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Chang J, Tsui J, Wong M. AB1207 EFFECT ON DIET MODIFICATION ON GOUT AND METABOLIC SYNDROME RISK FACTORS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Gout is the most prevalent inflammatory arthritis globally. Despite treatment advances, the prevalence of gout has continued to increase over the last several decades. There has also been increasing evidence that gout has a strong association with the metabolic syndrome. This indicates that gout is likely both an inflammatory and a metabolic disease that has a significant effect on quality of life and healthcare costs. Although current recommendations support aggressive medical therapy for gout treatment, dietary counseling is less emphasized. We hypothesize that emphasis on this nonpharmacological therapy will likely improve management and the metabolic syndrome in gout patients.Objectives:To analyze the effectiveness of dietary counseling on gout management and risk factors for metabolic syndrome in gout patients at the Veteran’s Affairs Medical Center in Long Beach, CA (VALB).Methods:A retrospective cohort study was created from 2009-2016 involving Long Beach Veterans Affairs Hospital gout patients (n= 119) based on International Classification of Disease version 9 or 10. Patients were then stratified into two cohorts: received diet counseling (n=90) and no diet counseling (n=29). Data was reviewed for 24 months following initial gout diagnosis or intervention. Management was evaluated based on frequency of flares and related ED visits, change in creatinine clearance, serum uric acid levels (sUA), and changes to risk factors for metabolic syndrome including blood pressure, body mass index (BMI), cholesterol panel and hemoglobin A1c levels at six-month intervals.Results:Although patients in both cohorts were noted to have decreased number of gout attacks, patients who received diet counseling had a significant decrease in number of gout attacks by month 12 (0=0.004). In addition, after 6 months, patients who received diet counseling were more likely to have sUA at goal (sUA<6 for nontophaeous gout and sUA<5 for tophaceous gout) (p=0.003). These patients were also noted to have improved creatinine clearance (p=0.08) and increased HDL (p =0.08). In addition, patients with improved HDL and LDL values more likely to have improved sUA levels and decreased ED visits (R2=0.4, slope 0.14 and R2=0.4, slope 0.05, respectively) by month 6. Patients with improved hemoglobin A1c levels were also noted to have a significant outcome in lowering serum uric acid level at month 18 (R2=0.9, slope 2.6).Conclusion:Gout patients who receive diet counseling had lower rate of future attacks and better control of sUA. In addition, these gout patients were also noted to have improvement in some risk factors associated with the metabolic syndrome. Notably, patients who had better control of their hemoglobin A1c levels were able to have lower serum uric acid levels. This may imply that controlling diabetes in patients may also help improve gout management. Given the serious complications and increased cardiovascular risks that can be associated with metabolic syndrome, optimization of gout through a nonpharmacologic intervention such as diet counseling can enhance clinical outcomes and optimize healthcare resources.References:[1]Rai SK et al. The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. BMJ. 2017;357:j1794.[2]Álvarez-lario B, et al. Hyperuricemia and gout; the role of diet. Nutr Hosp. 2014;29(4):760-70.Disclosure of Interests:None declared
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Penn C, Wong M, Walsh CS. Cost-effectiveness of various maintenance therapies based on mutation status following first-line treatment of primary epithelial ovarian cancer in the United States. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19399 Background: The recent SOLO1, PRIMA, and PAOLA trials all reported positive efficacy results, making it difficult to determine optimal upfront maintenance therapy for patients with primary, advanced ovarian cancer. We evaluated the cost-effectiveness of the maintenance strategies outlined in these trials for BRCA-positive patients, homologous-recombination deficient patients without a BRCA mutation (HRD-positive), and homologous-recombination proficient (HRD-negative) patients. Methods: Three decision analysis models were developed, one for each mutation status. We evaluated olaparib (SOLO1), olaparib/bevacizumab (PAOLA), bevacizumab alone (PAOLA), and niraparib (PRIMA) maintenance strategies. Base case 1 assessed olaparib vs olaparib/bevacizumab vs bevacizumab vs niraparib vs no maintenance therapy in BRCA-positive patients. Base cases 2 and 3 assessed olaparib/bevacizumab vs bevacizumab vs niraparib vs no maintenance therapy in HRD-positive and HRD-negative patients, respectively. Time horizon was 24 months. Costs, measured in U.S. dollars, were estimated from Medicare claims, wholesale acquisition prices, and previously published sources. Incremental cost-effectiveness ratios (ICERs) were in dollars per progression-free life-year saved (PF-LYS). One-way sensitivity analyses were performed varying drug cost and progression-free survival. Results: Assuming a willingness-to-pay threshold of $100,000/PF-LYS, none of the drug maintenance strategies could be considered cost effective compared with observation. In BRCA-positive patients (base case 1), olaparib monotherapy was the most cost-effective strategy, yielding an ICER of $181,059/PF-LYS. The third-party payer cost per 28-day supply of olaparib would need to be reduced from approximately $17,000 to $9,200 to be considered cost effective compared with observation. In HRD-positive patients (base case 2) and HRD-negative patients (base case 3), bevacizumab monotherapy was the most cost-effective option, with ICERs of $326,491/PF-LYS and $253,937/PF-LYS respectively. Conclusions: At current costs, maintenance therapy for primary ovarian cancer is not cost effective, regardless of mutation status. In BRCA-positive women, lowering the cost of olaparib may make it cost effective compared with observation.
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Lin L, Wong M, Deeth H, Oh H. Calcium-induced skim milk gels: Impact of holding temperature and ionic strength. Int Dairy J 2020. [DOI: 10.1016/j.idairyj.2020.104657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wong M. Late Presentation of Paediatric Pink Pulseless Supracondylar Fracture of Humerus: A Case Report. Malays Orthop J 2020; 14:100-101. [PMID: 32296493 PMCID: PMC7156170 DOI: 10.5704/moj.2003.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wong M, Oron AP, Faino A, Stanford S, Stevens J, Crowell CS, Javid PJ. Variation in hospital costs for gastroschisis closure techniques. Am J Surg 2020; 219:764-768. [PMID: 32199604 DOI: 10.1016/j.amjsurg.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In newborns with gastroschisis, both primary repair and delayed fascial closure with initial silo placement are considered safe with similar outcomes although cost differences have not been explored. METHODS A retrospective review was performed of newborns admitted with gastroschisis at a single center from 2011 to 2016. Demographic, clinical, and cost data during the initial hospitalization were collected. Differences between procedure costs and clinical endpoints were analyzed using multivariable linear regression adjusting for prematurity, complicated gastroschisis, and performance of additional operations. RESULTS 80 patients with gastroschisis met inclusion criteria. Rates of primary fascial, primary umbilical cord closure, and delayed closure were 14%, 65%, and 21%, respectively. Delayed closure was associated with an increase in total hospital costs by 57% compared to primary repair (p < 0.001). In addition, delayed closure was associated with increased total and NICU LOS (p < 0.05), parenteral nutrition duration (p = 0.02), ventilator days (p < 0.001), time to goal enteral feeds (p = 0.01), and all cost sub-categories except ward room costs (p < 0.01). CONCLUSION Delayed fascial closure was associated with significantly greater hospital costs during the index admission.
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Zimmer TS, Ciriminna G, Arena A, Anink JJ, Korotkov A, Jansen FE, van Hecke W, Spliet WG, van Rijen PC, Baayen JC, Idema S, Rensing NR, Wong M, Mills JD, van Vliet EA, Aronica E. Chronic activation of anti-oxidant pathways and iron accumulation in epileptogenic malformations. Neuropathol Appl Neurobiol 2020; 46:546-563. [PMID: 31869431 PMCID: PMC7308211 DOI: 10.1111/nan.12596] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/18/2019] [Indexed: 12/29/2022]
Abstract
Aims Oxidative stress is evident in resected epileptogenic brain tissue of patients with developmental brain malformations related to mammalian target of rapamycin activation: tuberous sclerosis complex (TSC) and focal cortical dysplasia type IIb (FCD IIb). Whether chronic activation of anti‐oxidant pathways is beneficial or contributes to pathology is not clear. Methods We investigated oxidative stress markers, including haem oxygenase 1, ferritin and the inflammation associated microRNA‐155 in surgically resected epileptogenic brain tissue of TSC (n = 10) and FCD IIb (n = 8) patients and in a TSC model (Tsc1GFAP−/− mice) using immunohistochemistry, in situ hybridization, real‐time quantitative PCR and immunoblotting. Using human foetal astrocytes we performed an in vitro characterization of the anti‐oxidant response to acute and chronic oxidative stress and evaluated overexpression of the disease‐relevant pro‐inflammatory microRNA‐155. Results Resected TSC or FCD IIb tissue displayed higher expression of oxidative stress markers and microRNA‐155. Tsc1GFAP−/− mice expressed more microRNA‐155 and haem oxygenase 1 in the brain compared to wild‐type, preceding the typical development of spontaneous seizures in these animals. In vitro, chronic microRNA‐155 overexpression induced haem oxygenase 1, iron regulatory elements and increased susceptibility to oxidative stress. Overexpression of iron regulatory genes was also detected in patients with TSC, FCD IIb and Tsc1GFAP−/− mice. Conclusion Our results demonstrate that early and sustained activation of anti‐oxidant signalling and dysregulation of iron metabolism are a pathological hallmark of FCD IIb and TSC. Our findings suggest novel therapeutic strategies aimed at controlling the pathological link between both processes.
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Leung R, Lee W, Wong M, Cheung S, Law G, Chan M. PV-058: PCSR correction factors of two measurement guided dose reconstruction 2D array for WFF & FFF. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee W, Leung R, Wong M, Cheung S, Kwan K. PO-179: Multi-Criteria Optimization with sliding-window VMAT delivery vs classical VMAT in H&N and SBRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yan H, Zhu GY, Wong M, Lee V. Computational platform for modelling, analysis, and prediction of anti-EGFR drug resistance for lung cancer. Hong Kong Med J 2019; 25 Suppl 9:40-42. [PMID: 31889035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
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Abstract
Patients with portal hypertension will increasingly present for nontransplant surgery because of the increasing incidence of, and improving long-term survival for, chronic liver disease. Such patients have increased perioperative morbidity and mortality caused by the systemic pathophysiology of liver disease. Preoperative assessment should identify modifiable causes of liver injury and distinguish between compensated and decompensated cirrhosis. Risk stratification, which is crucial to preparing patients and their families for surgery, relies on scores such as Child-Turcotte-Pugh and Model for End-stage Liver Disease to translate disease severity into quantified outcomes predictions. Risk factors for postoperative complications should also be recognized.
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Fernando S, Wallace EM, Rombauts L, White N, Hong J, Vollenhoven B, Lolatgis N, Hope N, Wong M, Lawrence M, Lawrence A, Russell C, Leong K, Thomas P, da Silva Costa F. The effect of melatonin on ultrasound markers of follicular development: A double-blind placebo-controlled randomised trial. Aust N Z J Obstet Gynaecol 2019; 60:141-148. [PMID: 31583699 DOI: 10.1111/ajo.13074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Melatonin is a potent oxygen scavenger and is capable of altering blood flow in various vascular beds. AIMS We aimed to determine the effect of melatonin on ovarian vascular indices during ovarian stimulation for in vitro fertilisation (IVF). MATERIALS AND METHODS This is a pilot double-blind placebo-controlled randomised trial. Sixty-nine women (mean age 35.8 ± 4.3 years) undergoing their first cycle of IVF were randomised to receive either placebo, 2, 4 or 8 mg of melatonin, twice a day. Each participant underwent a transvaginal ultrasound at days 6-10 assessing follicular number and size. The vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI) were measured. These indices were then correlated with embryological outcomes. Informed consent was obtained from participants. This trial was registered with the Australia New Zealand Clinical Trials Registry (ACTRN12613001317785). RESULTS The number of follicles did not differ between groups (P = 0.4). There were no differences in the VI (P = 0.4), FI (P = 0.1) or VFI (P = 0.3) in the right ovary or the FI (P = 0.3) or VFI (P = 0.3) in the left ovary between groups. When comparing placebo to any dose of melatonin, there were no differences in any measured parameter. While there was correlation between the number of follicles on ultrasound and all measured embryological outcomes, there was no correlation between ovarian vascular indices and these important clinical outcomes. CONCLUSIONS Melatonin does not appear to change ovarian vascular indices during ovarian stimulation. In addition, such vascular indices cannot predict the number or quality of oocytes or embryos obtained in an IVF cycle. These findings require confirmation in future larger studies.
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Gross N, Ferrarotto R, Nagarajan P, Bell D, El-Naggar A, Johnson J, Yuan Y, Glisson B, Wong M, Rosenthal D, Esmaeli B, Migden M, Wargo J, Weber R, Myers J. Phase II study of neoadjuvant cemiplimab prior to surgery in patients with stage III/IV (M0) cutaneous squamous cell carcinoma of the head and neck (CSCC-HN). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Burton E, Amaria R, Glitza I, Shephard M, Diab A, Milton D, Patel S, Mcquade J, Wong M, Hwu P, Wargo J, Davies M, Tawbi H. Safety and efficacy of TRIplet combination of nivolumab (N) with dabrafenib (D) and trametinib (T) [TRIDeNT] in patients (pts) with BRAF-mutated metastatic melanoma (MM): A single center phase II study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gaudreau P, Ajami N, Sepesi B, Karpinets T, Reuben A, Wong M, Parra E, Federico L, Gopalakrishnan V, Mitchell K, Negrao M, Spencer C, Vaporciyan A, Weissferdt A, Haymaker C, Tran H, Bernatchez C, Landry L, Roarty E, Cascone T, Heymach J, Zhang J, Wistuba I, Zhang J, Wargo J, Gibbons D. P1.04-11 Depicting the Intra-Tumoral Viral and Microbial Landscape of Localized NSCLC Using Standard Next Generation Sequencing Data. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Amin TN, Wong M, Pointer S, Goodhart V, Bean E, Jurkovic D. Reference ranges for uterine vein dimensions in non-pregnant women with normal pelvic organs. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:403-411. [PMID: 30834625 DOI: 10.1002/uog.20254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To establish reference ranges for uterine vein (UtV) diameters in non-pregnant women with normal pelvic organs. METHODS This was a prospective study of all women attending the general gynecological clinic of a university teaching hospital in the UK, between August 2015 and December 2016. All women aged ≥ 18 years underwent a transvaginal ultrasound examination in accordance with the study protocol. In women with normal pelvic organs, the largest trunk of the uterine venous plexus was identified in the transverse plane on each side. The maximum anteroposterior vessel diameter was measured by placing the calipers on the inner walls of the vein, and the mean of three measurements was used as the representative value. Inter- and intraobserver variability was assessed in a subgroup of 30 women. Maximum UtV diameter was compared between right and left UtVs and between pre- and postmenopausal women. Factors associated with UtV diameter were assessed and reference ranges were constructed. RESULTS Of 1500 women examined, 486 (32%) had normal pelvic organs on ultrasound scan and were included in the final analysis. In all women, the uterine venous trunk was clearly visualized and there was no significant difference between the maximum median left and right UtV diameters (P = 0.37). UtV diameters were generally lower in postmenopausal, compared with premenopausal, women, with the difference being statistically significant for the right UtV and the average of left and right UtVs. There was a gradual increase in UtV diameter with advancing age, with a peak observed in women aged 41-50 years and decreasing values in older age groups. Univariable analysis showed that parity, menopausal status and age were associated significantly with UtV diameters (P < 0.01). On multivariable analysis, only higher parity was significantly associated with increasing venous size in both pre- and postmenopausal women. Reference ranges were constructed separately for nulliparous and parous premenopausal women aged between 18 and 45 years. CONCLUSION UtVs can be identified and measured consistently in all women with normal pelvic organs using transvaginal ultrasound. Parity was the main factor influencing the maximum mean UtV diameter, which had to be taken into account when constructing reference ranges. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Bean E, Cutner A, Saridogan E, Wong M, Naftalin J, Jurkovic D. Hemoperitoneum as a precursor of deep pelvic endometriosis: prospective cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:389-394. [PMID: 30677178 DOI: 10.1002/uog.20222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine whether significant hemoperitoneum could be a precursor of deep pelvic endometriosis in non-pregnant premenopausal women presenting with severe acute lower abdominal pain. METHODS This was a prospective observational cohort study carried out at a dedicated gynecological diagnostic unit over a period of 18 months. We included consecutive non-pregnant, premenopausal women who attended with severe acute lower abdominal pain and underwent a pelvic ultrasound examination. Women were triaged for surgical or conservative management depending on the cause of pain and severity of their symptoms. Those who were selected for conservative management were invited for follow-up ultrasound scans. The main outcome measure was evidence of newly developed deep endometriosis at follow-up examination. RESULTS Of 118 non-pregnant women who attended our unit with severe acute lower abdominal pain, 20 underwent emergency surgery and 17 had a history of endometriosis, or evidence of endometriosis on the initial scan, and were excluded from the study. Therefore, conservative management was employed in 81 women, eight of whom had evidence of significant hemoperitoneum at presentation. A total of 35 women attended for all follow-up ultrasound scans. At the completion of follow-up, four of six (67% (95% CI, 22-96%)) women who presented initially with significant intra-abdominal bleeding had developed new evidence of deep endometriosis, compared with one of 29 (3% (95% CI, 0-18%)) of those without hemoperitoneum (relative risk, 19.3 (95% CI, 3-144); P < 0.001). CONCLUSION In some women, the presence of significant hemoperitoneum that is managed conservatively precedes the development of deep endometriosis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Harrison J, Wong M, McManimen S. Impact of Puberty and Age on Adolescent Inhibition Over Time. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz035.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
We measured how puberty impacted inhibition over three years. We hypothesized that age and puberty development would predict inhibition at each time point. Results revealed differential effects of puberty and age over time.
Method
Participants from Southern Idaho were 245 adolescents at Time 1 (T1) (M = 10.4, SD = 1.5, 50% female, 64% Caucasian), 196 adolescents at Time 2 (T2) (M = 11.8, SD = 1.5, 50% female, 81% Caucasian), and 87 adolescents at Time 3 (T3) (M = 13, SD = 1.5, 56% female, 82% Caucasian). Participants completed a physical exam with a registered nurse, which included the Tanner Scale (Apter & Hermanson, 2002; Tinggaard et. al., 2012) and the Puberty Development Scale (Petersen et al., 1988). Inhibition was assessed using stop-signal reaction time (SSRT) within the Stop-it Task (Logan, Cowan, & Davis, 1984).
Results
Using structural equation modeling, for T1, the overall model demonstrated a good fit, χ2(3) = 1.23, p = .75, RMSEA = .00, CFI = 1.00, TLI = 1.04. Puberty significantly predicted inhibition (β = -.21, p < .05), i.e., higher puberty scores predicted stronger inhibition. However, age was not a significant predictor. At T2, the model demonstrated a good fit, χ2(7) = 7.77, p = .35, RMSEA = .03, CFI = 1.00, TLI = .99. Age significantly predicted inhibition (β=-.39, p < .001). However, puberty was not a significant predictor. In T3, neither age nor puberty predicted inhibition.
Conclusions
Our results indicate that early adolescent increases in inhibition may be due to puberty development rather than age. As one ages, puberty has less effect, and chronological age becomes more significant. Finally, in mid-adolescence, neither age nor puberty significantly affects inhibition. These findings highlight the changing effects of age and puberty on inhibitory control across adolescence.
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Wong M, Paschal CR, Bozarth X. Diagnosing Coexisting Conditions of Angelman and Klinefelter Syndromes Using Chromosomal Microarray. JOURNAL OF PEDIATRIC NEUROLOGY 2019. [DOI: 10.1055/s-0038-1626699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractWe report here a 4-year-old male patient who presented with clinical features of Angelman syndrome (AS, OMIM 105830) including dysmorphic features, hypotonia, lack of language development, ataxia, severe developmental delay, and seizures. Due to insurance denial for DNA methylation test, a chromosomal microarray (CMA) was performed, which showed an approximately 5.0 Mb deletion of Prader–Willi/AS critical region (15q11.2 to q13.1). Subsequent Prader–Willi/AS methylation analysis was consistent with the diagnosis of AS. Gain of an X chromosome (Klinefelter syndrome, KS) was also detected by CMA. KS is not usually diagnosed before puberty due to lack of specific clinical features in early childhood. It is unclear if there is any direct association between these two genetic disorders. There has only been one other published case, to our knowledge, of a patient with coexistence of AS due to 15q11.2-q13 deletion and KS. CMA is a fast and effective diagnostic test to determine multiple genetic disorders. Early genetic diagnostic testing using CMA as an alternative first-step diagnostic genetic testing for children with clinical suspicion of AS would be beneficial.
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Wong M, Kim J, George B, Eriksen C, Pearson T, Robbins J, Zimmerman MA, Hong JC. Downstaging Locally Advanced Cholangiocarcinoma Pre-Liver Transplantation: A Prospective Pilot Study. J Surg Res 2019; 242:23-30. [PMID: 31059945 DOI: 10.1016/j.jss.2019.04.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Orthotopic liver transplantation (OLT) after neoadjuvant therapy (NT) in well-selected patients with unresectable hilar cholangiocarcinoma (CCA) achieves excellent recurrence-free survival. Current criteria for NT-OLT exclude patients with locally advanced hilar and intrahepatic CCA from potential cure. We sought to evaluate the efficacy of NT in downstaging locally advanced CCA, and examine outcomes after OLT. METHODS Among 24 patients referred for unresectable hilar and intrahepatic CCA from January 2013 through August 2017, 18 met center-specific inclusion criteria for the NT-OLT treatment protocol: hilar tumor size ≤3.5 cm or intrahepatic ≤8 cm, and regional lymphadenopathy but without distant metastasis. Median follow-up was 22.1 mo from diagnosis. RESULTS Of 18 patients who initiated NT, 11 were removed from the protocol due to tumor progression (n = 6) or uncontrolled infection and failure-to-thrive (n = 5). Median NT duration tended to be shorter for patients progressing to dropout than for those surviving to OLT (5.5 versus 13.5 mo, P = 0.109). Among five patients who received OLT, 1-y post-OLT patient survival was 80%: three survive recurrence-free (14.5-29.2 mo post-OLT); one developed an isolated tumor recurrence in a single portacaval lymph node at 12 mo post-OLT; and one experienced non-tumor-related death. All dropout patients died at a median of 14.4 mo after diagnosis. CONCLUSIONS This is the first prospective study to show successful NT downstaging of unresectable locally advanced hilar and intrahepatic CCA before OLT. NT-OLT for select patients with locally advanced hilar and intrahepatic CCA achieved acceptable short-term recurrence-free survival.
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Back M, Jayamanne D, Brazier D, Newey A, Bailey D, Schembri G, Hsiao E, Khasraw M, Wong M, Kastelan M, Brown C, Wheeler H. Pattern of failure in anaplastic glioma patients with an IDH1/2 mutation. Strahlenther Onkol 2019; 196:31-39. [PMID: 31028406 DOI: 10.1007/s00066-019-01467-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/29/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The current study aimed to assess patterns of failure (PoF) in anaplastic glioma (AG) patients managed with intensity-modulated radiation therapy (IMRT) and their relationship to molecular subtype. METHODS The outcomes of AG patients managed between 2008 and 2014 and entered into a prospective database were assessed, including PoF. AG was initially defined using the WHO 2007 classification, but for analysis, patients were subsequently recategorised based on WHO 2016 as anaplastic oligodendroglioma (AOD), astrocytoma isocitrate dehydrogenase (IDH) mutant (AAmut) or astrocytoma IDH wildtype (AAwt). Management involved IMRT and temozolomide (TMZ), including from 2011 patients with an IDH mutation (IDHmut) planned with 18F-fluoroethyltyrosine (FET) and 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET). PoF was local, marginal or distant in relation to the IMRT volume. Relapse-free survival (RFS) was calculated from the start of IMRT. RESULTS A total of 156 patients were assessed, with median follow-up of 5.1 years. Of these patients, 75% were IDHmut, 44% were managed at first or later relapse and 73% received TMZ. Relapse occurred in 68 patients, with 6‑year RFS of 75.0, 48.8 and 2.5% for AOD, AAmut and AAwt, respectively (p < 0.001). There was a component of local relapse in 63%, of marginal relapse in 19% and of distant relapse in 37% of relapses. Isolated local, marginal and distant relapse was evident in 51, 9 and 22%, respectively. A distant relapse pattern was more frequent in IDHmut compared to IDHwt patients (26% vs. 45%, p = 0.005), especially within the first 2 years post-IMRT. In multivariate analysis, distant relapse remained associated with AAmut (p < 0.002) and delayed IMRT until the second relapse (p < 0.001). CONCLUSION Although patients with IDH-mutated AG have improved outcomes, there was a higher proportion of distant relapses occurring during the 2 years after IMRT.
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Fan K, Wong M, Cheng K. Denovo Malignancy in Chinese Patients Post-Heart Transplant in Current Era-A “Not So Bad Prognosis”? J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Voskoboinik A, Kalman J, Nicholls T, Nanayakkara S, Wong G, Prabhu S, Nalliah C, Sugumar H, Stub D, Kaye D, Wong M, Kotschet E, Taylor A, Kistler P. Alcohol Abstinence in Moderate Drinkers with Atrial Fibrillation: Results from the Alcohol-AF Randomised Controlled Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reddy H, Wong M, Einarsson J. Laparoscopic Resection of Bladder Fibroid. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wong M, Cohen S, Einarsson J. Laparoscopic Ureteral End to End Anastomosis for Intrinsic Ureteral Endometriosis. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Keith P, Wong M. MARKERS OF TH2 INFLAMMATION IN PATIENTS WITH CHRONIC SPONTANEOUS URTICARIA: A SYSTEMATIC LITERATURE REVIEW. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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