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McClurg A, Goodwin D, Wong J, Carey E. Technique for cost effective cystoscopy following laparoscopic hysterectomy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wong J, Reid M, Moore K, Saul K, Carey E. Ergonomic simulation investigating the association between surgeon characteristics and laparoscopic device strain in gynecologic surgery. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Spanaki A, Miller O, Wong J, Pushparajah K, Theocharis P. Long term non-invasive endothelial function assessment in patients with paediatric inflammatory multisystem syndrome temporarily associated with Covid 19 (PIMS TS). Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Patients with PIMS-TS present with features of vasculitis (bright coronary arteries and diffuse coronary ectasia on transthoracic echocardiography) and prothrombotic features (e.g. elevated D Dimers) indicating involvement of the endothelial layer in the inflammatory process. Impairment in endothelial function may contribute to the acute but also to possible long-term consequences in patients with PIMS-TS. The aim of this pilot study is to assess non-invasively the endothelial (dys)function using reactive hyperemic peripheral arterial tonometry (RH-PAT) 6 months after the acute inflammatory phase.
Methods
Ten patients with previous diagnosis of PIMS-TS were compared to age-matched controls. The endothelial function was assessed using the EndoPAT device which provides the reactive hyperemic index (RHI) of endothelial function in a 15-min test. Cardiac function indices by means of LV fractional shortening (FS) was also assessed.
Results
There were no significant differences regarding age (11.2 ± 3.0 vs 13.6 ± 2.4, p = 0.063), height, weight and body surface area, (BSA: 1.49 ± 0.36 vs 1.52 ± 0.25, p = 0.856) in patients with previous diagnosis of PIMS-TS and controls respectively. The two groups also had similar LV systolic function assessed by FS (36.3 ± 9.1% vs 36.7 ± 7.1%, p = 0.922). The RHI in the PIMS TS group was similar to the control group (1.65 ± 0.43 vs 1.81 ± 0.60, p = 0.533 respectively).
Conclusions. Patients with PIMS-TS who may present with features of vasculitis during the acute phase, do not show evidence of endothelial dysfunction during the long term follow-up, suggesting resolution. Further studies are required to accurately determine the endothelial (dys)function during the acute phase of the inflammatory syndrome and course.
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Spinelli A, Fiorino C, Schwarz M, Tommasino F, Bellinzona E, Del Vecchio A, Mangili P, Shakarami Z, Deantoni C, Cianchetti M, Attili A, Galli R, Bisio A, Perani L, Simoniello P, Fuss M, Pawelke J, Wong J, Durante M, Scifoni E. FLASH Mechanisms Track (Oral Presentations) ADVANCED DOSIMETRY AND BIOPHYSICAL MODELING FOR PRECLINICAL FLASH RADIOTHERAPY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Rezaee M, Iordachita I, Wong J. FLASH Modalities Track (Oral Presentations) A NOVEL SELF-SHIELDED X-RAY IRRADIATION SYSTEM FOR LABORATORY FLASH RADIATION RESEARCH. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01491-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Perera P, Jayadeva P, Wong J, Lefkovits J. Characteristics and Outcomes of Recurrent Spontaneous Coronary Artery Dissection (SCAD) – A Single Centre Experience. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Yao J, Wong J, Joshi S. Apical Hypertrophic Cardiomyopathy Masquerading as Takotsubo Cardiomyopathy: The Importance of Serial Echocardiography. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang B, Wong J, Yao J, Grigg L, Wilson W. Early inflammatory reaction and thrombus formation post Gore® Septal Occluder Device insertion for an atrial septal defect. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Yao J, Ward-Ambler E, Wong J, Kalman J. Polymorphic Ventricular Tachycardia Following Valsalva Manoeuvre Used to Terminate Supraventricular Tachycardia. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Urban R, Wong J, Lim P, Zhang S, Spadinger I, Olson R, Bachand F, Ho C, Tinker A, Lovedeep G, Hamilton S. Cervical Cancer Patient Reported Gastrointestinal Outcomes: Intensity/Volumetric Modulated vs. 3D Conformal Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wong J, Levy D, Hsieh Y, Jean T. M043 GUMMY MULTIVITAMIN ANAPHYLAXIS FROM NIACIN PSEUDOALLERGY. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wong J, McClurg A, Carey E. Abdominal Wall Injections for Chronic Pelvic Pain: An Introduction and How-to Guide. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wong J, Reid M, Moore K, Saul K, Carey E. Investigation of the Association between Surgeon Sex and Ergonomic Strain with Laparoscopic Device Use. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yu D, Li P, Yu S, Yan B, Wong J. Does an empowerment-based self-care supportive intervention save cost for improving self-care and health service utilization among heart failure patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Heart failure (HF) evolves as a global pandemic and strains the over-stretched hospital service. Ineffective self-care remains the key factor to explain the avoidable hospital admission. Patient empowerment is as a theory-based strategy to optimize the patients' self-care changes for disease management [1]. Its cost-effectiveness to enhance self-care and health service utilization has yet to be determined.
Purpose
This was a double-blind randomized controlled trial to compare the effects and cost-effectiveness of a 12-week empowerment self-care program with a didactic education program on self-care maintenance and management as well as health service utilization among the community-dwelling HF patients.
Methods
A total of 236 HF patients were recruited from the specialist clinics of the Department of Cardiology in two regional hospitals. They were randomized to receive either the 12-week empowerment self-care program (Figure 1) or the 12-week didactic education. Outcome evaluation using the Self-care Heart Failure Index (SCHFI) at baseline, post-intervention (T1) and three months thereafter (T2), with record on the number of emergency room (ER) attendance and hospital admission. Cost effectiveness analyses were performed on total cost (medical, intervention and societal costs) incurred in both interventions as well as incremental cost-effectiveness ratios (ICER) expressed as incremental cost per 1) a reflected clinically meaningful improvement in self-care (i.e. a half standard deviation increase in SCHFI), 2) an ER attendance reduced, 3) a day of hospital stay reduced.
Results
As compared with the education group, the empowerment group reported significantly greater improvement in self-care management at T1 [B=13.77 (95% CI=6.07, 21.46), p<0.001] and T2 [B=10.98 (95% CI=3.21, 18.75), p=0.006]. For cost-effective analysis, The ICER (empowerment-education) was −USD220/0.5 SD increase in SCHFI, indicating the mean cost saved per patient for making a clinically significant improvement in self-care was USD 220. The cost-effectiveness acceptability curve showed patients were willing to pay at USD 207- 441 for a 80–90% chance of improved self-care, indicating that the empowerment approach was a cost saving strategy. Although the empowerment approach was associated with a lower risk of ER attendance [IRR=0.55, 95% CI=0.31–0.95)] and hospital admission [IRR=0.38 (95% CI=0.31–0.95)], it is not cost saving for reducing hospital service utilization.
Conclusions
The empowerment-based self-care program is a cost-saving strategy to produce a clinical significant change in HF-related self-care. Although it is associated with lower risk for hospital service utilization, its effect is not significant enough to be cost-saving. Future care model may explore the need to integrate dyadic science [2] and e-health [3] to strengthen the care continuity and effects of self-care intervention.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health and Medical Research Fund, Food and Health Bureau, Hong Kong Special Administrative Region Figure 1
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Wong J, Baliga S. 565 Predictors of Single Versus Multi-Level Lumbar Spinal Fusion: A Retrospective Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Degenerative spine disease (DSD) of the lumbar spine is a common disorder among the aging population in the world, with a substantial humanistic and economic burden. Although lumbar spinal fusion is currently the mainstay surgical management of DSD, surgery is also associated with adjacent segment disease due to the modification of spinal biomechanics. Therefore, it is important to identify potential risk factors of DSD in order to prevent progressive deterioration and provide early intervention before the surgical option is absolutely necessary.
Method
Adult patients who underwent posterior lumbar spinal fusion from 2006-2016 were identified via OPCS-4codes. Smoking status, weight, age of operation, gender, diagnosis of ischaemic heart disease (IHD) were obtained via TrakCare®. The degree of deprivation was extrapolated using the Scottish Index of Multiple Deprivation (SIMD) 2020 quintile score. Data were analysed using logistic regression.
Results
In total, 313 met inclusion criteria and had data available, of which 205 and 108 patients underwent single and multi-level lumbar fusion respectively. Within the study population, 66.8% (206) and 33.2% (104) were female and male. Adjusted for all outcome measures, age of operation achieved statistical significance (p = 0.040). There was a 1.021-fold increase in risk of multi-level spinal fusion with each additional year of age. Weight was approaching statistical significance (p = 0.068).
Conclusions
Lumbar spinal health declines over time, but some patients experience more progressive deterioration. While some components of the spine are irreparable, early prescription of regimented exercise programs may strengthen spinal musculature to maintain a healthy sagittal balance, particularly in older, overweight, female patients.
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Parikh K, Ma L, Treuner K, Wong J, Schnabel C, Gutierrez M. P59.05 Integration of Molecular Cancer Classification and NGS to Identify Metastatic Cancer Patients Eligible For Lung Cancer Directed Therapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Turner C, Childs A, Johnson A, Manzur A, Quinlivan R, Sarkozy A, Wong J, Guglieri M. DMD – CLINICAL CARE. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stark N, Wallin D, Wong J. 154 Getting Down to Business: The Creation and Implementation of a Novel Business Curriculum for Emergency Medicine Residents. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lee KF, Lo EYJ, Wong KKC, Fung AKY, Chong CCN, Wong J, Ng KKC, Lai PBS. Acute kidney injury following hepatectomy and its impact on long-term survival for patients with hepatocellular carcinoma. BJS Open 2021; 5:6380640. [PMID: 34601569 PMCID: PMC8487667 DOI: 10.1093/bjsopen/zrab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/19/2021] [Indexed: 12/29/2022] Open
Abstract
Background Acute kidney injury (AKI) is increasingly being recognized after hepatectomy. This study aimed to identify factors predicting its occurrence and its impact on long-term outcome among patients with hepatocellular carcinoma (HCC). Methods This was a retrospective analysis of the incidence of AKI, factors predicting its occurrence, and its impact on patients undergoing hepatectomy between September 2007 and December 2018. A subgroup analysis included patients with histologically proven HCC. Results The incidence of AKI was 9.2 per cent in 930 patients. AKI was associated with increased mortality, morbidity, posthepatectomy liver failure (PHLF), and a longer hospital stay. On multivariable analysis, study period December 2013 to December 2018, diabetes mellitus, mean intraoperative BP below 72.1 mmHg, operative blood loss exceeding 377ml, high Model for End-Stage Liver Disease (MELD) score, and PHLF were predictive factors for AKI. Among 560 patients with HCC, hypertension, BP below 76.9 mmHg, blood loss greater than 378ml, MELD score, and PHLF were predictive factors. The 1-, 3-, and 5-year overall survival rates were 74.1, 59.2, and 51.6 per cent respectively for patients with AKI, and 91.8, 77.9, and 67.3 per cent for those without AKI. Corresponding 1-, 3-, and 5-year disease-free survival rates were 56.9, 42.3, and 35.4 per cent respectively in the AKI group, and 71.7, 54.5, and 46.2 per cent in the no-AKI group. AKI was an independent predictor of survival in multivariable analysis. Conclusion AKI is associated with longer hospital stay, and higher morbidity and mortality rates. It is also associated with shorter long-term survival among patients with HCC. To avoid AKI, control of blood loss and maintaining a reasonable BP (72–77 mmHg) during hepatectomy is important.
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Dupain C, Gutman T, Girard E, du Rusquec P, Sablin MP, Tresca P, Neuzillet C, Vincent-Salomon A, Antonio S, Franck C, Galut M, Allory Y, Cyrta J, Guillou I, Wong J, Le Tourneau C, Bièche I, Servant N, Kamal M, Masliah-Planchon J. 75P Tumor mutational burden in clinical routine practice: Identifying the right threshold? Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lo KL, Leung D, Lai Z, Li C, Ma SF, Wong J, Yuen KK, Li J, Chiu P, Mak SK, Wong J, Ng CF. Picture-in-picture video demonstration of systematic transperineal prostate biopsy. Hong Kong Med J 2021; 27:304-305. [PMID: 34413262 DOI: 10.12809/hkmj208864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Emmanuel S, Badiani S, Wong J, Willcock H, Cash B, Lord RV. Does playing video games provide a benefit for acquiring laparoscopic surgical skills? Br J Surg 2021; 108:e101-e102. [PMID: 33793711 DOI: 10.1093/bjs/znaa060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 11/14/2022]
Abstract
This study assessed whether playing video games enhanced laparoscopic skill acquisition for preclinical medical students with no past surgical exposure. By the second attempt on a peg transfer task, there was no significant difference in timing between the two groups, indicating that video games did not confer a skill acquisition benefit in the gamer group.
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Joseph K, Wong J, Abraham A, Menon A, Ghosh S, Warkentin H, Walker J, Salopek T. PH-0331 Patterns And Predictors Of Relapse In Merkel Cell Carcinoma :Results From A Population Based Study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dharmaputra RK, Wan KL, Samad N, Herath M, Wong J, Sarlos S, Holdsworth SR, Naderpoor N. A novel approach to a rare case of non-islet cell hypoglycaemia. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210040. [PMID: 34236039 PMCID: PMC8284944 DOI: 10.1530/edm-21-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
SUMMARY Insulin autoimmune syndrome (IAS) is a rare cause of non-islet cell hypoglycaemia. Treatment of this condition is complex and typically involves long-term use of glucocorticoids. Immunotherapy may provide an alternative in the management of this autoimmune condition through the suppression of antibodies production by B-lymphocyte depletion. We present a case of a 62-year-old male, with refractory hypoglycaemia initially presenting with hypoglycaemic seizure during an admission for acute psychosis. Biochemical testing revealed hypoglycaemia with an inappropriately elevated insulin and C-peptide level and no evidence of exogenous use of insulin or sulphonylurea. Polyethylene glycol precipitation demonstrated persistently elevated free insulin levels. This was accompanied by markedly elevated anti-insulin antibody (IA) titres. Imaging included CT with contrast, MRI, pancreatic endoscopic ultrasound and Ga 68-DOTATATE position emission tomography (DOTATATE PET) scan did not reveal islet cell aetiology for hyperinsulinaemia. Maintenance of euglycaemia was dependent on oral steroids and dextrose infusion. Complete resolution of hypoglycaemia and dependence on glucose and steroids was only achieved following treatment with plasma exchange and rituximab. LEARNING POINTS Insulin autoimmune syndrome (IAS) should be considered in patients with recurrent hyperinsulinaemic hypoglycaemia in whom exogenous insulin administration and islet cell pathologies have been excluded. Biochemical techniques play an essential role in establishing high insulin concentration, insulin antibody titres, and eliminating biochemical interference. High insulin antibody concentration can lead to inappropriately elevated serum insulin levels leading to hypoglycaemia. Plasma exchange and B-lymphocyte depletion with rituximab and immunosuppression with high dose glucocorticoids are effective in reducing serum insulin levels and hypoglycaemia in insulin autoimmune syndrome (IAS). Based on our observation, the reduction in serum insulin level may be a better indicator of treatment efficacy compared to anti-insulin antibody (IA) titre as it demonstrated greater correlation to the frequency of hypoglycaemia and to hypoglycaemia resolution.
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Torka P, Groman A, Wong J, Baysal B, Nichols J, Kader A, Mavis C, Jani Sait S, Block A, Przespolewski E, Mohr A, Lund I, McWhite K, Kostrewa J, DeMarco J, Johnson M, Darrall A, Thomas R, Sundaram S, Ghione P, Hutson A, Hernandez‐Ilizaliturri F. A PHASE 1 STUDY OF CARFILZOMIB WITH RITUXIMAB, IFOSFAMIDE, CARBOPLATIN AND ETOPOSIDE (C‐RICE) IN TRANSPLANT‐ELIGIBLE RELAPSED/REFRACTORY DIFFUSE LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.83_2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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