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Lim WH, Lee JH, Park H, Park CM, Yoon SH. Effect of smoking on the diagnostic results and complication rates of percutaneous transthoracic needle biopsy. Eur Radiol 2024:10.1007/s00330-024-10705-8. [PMID: 38528137 DOI: 10.1007/s00330-024-10705-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/01/2024] [Accepted: 02/25/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To investigate the association of smoking with the outcomes of percutaneous transthoracic needle biopsy (PTNB). METHODS In total, 4668 PTNBs for pulmonary lesions were retrospectively identified. The associations of smoking status (never, former, current smokers) and smoking intensity (≤ 20, 21-40, > 40 pack-years) with diagnostic results (malignancy, non-diagnostic pathologies, and false-negative results in non-diagnostic pathologies) and complications (pneumothorax and hemoptysis) were assessed using multivariable logistic regression analysis. RESULTS Among the 4668 PTNBs (median age of the patients, 66 years [interquartile range, 58-74]; 2715 men), malignancies, non-diagnostic pathologies, and specific benign pathologies were identified in 3054 (65.4%), 1282 (27.5%), and 332 PTNBs (7.1%), respectively. False-negative results for malignancy occurred in 20.5% (236/1153) of non-diagnostic pathologies with decidable reference standards. Current smoking was associated with malignancy (adjusted odds ratio [OR], 1.31; 95% confidence interval [CI]: 1.02-1.69; p = 0.03) and false-negative results (OR, 2.64; 95% CI: 1.32-5.28; p = 0.006), while heavy smoking (> 40 pack-years) was associated with non-diagnostic pathologies (OR, 1.69; 95% CI: 1.19-2.40; p = 0.003) and false-negative results (OR, 2.12; 95% CI: 1.17-3.92; p = 0.02). Pneumothorax and hemoptysis occurred in 21.8% (1018/4668) and 10.6% (495/4668) of PTNBs, respectively. Heavy smoking was associated with pneumothorax (OR, 1.33; 95% CI: 1.01-1.74; p = 0.04), while heavy smoking (OR, 0.64; 95% CI: 0.40-0.99; p = 0.048) and current smoking (OR, 0.64; 95% CI: 0.42-0.96; p = 0.04) were inversely associated with hemoptysis. CONCLUSION Smoking history was associated with the outcomes of PTNBs. Current and heavy smoking increased false-negative results and changed the complication rates of PTNBs. CLINICAL RELEVANCE STATEMENT Smoking status and intensity were independently associated with the outcomes of PTNBs. Non-diagnostic pathologies should be interpreted cautiously in current or heavy smokers. A patient's smoking history should be ascertained before PTNB to predict and manage complications. KEY POINTS • Smoking status and intensity might independently contribute to the diagnostic results and complications of PTNBs. • Current and heavy smoking (> 40 pack-years) were independently associated with the outcomes of PTNBs. • Operators need to recognize the association between smoking history and the outcomes of PTNBs.
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Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyungin Park
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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2
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Lim WH, Lee KH, Lee JH, Park H, Nam JG, Hwang EJ, Chung JH, Goo JM, Park S, Kim YT, Kim H. Diagnostic performance and prognostic value of CT-defined visceral pleural invasion in early-stage lung adenocarcinomas. Eur Radiol 2024; 34:1934-1945. [PMID: 37658899 DOI: 10.1007/s00330-023-10204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES To analyze the diagnostic performance and prognostic value of CT-defined visceral pleural invasion (CT-VPI) in early-stage lung adenocarcinomas. METHODS Among patients with clinical stage I lung adenocarcinomas, half of patients were randomly selected for a diagnostic study, in which five thoracic radiologists determined the presence of CT-VPI. Probabilities for CT-VPI were obtained using deep learning (DL). Areas under the receiver operating characteristic curve (AUCs) and binary diagnostic measures were calculated and compared. Inter-rater agreement was assessed. For all patients, the prognostic value of CT-VPI by two radiologists and DL (using high-sensitivity and high-specificity cutoffs) was investigated using Cox regression. RESULTS In 681 patients (median age, 65 years [interquartile range, 58-71]; 382 women), pathologic VPI was positive in 130 patients. For the diagnostic study (n = 339), the pooled AUC of five radiologists was similar to that of DL (0.78 vs. 0.79; p = 0.76). The binary diagnostic performance of radiologists was variable (sensitivity, 45.3-71.9%; specificity, 71.6-88.7%). Inter-rater agreement was moderate (weighted Fleiss κ, 0.51; 95%CI: 0.43-0.55). For overall survival (n = 680), CT-VPI by radiologists (adjusted hazard ratio [HR], 1.27 and 0.99; 95%CI: 0.84-1.92 and 0.63-1.56; p = 0.26 and 0.97) or DL (HR, 1.44 and 1.06; 95%CI: 0.86-2.42 and 0.67-1.68; p = 0.17 and 0.80) was not prognostic. CT-VPI by an attending radiologist was prognostic only in radiologically solid tumors (HR, 1.82; 95%CI: 1.07-3.07; p = 0.03). CONCLUSION The diagnostic performance and prognostic value of CT-VPI are limited in clinical stage I lung adenocarcinomas. This feature may be applied for radiologically solid tumors, but substantial reader variability should be overcome. CLINICAL RELEVANCE STATEMENT Although the diagnostic performance and prognostic value of CT-VPI are limited in clinical stage I lung adenocarcinomas, this parameter may be applied for radiologically solid tumors with appropriate caution regarding inter-reader variability. KEY POINTS • Use of CT-defined visceral pleural invasion in clinical staging should be cautious, because prognostic value of CT-defined visceral pleural invasion remains unexplored. • Diagnostic performance and prognostic value of CT-defined visceral pleural invasion varied among radiologists and deep learning. • Role of CT-defined visceral pleural invasion in clinical staging may be limited to radiologically solid tumors.
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Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-Do, Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hyungin Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ju Gang Nam
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Jin-Haeng Chung
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-Do, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
- Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young Tae Kim
- Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyungjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
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Lim WH, Jeong S, Park CM. Cigarette smoking and disproportionate changes of thoracic skeletal muscles in low-dose chest computed tomography. Sci Rep 2023; 13:20110. [PMID: 37978301 PMCID: PMC10656498 DOI: 10.1038/s41598-023-46360-0] [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: 05/22/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
Association between smoking intensity and the quantity and quality of thoracic skeletal muscles (TSMs) remains unexplored. Skeletal muscle index (SMI; skeletal muscle area/height2) and percentage of normal attenuation muscle area (NAMA%) were measured to represent the quantity and quality of the skeletal muscles, respectively, and quantification was performed in pectoralis muscle at aortic arch (AA-PM), TSM at carina (C-TSM), erector spinae muscle at T12 (T12-ESM), and skeletal muscle at L1 (L1-SM). Among the 258 men (median age, 62 years [IQR: 58-69]), 183 were current smokers (median smoking intensity, 40 pack-years [IQR: 30-46]). SMI and NAMA% of AA-PM significantly decreased with pack-year (β = - 0.028 and - 0.076; P < 0.001 and P = 0.021, respectively). Smoking intensity was inversely associated with NAMA% of C-TSM (β = - 0.063; P = 0.001), whereas smoking intensity showed a borderline association with SMI of C-TSM (β = - 0.023; P = 0.057). Smoking intensity was associated with the change in NAMA% of L1-SM (β = - 0.040; P = 0.027), but was not associated with SMI of L1-SM (P > 0.05). Neither NAMA% nor SMI of T12-ESM was affected by smoking intensity (P > 0.05). In conclusion, smoking intensity was associated with the change of TSMs. Its association varied according to the location of TSMs, with the most associated parts being the upper (AA-PM) and middle TSMs (C-TSM).
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Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Suhyun Jeong
- Department of Radiology, Namwon Medical Center, 365 Chungjeong-no, Namwon, Jeollabuk-do, 55726, Republic of Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea.
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Park J, Hwang EJ, Lee JH, Hong W, Nam JG, Lim WH, Kim JH, Goo JM, Park CM. Identification of Active Pulmonary Tuberculosis Among Patients With Positive Interferon-Gamma Release Assay Results: Value of a Deep Learning-based Computer-aided Detection System in Different Scenarios of Implementation. J Thorac Imaging 2023; 38:145-153. [PMID: 36744946 DOI: 10.1097/rti.0000000000000691] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the accuracy of a deep learning-based computer-aided detection (CAD) system in identifying active pulmonary tuberculosis on chest radiographs (CRs) of patients with positive interferon-gamma release assay (IGRA) results in different scenarios of clinical implementation. MATERIALS AND METHODS We collected the CRs of consecutive patients with positive IGRA results. Findings of active pulmonary tuberculosis on CRs were independently evaluated by the CAD and a thoracic radiologist, followed by interpretation using the CAD. Sensitivity and specificity were evaluated in different scenarios: (a) radiologists' interpretation, (b) radiologists' CAD-assisted interpretation, and (c) CAD-based prescreening (radiologists' interpretation for positive CAD results only). We conducted a reader test to compare the accuracy of the CAD with those of 5 radiologists. RESULTS Among 1780 patients (men, 53.8%; median age, 56 y), 44 (2.5%) were diagnosed with active pulmonary tuberculosis. The CAD-assisted interpretation exhibited a higher sensitivity (81.8% vs. 72.7%; P =0.046) but lower specificity than the radiologists' interpretation (84.1% vs. 85.7%; P <0.001). The CAD-based prescreening exhibited a higher specificity than the radiologists' interpretation (88.8% vs. 85.7%; P <0.001) at the same sensitivity, with a workload reduction of 85.2% (1780 to 263). In the reader test, the CAD exhibited a higher sensitivity than radiologists (72.7% vs. 59.5%; P =0.005) at the same specificity (88.0%), and CAD-assisted interpretation significantly improved the sensitivity of radiologists' interpretation (72.3%; P <0.001). CONCLUSIONS For identifying active pulmonary tuberculosis among patients with positive IGRA results, deep learning-based CAD can enhance the sensitivity of interpretation. CAD-based prescreening may reduce the radiologists' workload at an improved specificity.
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Affiliation(s)
- Jongsoo Park
- Department of Radiology, Seoul National University Hospital
- Department of Radiology, Yeungnam University Medical Center, Daegu
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University Hospital
- Department of Radiology, Seoul National University College of Medicine, Seoul
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital
| | - Wonju Hong
- Department of Radiology, Seoul National University Hospital
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do, Korea
| | - Ju Gang Nam
- Department of Radiology, Seoul National University Hospital
| | - Woo Hyeon Lim
- Department of Radiology, Seoul National University Hospital
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital
- Department of Radiology, Seoul National University College of Medicine, Seoul
| | - Chang Min Park
- Department of Radiology, Seoul National University Hospital
- Department of Radiology, Seoul National University College of Medicine, Seoul
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Lim OZH, Chen Y, Dimmeler S, Yong AWJ, Singh H, Sim MLE, Kong G, Lim WH, Low TT, Park DW, Chew NWS, Foo R. Disparity in female and Asian representation amongst cardiology journal editorial boards members: a call for empowerment. QJM 2022; 115:830-836. [PMID: 35866641 DOI: 10.1093/qjmed/hcac176] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While progress is evident in gender and ethnic representation in the workplace, this disparity remains prevalent in academic positions. OBJECTIVES We examined gender and Asian ethnic representation in editorial boards of cardiology journals. METHODS A cross-sectional analysis was conducted using publicly available data on Cardiology and Cardiovascular medicine journals in the first quartile of the 2020 Scimago Journal & Country Rank indicator. The proportions of female and Asian editorial board members, associate editors and editors-in-chief were assessed. Subgroup analyses were conducted based on the journal's geographical origin, subspecialty and demographic of the editor-in-chief. RESULTS Seventy-six cardiology journals, involving 8915 editorial board members, were included. Only 19.6% of editorial board members were female, 20.8% Asians and 4.0% Asian females. There were less female representation amongst editors-in-chief (9.9%) compared to associate editors (22.3%). European (18.1%) and North American-based journals (21.1%) had higher female representation compared to Asian-based journals (8.7%). There was lower Asian representation in European (18.1%) and North American-based journals (19.9%) compared to Asian-based journals (72.3%). Females were underrepresented in interventional (14.5%) journals, while Asians were underrepresented in general cardiology (18.3%) and heart failure (18.3%) journals. Journals led by female editors-in-chief had significantly higher female representation compared to male-led ones, while journals with Asian editors-in-chief had greater Asian representation compared to non-Asian led ones. CONCLUSION This study highlights the female and Asian ethnic underrepresentation in academic roles in cardiology journal editorial boards. Further analysis is needed for other ethnicities, while the community pushes towards gender-balanced and ethnic diversity across editorial boards.
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Affiliation(s)
- O Z H Lim
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Y Chen
- Department of Cardiology, First Medical Centre of Chinese People's Liberation Army (PLA) General Hospital, Wanshoulu, 100036 Beijing, China
| | - S Dimmeler
- Institute for Cardiovascular Regeneration, Goethe University, Theodor-Stern-Kai 7 60590 Frankfurt am Main, Germany
| | - A W J Yong
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - H Singh
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - M L E Sim
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - G Kong
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - W H Lim
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - T T Low
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - D-W Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, South Korea
| | - N W S Chew
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - R Foo
- From the Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Cardiovascular Diseases Translational Research Programme, National University Health Systems, 1E Kent Ridge Rd, Singapore 119228, Singapore
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Chew N, Ng CH, Kong G, Chin YH, Lim O, Lim WH, Dalakoti M, Khoo CM, Kong W, Poh KK, Foo R, Lee CH, Chan MY, Muthiah M, Loh PH. Metabolic associated fatty liver disease increases risk of adverse events after acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Metabolic Associated Fatty Liver Disease (MAFLD) was recently introduced as an alternative definition for fatty liver, that has been linked to an increased risk of systemic end-organ damage. However, current studies have not examined the impact of MAFLD on patients presenting with acute coronary syndrome (ACS). Here, we present a retrospective analysis on the short and long-term outcomes of ACS patients with MAFLD.
Methods
A retrospective analysis was conducted in a tertiary care centre. Hepatic steatosis and fibrosis was examined with hepatic steatosis index and fibrosis-4 (FIB-4) index. The primary and secondary outcomes of the analysis were long term all-cause mortality, and in-hospital all-cause mortality, stroke, heart failure and cardiogenic shock respectively. Adjusted analysis was conducted for primary and secondary outcomes with covariates including age, sex, race, type of ACS and previous myocardial infarction.
Results
A total of 5770 patients were included in the analysis, and 21% of ACS patients had concomitant MAFLD. MAFLD resulted in a 23% increase in long-term all-cause mortality compared to non-MAFLD (HR: 1.230, CI: 1.065 to 1.420, p=0.005). MAFLD increased the risk of in-hospital mortality, stroke, heart failure and cardiogenic shock compared to non-MAFLD. A sensitivity analysis conducted based on MAFLD with advance fibrosis, chronic kidney disease and diabetes also demonstrated significantly increased effect size magnitude of all-cause mortality, compared to non-MAFLD.
Conclusion
MAFLD represents an encapsulation of metabolism dysregulation and has been associated with increased risk of systematic disease. The present study shows that MAFLD is associated with significantly increased adverse prognostic outcomes after ACS compared to non-MAFLD. An increase in awareness of MAFLD is required beyond the field of hepatology for improvements in multidisciplinary care and management.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University Health System , Singapore , Singapore
| | - G Kong
- National University Health System , Singapore , Singapore
| | - Y H Chin
- National University Health System , Singapore , Singapore
| | - O Lim
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - M Dalakoti
- National University of Singapore , Singapore , Singapore
| | - C M Khoo
- National University Health System , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - M Muthiah
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
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Chew NWS, Ng CH, Kong G, Tan D, Lim WH, Kofidis T, Yip J, Loh PH, Chan KH, Low A, Lee CH, Yeo TC, Tan HC, Chan MY. Reconstructed meta-analysis of percutaneous coronary intervention versus coronary artery bypass grafting for left main disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) for patients with left main coronary artery disease (LMCAD) have reported conflicting results.
Objectives
We performed a systematic review from inception to 23 May 2021 and one-stage reconstructed individual-patient data meta-analysis (IPDMA) that included 10-year mortality outcomes.
Methods
The primary outcome was 10-year all-cause mortality. Secondary outcomes included myocardial infarction (MI), stroke and unplanned revascularization at 5 years. We did IPDMA using published Kaplan-Meier curves to provide individual data points in coordinates and numbers at risk were used to increase the calibration accuracy of the reconstructed data. Shared frailty model or, when proportionality assumptions were not met, a restricted mean survival time model were fitted to compare outcomes between treatment groups.
Results
Of 583 articles retrieved, 5 RCTs were included. A total of 4595 patients from these 5 RCTs were randomly assigned to PCI (N=2297) or CABG (N=2298). The cumulative 10-year all-cause mortality after PCI and CABG was 12.0% versus 10.6% respectively (HR 1.093, 95% CI: 0.925–1.292; p=0.296). PCI conferred similar time-to-MI (RMST ratio 1.006, 95% CI: 0.992–1.021, p=0.391) and stroke (RMST ratio 1.005, 95% CI: 0.998–1.013, p=0.133) at 5 years. Unplanned revascularization was more frequent following PCI compared with CABG (HR 1.807, 95% CI: 1.524–2.144, p<0.001) at 5 years.
Conclusion
This meta-analysis using reconstructed participant-level time-to-event data showed no statistically significant difference in cumulative 10-year all-cause mortality between PCI versus CABG in the treatment of LMCAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - D Tan
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - T Kofidis
- National University Heart Centre , Singapore , Singapore
| | - J Yip
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - K H Chan
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
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Lee JH, Hwang EJ, Lim WH, Goo JM. Determination of the optimum definition of growth evaluation for indeterminate pulmonary nodules detected in lung cancer screening. PLoS One 2022; 17:e0274583. [PMID: 36108077 PMCID: PMC9477274 DOI: 10.1371/journal.pone.0274583] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
To determine the optimum definition of growth for indeterminate pulmonary nodules detected in lung cancer screening.
Materials and methods
Individuals with indeterminate nodules as defined by volume of 50–500 mm3 (solid nodules) and solid component volume of 50–500 mm3 or average diameter of non-solid component ≥8 mm (part-solid nodules) on baseline lung cancer screening low-dose chest CT (LDCT) were included. The average diameters and volumes of the nodules were measured on baseline and follow-up LDCTs with semi-automated segmentation. Sensitivities and specificities for lung cancer diagnosis of nodule growth defined by a) percentage volume growth ≥25% (defined in the NELSON study); b) absolute diameter growth >1.5 mm (defined in the Lung-RADS version 1.1); and c) subjective decision by a radiologist were evaluated. Sensitivities and specificities of diagnostic referral based on various thresholds of volume doubling time (VDT) were also evaluated.
Results
Altogether, 115 nodules (one nodule per individual; 93 solid and 22 part-solid nodules; 105 men; median age, 68 years) were evaluated (median follow-up interval: 201 days; interquartile range: 127–371 days). Percentage volume growth ≥25% exhibited higher sensitivity but lower specificity than those of diametrical measurement compared to absolute diameter growth >1.5 mm (sensitivity, 69.2% vs. 42.3%, p = 0.023; specificity, 82.0% vs. 96.6%, p = 0.002). The radiologist had an equivalent sensitivity (53.9%; p = 0.289) but higher specificity (98.9%; p = 0.002) compared to those of volume growth, but did not differ from those of diameter growth (p>0.05 both in sensitivity and specificity). Compared to the VDT threshold of 600 days (sensitivity, 61.5%; specificity, 87.6%), VDT thresholds ≤200 and ≤300 days exhibited significantly lower sensitivity (30.8%, p = 0.013) and higher specificity (94.4%, p = 0.041), respectively.
Conclusion
Growth evaluation of screening-detected indeterminate nodules with volumetric measurement exhibited higher sensitivity but lower specificity compared to diametric measurements.
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Affiliation(s)
- Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- * E-mail:
| | - Woo Hyeon Lim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
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9
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Gebre AK, Prince RL, Schousboe JT, Kiel DP, Thompson PL, Zhu K, Lim WH, Sim M, Lewis JR. Calcaneal quantitative ultrasound is associated with all-cause and cardiovascular disease mortality independent of hip bone mineral density. Osteoporos Int 2022; 33:1557-1567. [PMID: 35147712 PMCID: PMC9187548 DOI: 10.1007/s00198-022-06317-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/20/2022] [Indexed: 11/26/2022]
Abstract
UNLABELLED Osteoporosis has been linked with increased risk of cardiovascular disease previously. However, few studies have detailed bone and vascular information. In a prospective study of older women, we demonstrated heel quantitative ultrasound measures were associated with increased cardiovascular and all-cause mortality, independent of established cardiovascular risk factors. INTRODUCTION Osteoporosis and low bone mineral density (BMD) have been previously linked to cardiovascular disease (CVD) and mortality. Calcaneal quantitative ultrasound (QUS) is used to evaluate bone material properties, especially in older women. However, it is uncertain whether it is related to risk of mortality. This study was aimed to investigate the association between calcaneal QUS measurements and 15-year all-cause and CVD mortality in 1404 older women (mean age 75.2 ± 2.7 years). METHODS One thousand four hundred four older women, participants of Calcium Intake Fracture Outcome study (CAIFOS), had calcaneal bone measured at baseline (1998) and followed for 15 years. The primary outcomes, any deaths, and deaths attributable to cardiovascular causes ascertained by using linked data were obtained from Western Australia data linkage system. RESULTS Over the 15 years of follow-up (17,955 person years), 584 of the women died, and 223 from CVD. For every standard deviation (SD), reduction in broadband ultrasound attenuation (BUA) in minimally and multivariable-adjusted model including cardiovascular risk factors increased relative hazards for all-cause (multivariable-adjusted HR 1.15; 95%CI: 1.06-1.26, p = 0.001) and CVD mortality (multivariable-adjusted HR 1.20; 95%CI: 1.04-1.38, p = 0.010). Such relationships also persisted when hip BMD was included in the model (all-cause mortality HR 1.19; 95%CI: 1.07-1.33, p = 0.002; CVD mortality HR 1.28; 95%CI: 1.07-1.53, p = 0.008). CONCLUSION BUA is associated with all-cause and CVD mortality in older women independent of BMD and established CVD risk factors. Understanding why and how these are related may provide further insights about the bone-vascular nexus as well as therapeutic targets benefiting both systems.
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Affiliation(s)
- A K Gebre
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, 6027, Australia
- School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - R L Prince
- Medical School, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - J T Schousboe
- Park Nicollet Osteoporosis Center and HealthPartners Institute, HealthPartners, Minneapolis, MN, 55416, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, 55455, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - P L Thompson
- Medical School, The University of Western Australia, Perth, Australia
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia
| | - K Zhu
- Medical School, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - W H Lim
- Medical School, The University of Western Australia, Perth, Australia
- Renal Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - M Sim
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, 6027, Australia
- Medical School, The University of Western Australia, Perth, Australia
| | - J R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, 6027, Australia.
- Medical School, The University of Western Australia, Perth, Australia.
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
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10
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Krishnan A, Wong G, Teixeira-Pinto A, Lim WH. Incidence and Outcomes of Early Cancers After Kidney Transplantation. Transpl Int 2022; 35:10024. [PMID: 35592449 PMCID: PMC9110645 DOI: 10.3389/ti.2022.10024] [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: 09/05/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022]
Abstract
Outcomes of early cancers after kidney transplantation are not well-understood. We included recipients of first live and deceased donor kidney transplants who developed de novo cancers in Australia and New Zealand between 1980–2016. We compared the frequency and stage of specific cancer types that developed early (≤12-months) and late (>12-months) post-transplantation. Risk factors for death were evaluated using multivariable Cox regression analyses. Of 2,759 recipients who developed de novo cancer, followed-up for 40,035 person-years, 243 (8.8%) patients were diagnosed with early cancer. Post-transplant lymphoproliferative disease, urinary cancers and melanoma were the most common cancer types (26%, 18%, and 12%) and the majority were either in-situ or locally invasive lesions (55%, 84%, and 86%). Tumors arising early from the gastrointestinal and respiratory systems were uncommon but aggressive, with 40% presenting with metastatic disease at time of diagnosis. Overall, 32% of patients with early cancers died within a median of 4.7 months (IQR:0.6–16) post-diagnosis and 91% were cancer-related deaths. Older recipient and donor age were associated with an increased risk of all-cause death. Early cancers, though infrequent in kidney transplant recipients, are associated with poor outcomes, as nearly 1 in 3 died from cancer-related death; with majority of deaths occurring within 12-months of cancer diagnosis.
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Affiliation(s)
- A Krishnan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - G Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - A Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - W H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
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11
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Lim WH, Park CM. Percutaneous transthoracic needle biopsies in immunocompromised hosts with suspicious pulmonary infection: diagnostic yields and complications. Acta Radiol 2022; 63:606-614. [PMID: 33906417 DOI: 10.1177/02841851211005087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pulmonary infection is a major cause of morbidity and mortality in immunocompromised patients, in whom diagnostic yields of cone-beam computed tomography (CBCT)-guided percutaneous transthoracic needle biopsies (PTNBs) have not been evaluated so far. PURPOSE To evaluate diagnostic yields and complications of CBCT-guided PTNBs in immunocompromised patients. MATERIAL AND METHODS From January 2015 to January 2018, 43 patients (25 men, 18 women; mean age 54.1 ± 16.4 years) who were suspected of having pulmonary infections were included in this retrospective study. Electronic medical records and radiologic studies were reviewed, including the underlying medical status, information on target lesions, PTNB procedural factors, and pathologic results. Logistic regression was performed to explore factors related with post-PTNB complications. RESULTS Among 43 patients, specific causative organisms or family of organisms were identified by PTNBs in 16 patients (37.2%). The most common causative organism was fungus (10/16, 62.5%), while bacterial infection was pathologically proven only in one patient (6.3%). Clinically significant change in management occurred in 12 of 43 patients (27.9%). Post-PTNB complications developed in 12 patients (27.9%; pneumothorax [n = 6] and hemoptysis [n = 6]) without PTNB-related mortality. Lower lobar location (odds ratio [OR] = 0.07, P = 0.006) was related with post-PTNB pneumothorax, while lower platelet counts (≤127 × 103/µL) were associated with post-PTNB hemoptysis (OR = 9.82, P = 0.025). CONCLUSION CBCT-guided PTNBs revealed microbiological pathogens in 37.2% of immunocompromised patients and led to subsequent clinical actions in 27.9% of patients. Post-PTNB complications occurred in 27.9% of patients, and it might be necessary to perform PTNBs more carefully in immunocompromised patients with lower platelet counts.
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Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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12
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Lim WH, Park CM. Validation for measurements of skeletal muscle areas using low-dose chest computed tomography. Sci Rep 2022; 12:463. [PMID: 35013501 PMCID: PMC8748601 DOI: 10.1038/s41598-021-04492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 12/23/2021] [Indexed: 11/21/2022] Open
Abstract
Various methods were suggested to measure skeletal muscle areas (SMAs) using chest low-dose computed tomography (chest LDCT) as a substitute for SMA at 3rd lumbar vertebra level (L3-SMA). In this study, four SMAs (L1-SMA, T12-erector spinae muscle areas, chest wall muscle area at carina level, pectoralis muscle area at aortic arch level) were segmented semi-automatically in 780 individuals taking concurrent chest and abdomen LDCT for healthcare screening. Four SMAs were compared to L3-SMA and annual changes were calculated from individuals with multiple examinations (n = 101). Skeletal muscle index (SMI; SMA/height2) cut-off for sarcopenia was determined by lower 5th percentile of young individuals (age ≤ 40 years). L1-SMA showed the greatest correlation to L3-SMA (men, R2 = 0.7920; women, R2 = 0.7396), and the smallest annual changes (0.3300 ± 4.7365%) among four SMAs. L1-SMI cut-offs for determining sarcopenia were 39.2cm2/m2 in men, and 27.5cm2/m2 in women. Forty-six men (9.5%) and ten women (3.4%) were found to have sarcopenia using L1-SMI cut-offs. In conclusion, L1-SMA could be a reasonable substitute for L3-SMA in chest LDCT. Suggested L1-SMI cut-offs for sarcopenia were 39.2cm2/m2 for men and 27.5cm2/m2 for women in Asian.
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Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Namwon Medical Center, Namwon-si, Jeollabuk-do, Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. .,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea.
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13
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Hwang EJ, Lee JH, Kim JH, Lim WH, Goo JM, Park CM. Deep learning computer-aided detection system for pneumonia in febrile neutropenia patients: a diagnostic cohort study. BMC Pulm Med 2021; 21:406. [PMID: 34876075 PMCID: PMC8650735 DOI: 10.1186/s12890-021-01768-0] [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: 03/17/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Diagnosis of pneumonia is critical in managing patients with febrile neutropenia (FN), however, chest X-ray (CXR) has limited performance in the detection of pneumonia. We aimed to evaluate the performance of a deep learning-based computer-aided detection (CAD) system in pneumonia detection in the CXRs of consecutive FN patients and investigated whether CAD could improve radiologists’ diagnostic performance when used as a second reader. Methods CXRs of patients with FN (a body temperature ≥ 38.3 °C, or a sustained body temperature ≥ 38.0 °C for an hour; absolute neutrophil count < 500/mm3) obtained between January and December 2017 were consecutively included, from a single tertiary referral hospital. Reference standards for the diagnosis of pneumonia were defined by consensus of two thoracic radiologists after reviewing medical records and CXRs. A commercialized, deep learning-based CAD system was retrospectively applied to detect pulmonary infiltrates on CXRs. For comparing performance, five radiologists independently interpreted CXRs initially without the CAD results (radiologist-alone interpretation), followed by the interpretation with CAD. The sensitivities and specificities for detection of pneumonia were compared between radiologist-alone interpretation and interpretation with CAD. The standalone performance of the CAD was also evaluated, using area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Moreover, sensitivity and specificity of standalone CAD were compared with those of radiologist-alone interpretation. Results Among 525 CXRs from 413 patients (52.3% men; median age 59 years), pneumonia was diagnosed in 128 (24.4%) CXRs. In the interpretation with CAD, average sensitivity of radiologists was significantly improved (75.4% to 79.4%, P = 0.003) while their specificity remained similar (75.4% to 76.8%, P = 0.101), compared to radiologist-alone interpretation. The CAD exhibited AUC, sensitivity, and specificity of 0.895, 88.3%, and 68.3%, respectively. The standalone CAD exhibited higher sensitivity (86.6% vs. 75.2%, P < 0.001) and lower specificity (64.8% vs. 75.4%, P < 0.001) compared to radiologist-alone interpretation. Conclusions In patients with FN, the deep learning-based CAD system exhibited radiologist-level performance in detecting pneumonia on CXRs and enhanced radiologists’ performance. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01768-0.
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Affiliation(s)
- Eui Jin Hwang
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Woo Hyeon Lim
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Namwon Medical Center, 365 Chungjeong-ro, Namwon, 55726, Jeollabuk-do, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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14
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Misal M, Behbehani S, Bindra V, Girardo M, Hoffman MR, Lim WH, Martin CB, Mehta SK, Nensi A, Soares TR, Taylor D, Wagner S, Wright KN, Wasson MN. Evaluating Surgical Complexity of Endoscopic Hysterectomy: An Inter-Rater Agreement Study for Novel Scoring Tool. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Chew N, Tan EX, Tan CH, Lim WH, Xiao JL, Chin YH, Syn N, Low TT, Wong R, Yip J, Siddiqui MS, Muthiah M. A network meta-analysis on the vasomodulators for portopulmonary hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with portopulmonary hypertension (PoPH) who are eligible and awaiting liver transplant, guidelines recommend lowering pulmonary pressures with vasomodulators as a bridge to transplant. However, efficacy of each vasomodulator class as a bridge to transplant remains unknown.
Purpose
This review compares the use of endothelin receptor antagonists (ERA), phosphodiesterase type-5 inhibitors (PDE5-I), prostacyclin (PC) and combination therapy in its pulmonary pressure-lowering effects and pre-transplant mortality in this strictly selected subset of patients.
Methods
A search conducted on Medline and Embase on articles relating to vasomodulator use in PoPH for pulmonary pressure-lowering effects and mortality. Network analysis was conducted to summarize the evidence. Surface under the cumulative ranking curve (SUCRA) was used to rank treatments.
Results
Ten studies with 180 patients were included. SUCRA analysis demonstrated largest mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) lowering effects in ERA and combination therapy, followed by PDE5-I and PC. mPAP-lowering effects were largest in ERA (MD −19.440, CI: −62.280 to 23.400) and combination therapy (MD −18.223, CI: −29.677 to −6.770) when compared to PDE5-I (table 1). Pre-transplant mortality were comparable between ERA, PDE5-I and combination therapy. Both ERA (RR:0.349. CI: 0.137–0.891) and PDE5-I (RR: 0.279, CI: 0.091–0.854) had significantly lower mortality than PC (table 2).
Conclusion
This meta-analysis provides preliminary evidence that ERA have shown larger pulmonary pressure-lowering effects than PDE5-I in PoPH patients who were eligible for LT. Both ERA and PDE5-I have comparable mortality outcomes, with unfavorable outcomes in PC users.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Health System, Singapore, Singapore
| | - E X Tan
- National University Hospital, Division of Gastroenterology and Hepatology, Singapore, Singapore
| | - C H Tan
- National University of Singapore, Singapore, Singapore
| | - W H Lim
- National University of Singapore, Singapore, Singapore
| | - J L Xiao
- National University of Singapore, Singapore, Singapore
| | - Y H Chin
- National University of Singapore, Singapore, Singapore
| | - N Syn
- National University of Singapore, Singapore, Singapore
| | - T T Low
- National University Heart Centre, Singapore, Singapore
| | - R Wong
- National University Heart Centre, Singapore, Singapore
| | - J Yip
- National University Heart Centre, Singapore, Singapore
| | - M S Siddiqui
- Virginia Commonwealth University, Division of Gastroenterology and Hepatology, Richmond, United States of America
| | - M Muthiah
- National University Hospital, Division of Gastroenterology and Hepatology, Singapore, Singapore
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16
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Hwang EJ, Lee JS, Lee JH, Lim WH, Kim JH, Choi KS, Choi TW, Kim TH, Goo JM, Park CM. Deep Learning for Detection of Pulmonary Metastasis on Chest Radiographs. Radiology 2021; 301:455-463. [PMID: 34463551 DOI: 10.1148/radiol.2021210578] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background A computer-aided detection (CAD) system may help surveillance for pulmonary metastasis at chest radiography in situations where there is limited access to CT. Purpose To evaluate whether a deep learning (DL)-based CAD system can improve diagnostic yield for newly visible lung metastasis on chest radiographs in patients with cancer. Materials and Methods A regulatory-approved CAD system for lung nodules was implemented to interpret chest radiographs from patients referred by the medical oncology department in clinical practice. In this retrospective diagnostic cohort study, chest radiographs interpreted with assistance from a CAD system after the implementation (January to April 2019, CAD-assisted interpretation group) and those interpreted before the implementation (September to December 2018, conventional interpretation group) of the CAD system were consecutively included. The diagnostic yield (frequency of true-positive detections) and false-referral rate (frequency of false-positive detections) of formal reports of chest radiographs for newly visible lung metastasis were compared between the two groups using generalized estimating equations. Propensity score matching was performed between the two groups for age, sex, and primary cancer. Results A total of 2916 chest radiographs from 1521 patients (1546 men, 1370 women; mean age, 62 years) and 5681 chest radiographs from 3456 patients (2941 men, 2740 women; mean age, 62 years) were analyzed in the CAD-assisted interpretation and conventional interpretation groups, respectively. The diagnostic yield for newly visible metastasis was higher in the CAD-assisted interpretation group (0.86%, 25 of 2916 [95% CI: 0.58, 1.3] vs 0.32%, 18 of 568 [95% CI: 0.20, 0.50%]; P = .004). The false-referral rate in the CAD-assisted interpretation group (0.34%, 10 of 2916 [95% CI: 0.19, 0.64]) was not inferior to that in the conventional interpretation group (0.25%, 14 of 5681 [95% CI: 0.15, 0.42]) at the noninferiority margin of 0.5% (95% CI of difference: -0.15, 0.35). Conclusion A deep learning-based computer-aided detection system improved the diagnostic yield for newly visible metastasis on chest radiographs in patients with cancer with a similar false-referral rate. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Eui Jin Hwang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Jeong Su Lee
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Jong Hyuk Lee
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Woo Hyeon Lim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Jae Hyun Kim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Kyu Sung Choi
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Tae Won Choi
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Tae-Hyung Kim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Jin Mo Goo
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Chang Min Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
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17
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Wong C, Lim WH, Jain SR, Ng CH, Tai CH, Devi MK, Samarasekera DD, Iyer SG, Chong CS. 46 The Hidden Truth About Gender Bias in Surgery. A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Gender discrimination remains pervasive in surgery, significantly impacting current and future surgeons and population health. This study analyses the gender barriers and critical retention factors for female surgeons and trainees in surgery.
Method
Five electronic databases were searched till May 2020. Titles and abstracts were sieved, followed by a full text review. Data synthesis and inductive thematic analysis were conducted using the Thomas and Harden methodology.
Result
14 articles were included, involving 528 participants. Four themes were generated–unfavourable working environment, male-dominated culture, societal pressures and progress towards gender equality. Females in surgery often faced harassment, disrespect and perceptions of incompetence, resulting in hostile work conditions, which were aggravated by the inadequate support and mentorship. The persistence of male-dominated cultures was observed, with females facing prejudice and exclusion from professional and social circles. Differential treatment and higher expectations of female surgeons also arose from entrenched societal pressures. Despite these, increased acceptance of motherhood and greater recognition of contributions by female surgeons were reported, indicating some progress in gendered culture.
Conclusions
There is a need to increase female surgical leadership and allocate resources to address the deep-rooted causes of biased surgical culture and ingrained perceptions, to achieve greater gender equality in surgery.
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Affiliation(s)
- C Wong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - S R Jain
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - C H Tai
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - M K Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - D D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S G Iyer
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Liver Transplantation, National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - C S Chong
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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18
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Ng CH, Jain SR, Ow ZGW, Lim WH, Tham HY, Wong NW, Chong CS, Foo FJ. 20 Post-Operative Biologics and the Rate of Recurrence in Crohn’s Disease. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Post-operative recurrence after Crohn’s surgery poses a significant challenge to clinicians with an estimated of 70-90% recurrence rate. However, with the advent of biologics, reduction of recurrence after surgery has been observed in various landmark trials. Hence, we aim to quantify the rate of recurrence with post-operative biologics.
Method
Searches were done on Embase and Medline database for articles using biologics for post-operative management. A single arm meta-analysis with generalized linear mixed model and Clopper-Pearson method confidence interval was applied in the synthesis of the data on six months, one year, two year and five year.
Results
A total of 1,864 abstracts were identified, with a final total of 24 articles and 1042 patients were included in the meta-analysis. The one-year rate of recurrence for surgical, endoscopic and clinical was 3.08% (CI: 0.74% - 11.95%), 19.93% (15.81% - 24.81%) and 13.06% (CI: 8.18% - 18.92%) respectively. Correspondingly, the five-year recurrence 16.90% (CI: 9.57% - 28.11%), 84.21% (CI: 72.35% - 91.57%), 5.60% (CI: 9.92% -23.66%) respectively.
Conclusions
An observed reduction in surgical rates was reduced at five years with post-operative Crohn’s disease with biologics. Biologics therapy thus can be considered as a suitable alternative for reducing post-operative recurrence in individuals with higher risk.
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Affiliation(s)
- C H Ng
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - S R Jain
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Z G W Ow
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - N W Wong
- National University Hospital, Singapore, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - F J Foo
- Sengkang General Hospital, Singapore, Singapore
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19
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Tay PWL, Xiao JL, Lim WH, Wong NW, Chong CS. 207 Laparoscopic versus Open Surgery for Locally Advanced Colon Cancer: A Retrospective Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
While an increasing number of studies substantiate the non-inferiority of laparoscopy to open surgery for pT4 colon cancer, studies investigating its value specific to the subgroup pT4a in right hemicolectomies remain scarce.
Method
We performed a retrospective cohort analysis in National University Hospital of Singapore of patients who underwent a right hemicolectomy for pT4 colon cancer. Statistical analysis was performed using Wilcoxon rank sum test and chi square/fisher exact.
Results
In total, 65 patients had T4 colon cancer. 55 underwent right hemicolectomy and 10 underwent extended right hemicolectomy. Baseline demographics were similar in laparoscopic (n = 27) and open (n = 38) groups, with no significant difference in proportion of pT4a patients (p = 0.724). For pT4, 30-day mortality (7%, 5% respectively, p = 0.723), overall survival (p = 0.1903) and disease-free survival (p = 0.3476) did not differ significantly between laparoscopic and open groups. R0 resection rates were significantly higher in laparoscopic group (p = 0.039). pT4a subgroup analysis found similar observations. Other complications including postoperative wound infection and anastomotic bleed were not significantly different for both T4 and T4a analysis.
Conclusions
This study presented comparable safety and oncological outcomes between the two surgical methods for right hemicolectomy, suggesting laparoscopy to be a viable alternative approach for locally advanced right colon cancer.
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Affiliation(s)
- P W L Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J L Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - N W Wong
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore, Singapore, Singapore
| | - C S Chong
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore, Singapore, Singapore
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20
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Ng CH, Chin YH, Nistala KRY, Jain SR, Ow ZGW, Wong NW, Tham HY, Lim WH, Chong CS. 189 Preliminary Results from an Innovative Surgical Research Group for Medical Students. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Learning research in medical school can be daunting and difficult with many lacking appropriate guidance. Particularly, research in surgery can be difficult with most clinicians tied to long hours from clinical duties, leaving medical students lost to learn the ropes for medical research.
Method
We started a surgical research group in January of 2020 under a shepherd sheep model. Shepards were senior medical students who had previous experience in research and were provided resources from consultants on statistics and research designs. Thereafter, each Shepard were paired with junior medical students (sheep) and a resident to provide clinical background. Research was then carried out small teams with minimal guidance from consultants.
Results
To date, the group has published 11 articles (median impact factor: 2.41, range: 1.89 - 3.42), 3 articles in revision and 9 articles in review.
Conclusions
We provide preliminary evidence of a successful model for building medical student research in surgery. While current analysis was limited to meta-analysis and systematic review due to the availability of data, current expansion is currently underway to expand to observational studies.
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Affiliation(s)
- C H Ng
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - K R Y Nistala
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - S R Jain
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Z G W Ow
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - N W Wong
- National University Hospital, Singapore, Singapore
| | - H Y Tham
- National University Hospital, Singapore, Singapore
| | - W H Lim
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, Singapore, Singapore
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21
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Kim H, Goo JM, Kim TJ, Kim HY, Gu G, Gil B, Kim W, Park SY, Park J, Park J, Park H, Song W, Shin KE, Oh J, Yoon SH, Lee S, Lee Y, Lim WH, Jeong WG, Jung JI, Cha MJ, Choi S, In Choi H, Ham SY, Kim Y. Effectiveness of radiologist training in improving reader agreement for Lung-RADS 4X categorization. Eur Radiol 2021; 31:8147-8159. [PMID: 33884472 DOI: 10.1007/s00330-021-07990-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/11/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To identify the agreement on Lung CT Screening Reporting and Data System 4X categorization between radiologists and an expert-adjudicated reference standard and to investigate whether training led to improvement of the agreement measures and diagnostic potential for lung cancer. METHODS Category 4 nodules in the Korean Lung Cancer Screening Project were identified retrospectively, and each 4X nodule was matched with one 4A or 4B nodule. An expert panel re-evaluated the categories and determined the reference standard. Nineteen radiologists were asked to determine the presence of CT features of malignancy and 4X categorization for each nodule. A review was performed in two sessions, and training material was given after session 1. Agreement on 4X categorization between radiologists and the expert-adjudicated reference standard and agreement between radiologist-assessed 4X categorization and lung cancer diagnosis were evaluated. RESULTS The 48 expert-adjudicated 4X nodules and 64 non-4X nodules were evenly distributed in each session. The proportion of category 4X decreased after training (56.4% ± 16.9% vs. 33.4% ± 8.0%; p < 0.001). Cohen's κ indicated poor agreement (0.39 ± 0.16) in session 1, but agreement improved in session 2 (0.47 ± 0.09; p = 0.03). The increase in agreement in session 2 was observed among inexperienced radiologists (p < 0.05), and experienced and inexperienced reviewers exhibited comparable agreement performance in session 2 (p > 0.05). All agreement measures between radiologist-assessed 4X categorization and lung cancer diagnosis increased in session 2 (p < 0.05). CONCLUSION Radiologist training can improve reader agreement on 4X categorization, leading to enhanced diagnostic performance for lung cancer. KEY POINTS • Agreement on 4X categorization between radiologists and an expert-adjudicated reference standard was initially poor, but improved significantly after training. • The mean proportion of 4X categorization by 19 radiologists decreased from 56.4% ± 16.9% in session 1 to 33.4% ± 8.0% in session 2. • All agreement measures between the 4X categorization and lung cancer diagnosis increased significantly in session 2, implying that appropriate training and guidance increased the diagnostic potential of category 4X.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea. .,Cancer Research Institute, Seoul National University, Seoul, South Korea.
| | - Tae Jung Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Guanmin Gu
- Pohang St. Mary's Hospital, Pohang, South Korea
| | - Bomi Gil
- Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Wooil Kim
- Asan Medical Center, Seoul, South Korea
| | | | - Junghoan Park
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Juil Park
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | | | | | - Kyung Eun Shin
- SoonChunHyang University Bucheon Hospital, Bucheon, South Korea
| | - Jiseon Oh
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Sung Hyun Yoon
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - Youkyung Lee
- Hanyang University Guri Hospital, Guri, South Korea
| | - Woo Hyeon Lim
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Won Gi Jeong
- Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Jung Im Jung
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Min Jae Cha
- Chung-Ang University Hospital, Seoul, South Korea
| | - Sinae Choi
- Wesarang Internal Medicine Clinic, Jeonju, South Korea
| | - Hyoung In Choi
- Korean Armed Forces Capital Hospital, Seongnam, South Korea
| | - Soo-Youn Ham
- Sungkyunkwan University Kangbuk Samsung Hospital, Seoul, South Korea
| | - Yeol Kim
- National Cancer Center, Goyang, South Korea
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22
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Park SJ, Yoon JH, Lee DH, Lim WH, Lee JM. Tumor Stiffness Measurements on MR Elastography for Single Nodular Hepatocellular Carcinomas Can Predict Tumor Recurrence After Hepatic Resection. J Magn Reson Imaging 2020; 53:587-596. [PMID: 32914909 DOI: 10.1002/jmri.27359] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Tumor stiffness (TS), measured by magnetic resonance elastography (MRE), could be associated with tumor mechanical properties and tumor grade. PURPOSE To determine whether TS obtained using MRE is associated with survival in patients with single nodular hepatocellular carcinoma (HCC) after hepatic resection (HR). STUDY TYPE Retrospective. POPULATION In all, 95 patients with pathologically confirmed HCCs. FIELD STRENGTH/SEQUENCE 1.5T/3D spin-echo echo-planar imaging MRE. ASSESSMENT TS values of the whole tumor (TS-WT) and of a solid portion of the tumor (TS-SP) after excluding the necrotic area were measured on stiffness maps. Known imaging prognostic factors of HCC were also analyzed. After surgery, pathologic findings were evaluated from resected pathology specimens. STATISTICAL TESTS Fisher's exact test and the Mann-Whitney U-test were performed to determine the significance of differences according to the tumor grade. Overall survival (OS) / recurrence-free survival (RFS) analyses were performed using Kaplan-Meier analyses and Cox multivariable models. RESULTS The average TS-WT was 2.14 ± 0.74 kPa, and the average TS-SP was 2.51 ± 1.07 kPa. The cumulative incidence of RFS was 73.1%, 63.1%, and 57.3% at 1, 3, and 5 years, respectively. The TS-WT, TS-SP, and tumor size (≥5 cm) were significant prognostic factors for RFS (P < 0.001; P < 0.001; P = 0.017, respectively). The estimated overall 1-, 3-, and 5-year survival rates were 95.7%, 86.9%, and 80.8%, respectively. The alpha-fetoprotein changes, platelets, tumor size (≥5 cm), and vascular invasion in pathology were significant predictive factors for overall survival (all P < 0.05). Tumor necrosis, TS-WT, TS-SP, and vascular invasion in pathology were significantly correlated with poorly differentiated HCC (all P < 0.05). DATA CONCLUSION The TS-WT, TW-SP, and tumor size (≥5 cm) were significant predictive factors of RFS after HR in patients with HCC. Level of Evidence Technical Efficacy Stage 5 J. MAGN. RESON. IMAGING 2021;53:587-596.
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Affiliation(s)
- Sae-Jin Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Woo Hyeon Lim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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23
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Lim WH, Choi YH, Park JE, Cho YJ, Lee S, Cheon JE, Kim WS, Kim IO, Kim JH. Application of Vendor-Neutral Iterative Reconstruction Technique to Pediatric Abdominal Computed Tomography. Korean J Radiol 2020; 20:1358-1367. [PMID: 31464114 PMCID: PMC6715563 DOI: 10.3348/kjr.2018.0715] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/05/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To compare image qualities between vendor-neutral and vendor-specific hybrid iterative reconstruction (IR) techniques for abdominopelvic computed tomography (CT) in young patients. Materials and Methods In phantom study, we used an anthropomorphic pediatric phantom, age-equivalent to 5-year-old, and reconstructed CT data using traditional filtered back projection (FBP), vendor-specific and vendor-neutral IR techniques (ClariCT; ClariPI) in various radiation doses. Noise, low-contrast detectability and subjective spatial resolution were compared between FBP, vendor-specific (i.e., iDose1 to 5; Philips Healthcare), and vendor-neutral (i.e., ClariCT1 to 5) IR techniques in phantom. In 43 patients (median, 14 years; age range 1–19 years), noise, contrast-to-noise ratio (CNR), and qualitative image quality scores of abdominopelvic CT were compared between FBP, iDose level 4 (iDose4), and ClariCT level 2 (ClariCT2), which showed most similar image quality to clinically used vendor-specific IR images (i.e., iDose4) in phantom study. Noise, CNR, and qualitative imaging scores were compared using one-way repeated measure analysis of variance. Results In phantom study, ClariCT2 showed noise level similar to iDose4 (14.68–7.66 Hounsfield unit [HU] vs. 14.78–6.99 HU at CT dose index volume range of 0.8–3.8 mGy). Subjective low-contrast detectability and spatial resolution were similar between ClariCT2 and iDose4. In clinical study, ClariCT2 was equivalent to iDose4 for noise (14.26–17.33 vs. 16.01–18.90) and CNR (3.55–5.24 vs. 3.20–4.60) (p > 0.05). For qualitative imaging scores, the overall image quality ([reader 1, reader 2]; 2.74 vs. 2.07, 3.02 vs. 2.28) and noise (2.88 vs. 2.23, 2.93 vs. 2.33) of ClariCT2 were superior to those of FBP (p < 0.05), and not different from those of iDose4 (2.74 vs. 2.72, 3.02 vs. 2.98; 2.88 vs. 2.77, 2.93 vs. 2.86) (p > 0.05). Conclusion Vendor-neutral IR technique shows image quality similar to that of clinically used vendor-specific hybrid IR technique for abdominopelvic CT in young patients.
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Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Ji Eun Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - In One Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jong Hyo Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.,Advanced Institute of Convergence Technology, Suwon, Korea
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24
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Lee JH, Lim WH, Hong JH, Nam JG, Hwang EJ, Kim H, Goo JM, Park CM. Growth and Clinical Impact of 6-mm or Larger Subsolid Nodules after 5 Years of Stability at Chest CT. Radiology 2020; 295:448-455. [PMID: 32181731 DOI: 10.1148/radiol.2020191921] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background It remains unclear whether 5 years of stability is sufficient to establish the benign behavior of subsolid nodules (SSNs) of the lung. There are no guidelines for the length of follow-up needed for these SSNs. Purpose To investigate the incidence of interval growth of pulmonary SSNs 6 mm or greater in diameter after 5 years of stability and their clinical outcome. Materials and Methods This retrospective study assessed SSNs 6 mm or greater that were stable for 5 years after detection (January 2002 to December 2018). The incidence of interval growth after 5 years of stability and the clinical and radiologic features of these SSNs were investigated. Clinical stage shifts of growing SSNs, presence of metastasis, and overall survival were assessed during the follow-up period. Subgroup analysis was performed in patients with nonenhanced thin-section (section thickness ≤1.5 mm) CT for interval growth after 5 years of stability. Results A total of 235 SSNs in 235 patients (mean age, 64 years ± 10 [standard deviation]; 132 women) were evaluated. There were 212 pure ground-glass nodules and 24 part-solid nodules. During follow-up (median, 112 months; range, 84-208 months), five of the 235 SSNs (2%; three primary ground-glass nodules and two part-solid nodules) showed interval growth. Three of these five growing SSNs were 10 mm or greater. Three of the five SSNs with interval growth had clinical stage shifts after growth (from Tis [in situ] to T1mi [minimally invasive] in one lesion; from T1mi to T1a in two lesions). There were no deaths or metastases from lung cancer during follow-up. Of 160 SSNs imaged with section thickness of 1.5 mm or less, two (1%) grew; both lesions were 10 mm or greater. Conclusion Only 2% of subsolid pulmonary nodules greater than or equal to 6 mm that had been stable for 5 years showed subsequent growth. At median follow-up of 9 years (after the initial 5-year period of stability), growth of those lung nodules had no clinical effect. © RSNA, 2020 See also the editorial by Naidich and Azour in this issue.
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Affiliation(s)
- Jong Hyuk Lee
- From the Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.L., W.H.L., J.H.H., J.G.N., E.J.H., H.K., J.M.G., C.M.P.); and Armed Forces Seoul District Hospital, Seoul, Korea (J.H.L.)
| | - Woo Hyeon Lim
- From the Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.L., W.H.L., J.H.H., J.G.N., E.J.H., H.K., J.M.G., C.M.P.); and Armed Forces Seoul District Hospital, Seoul, Korea (J.H.L.)
| | - Jung Hee Hong
- From the Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.L., W.H.L., J.H.H., J.G.N., E.J.H., H.K., J.M.G., C.M.P.); and Armed Forces Seoul District Hospital, Seoul, Korea (J.H.L.)
| | - Ju Gang Nam
- From the Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.L., W.H.L., J.H.H., J.G.N., E.J.H., H.K., J.M.G., C.M.P.); and Armed Forces Seoul District Hospital, Seoul, Korea (J.H.L.)
| | - Eui Jin Hwang
- From the Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.L., W.H.L., J.H.H., J.G.N., E.J.H., H.K., J.M.G., C.M.P.); and Armed Forces Seoul District Hospital, Seoul, Korea (J.H.L.)
| | - Hyungjin Kim
- From the Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.L., W.H.L., J.H.H., J.G.N., E.J.H., H.K., J.M.G., C.M.P.); and Armed Forces Seoul District Hospital, Seoul, Korea (J.H.L.)
| | - Jin Mo Goo
- From the Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.L., W.H.L., J.H.H., J.G.N., E.J.H., H.K., J.M.G., C.M.P.); and Armed Forces Seoul District Hospital, Seoul, Korea (J.H.L.)
| | - Chang Min Park
- From the Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.L., W.H.L., J.H.H., J.G.N., E.J.H., H.K., J.M.G., C.M.P.); and Armed Forces Seoul District Hospital, Seoul, Korea (J.H.L.)
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Kim M, Kim HL, Park KT, Lim WH, Seo JB, Kim SH, Kim MA, Zo JH. P1348 Impact of left ventricular ejection fraction and aortic valve sclerosis on cardiovascular outcome in patients with acute ischemic stroke. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Previous studies have focused on only 1 or 2 echocardiographic parameters as prognostic marker in patients with acute ischemic stroke (AIS).
Purpose
Various echocardiographic parameters in the same patient were systemically evaluated for their prognostic significance in AIS.
Methods
A total of 900 patients with AIS who underwent transthoracic echocardiography (TTE) (72.6 ± 12.0 years and 60% male) were retrospectively reviewed. Composite events including all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and coronary revascularization were assessed during clinical follow-up.
Results
During a median follow-up of 3.3 years (interquartile range, 0.6-5.1 years), there were 151 (16.8%) composite events. Univariable analyses showed that low left ventricular ejection fraction (LVEF) (< 60%), increased peak tricuspid regurgitation (TR) velocity (> 2.8 m/s) and aortic valve (AV) sclerosis were associated with composite events (P < 0.05 for each). In the multivariable analyses after controlling for potential confounders, LVEF < 60% (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.30-2.77; P = 0.001) and AV sclerosis (HR, 1.56; 95% CI, 1.10-2.21; P = 0.013) were independent prognostic factors associated with composite events. Multivariable analysis showed that HR for composite events gradually increased according to LVEF and AV sclerosis: HR was 2.8-fold higher in the highest-risk group than in the lowest group (P = 0.001).
Conclusions
In patients with AIS, LVEF < 60% and the presence of AV sclerosis predicts the future vascular events. Patients with AIS exhibiting reduced LVEF and AV sclerosis may benefit from aggressive secondary prevention
Abstract P1348 Figure. COX plot for composite event
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Affiliation(s)
- M Kim
- Boramae Hospital, Seoul, Korea (Republic of)
| | - H L Kim
- Boramae Hospital, Seoul, Korea (Republic of)
| | - K T Park
- Boramae Hospital, Seoul, Korea (Republic of)
| | - W H Lim
- Boramae Hospital, Seoul, Korea (Republic of)
| | - J B Seo
- Boramae Hospital, Seoul, Korea (Republic of)
| | - S H Kim
- Boramae Hospital, Seoul, Korea (Republic of)
| | - M A Kim
- Boramae Hospital, Seoul, Korea (Republic of)
| | - J H Zo
- Boramae Hospital, Seoul, Korea (Republic of)
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Hwang EJ, Nam JG, Lim WH, Park SJ, Jeong YS, Kang JH, Hong EK, Kim TM, Goo JM, Park S, Kim KH, Park CM. Deep Learning for Chest Radiograph Diagnosis in the Emergency Department. Radiology 2019; 293:573-580. [DOI: 10.1148/radiol.2019191225] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Eui Jin Hwang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Ju Gang Nam
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Woo Hyeon Lim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Sae Jin Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Yun Soo Jeong
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Ji Hee Kang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Eun Kyoung Hong
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Taek Min Kim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Jin Mo Goo
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Sunggyun Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Ki Hwan Kim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
| | - Chang Min Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.G.N., W.H.L., S.J.P., Y.S.J., J.H.K., E.K.H., T.M.K., J.M.G., C.M.P.); and Lunit, Seoul, Korea (S.P., K.H.K.)
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Lewis JR, Brennan-Speranza TC, Levinger I, Byrnes E, Lim EM, Blekkenhorst LC, Sim M, Hodgson JM, Zhu K, Lim WH, Adams LA, Prince RL. Effects of calcium supplementation on circulating osteocalcin and glycated haemoglobin in older women. Osteoporos Int 2019; 30:2065-2072. [PMID: 31342138 DOI: 10.1007/s00198-019-05087-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/23/2019] [Accepted: 07/09/2019] [Indexed: 01/18/2023]
Abstract
UNLABELLED One year of calcium supplementation in older women led to modest reductions in total osteocalcin and undercarboxylated osteocalcin (ucOC), with no changes in muscle or fat mass, or glycated haemoglobin. Future studies should explore whether treatments with more profound effects of suppressing ucOC may lead to impaired glycaemic control. INTRODUCTION Total osteocalcin (TOC) is a marker of bone turnover, while its undercarboxylated form has beneficial effects on glucose metabolism in mice. This post hoc analysis of a randomised double-blind, placebo-controlled trial examined whether 1 year of calcium supplementation affected circulating TOC, undercarboxylated osteocalcin (ucOC) or glycated haemoglobin (HbA1c) in 1368 older community-dwelling women (mean age 75.2 ± 2.7 years). METHODS Women enrolled in the Calcium Intake Fracture Outcome Study trial (1998-2003) were supplemented with 1.2 g/d of elemental calcium (in the form of calcium carbonate) or placebo. Circulating TOC, ucOC and HbA1c was measured at 1 year (1999). RESULTS After 1 year of calcium supplementation, TOC and ucOC levels were 17% and 22% lower compared with placebo (mean 22.7 ± 9.1 vs. 27.3 ± 10.9 μg/L and 11.1 ± 4.9 vs. 13.0 ± 5.7 μg/L, both P < 0.001). Carboxylated osteocalcin/ucOC was 6% lower after calcium supplementation (P < 0.05). Despite this, no differences in HbA1c were observed (calcium, 5.2 ± 0.6 vs. placebo, 5.3 ± 0.8%; P = 0.08). Calcium supplementation did not affect BMI, whole body lean or fat mass. In exploratory analyses, total calcium (dietary and supplemental) was inversely related to TOC and ucOC, indicating calcium intake is an important dietary determinant of osteocalcin levels. CONCLUSION One year of calcium supplementation in older women led to modest reductions in TOC and ucOC, with no changes in muscle or fat mass, or HbA1c. Future studies should explore whether treatments with more profound effects of suppressing ucOC may lead to impaired glycaemic control.
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Affiliation(s)
- J R Lewis
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
- Medical School, University of Western Australia, Perth, Australia.
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - T C Brennan-Speranza
- Department of Physiology, Bosch Institute for Medical Research, University of Sydney, Sydney, Australia
| | - I Levinger
- Institute of Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - E Byrnes
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - E M Lim
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - L C Blekkenhorst
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - M Sim
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Australia
| | - J M Hodgson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Australia
| | - K Zhu
- Medical School, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - W H Lim
- Medical School, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - L A Adams
- Medical School, University of Western Australia, Perth, Australia
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - R L Prince
- Medical School, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
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Chung JH, Kim HL, Lim WH, Kim MA, Kim SH. P5392Statin intensity and new onset diabetes mellitus in patients undergoing percutaneous coronary intervention with drug-eluting stents. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J H Chung
- National Medical Center, Cardiology, Internal Medicine, Seoul, Korea Republic of
| | - H L Kim
- Boramae Hospital, Internal Medicine, Cardiology, sSeoul, Korea Republic of
| | - W H Lim
- Boramae Hospital, Internal Medicine, Cardiology, sSeoul, Korea Republic of
| | - M A Kim
- Boramae Hospital, Internal Medicine, Cardiology, sSeoul, Korea Republic of
| | - S H Kim
- Boramae Hospital, Internal Medicine, Cardiology, sSeoul, Korea Republic of
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Kim H, Park CM, Jeon S, Lee JH, Ahn SY, Yoo RE, Lim HJ, Park J, Lim WH, Hwang EJ, Lee SM, Goo JM. Validation of prediction models for risk stratification of incidentally detected pulmonary subsolid nodules: a retrospective cohort study in a Korean tertiary medical centre. BMJ Open 2018; 8:e019996. [PMID: 29794091 PMCID: PMC5988095 DOI: 10.1136/bmjopen-2017-019996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To validate the performances of two prediction models (Brock and Lee models) for the differentiation of minimally invasive adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IPA) from preinvasive lesions among subsolid nodules (SSNs). DESIGN A retrospective cohort study. SETTING A tertiary university hospital in South Korea. PARTICIPANTS 410 patients with 410 incidentally detected SSNs who underwent surgical resection for the pulmonary adenocarcinoma spectrum between 2011 and 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Using clinical and radiological variables, the predicted probability of MIA/IPA was calculated from pre-existing logistic models (Brock and Lee models). Areas under the receiver operating characteristic curve (AUCs) were calculated and compared between models. Performance metrics including sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were also obtained. RESULTS For pure ground-glass nodules (n=101), the AUC of the Brock model in differentiating MIA/IPA (59/101) from preinvasive lesions (42/101) was 0.671. Sensitivity, specificity, accuracy, PPV and NPV based on the optimal cut-off value were 64.4%, 64.3%, 64.4%, 71.7% and 56.3%, respectively. Sensitivity, specificity, accuracy, PPV and NPV according to the Lee criteria were 76.3%, 42.9%, 62.4%, 65.2% and 56.3%, respectively. AUC was not obtained for the Lee model as a single cut-off of nodule size (≥10 mm) was suggested by this model for the assessment of pure ground-glass nodules. For part-solid nodules (n=309; 26 preinvasive lesions and 283 MIA/IPAs), the AUC was 0.746 for the Brock model and 0.771 for the Lee model (p=0.574). Sensitivity, specificity, accuracy, PPV and NPV were 82.3%, 53.8%, 79.9%, 95.1% and 21.9%, respectively, for the Brock model and 77.0%, 69.2%, 76.4%, 96.5% and 21.7%, respectively, for the Lee model. CONCLUSIONS The performance of prediction models for the incidentally detected SSNs in differentiating MIA/IPA from preinvasive lesions might be suboptimal. Thus, an alternative risk calculation model is required for the incidentally detected SSNs.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Sunkyung Jeon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Su Yeon Ahn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Hyun-Ju Lim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Juil Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Hyeon Lim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Cancer Research Institute, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Lim WH, Shin CI, Chang JM, Sohn CH, Park CM. Critical Test Result Notification via Mobile Phone-Based Automated Text Message System in the Radiologic Field: Single Institutional Experience. J Am Coll Radiol 2018; 15:973-979. [PMID: 29606633 DOI: 10.1016/j.jacr.2018.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/09/2018] [Accepted: 02/22/2018] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the feasibility of sharing critical test result (CTR) notifications (CTRNs) via automated text messaging. MATERIALS AND METHODS CTRNs via automated text messaging was used to notify physicians of CTRs in a tertiary hospital with 1,786 beds. From June 2016 to September 2016, notifications for 545 CTRs were given via a CTRN system. Among them, 490 CTRs (292 male and 198 female patients; mean age, 53.6 years old [range, 1-88]) were included in analysis. CTR levels (CTRLs) were assigned to four categories (CTRL1 to CTRL3 and unclassified) when reported, and reclassified into three CTRLs according to their clinical relevance and urgency. Response time was defined as time lapse between CTR reporting and documentation by physicians. Analysis of variance was performed to compare response times according to CTRLs and patients' location. RESULTS Corresponding actions were taken in 404 of 490 cases (82.4%) without any delayed CTRN-related morbidity. There were 15 CTRL1 (3.1%), 50 CTRL2 (10.2%), 112 CTRL3 (22.9%) cases, and the remaining 313 CTRL cases were unclassified. After reclassification, CTRL1, CTRL2, and CTRL3 were 81 (16.5%), 177 (36.1%), and 232 cases (47.3%), respectively. Response time of reclassified CTRL3 was significantly longer than that of reclassified CTRL1 (median 23.0, [interquartile range 2.0-133.5] hours versus 4.0 [0.0-22.0] hours; P < .001). Response time of outpatient cases (80.0 [6.0 to 157.0] hours) was significantly longer (P < .001) than those of inpatient (3.0 [0.0-16.0]) and emergency department cases (5.0 [1.0-21.0]). CONCLUSION Automated text messaging could be a feasible option for CTRNs in the radiologic field. Further large-scale investigations regarding efficiency of this system are warranted.
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Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheong-Il Shin
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Lim WH, Choi SH, Yoo RE, Kang KM, Yun TJ, Kim JH, Sohn CH. Does radiation therapy increase gadolinium accumulation in the brain?: Quantitative analysis of T1 shortening using R1 relaxometry in glioblastoma multiforme patients. PLoS One 2018; 13:e0192838. [PMID: 29444157 PMCID: PMC5812640 DOI: 10.1371/journal.pone.0192838] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/31/2018] [Indexed: 11/18/2022] Open
Abstract
Objective This study evaluated the possibility of accelerated gadolinium accumulation in irradiated brain parenchyma where the blood-brain barrier was weakened. Methods From January 2010 to June 2015, 44 patients with supratentorial glioblastoma were retrospectively identified who underwent pre- and post-radiation brain MR imaging, including R1 mapping. The mean dose of administered gadobutrol (Gadovist, Bayer, Germany) was 5.1 vials. Regions of interest (ROIs) were drawn around tumors that were located within 50–100% iso-dose lines of maximum radiation dose. ROIs were also drawn at globus pallidus, thalamus, and cerebral white matter. Averages of R1 values (unit: s-1) before and after radiation and those of R1 ratio (post-radiation R1 / pre-radiation R1) were compared by t-test or rank sum test as appropriate. Multiple linear regression analysis was performed to evaluate independent association factors for R1 value increase at irradiated parenchyma. Results The mean R1 values in peri-tumoral areas were significantly increased after radiotherapy (0.7901±0.0977 [mean±SD] vs. 0.8146±0.1064; P <.01). The mean R1 ratio of high radiation dose areas was significantly higher than that of low dose areas (1.0055±0.0654 vs. 0.9882±0.0642; P <.01). The mean R1 ratio was lower in those who underwent hypofractionated radiotherapy (mean dose, 45.0 Gy) than those who underwent routine radiotherapy (mean dose, 61.1 Gy) (0.9913±0.0740 vs. 1.0463±0.0633; P = .08). Multiple linear regression analysis revealed that only radiotherapy type was significantly associated with increased R1 (P = .02) around tumors. Conclusions Radiotherapy can induce R1 value increase in the brain parenchyma, which might suggest accelerated gadolinium accumulation due to damage to the blood-brain barrier.
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Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul National University, Seoul, Korea
- School of Chemical and Biological Engineering, Seoul National University, Seoul, Korea
- * E-mail:
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Lim TK, Chee CB, Chow P, Chua GSW, Eng SK, Goh SK, Kng KK, Lim WH, Ng TP, Ong TH, Seah STA, Tan HY, Tee KH, Palanichamy V, Yeung MT. Ministry of Health Clinical Practice Guidelines: Chronic Obstructive Pulmonary Disease. Singapore Med J 2018; 59:76-86. [DOI: 10.11622/smedj.2018015] [Citation(s) in RCA: 8] [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: 11/18/2022]
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Nam JG, Kang KM, Choi SH, Lim WH, Yoo RE, Kim JH, Yun TJ, Sohn CH. Comparison between the Prebolus T1 Measurement and the Fixed T1 Value in Dynamic Contrast-Enhanced MR Imaging for the Differentiation of True Progression from Pseudoprogression in Glioblastoma Treated with Concurrent Radiation Therapy and Temozolomide Chemotherapy. AJNR Am J Neuroradiol 2017; 38:2243-2250. [PMID: 29074633 DOI: 10.3174/ajnr.a5417] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Glioblastoma is the most common primary brain malignancy and differentiation of true progression from pseudoprogression is clinically important. Our purpose was to compare the diagnostic performance of dynamic contrast-enhanced pharmacokinetic parameters using the fixed T1 and measured T1 on differentiating true from pseudoprogression of glioblastoma after chemoradiation with temozolomide. MATERIALS AND METHODS This retrospective study included 37 patients with histopathologically confirmed glioblastoma with new enhancing lesions after temozolomide chemoradiation defined as true progression (n = 15) or pseudoprogression (n = 22). Dynamic contrast-enhanced pharmacokinetic parameters, including the volume transfer constant, the rate transfer constant, the blood plasma volume per unit volume, and the extravascular extracellular space per unit volume, were calculated by using both the fixed T1 of 1000 ms and measured T1 by using the multiple flip-angle method. Intra- and interobserver reproducibility was assessed by using the intraclass correlation coefficient. Dynamic contrast-enhanced pharmacokinetic parameters were compared between the 2 groups by using univariate and multivariate analysis. The diagnostic performance was evaluated by receiver operating characteristic analysis and leave-one-out cross validation. RESULTS The intraclass correlation coefficients of all the parameters from both T1 values were fair to excellent (0.689-0.999). The volume transfer constant and rate transfer constant from the fixed T1 were significantly higher in patients with true progression (P = .048 and .010, respectively). Multivariate analysis revealed that the rate transfer constant from the fixed T1 was the only independent variable (OR, 1.77 × 105) and showed substantial diagnostic power on receiver operating characteristic analysis (area under the curve, 0.752; P = .002). The sensitivity and specificity on leave-one-out cross validation were 73.3% (11/15) and 59.1% (13/20), respectively. CONCLUSIONS The dynamic contrast-enhanced parameter of rate transfer constant from the fixed T1 acted as a preferable marker to differentiate true progression from pseudoprogression.
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Affiliation(s)
- J G Nam
- From the Department of Radiology (J.G.N., K.M.K., S.H.C., W.H.L., R.-E.Y., J.-H.K., T.J.Y., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - K M Kang
- From the Department of Radiology (J.G.N., K.M.K., S.H.C., W.H.L., R.-E.Y., J.-H.K., T.J.Y., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - S H Choi
- From the Department of Radiology (J.G.N., K.M.K., S.H.C., W.H.L., R.-E.Y., J.-H.K., T.J.Y., C.-H.S.), Seoul National University Hospital, Seoul, Korea
- Center for Nanoparticle Research, Institute for Basic Science (S.H.C., C.-H.S.)
- School of Chemical and Biological Engineering (S.H.C.), Seoul National University, Seoul, Korea
| | - W H Lim
- From the Department of Radiology (J.G.N., K.M.K., S.H.C., W.H.L., R.-E.Y., J.-H.K., T.J.Y., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - R-E Yoo
- From the Department of Radiology (J.G.N., K.M.K., S.H.C., W.H.L., R.-E.Y., J.-H.K., T.J.Y., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - J-H Kim
- From the Department of Radiology (J.G.N., K.M.K., S.H.C., W.H.L., R.-E.Y., J.-H.K., T.J.Y., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - T J Yun
- From the Department of Radiology (J.G.N., K.M.K., S.H.C., W.H.L., R.-E.Y., J.-H.K., T.J.Y., C.-H.S.), Seoul National University Hospital, Seoul, Korea
| | - C-H Sohn
- From the Department of Radiology (J.G.N., K.M.K., S.H.C., W.H.L., R.-E.Y., J.-H.K., T.J.Y., C.-H.S.), Seoul National University Hospital, Seoul, Korea
- Center for Nanoparticle Research, Institute for Basic Science (S.H.C., C.-H.S.)
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Lim WH, Park CM, Yoon SH, Lim HJ, Hwang EJ, Lee JH, Goo JM. Time-dependent analysis of incidence, risk factors and clinical significance of pneumothorax after percutaneous lung biopsy. Eur Radiol 2017; 28:1328-1337. [PMID: 28971242 DOI: 10.1007/s00330-017-5058-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 06/25/2017] [Revised: 08/22/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the time-dependent incidence, risk factors and clinical significance of percutaneous lung biopsy (PLB)-related pneumothorax. METHODS From January 2012-November 2015, 3,251 patients underwent 3,354 cone-beam CT-guided PLBs for lung lesions. Cox, logistic and linear regression analyses were performed to identify time-dependent risk factors of PLB-related pneumothorax, risk factors of drainage catheter insertion and those of prolonged catheter placement, respectively. RESULTS Pneumothorax occurred in 915/3,354 PLBs (27.3 %), with 230/915 (25.1 %) occurring during follow-ups. Risk factors for earlier occurrence of PLB-related pneumothorax include emphysema (HR=1.624), smaller target (HR=0.922), deeper location (HR=1.175) and longer puncture time (HR=1.036), while haemoptysis (HR=0.503) showed a protective effect against earlier development of pneumothorax. Seventy-five cases (8.2 %) underwent chest catheter placement. Mean duration of catheter placement was 3.2±2.0 days. Emphysema (odds ratio [OR]=2.400) and longer puncture time (OR=1.053) were assessed as significant risk factors for catheter insertion, and older age (parameter estimate=1.014) was a predictive factor for prolonged catheter placement. CONCLUSION PLB-related pneumothorax occurred in 27.3 %, of which 25.1 % developed during follow-ups. Smaller target size, emphysema, deeply-located lesions were significant risk factors of PLB-related pneumothorax. Emphysema and older age were related to drainage catheter insertion and prolonged catheter placement, respectively. KEY POINTS • One-fourth of percutaneous lung biopsy (PLB)-related pneumothorax occurs during follow-up. • Smaller, deeply-located target and emphysema lead to early occurrence of pneumothorax. • Emphysema is related to drainage catheter insertion for PLB-related pneumothorax. • Older age may lead to prolonged catheter placement for PLB-related pneumothorax. • Tailored management can be possible with time-dependent information of PLB-related pneumothorax.
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Affiliation(s)
- Woo Hyeon Lim
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Hyun-Ju Lim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Wong G, Au E, Badve SV, Lim WH. Breast Cancer and Transplantation. Am J Transplant 2017; 17:2243-2253. [PMID: 28544474 DOI: 10.1111/ajt.14368] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 12/13/2016] [Revised: 04/12/2017] [Accepted: 05/04/2017] [Indexed: 01/25/2023]
Abstract
Breast cancer is an important cancer among solid organ transplant recipients. While the incidence of breast cancer in solid organ transplant recipients is comparable to the age-matched general population, the outcomes are generally poor. Interventions such as cancer screening that preclude the development of late-stage disease through early detection are not well studied, and clinical practice guidelines for cancer screening rely solely on recommendations from the general population. Among patients with a prior breast cancer history, disease recurrence after transplantation is a rare but fearful event. Once disease recurs, the risk of death is high. The focus of this review is to present the epidemiology of breast cancer in solid organ transplant recipients, screening and preventive strategies for those who may be at risk, novel genomic profiling for determining tumor progression, and the newer targeted interventions for recipients who have developed breast cancers after solid organ transplantation.
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Affiliation(s)
- G Wong
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - E Au
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - S V Badve
- Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia
| | - W H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Krishnan AR, Wong G, Chapman JR, Coates PT, Russ GR, Pleass H, Russell C, He B, Lim WH. Prolonged Ischemic Time, Delayed Graft Function, and Graft and Patient Outcomes in Live Donor Kidney Transplant Recipients. Am J Transplant 2016; 16:2714-23. [PMID: 27037866 DOI: 10.1111/ajt.13817] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 09/13/2015] [Revised: 02/22/2016] [Accepted: 03/24/2016] [Indexed: 01/25/2023]
Abstract
The association between prolonged cold ischemic time (CIT) and graft and patient outcomes in live donor kidney transplant recipients remains unclear. The aims of this study were to examine the association of CIT with delayed graft function and graft loss in live donor kidney transplant recipients and those who participated in the Australian Paired Kidney Exchange program using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry. Of 3717 live donor transplant recipients between 1997 and 2012 who were followed for a median of 6.6 years (25 977 person-years), 224 (25%) experienced CIT >4-8 h. Donor age was an effect modifier between CIT and graft outcomes. In recipients who received kidneys from older donors aged >50 years, every hour of increase in CIT was associated with adjusted odds of 1.28 (95% confidence interval [CI] 1.07-1.53, p = 0.007) for delayed graft function, whereas CIT >4-8 h was associated with adjusted hazards of 1.93 (95% CI 1.21-3.09, p = 0.006) and 1.91 (95% CI 1.05-3.49, p = 0.035) for overall and death-censored graft loss, respectively, compared with CIT of 1-2 h. Attempts to reduce CIT in live donor kidney transplants involving older donor kidneys may lead to improvement of graft outcomes.
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Affiliation(s)
- A R Krishnan
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - G Wong
- Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - J R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia
| | - P T Coates
- Central and Northern Adelaide Renal and Transplantation Services, South Australia, Australia
| | - G R Russ
- Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia.,Central and Northern Adelaide Renal and Transplantation Services, South Australia, Australia
| | - H Pleass
- Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia
| | - C Russell
- Central and Northern Adelaide Renal and Transplantation Services, South Australia, Australia
| | - B He
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - W H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia.,Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia
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Chong WY, Lim WH, Yap YK, Lai CK, De La Rue RM, Ahmad H. Photo-induced reduction of graphene oxide coating on optical waveguide and consequent optical intermodulation. Sci Rep 2016; 6:23813. [PMID: 27034015 PMCID: PMC4817118 DOI: 10.1038/srep23813] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 07/07/2015] [Accepted: 03/15/2016] [Indexed: 11/24/2022] Open
Abstract
Increased absorption of transverse-magnetic (TM) - polarised light by a graphene-oxide (GO) coated polymer waveguide has been observed in the presence of transverse-electric (TE) - polarised light. The GO-coated waveguide exhibits very strong photo-absorption of TE-polarised light - and acts as a TM-pass waveguide polariser. The absorbed TE-polarised light causes a significant temperature increase in the GO film and induces thermal reduction of the GO, resulting in an increase in optical-frequency conductivity and consequently increased optical propagation loss. This behaviour in a GO-coated waveguide gives the action of an inverted optical switch/modulator. By varying the incident TE-polarised light power, a maximum modulation efficiency of 72% was measured, with application of an incident optical power level of 57 mW. The GO-coated waveguide was able to respond clearly to modulated TE-polarised light with a pulse duration of as little as 100 μs. In addition, no wavelength dependence was observed in the response of either the modulation (TE-polarised light) or the signal (TM-polarised light).
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Affiliation(s)
- W Y Chong
- Photonics Research Centre, Physics Department, Science Faculty, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - W H Lim
- Photonics Research Centre, Physics Department, Science Faculty, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Y K Yap
- Heriot-Watt University Malaysia, Putrajaya, 62200 Federal Territory, Malaysia
| | - C K Lai
- Photonics Research Centre, Physics Department, Science Faculty, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - R M De La Rue
- Optoelectronics Research Group, School of Engineering, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - H Ahmad
- Photonics Research Centre, Physics Department, Science Faculty, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Yin X, Li J, Salmon B, Huang L, Lim WH, Liu B, Hunter DJ, Ransom RC, Singh G, Gillette M, Zou S, Helms JA. Wnt Signaling and Its Contribution to Craniofacial Tissue Homeostasis. J Dent Res 2015; 94:1487-94. [PMID: 26285808 DOI: 10.1177/0022034515599772] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A new field of dental medicine seeks to exploit nature's solution for repairing damaged tissues, through the process of regeneration. Most adult mammalian tissues have limited regenerative capacities, but in lower vertebrates, the molecular machinery for regeneration is an elemental part of their genetic makeup. Accumulating data suggest that the molecular pathways responsible for the regenerative capacity of teleosts, amphibians, and reptiles have fallen into disuse in mammals but that they can be "jumpstarted" by the selective activation of key molecules. The Wnt family of secreted proteins constitutes one such critical pathway: Wnt proteins rank among the most potent and ubiquitous stem cell self-renewing factors, with tremendous potential for promoting human tissue regeneration. Wnt reporter and lineage-tracing strains of mice have been employed to create molecular maps of Wnt responsiveness in the craniofacial tissues, and these patterns of Wnt signaling colocalize with stem/progenitor populations in the rodent incisor apex, the dental pulp, the alveolar bone, the periodontal ligament, the cementum, and oral mucosa. The importance of Wnt signaling in both the maintenance and healing of these craniofacial tissues is summarized, and the therapeutic potential of Wnt-based strategies to accelerate healing through activation of endogenous stem cells is highlighted.
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Affiliation(s)
- X Yin
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - J Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - B Salmon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA Dental School, University Paris Descartes PRES Sorbonne Paris Cite, Montrouge, France; and AP-HP Odontology Department Bretonneau, Hopitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - L Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA Orthodontic Department, Stomatology Hospital of Chongqing Medical University; Chongqing Key Laboratory of Oral Disease and Biomedical Sciences; and Chongqing Municipal Key Laboratory, Chongqing, China
| | - W H Lim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - B Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - D J Hunter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - R C Ransom
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - G Singh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - M Gillette
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - S Zou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - J A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
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Lim WH, Eris J, Kanellis J, Pussell B, Wiid Z, Witcombe D, Russ GR. A systematic review of conversion from calcineurin inhibitor to mammalian target of rapamycin inhibitors for maintenance immunosuppression in kidney transplant recipients. Am J Transplant 2014; 14:2106-19. [PMID: 25088685 DOI: 10.1111/ajt.12795] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [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: 12/20/2013] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 01/25/2023]
Abstract
This was a systematic review of randomized controlled trials comparing delayed conversion of mammalian target of rapamycin inhibitors (mTORi) for calcineurin inhibitors (CNIs) versus CNI continuation in kidney transplantation. Databases (2000-2012) and conference abstracts (2009-2012) were searched giving a total of 29 trials. Outcomes analyzed included GFR, graft loss, rejection and adverse events and were expressed as weighted mean differences (WMDs) or as risk ratios (RRs). Patients converted to mTORi up to 1 year posttransplant in intention-to-treat analysis had higher GFR compared with those remaining on CNI (WMD 0.28 mL/min/1.73 m(2) , 95% confidence interval [CI] 0.21-0.36; I(2) = 68%, p < 0.001). Stratifying trials by time posttransplant or type of mTORi did not change the overall heterogeneity. For on-treatment population, mTORi was associated with higher GFR (14.21 mL/min/1.73 m(2) , 10.34-18.08; I(2) = 0%, p = 0.970) 2-5 years posttransplant. The risk of rejection at 1 year was higher in mTORi trials (RR 1.72, 1.34-2.22; I(2) = 12%, p = 0.330). Discontinuation secondary to adverse events was more common in patients on mTORi, whereas the incidence of skin cancers and cytomegalovirus infection was lower in patients on mTORi. Conversion from CNI to mTORi is associated with short-term improvements in GFR in a number of studies but longer-term follow-up data of graft and patient survival are required.
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Affiliation(s)
- W H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
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Lim WH, Yap YK, Chong WY, Pua CH, Huang NM, De La Rue RM, Ahmad H. Graphene oxide-based waveguide polariser: from thin film to quasi-bulk. Opt Express 2014; 22:11090-11098. [PMID: 24921807 DOI: 10.1364/oe.22.011090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We have demonstrated a broadband waveguide polariser with high extinction ratio on a polymer optical waveguide coated with graphene oxide via the drop-casting method. The highest extinction ratio of nearly 40 dB is measured at 1590 nm, with a variation of 4.5 dB across a wavelength range from 1530 nm to 1630 nm, a ratio that is (to our knowledge) the highest reported for graphene-based waveguide polarisers to date. This result is achieved with a graphene oxide coating length along the propagation direction of only 1.3 mm and a bulk film thickness of 2.0 µm. The underlying principles of the strongly polarisation dependent propagation loss demonstrated have been studied and are attributed to the anisotropic complex dielectric function of graphene oxide bulk film.
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Lim WH, Liu B, Cheng D, Williams BO, Mah SJ, Helms JA. Wnt signaling regulates homeostasis of the periodontal ligament. J Periodontal Res 2014; 49:751-9. [PMID: 24410666 DOI: 10.1111/jre.12158] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVE In health, the periodontal ligament maintains a constant width throughout an organism's lifetime. The molecular signals responsible for maintaining homeostatic control over the periodontal ligament are unknown. The purpose of this study was to investigate the role of Wnt signaling in this process by removing an essential chaperone protein, Wntless (Wls), from odontoblasts and cementoblasts, and observing the effects of Wnt depletion on cells of the periodontal complex. MATERIAL AND METHODS The Wnt responsive status of the periodontal complex was assessed using two strains of Wnt reporter mice: Axin2(LacZ/+) and Lgr5(LacZ/+) . The function of this endogenous Wnt signal was evaluated by conditionally eliminating the Wntless (Wls) gene using an osteocalcin Cre driver. The resulting OCN-Cre;Wls (fl/fl) mice were examined using micro-computed tomography and histology, immunohistochemical analyses for osteopontin, Runx2 and fibromodulin, in-situ hybridization for osterix and alkaline phosphatase activity. RESULTS The adult periodontal ligament is Wnt responsive. Elimination of Wnt signaling in the periodontal complex of OCN-Cre;Wls(fl/fl) mice resulted in a wider periodontal ligament space. This pathologically increased periodontal width is caused by a reduction in the expression of osteogenic genes and proteins, which results in thinner alveolar bone. A concomitant increase in fibrous tissue occupying the periodontal space was observed, along with a disruption in the orientation of the periodontal ligament. CONCLUSION The periodontal ligament is a Wnt-dependent tissue. Cells in the periodontal complex are Wnt responsive, and eliminating an essential component of the Wnt signaling network leads to a pathological widening of the periodontal ligament space. Osteogenic stimuli are reduced, and a disorganized fibrillary matrix results from the depletion of Wnt signaling. Collectively, these data underscore the importance of Wnt signaling in homeostasis of the periodontal ligament.
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Affiliation(s)
- W H Lim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA; Department of Orthodontics, School of Dentistry & Dental Research Institute, Seoul National University, Seoul, Korea
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Lim WH, Lewis JR, Wong G, Dogra GK, Zhu K, Lim EM, Dhaliwal SS, Prince RL. Five-year decline in estimated glomerular filtration rate associated with a higher risk of renal disease and atherosclerotic vascular disease clinical events in elderly women. QJM 2013; 106:443-50. [PMID: 23407347 DOI: 10.1093/qjmed/hct043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) has been demonstrated to predict atherosclerotic vascular disease (ASVD)-associated clinical events independent of traditional vascular risk factors. Recent studies have demonstrated that eGFR decline over time may improve prediction of ASVD-associated mortality risk in chronic kidney disease (CKD) patients. AIM The aim of this study is to evaluate the association between 5-year change in eGFR with renal disease and ASVD-associated clinical events. DESIGN Prospective observational study. METHODS A total of 1012 women over the age of 70 years from the Calcium Intake Fracture Outcome Study were included. Baseline characteristics including baseline and 5-year creatinine, participants' comorbidities and complete verified 10-year records for ASVD and renal disease-associated hospitalization and/or mortality were obtained using the Western Australian Data Linkage System. RESULTS Participants were stratified according to annual rate of eGFR change in quartiles [≤-1.2 (first quartile), >-1.2 to 0.1 (second quartile), >0.1-1.7 (third quartile) and >1.7 ml/min/1.73 m(2)/year (fourth quartile)]. In the adjusted model, compared with participants in the fourth quartile, those in the first and/or second quartiles of annual eGFR change had significantly higher risk of renal disease and/or ASVD-associated clinical events. However, the association with renal clinical events was more pparent in participants with baseline eGFR of <60 ml/min/1.73 m(2). CONCLUSION The results of this study suggest that the inclusion of long-term eGFR change over time might augment prognostication for renal disease and ASVD-associated clinical events in elderly women.
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Affiliation(s)
- W H Lim
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Western Australia, Australia.
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Chong WY, Lim KS, Lim WH, Harun SW, Adikan FRM, Ahmad H. Spreading profile of evaporative liquid drops in thin porous layer. Phys Rev E Stat Nonlin Soft Matter Phys 2012; 85:016314. [PMID: 22400665 DOI: 10.1103/physreve.85.016314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 10/13/2011] [Indexed: 05/31/2023]
Abstract
Spreading of evaporative liquid drops in a thin porous layer has been studied. The entire spreading process can be divided into three distinct phases according to the change of the wetted porous region size. The first phase is characterized by the expansion of the wetted porous region and shrinking of the liquid drop. Contact line pinning is observed in the wetted porous region in the second phase even with the liquid drop totally absorbed into the porous layer. The third phase sees the shrinkage of the wetted porous region until it is not observable. Based on these observations, a model is devised to simulate the spreading of a liquid drop under the studied conditions. Partial differential equations are used to describe the relation between liquid drop volume and other important parameters of a fluid flow, including maximum wetted region diameter achieved, time taken to reach each spreading process phase, and evaporation rate. Calculated results are in good agreement with the experimental data.
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Affiliation(s)
- W Y Chong
- Photonic Research Centre, Department of Physics, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Abstract
We report the demonstration of a low-disorder silicon metal-oxide-semiconductor (Si MOS) quantum dot containing a tunable number of electrons from zero to N = 27. The observed evolution of addition energies with parallel magnetic field reveals the spin filling of electrons into valley-orbit states. We find a splitting of 0.10 meV between the ground and first excited states, consistent with theory and placing a lower bound on the valley splitting. Our results provide optimism for the realisation in the near future of spin qubits based on silicon quantum dots.
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Affiliation(s)
- W H Lim
- Centre for Quantum Computation and Communication Technology, School of Electrical Engineering and Telecommunications, University of New South Wales, Sydney, NSW 2052, Australia.
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Cheong YK, Lim KS, Lim WH, Chong WY, Zakaria R, Ahmad H. Note: Fabrication of tapered fibre tip using mechanical polishing method. Rev Sci Instrum 2011; 82:086115. [PMID: 21895293 DOI: 10.1063/1.3627374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Tapered fibre tips fabricated using mechanical polishing method is studied. The fibre tips are formed by sequential polishing flat-ended single mode fibres with decreasing aluminium oxide polishing film grit size. Based on the proposed technique, tapered fibre tips with cone angle ranging from 30° to 130° are fabricated by controlling the polishing angle. Besides the variety of cone angle, considerable smoothness of the fibre tip surface may assist in good metal coating and hence a well-defined aperture can be obtained. In addition, this paper presents a two-step hybrid fabrication method combining the proposed polishing method with chemical etching method to increase the possible fibre tip cone angles achievable by chemical etching method.
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Affiliation(s)
- Y K Cheong
- Photonics Research Centre, Physics Department, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
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Lim JE, Lee SJ, Kim YJ, Lim WH, Chun YS. Comparison of cortical bone thickness and root proximity at maxillary and mandibular interradicular sites for orthodontic mini-implant placement. Orthod Craniofac Res 2009; 12:299-304. [PMID: 19840282 DOI: 10.1111/j.1601-6343.2009.01465.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare maxillary and mandibular cortical bone thickness and rootic proximity for optimal mini-implant placement. SETTING AND SAMPLE POPULATION CT images from 14 men and 14 women were used to evaluate buccal interradicular cortical bone thickness and root proximity from mesial of the central incisor to the 2nd molar. Cortical bone thickness was measured at 0 degrees , 15 degrees , 30 degrees , and 45 degrees angles relative to the root surface using three-dimensional images. RESULTS For the cortical bone thickness, there was no statistically significant difference between the maxilla and the mandible in the anterior area; however, there was a significant difference in the posterior area. Cortical bone in the maxilla, mesial and distal to canine interradicular sites, was thickest while thickness in the mandible exhibited a gradual anterior to posterior increase. Cortical bone thickness in the maxilla increased as both level and angle increased, while the cortical bone thickness in the mandible was greatest at 4 mm from the alveolar crest. Root proximity mesial and distal to 2nd premolar interradicular sites was greatest. CONCLUSION Based on our results, cortical bone thickness depends on the interradicular site rather than sex or individual differences.
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Affiliation(s)
- J E Lim
- School of Clinical Dentistry, Ewha Womans University, Seoul, Korea
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Lim WH, Toothman J, Miller JH, Tallents RH, Brouxhon SM, Olschowka ME, Kyrkanides S. IL-1beta inhibits TGFbeta in the temporomandibular joint. J Dent Res 2009; 88:557-62. [PMID: 19587162 DOI: 10.1177/0022034509336823] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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
Similarly to humans, healthy, wild-type mice develop osteoarthritis, including of the temporomandibular joint (TMJ), as a result of aging. Pro-inflammatory cytokines, such as IL-1beta, IL-6, and TNFalpha, are known to contribute to the development of osteoarthritis, whereas TGFbeta has been associated with articular regeneration. We hypothesized that a balance between IL-1beta and TGFbeta underlies the development of TMJ osteoarthritis, whereby IL-1beta signaling down-regulates TGFbeta expression as part of disease pathology. Our studies in wild-type mice, as well as the Col1-IL1beta(XAT) mouse model of osteoarthritis, demonstrated an inverse correlation between IL-1beta and TGFbeta expression in the TMJ. IL-1beta etiologically correlated with joint pathology, whereas TGFbeta expression associated with IL-1beta down-regulation and improvement of articular pathology. Better understanding of the underlying inflammatory processes during disease will potentially enable us to harness inflammation for orofacial tissue regeneration.
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Affiliation(s)
- W H Lim
- Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Korea
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Abstract
OBJECTIVES Implant stability is primarily related to local bone density; Few studies have evaluated interradicular bone density related to mini-implant placement for orthodontic anchorage. Therefore, this study evaluated bone density differences between interradicular sites. SETTING AND SAMPLE POPULATION Computed tomographic (CT) images were obtained from 14 males and 14 females (mean age 27 years, range 23-35 years). Bone density in Hounsfield units (HU) was measured at 13 interradicular sites and four bone levels. RESULTS Bone densities in most areas were higher than 850 HU. Statistically significant differences in bone density were detected at different levels and sites. Bone densities in both maxilla and mandible significantly increased from the alveolar crest toward basal bone in posterior areas, while the opposite was observed in anterior areas. There were statistically significant differences in bone densities between the maxilla and mandible in posterior areas. Bone densities progressively increased from anterior to posterior areas in the mandible. CONCLUSION The results suggest that mini-implants for orthodontic anchorage may be effective when placed in most areas with equivalent bone density up to 6 mm apical to the alveolar crest. Site selection should be adjusted according to bone density assessment.
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Affiliation(s)
- Y S Chun
- Division of Orthodontics, Department of Dentistry, Ewha Womans University, Seoul, Korea
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Chun YS, Lee SK, Wikesjö UME, Lim WH. The interdental gingiva, a visible guide for placement of mini-implants. Orthod Craniofac Res 2009; 12:20-4. [PMID: 19154271 DOI: 10.1111/j.1601-6343.2008.01433.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether the tip of the interdental gingiva can serve as a visible guide for placement of mini-implants. SETTING AND SAMPLE POPULATION Computer tomography (CT) images from 15 males and 15 females (mean age 27 years, range: 23-35 years) were used to evaluate the distance from the tip of the interdental gingiva to the alveolar crest from the central incisor to the 1st molar. The distance from a reference point to the tip of interdental gingiva was recorded from study models using a caliper. The distance between the reference point and the alveolar crest was recorded using CT and added to the model recordings thus providing the distance from the tip of interdental gingiva to the alveolar crest for the various interdental sites. Two-way anova and Student-Newman-Keuls test for multiple comparisons were used for the statistical analysis. RESULTS There was no significant difference in the distance from the tip of interdental gingiva to the alveolar crest between maxilla and mandible. The distance between the tip of interdental gingiva and the alveolar crest at the central/lateral incisors was the shortest compared with that of other sites. There was also a statistically significant difference between the male and female groups except for the maxillary 2nd premolar/1st molar interradicular site. CONCLUSION The tip of interdental gingiva appears a reasonable visual guide for the placement of mini-implants for orthodontic anchorage.
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Affiliation(s)
- Y S Chun
- Division of Orthodontics, Department of Dentistry, Ewha Womans University, Mokdong Hospital, Seoul, Korea
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Lim WH, Kireta S, Leedham E, Russ GR, Coates PT. Uremia impairs monocyte and monocyte-derived dendritic cell function in hemodialysis patients. Kidney Int 2007; 72:1138-48. [PMID: 17728708 DOI: 10.1038/sj.ki.5002425] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with chronic renal failure maintained on intermittent hemodialysis have frequent infections and a suboptimal response to vaccinations. Dendritic cells are potent antigen-presenting cells essential for the initiation and maintenance of innate and adaptive immunity. In this study we used uremic sera from hemodialysis patients to measure its impact on monocyte and monocyte-derived dendritic cell function in vitro. Monocytes from healthy and uremic subjects were isolated using immunomagnetic beads and differentiated into dendritic cells in the presence of either complete sera or sera from hemodialysis patients. Dendritic cells from normal patients cultured in uremic sera had decreased endocytosis and impaired maturation. These cells, however, had enhanced IL-12p70 production and increased allogeneic T-cell proliferation compared to cells of normal subjects cultured in normal sera. Monocyte derived dendritic cells of hemodialysis patients cultured in either normal or uremic sera were functionally impaired for endocytosis and maturation but had enhanced IL-12p70 production and allogeneic T-cell proliferation only when cultured with uremic sera. High concentrations of urea in normal sera inhibited all aspects of normal dendritic cell function in vitro. Our study suggests that hemodialysis regimes tailored to remove uremic toxins more efficiently may improve immune functions of these patients.
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Affiliation(s)
- W H Lim
- Transplantation Immunology Laboratory and Department of Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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