highly susceptible to nicotine self-administration and relapse, and this susceptibility is not likely caused by general reward deficits in NP rats. The present findings provide experimental evidence for the hypothesis that a shared genetic determinant accounts for the co-abuse of nicotine and alcohol.
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Affiliation(s)
- A D Lê
- Department of Neuroscience, Center for Addiction and Mental Health, Toronto, Ontario, M5S 2S1, Canada.
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MacDonald-Jankowski DS, Yeung R, Lee KM, Li TK. Ameloblastoma in the Hong Kong Chinese. Part 2: systematic review and radiological presentation. Dentomaxillofac Radiol 2004; 33:141-51. [PMID: 15371313 DOI: 10.1259/dmfr/28001874] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this part of the study was to determine the radiological presentation on conventional radiographs of central ameloblastomas in the Hong Kong Chinese and compare them with other reported series by a systematic review (SR). METHODS The study had two elements, that of a complete series of all ameloblastomas presenting at a major Chinese maxillofacial surgical unit and a SR. The files of the Department of Oral and Maxillofacial Surgery of the University of Hong Kong between 1989 and 2000 were reviewed for ameloblastoma cases. The relevant literature was identified by electronic databases, review of citation lists and handsearching of key journals. The principal selection criterion was that the study should represent a complete collection of cases. RESULTS Only 13 reports gave any radiological details. The present study of the Hong Kong Chinese contained 61 cases. With the exception of radiodensity and shape of radiolucency, the majority of the 13 other reports did not record the other radiological features that could be important in the diagnosis. The present study agreed with the synthesis of the 13 reports with regards to complete radiolucency and cortication of ameloblastomas, but disagreed with regards to other important features. The present study had a significantly higher proportion of unilocular lesions, better marginal definition, and more frequent perforation of the cortex and buccolingual expansion. Nine of the ten maxillary lesions straddled both anterior and posterior sextants with four crossing the midline, whereas only 13 of the 51 mandibular cases affected both sextants, of which eight crossed the midline. The unicystic form, which was most prevalent, appeared significantly more frequently as unilocular radiolucencies in comparison with the non-unicystic forms. The frequencies of unicystic forms and unilocular presentations were significantly greater in the young. The lesions in the young were significantly sited solely in the posterior sextant. The lower border of the mandible was reached and affected by ameloblastoma in 36 cases in the present report. It was displaced and thinned in 15 cases whereas in just five it was at least partially undisplaced with the lesion expanding down past it either buccally or lingually to it. The unicystic form was significantly more associated with root resorption, tooth displacement and crowns of unerupted teeth. CONCLUSIONS Radiologically, ameloblastomas in the Hong Kong Chinese differ significantly with regards to many features. This can be in part explained by the higher proportion of the unicystic form.
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Affiliation(s)
- D S MacDonald-Jankowski
- Division of Oral and Maxillofacial Radiology, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada.
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MacDonald-Jankowski DS, Yeung R, Lee KM, Li TK. Ameloblastoma in the Hong Kong Chinese. Part 1: systematic review and clinical presentation. Dentomaxillofac Radiol 2004; 33:71-82. [PMID: 15313997 DOI: 10.1259/dmfr/23357977] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of Part 1 of this study was to determine the clinical presentation of central ameloblastomas in the Hong Kong Chinese and to compare them with other reported series by a systematic review (SR). METHODS The study had two elements, that of a complete series of all ameloblastomas presenting at a major Chinese maxillofacial surgical unit as well as a SR. The files of the Department of Oral and Maxillofacial Surgery of the University of Hong Kong between 1989 and 2000 were reviewed for ameloblastoma cases. The relevant literature was identified by electronic databases, review of citation lists and hand searching of key journals. The principal selection criterion was that the study should represent a complete collection of cases. RESULTS Fifty-three published series of cases were included in the SR. They generally reported little more than sex, mean age and range, and affected jaw. Only 16 studies considered recurrence. Sixty-one cases of ameloblastoma were identified in the present study. There were 30 males and 31 females, contrary to the predilection for males in other reports. Eighty-four percent of cases were found in the mandible, agreeing with the SR. The mean age at first presentation was 30.5 years, lower than that of the SR; only a Korean report and a small Bangladeshi report showed younger presentation. The present report had the shortest period between first becoming aware of the lesion and seeking treatment; this period was significantly shorter for younger patients. Although the present study was in agreement with the SR with regard to swelling, this study reported a significantly higher proportion of patients presenting with pain. CONCLUSION Although the presentation of ameloblastoma within this Chinese community was broadly similar to that observed in other populations, it differed in a number of important respects. It had a younger age at first presentation than many other communities, including other Orientals; it was associated with a shorter period between first becoming aware of the lesion and seeking treatment, particularly in the young; and it was more frequently associated with pain than in the SR.
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Affiliation(s)
- D S MacDonald-Jankowski
- Division of Oral and Maxillofacial Radiology, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Canada.
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Abstract
OBJECTIVE Fibrous dysplasia (FD) is an uncommon, but important lesion affecting the jaws. The aim of this study was to reveal its presentation on computed tomography (CT) in a consecutive series of cases. METHODS The files of the Department of Oral and Maxillofacial Surgery of Hong Kong University between 1989 and 2000 were reviewed for cases of FD. RESULTS Of the ten cases investigated by CT, two were rejected because of extensive biopsy or surgery before the CT investigation. Seven of the remaining eight cases were Chinese and one was Indian. The mandible and maxilla were equally affected. The cortex was generally intact, except when adjacent to the teeth in the maxilla. The margins were generally poorly-defined, but well-defined on at least some sections of each maxillary case. Five cases were extensive, affecting or nearly affecting the whole hemi-mandible or hemi-maxilla to the midline. All cases displayed expansion, which was fusiform in the mandible and an enlargement of the normal contour in the maxilla. The maxillary antrum was completely obturated in three maxillary cases; one displayed a rounded dome-shaped lesion more suggestive of a benign neoplasm. The orbital floor was displaced in three cases; one of those cases presented with proptosis. All maxillary cases extended back to the pterygoid process, but did not displace it. The "bone windows" of eight cases generally displayed a "ground-glass" pattern; one also displayed cyst-like radiolucencies. The soft tissue window, which depicts mineralized tissue as "white", showed that five cases were completely mineralized. CONCLUSION CT can be used to determine the extent, specific dimensions and radiodensity of FD.
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Affiliation(s)
- D S MacDonald-Jankowski
- Division of Oral and Maxillofacial Radiology, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Canada.
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