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Wee LE, Lim JT, Tay AT, Pang D, Dickens B, Chiew CJ, Ong B, Lye DCB, Tan KB. Long-term neuropsychiatric sequelae of Delta versus Omicron SARS-CoV-2 infection. Clin Microbiol Infect 2024; 30:531-539. [PMID: 38141822 DOI: 10.1016/j.cmi.2023.12.019] [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: 08/18/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES Studies have reported increased rates of long-term neuropsychiatric sequelae after SARS-CoV-2 infection using electronic health-record (EHR) data; however, the majority were conducted before Omicron and booster rollout. We estimated the long-term risks and excess burdens of pre-specified new-incident neuropsychiatric diagnoses after Delta versus Omicron BA.1/2 infection in a highly-vaccinated and boosted cohort of adult Singaporeans. METHODS The national SARS-CoV-2 testing registry was used to construct cohorts of Singaporean adults infected during periods of Delta and Omicron BA.1/2 predominance and a contemporaneous test-negative control group. New-incident neuropsychiatric diagnoses recorded in the national health care claims database were identified up to 300 days postinfection. Risks and excess burden were estimated using a doubly robust competing-risks survival analysis. RESULTS 104 179 and 375 903 infected cases were assigned to Delta and Omicron cohorts and compared against test-negative controls (Delta: N = 666 575 and Omicron: N = 619 379). Elevated risk of cognition or memory disorders was consistently reported across Omicron (Adjusted hazards ratio [aHR], 1.24; 95% CI, 1.12-1.38) and Delta cohorts (aHR, 1.63; 95% CI, 1.39-1.92). Delta-variant infection was associated with an increased risk of anosmia or dysgeusia (aHR, 4.53; 95% CI, 2.78-7.41) and psychosis (aHR, 1.65; 95% CI, 1.22-2.22). By contrast, Omicron-variant infection was associated with a risk of abnormal involuntary movements (aHR, 1.93; 95% CI, 1.32-2.83). Risks of neuropsychiatric sequelae predominantly accrued in hospitalized individuals. DISCUSSIONS A modestly increased risk of cognition and memory disorders at 300 days after SARS-CoV-2 infection was observed among adult Singaporeans infected during the Delta/Omicron BA.1/2 transmission. There was no overall increased risk of neuropsychiatric sequelae observed across other domains. Variant-specific differences were also observed in individual neuropsychiatric sequelae, including an elevated risk of anosmia or dysgeusia after Delta-variant infection.
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Affiliation(s)
- Liang En Wee
- National Centre for Infectious Diseases, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Jue Tao Lim
- National Centre for Infectious Diseases, Singapore General Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - An Ting Tay
- Division of Communicable Disease, Ministry of Health, Singapore
| | - Deanette Pang
- Division of Communicable Disease, Ministry of Health, Singapore
| | - Borame Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Calvin J Chiew
- National Centre for Infectious Diseases, Singapore General Hospital, Singapore; Division of Communicable Disease, Ministry of Health, Singapore
| | - Benjamin Ong
- Division of Communicable Disease, Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Boon Lye
- National Centre for Infectious Diseases, Singapore General Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- National Centre for Infectious Diseases, Singapore General Hospital, Singapore; Division of Communicable Disease, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Lim JT, Liang En W, Tay AT, Pang D, Chiew CJ, Ong B, Lye DCB, Tan KB. Long-term Cardiovascular, Cerebrovascular, and Other Thrombotic Complications in COVID-19 Survivors: A Retrospective Cohort Study. Clin Infect Dis 2024; 78:70-79. [PMID: 37746872 PMCID: PMC10810710 DOI: 10.1093/cid/ciad469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Growing evidence suggests that some coronavirus disease 2019 (COVID-19) survivors experience a wide range of long-term postacute sequelae. We examined the postacute risk and burden of new-incident cardiovascular, cerebrovascular, and other thrombotic complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a highly vaccinated multiethnic Southeast Asian population, during Delta predominance. METHODS This cohort study used national testing and healthcare claims databases in Singapore to build a cohort of individuals who had a positive SARS-CoV-2 test between 1 September and 30 November 2021 when Delta predominated community transmission. Concurrently, we constructed a test-negative control group by enrolling individuals between 13 April 2020 and 31 December 2022 with no evidence of SARS-CoV-2 infection. Participants in both groups were followed up for a median of 300 days. We estimated risks of new-incident cardiovascular, cerebrovascular, and other thrombotic complications using doubly robust competing-risks survival analysis. Risks were reported using 2 measures: hazard ratio (HR) and excess burden (EB) with 95% confidence intervals. RESULTS We included 106 012 infected cases and 1 684 085 test-negative controls. Compared with the control group, individuals with COVID-19 exhibited increased risk (HR, 1.157 [1.069-1.252]) and excess burden (EB, 0.70 [.53-.88]) of new-incident cardiovascular and cerebrovascular complications. Risks decreased in a graded fashion for fully vaccinated (HR, 1.11 [1.02-1.22]) and boosted (HR, 1.10 [.92-1.32]) individuals. Conversely, risks and burdens of subsequent cardiovascular/cerebrovascular complications increased for hospitalized and severe COVID-19 cases (compared to nonhospitalized cases). CONCLUSIONS Increased risks and excess burdens of new-incident cardiovascular/cerebrovascular complications were reported among infected individuals; risks can be attenuated with vaccination and boosting.
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Affiliation(s)
- Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University
- National Centre for Infectious Diseases
| | - Wee Liang En
- National Centre for Infectious Diseases
- Duke-NUS Graduate Medical School, National University of Singapore
- Department of Infectious Diseases, Singapore General Hospital
| | | | | | - Calvin J Chiew
- National Centre for Infectious Diseases
- Singapore Ministry of Health
| | - Benjamin Ong
- Singapore Ministry of Health
- Yong Loo Lin School of Medicine, National University of Singapore
| | - David Chien Boon Lye
- Lee Kong Chian School of Medicine, Nanyang Technological University
- National Centre for Infectious Diseases
- Yong Loo Lin School of Medicine, National University of Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital
| | - Kelvin Bryan Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University
- Singapore Ministry of Health
- Saw Swee Hock School of Public Health, National University of Singapore
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Lim JT, En WL, Tay AT, Pang D, Chiew CJ, Ong B, Lye DCB, Tan KB. Unlinking time zero from test-negative date does not influence risk estimates of long-term cardiovascular complications due to COVID-19. Clin Infect Dis 2023:ciad742. [PMID: 38059493 DOI: 10.1093/cid/ciad742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Wee Liang En
- National Centre for Infectious Diseases, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | | | | | - Calvin J Chiew
- National Centre for Infectious Diseases, Singapore
- Ministry of Health, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Boon Lye
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Centre for Infectious Diseases, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Wee LE, Tang N, Pang D, Chiew C, Yung CF, Chong CY, Lee V, Ong B, Lye DC, Tan KB. Effectiveness of Monovalent mRNA Vaccines Against Omicron XBB Infection in Singaporean Children Younger Than 5 Years. JAMA Pediatr 2023; 177:1324-1331. [PMID: 37843856 PMCID: PMC10580153 DOI: 10.1001/jamapediatrics.2023.4505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/22/2023] [Indexed: 10/17/2023]
Abstract
Importance Literature on vaccine effectiveness of SARS-CoV-2 messenger RNA (mRNA) vaccines for children younger than 5 years is limited. Objective To report the effectiveness of monovalent mRNA vaccines against SARS-CoV-2 infection among Singaporean children aged 1 through 4 years during a COVID-19 pandemic wave of the Omicron XBB variant. Design, Setting, and Participants This was a population-based cohort study, conducted over a 6-month study period from October 1, 2022, through March 31, 2023, after the implementation of community vaccination among all Singaporean children aged 1 through 4 years. The study period was dominated by the Omicron XBB subvariant. Exposure Receipt of SARS-CoV-2 mRNA vaccines. Main Outcome Measure Vaccine effectiveness against confirmed SARS-CoV-2 infection. The adjusted incidence rate ratio for confirmed infections using Poisson regression was reported, with the reference group being those who were unvaccinated. Analyses were stratified by prior documented SARS-CoV-2 infection. Results A total of 121 628 children (median [IQR] age, 3.1 [2.2-3.9] years; 61 925 male [50.9%]) were included in the study, contributing 21 015 956 person-days of observation. The majority of children (11 294 of 11 705 [96.5%]) received the mRNA-1273 COVID-19 vaccine (Moderna). Vaccine effectiveness against confirmed infection was 45.2% (95% CI, 24.7%-60.2%) in partially vaccinated, infection-naive children and 63.3% (95% CI, 40.6%-77.3%) in fully vaccinated, infection-naive children compared with the unvaccinated group. Among previously infected children, vaccine effectiveness against reinfections in those with at least 1 vaccine dose was estimated at 74.6% (95% CI, 38.7%-89.5%). Conclusions and Relevance Study results suggest that completion of a primary mRNA vaccine series provided protection against SARS-CoV-2 infection in children aged 1 through 4 years. Although incidence of hospitalization and severe illness is low in this age group, there is potential benefit of vaccination in preventing infection and potential sequelae.
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Affiliation(s)
- Liang En Wee
- National Centre for Infectious Diseases, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | | | | | - Calvin Chiew
- National Centre for Infectious Diseases, Singapore
- Ministry of Health, Singapore
| | - Chee-Fu Yung
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
| | - Chia Yin Chong
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vernon Lee
- National Centre for Infectious Diseases, Singapore
- Ministry of Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Tan CY, Chiew CJ, Pang D, Lee VJ, Ong B, Wang LF, Ren EC, Lye DC, Tan KB. Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study. Lancet Infect Dis 2023; 23:1343-1348. [PMID: 37543042 DOI: 10.1016/s1473-3099(23)00373-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Emergence of the SARS-CoV-2 omicron (B.1.1.529) variant with high immune evasion has led to the development and roll-out of bivalent mRNA vaccines targeting original and omicron strains. However, real-world observational data on effectiveness of bivalent vaccines are scarce. We aimed to assess the relative effectiveness of a fourth vaccine dose with the BA.1-adapted or BA.4/BA.5-adapted bivalent vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals in Singapore. METHODS We conducted a retrospective cohort study among Singapore residents aged 18 years and older who had received three monovalent mRNA vaccine doses and were eligible for a fourth dose. Data were collected from official databases on COVID-19 cases and vaccinations maintained by the Singapore Ministry of Health. We analysed the incidence of medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission between Oct 14, 2022, and Jan 31, 2023, by previous infection status and type of fourth vaccine dose received. Inverse probability-weighted Cox regressions were used to estimate hazard ratios (HRs). FINDINGS 2 749 819 individuals were included in the analysis. For the SARS-CoV-2-naive group, a fourth monovalent vaccine dose did not confer additional protection over three monovalent doses against symptomatic infection (HR 1·09 [95% CI 1·07-1·11]), whereas the bivalent vaccine did provide additional protection (0·18 [0·17-0·19]). Among individuals with previous infection, the HR was 0·87 (95% CI 0·84-0·91) and 0·14 (0·13-0·15) with receipt of the fourth monovalent and bivalent doses, respectively. Against COVID-19-related hospital admission, the bivalent vaccine (HR 0·12 [95% CI 0·08-0·18] in SARS-CoV-2-naive participants and 0·04 [0·01-0·15] in previously infected participants) conferred greater benefit compared with the fourth monovalent dose (0·84 [0·77-0·91] in SARS-CoV-2-naive participants and 0·85 [0·69-1·04] in previously infected participants). INTERPRETATION A fourth dose with the bivalent vaccine was substantially more effective against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission than four monovalent doses among both SARS-CoV-2-naive and previously infected individuals. Boosters with the bivalent vaccine might be preferred in this omicron-predominant pandemic, regardless of previous infection history. FUNDING None.
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Affiliation(s)
- Celine Y Tan
- Communicable Diseases Division, Ministry of Health, Singapore.
| | - Calvin J Chiew
- Communicable Diseases Division, Ministry of Health, Singapore; National Centre for Infectious Diseases, Singapore
| | - Deanette Pang
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Vernon J Lee
- Communicable Diseases Division, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Benjamin Ong
- Communicable Diseases Division, Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lin-Fa Wang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Ee Chee Ren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Immunology Network, Agency for Science Technology and Research, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Communicable Diseases Division, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Goh O, Pang D, Tan J, Lye D, Chong CY, Ong B, Tan KB, Yung CF. mRNA SARS-CoV-2 Vaccination Before vs During Pregnancy and Omicron Infection Among Infants. JAMA Netw Open 2023; 6:e2342475. [PMID: 37948079 PMCID: PMC10638647 DOI: 10.1001/jamanetworkopen.2023.42475] [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: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 11/12/2023] Open
Abstract
Importance Infants younger than 6 months are at risk of severe SARS-CoV-2 infection. Data are lacking on the optimum timing for maternal vaccination and estimated effectiveness against Omicron variants, including XBB, for infants. Objective To investigate maternal vaccination against Omicron variants, including XBB, and the association of vaccination timing during pregnancy vs prior to pregnancy and risks of SARS-CoV-2 infection among infants aged 6 months or younger. Design, Setting, and Participants This population-based cohort study was conducted between January 1, 2022, and March 31, 2023. Singapore's national dataset was used to study infants born at greater than 32 weeks' gestation between January 1, 2022, and September 30, 2022. The study included infants whose parents had a confirmed SARS-CoV-2 infection from the date of birth up to 6 months of age. Of 21 609 infants born during this period, 7292 (33.7%) had at least 1 parent infected with SARS-CoV-2 before the age of 7 months. Statistical analysis was performed from April to July 2023. Exposure Infants' mothers were unvaccinated, vaccinated prior to pregnancy, or vaccinated with a messenger RNA (mRNA) SARS-CoV-2 vaccine during pregnancy. Main Outcome and Measure Infants were considered infected if they had a positive polymerase chain reaction test. Results Among 7292 infants included in this study, 4522 (62.0%) had mothers who were Chinese, 527 (7.2%) had mothers who were Indian, 2007 (27.5%) had mothers who were Malay, and 236 (3.2%) had mothers who were other ethnicity; 6809 infants (93.4%) were born at full term, and 1272 infants (17.4%) were infected during the study period. There were 7120 infants (97.6%) born to mothers who had been fully vaccinated or boosted as of 14 days prior to delivery. The crude incidence rate was 174.3 per 100 000 person-days among infants born to mothers who were unvaccinated, 122.2 per 100 000 person-days among infants born to mothers who were vaccinated before pregnancy, and 128.5 per 100 000 person-days among infants born to mothers who were vaccinated during pregnancy. The estimated vaccine effectiveness (VE) was 41.5% (95% CI, 22.8% to 55.7%) among infants born to mothers vaccinated during pregnancy. Infants of mothers who received vaccination prior to pregnancy did not have a lower risk for infection (estimated VE, 15.4% [95% CI, -17.6% to 39.1%]). A lower risk for Omicron XBB infection was only observed among mothers vaccinated with the third (booster) dose antenatally (estimated VE, 76.7% [95% CI, 12.8% to 93.8%]). Conclusions and Relevance In this population-based cohort study, maternal mRNA vaccination was associated with a lower risk of Omicron SARS-CoV-2 infection among infants up to 6 months of age only if the vaccine was given during the antenatal period. These findings suggest that mRNA vaccination during pregnancy may be needed for lower risk of SARS-CoV-2 infection among newborns.
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Affiliation(s)
- Orlanda Goh
- Department of Internal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore
| | | | | | - David Lye
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National Centre for Infectious Disease, Singapore
| | - Chia Yin Chong
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore
- Duke-NUS Medical School, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore
- Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chee Fu Yung
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
- Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore
- Duke-NUS Medical School, Singapore
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Wee LE, Pang D, Chiew C, Tan J, Lee V, Ong B, Lye DC, Tan KB. Long-term Real-world Protection Afforded by Third mRNA Doses Against Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infections, Coronavirus Disease 19-related Emergency Attendances and Hospitalizations Amongst Older Singaporeans During an Omicron XBB Wave. Clin Infect Dis 2023; 77:1111-1119. [PMID: 37280047 DOI: 10.1093/cid/ciad345] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/15/2023] [Revised: 05/23/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Literature on long-term real-world vaccine effectiveness of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) booster vaccines (up to and beyond 360 days) is scarce. We report estimates of protection against symptomatic infection, emergency department (ED) attendances and hospitalizations up to and beyond 360 days post-receipt of booster messenger RNA (mRNA) vaccines among Singaporeans aged ≥60 years during an Omicron XBB wave. METHODS We conducted a population-based cohort study including all Singaporeans aged ≥60 years with no documented prior SARS-CoV-2 infection who had previously received ≥3 doses of mRNA vaccines (BNT162b2/mRNA-1273), over a 4-month period during transmission of Omicron XBB. We reported the adjusted incidence-rate-ratio (IRR) for symptomatic infections, ED attendances and hospitalizations at different time-intervals from both first and second boosters, using Poisson regression; with the reference group being those who received their first booster 90 to 179 days prior. RESULTS In total, 506 856 boosted adults were included, contributing 55 846 165 person-days of observation. Protection against symptomatic infections among those who received a third vaccine dose (first booster) waned after 180 days with increasing adjusted IRRs; however, protection against ED attendances and hospitalizations held up, with comparable adjusted IRRs with increasing time from third vaccine doses (≥360 days from third dose: adjusted IRR [ED attendances] = 0.73, 95% confidence interval [CI] = .62-.85; adjusted IRR [hospitalization] = 0.58, 95% CI = .49-.70). CONCLUSIONS Our results highlight the benefit of a booster dose in reducing ED attendances and hospitalizations amongst older adults aged ≥60 years with no documented prior SARS-CoV-2 infection, during an Omicron XBB wave; up to and beyond 360 days post-booster. A second booster provided further reduction.
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Affiliation(s)
- Liang En Wee
- National Centre for Infectious Diseases, Singapore, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | | | - Calvin Chiew
- National Centre for Infectious Diseases, Singapore, Singapore
- Ministry of Health, Singapore, Singapore
| | - Janice Tan
- Ministry of Health, Singapore, Singapore
| | - Vernon Lee
- Ministry of Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Amarell K, Carrasquilla M, McGunigal M, Pang D, He A, Unger KR. Hypofractionated Intensity Modulated Proton Therapy (IMPT) and Systemic Therapy for Unresectable Hepatobiliary Cancers. Int J Radiat Oncol Biol Phys 2023; 117:e282. [PMID: 37785054 DOI: 10.1016/j.ijrobp.2023.06.1265] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Proton therapy offers significantly reduced normal liver dose compared to photon therapy for liver tumors, and therefore has the potential for dose escalation and hypofractionation. Employing IMPT, we have initiated a hypofractionated treatment regimen for unresectable liver cancer at a single academic institution. Here we report our initial results on dosimetry and clinical outcomes of hypofractionated IMPT for unresectable hepatocellular carcinoma (HCC) and cholangiocarcomas (CC). MATERIALS/METHODS We retrospectively reviewed records of consecutive patients treated with IMPT for CC and HCC from 2018 to 2021. Inverse treatment planning with robust optimization, daily image guidance, pencil beam scanning dose delivery were used for all patients. Motion management included 4D-CT and abdominal compression. Toxicity was graded using the Common Terminology Criteria for Adverse Events version 5.0 and survival was calculated using the Kaplan Meier method. RESULTS We identified 15 patients (3 HCC, 4 intrahepatic CC, 8 hilar CC) treated with IMPT to a median dose of 5805 cGy (range, 4500 - 6000 cGy) in 15 fractions. Two had metastatic and 13 had regional disease. Median tumor volume was 91.5 cc (range, 10.92 - 366.31 cc). Prior therapies included: 12 patients received upfront chemotherapy, (gemcitabine plus cisplatin most common), 4 received prior surgery on the liver, and 5 received prior liver directed treatment. With a median follow up of 10 months, the median overall survival (OS) and 1-year OS was 18.7 months and 76% respectively. One patient underwent resection and 1 patient received liver transplant; 7 (47%) patients had disease progression (3 local, 1 regional lymph node, 4 elsewhere liver, 5 distant metastatic). Five patients with CC developed grade 3 toxicity in the form of cholangitis (4) and hemobilia (1). Of these patients, 4 patients were of the hilar type. CONCLUSION Our early results using hypofractionated IMPT for unresectable HCC and CC resulted in encouraging local control rates with an acceptable toxicity profile. Further study is warranted to determine the optimal liver directed therapy for this challenging patient population.
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Affiliation(s)
- K Amarell
- University Hospitals Geauga Medical Center, Chardon, OH
| | - M Carrasquilla
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - M McGunigal
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - D Pang
- Medstar Georgetown University Hospital, Washington, DC
| | - A He
- Department of Hematology/Oncology Georgetown University Hospital, Washington, DC
| | - K R Unger
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
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Mullins CF, Fuccaro M, Pang D, Min L, Andreou AP, Lambru G. A single infusion of intravenous lidocaine for primary headaches and trigeminal neuralgia: a retrospective analysis. Front Neurol 2023; 14:1202426. [PMID: 37638187 PMCID: PMC10448809 DOI: 10.3389/fneur.2023.1202426] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Intravenous (IV) lidocaine has been used as a transitional treatment in headache and facial pain conditions, typically as an inpatient infusion over several days, which is costly and may increase the risk of adverse effects. Here we report on our experience using a single one-hour IV lidocaine infusion in an outpatient day-case setting for the management of refractory primary headache disorders with facial pain and trigeminal neuralgia. Methods This is a retrospective, single-center analysis on patients with medically refractory headache with facial pain and trigeminal neuralgia who were treated with IV lidocaine between March 2018 and July 2022. Lidocaine 5 mg.kg-1 in 60 mL saline was administered over 1 h, followed by an observation period of 30 min. Patients were considered responders if they reported reduction in pain intensity and/or headache frequency of 50% or greater. Duration of response was defined as short-term (< 2 weeks), medium-term (2-4 weeks) and long-term (> 4 weeks). Results Forty infusions were administered to 15 patients with trigeminal autonomic cephalalgias (n = 9), chronic migraine (n = 3) and trigeminal neuralgia (n = 3). Twelve patients were considered responders (80%), eight of whom were complete responders (100% pain freedom). The average duration of the treatment effect for each participant was 9.5 weeks (range 1-22 weeks). Six out of 15 patients reported mild and self-limiting side effects (40%). Conclusion A single infusion of IV lidocaine might be an effective and safe transitional treatment in refractory headache conditions with facial pain and trigeminal neuralgia. The sustained effect of repeated treatment cycles in some patients may suggest a role as long-term preventive therapy in some patients.
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Affiliation(s)
- C. F. Mullins
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - M. Fuccaro
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - D. Pang
- Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - L. Min
- Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - A. P. Andreou
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - G. Lambru
- The Headache and Facial Pain Service, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Yung CF, Pang D, Kam KQ, Lye DC, Ong B, Chong CY, Tan KB. BNT162b2 vaccine protection against omicron and effect of previous infection variant and vaccination sequence among children and adolescents in Singapore: a population-based cohort study. Lancet Child Adolesc Health 2023; 7:463-470. [PMID: 37201540 PMCID: PMC10185330 DOI: 10.1016/s2352-4642(23)00101-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Information on variant-specific vaccine protection and the effect of previous infection variant is scarce in children. We aimed to ascertain the level of protection conferred by BNT162b2 COVID-19 vaccination against omicron variant infection (BA.4 or BA.5, and XBB) in a previously infected national paediatric cohort. We also explored the association between sequence of previous infection (variant) and vaccination on protection. METHODS We did a retrospective, population-based cohort study using the national databases of all confirmed SARS-CoV-2 infections, vaccines administered, and demographic records maintained by the Ministry of Health, Singapore. The study cohort consisted of children aged 5-11 years and adolescents aged 12-17 years who had a previous SARS-CoV-2 infection from Jan 1, 2020, to Dec 15, 2022. People who were infected during the pre-delta period or were immunocompromised (received three vaccination doses [children 5-11 years old] and four vaccinations doses [adolescents 12-17 years old]) were excluded. Those who had multiple episodes of infection before the study start date, were not vaccinated before infection but completed three doses, received bivalent mRNA vaccine, or received non-mRNA vaccine doses were also excluded. All SARS-CoV-2 infections confirmed by reverse transcriptase polymerase chain reaction or rapid antigen testing were grouped into delta, BA.1, BA.2, BA.4 or BA.5, or XBB variants using a combination of whole-genome sequencing, S-gene target failure results, and imputation. For BA.4 or BA.5, the study outcome period was June 1-Sept 30, 2022, and for XBB variants the outcome period was Oct 18-Dec 15, 2022. Incidence rate ratios between vaccinated and unvaccinated were derived using adjusted Poisson regressions and vaccine effectiveness was estimated as (1-risk ratio) × 100%. FINDINGS 135 197 people aged 5-17 years (79 332 children and 55 865 adolescents) were included in the cohort for the vaccine effectiveness analysis against omicron BA.4 or BA.5, and 164 704 people aged 5-17 years (97 235 children and 67 469 adolescents) were included for the analysis against omicron XBB. Approximately 47% of participants were female and 53% were male. Among those previously infected, vaccine effectiveness against BA.4 or BA.5 infection in fully vaccinated children (two doses) was 74·0% (95% CI 67·7-79·1) and in adolescents (three doses) was 85·7% (80·2-89·6). Against XBB, protection conferred with full vaccination was lower at 62·8% (95% CI 42·3-76·0) in children and 47·9% (20·2-66·1) in adolescents. In children, receipt of two-dose vaccination before first SARS-CoV-2 infection provided them with the highest protection against subsequent BA.4 or BA.5 infection at 85·3% (95% CI 80·2-89·1); however, this was not shown to be the case for adolescents. First infection variant had an effect on vaccine effectiveness against omicron BA.4 or BA.5 reinfection in the following descending order: BA.2 conferred the highest protection (92·3% [95% CI 88·9-94·7] in children and 96·4% [93·5-98·0] in adolescents) followed by BA.1 (81·9% [75·9-86·4] in children and 95·0% [91·6-97·0] in adolescents), and delta which conferred the lowest protection (51·9% [5·3-75·6] in children and 77·5% [63·9-86·0] in adolescents). INTERPRETATION In previously infected children and adolescents, BNT162b2 vaccination provided additional protection against omicron BA.4 or BA.5 and XBB variants compared with those who remained unvaccinated. Hybrid immunity against XBB was lower than against BA.4 or BA.5, especially in adolescents. Early vaccination of previously uninfected children before their first SARS-CoV-2 exposure could potentially strengthen population immunity resilience against future variants. FUNDING None.
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Affiliation(s)
- Chee Fu Yung
- Infectious Disease Service, Department of Paediatrics, and SingHealth Duke-NUS Paediatrics Academic Clinical Program, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore.
| | | | - Kai Qian Kam
- Infectious Disease Service, Department of Paediatrics, and SingHealth Duke-NUS Paediatrics Academic Clinical Program, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David C Lye
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National Centre for Infectious Diseases, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of Paediatrics, and SingHealth Duke-NUS Paediatrics Academic Clinical Program, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kelvin B Tan
- Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore; Ministry of Health, Singapore; National Centre for Infectious Diseases, Singapore
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Goh AXC, Chae SR, Chiew CJ, Tang N, Pang D, Lin C, Tan KB, Lee VJ, Ho ZJM. Characteristics of the omicron XBB subvariant wave in Singapore. Lancet 2023; 401:1261-1262. [PMID: 37061259 DOI: 10.1016/s0140-6736(23)00390-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 04/17/2023]
Affiliation(s)
| | - Sae-Rom Chae
- Ministry of Health, Singapore; National Centre for Infectious Diseases, Singapore
| | - Calvin J Chiew
- Ministry of Health, Singapore; National Centre for Infectious Diseases, Singapore
| | | | | | - Cui Lin
- National Centre for Infectious Diseases, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vernon J Lee
- Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Zheng Jie Marc Ho
- Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Tan CY, Chiew CJ, Pang D, Lee VJ, Ong B, Lye DC, Tan KB. Protective immunity of SARS-CoV-2 infection and vaccines against medically attended symptomatic omicron BA.4, BA.5, and XBB reinfections in Singapore: a national cohort study. Lancet Infect Dis 2023:S1473-3099(23)00060-9. [PMID: 36924786 DOI: 10.1016/s1473-3099(23)00060-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/09/2022] [Accepted: 01/26/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Despite a large proportion of the population having been vaccinated and infected, Singapore had SARS-CoV-2 waves driven by the BA.5 and XBB sublineages of the omicron (B.1.1.529) variant. Data on the protective immunity against medically attended, symptomatic reinfections with omicron BA.4, BA.5, and XBB conferred by previous SARS-CoV-2 infections and vaccinations are scarce. We therefore aimed to derive information from Singapore's experience as one of the first countries with an XBB-driven wave. METHODS For this retrospective national cohort study, we used information from official databases of the Ministry of Health of Singapore to assess hybrid immunity (obtained from previous infection and vaccination) against medically attended, symptomatic BA.4 and BA.5 reinfections from Oct 1, 2022, to Nov 1, 2022, and medically attended, symptomatic XBB reinfections from Oct 18, 2022, to Nov 1, 2022, among Singapore citizens and permanent residents aged at least 18 years. All individuals with acute respiratory symptoms who presented at any health-care facility in Singapore between the stated dates were tested for SARS-CoV-2. Individuals were grouped into SARS-CoV-2-naive, pre-omicron, omicron BA.1, and omicron BA.2 groups according to their previous infection status. Data were also stratified by time from first infection to analyse the waning of immunity. Incidence rate ratios (IRRs) were measured by generalised linear Poisson regressions, with SARS-CoV-2-naive individuals as the reference group, and protective immunity was calculated as one minus the risk ratio multiplied by 100. FINDINGS 2 456 791 individuals were included in the study, contributing 53·1 million person-days of observation for the SARS-CoV-2-naive group, 3·4 million person-days for the pre-omicron group, 6·6 million person-days for the BA.1 group, and 13·7 million person-days for the BA.2 group between Oct 1, 2022, and Nov 1, 2022. Compared with SARS-CoV-2-naive individuals, first infections with pre-omicron variants did not confer protection against reinfection with BA.4 or BA.5 (IRR 0·87 [95% CI 0·73-1·05] for pre-omicron infection with booster vaccination) or XBB (IRR 1·29 [1·23-1·35] for pre-omicron infection with booster vaccination). Previous BA.2 infection with booster provided the greatest protection against reinfection, but this was lower against reinfection with XBB (protective immunity 51%; 95% CI 49-53) than against reinfection with BA.4 or BA.5 (78%; 74-82). Protection conferred by previous BA.2 infection against XBB reinfection waned faster over time from first infection (from 74% [72-75] at 3-6 months to 49% [47-52] at 7-8 months) than protection against BA.4 or BA.5 reinfection (from 87% [82-90] at 3-6 months to 74% [66-80] at 7-8 months). INTERPRETATION Protection against XBB reinfection conferred by a previous omicron infection with vaccination was lower and waned faster than protection against BA.4 or BA.5 reinfection, which is indicative of the greater immune evasiveness of the XBB sublineage. Although severe COVID-19 is uncommon, populations remain vulnerable to future reinfection waves from emerging SARS-CoV-2 variants despite high rates of vaccination and infection, as reflected by substantially higher reinfection rates during Singapore's XBB wave than during the previous BA.5-driven wave. Policy makers could consider emerging public health interventions, such as omicron-adapted bivalent vaccines, to maintain population immunity against COVID-19. FUNDING None.
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Affiliation(s)
- Celine Y Tan
- Public Health Group, Ministry of Health, Singapore.
| | - Calvin J Chiew
- Public Health Group, Ministry of Health, Singapore; National Centre for Infectious Diseases, Singapore
| | - Deanette Pang
- Crisis Strategy and Operations Group, Ministry of Health, Singapore
| | - Vernon J Lee
- Public Health Group, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Benjamin Ong
- DMS Office, Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Crisis Strategy and Operations Group, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Tan CY, Chiew CJ, Pang D, Lee VJ, Ong B, Lye DC, Tan KB. Vaccine effectiveness against Delta, Omicron BA.1, and BA.2 in a highly vaccinated Asian setting: a test-negative design study. Clin Microbiol Infect 2023; 29:101-106. [PMID: 36028091 PMCID: PMC9398552 DOI: 10.1016/j.cmi.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We compared the vaccine effectiveness over time of the primary series and booster against infection and severe disease with the Delta, Omicron BA.1, and BA.2 variants in Singapore, an Asian setting with high vaccination coverage. METHODS We conducted a test-negative case-control study on all adult residents in Singapore who underwent PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in acute hospitals. Individuals with a negative PCR from 1 September, 2021, to 30 November, 2021, and 1 December, 2021, to 25 April, 2022, served as controls for the Delta and Omicron variants respectively, and PCR-positive individuals within these two time periods served as cases. Associations between vaccination status and SARS-CoV-2 infection and severe disease with the Delta or Omicron variants were measured using Poisson regressions. Vaccine effectiveness was calculated by taking 1 minus risk ratio. RESULTS There were 68 114 individuals comprising 58 495 controls and 9619 cases for the Delta period, of whom 53 093 completed the primary series and 9161 were boosted. For the Omicron period, 104 601 individuals comprising 80 428 controls, 8643 BA.1 cases, and 15 530 BA.2 cases were included, of whom 29 183 and 71 513 were vaccinated with the primary series and boosted, respectively. The primary series provided greater protection against infection with Delta (45%, 95% CI 40-50%) than against infection with Omicron (21%, 95% CI 7-34% for BA.1; 18%, 95% CI 6-29% for BA.2) at <2 months from vaccination. Vaccine effectiveness of the booster was similar against infection with BA.1 (44%, 95% CI 38-50%) and BA.2 (40%, 95% CI 35-40%). Protection against severe disease by the booster for BA.1 (83%, 95% CI 76-88%) and BA.2 (78%, 95% CI 73-82%) was comparable to that by the primary series for Delta (80%, 95% CI 73-85%). CONCLUSION Our findings support the use of a booster dose to reduce the risk of severe disease and mitigate the impact on the healthcare system in an Omicron-predominant epidemic.
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Affiliation(s)
- Celine Y. Tan
- Ministry of Health, Singapore,Corresponding author. Communicable Diseases Division, Ministry of Health, 12 College Road, Singapore 169852
| | | | | | - Vernon J. Lee
- Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,National Centre for Infectious Diseases, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
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Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
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Shao Z, Huang T, Fan Z, Wang Y, Yan X, Yang H, Wang S, Pang D, Li H, Wang H, Geng C, Huang L, Siddiqui A, Wang B, Xie B, Sun G, Restuccia E. 1MO The fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC) in Chinese patients (pts) with HER2-positive early breast cancer (EBC): Primary analysis of the phase III, randomised FDChina study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Geyer C, Garber J, Gelber R, Yothers G, Taboada M, Ross L, Rastogi P, Cui K, Arahmani A, Aktan G, Armstrong A, Arnedos M, Balmaña J, Bergh J, Bliss J, Delaloge S, Domchek S, Eisen A, Elsafy F, Fein L, Fielding A, Ford J, Friedman S, Gelmon K, Gianni L, Gnant M, Hollingsworth S, Im SA, Jager A, Jóhannsson Ó, Lakhani S, Janni W, Linderholm B, Liu TW, Loman N, Korde L, Loibl S, Lucas P, Marmé F, Martinez de Dueñas E, McConnell R, Phillips KA, Piccart M, Rossi G, Schmutzler R, Senkus E, Shao Z, Sharma P, Singer C, Španić T, Stickeler E, Toi M, Traina T, Viale G, Zoppoli G, Park Y, Yerushalmi R, Yang H, Pang D, Jung K, Mailliez A, Fan Z, Tennevet I, Zhang J, Nagy T, Sonke G, Sun Q, Parton M, Colleoni M, Schmidt M, Brufsky A, Razaq W, Kaufman B, Cameron D, Campbell C, Tutt A. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high risk, early breast cancer. Ann Oncol 2022; 33:1250-1268. [PMID: 36228963 DOI: 10.1016/j.annonc.2022.09.159] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety. PATIENTS AND METHODS One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015. RESULTS With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome. CONCLUSION With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.
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Liuru T, Pang D, Zhang J, Shao G, Li J, Liu Z, Sun Z. EP02.03-015 Fully Robotic Arm Robot Assisted Lung Surgery Exploration. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.371] [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: 10/14/2022]
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Riandini T, Pang D, Toh MPHS, Tan CS, Choong AMTL, Lo ZJ, Chandrasekar S, Tai ES, Tan KB, Venkataraman K. National Rates of Lower Extremity Amputation in People With and Without Diabetes in a Multi-Ethnic Asian Population: a Ten Year Study in Singapore. Eur J Vasc Endovasc Surg 2021; 63:147-155. [PMID: 34916107 DOI: 10.1016/j.ejvs.2021.09.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/20/2021] [Revised: 08/29/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Population level data from Asia on amputation rates in people with and without diabetes are extremely limited. Hence it is unclear how the rising diabetes prevalence in Asia has affected the amputation burden. The present study examined national amputation rates in people with and without diabetes in Singapore from 2008 to 2017 in the context of increasing diabetes prevalence and health system changes. METHODS This was a retrospective observational study using national population data for ages 16 - 100 years obtained from the Ministry of Health Singapore administrative datasets. Age sex standardised major and toe/ray amputation rates per 100 000 people with diabetes and per 100 000 people without diabetes were calculated. Rates were calculated overall and in each ethnic group (Chinese, Malay, Indian, Others), with trends over time calculated using joinpoint trend analysis. In addition, age specific rates, relative risk (RR) of amputation in diabetics compared with non-diabetics and proportion of amputations in the population attributable to diabetes were also calculated. RESULTS Between 2008 and 2017, the database included 3.6 million unique individuals, of whom 75% were Chinese, 8.6% Malay, 7.9% Indian, and 8.4% Others. Of those, 413 486 (11%) had diabetes. Major amputation rates in people with diabetes remained stable (2008: 99.5/100 000; 2017: 95.0/100 000 people with diabetes, p = .91) as did toe/ray amputation rates. Rates in people without diabetes were substantially lower, with major amputation rates decreasing significantly (2008: 3.0/100 000; 2017: 2.1/100 000 people without diabetes, 3% annual reduction, p = .048). Diabetes related amputation rates were highest in Malays and lowest in Chinese. Diabetes related major amputation rates declined significantly among Chinese (3.1% annual reduction, p < .038). While the RR for amputations in diabetes remained stable, the proportion of major amputations attributable to diabetes increased from 63.6% in 2008 to 81.7% in 2017 (3% annual increase, p = .003). CONCLUSION Diabetes related major and toe/ray amputation rates have remained stable but relatively high in Singapore compared with other countries, and the proportion of amputations attributable to diabetes has increased over time. More research is needed to understand the aetiopathological, sociocultural, and health system factors that may underlie the continued high rates of diabetes related amputations in this population.
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Affiliation(s)
- Tessa Riandini
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Deanette Pang
- Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Matthias P H S Toh
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Chuen S Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Andrew M T L Choong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore, Republic of Singapore
| | - Zhiwen J Lo
- Department of Vascular Surgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Sadhana Chandrasekar
- Department of Vascular Surgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore; Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore.
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Abstract
Abstract
Background
Ageing leads to inactivity and conditions like heart disease, type II diabetes, and risk of falls. Regular physical activity (PA) helps with a renewed feeling of ability, efficient blood circulation, balance, and coordination. In the UK, physical inactivity is the fourth largest killer of the elderly. This study examines some physical activity determinants in older people.
Methods
A cross-sectional analysis of the UKUS cohort study Wave 2 (2010-12) with participants aged 65 and above was done. The descriptive analyses involved crosstabulations and pictorials in SPSS and Microsoft Office. Data was dichotomised for 2x2 tables in OpenEpi for the univariate analyses. Multivariate analysis was via ordinal logistic regression in SPSS. As Wave 2 had no variable describing PA, a ‘total physical activity' (TPA) score was created. TPA is composed of the addition of the total walking score (TWS), total hobbies/sports score (THSS), ‘total physicality score' (TPS), and total sport frequency (TSF). All five variants were created by indexing available proxy variables unique to each category. Results were reported with odds ratios and 95% confidence intervals.
Results
Univariate analysis with TPA showed an association with some variables like income, OR = 15.25 (8.57-27.12), social interaction, OR = 2.11 (1.46-3.05), family interaction, OR = 2.69(1.45-4.98), wellbeing, OR = 312(157.5-617.9), physical health, OR = 2.84(1.39-5.81) and emotional health, OR = 2.42(1.21-5.07). Multivariable analysis after adjusting for age and sex yielded no significant associations between most PA and predictors. Some significant associations include TWS and social class, AOR= 2.59 (P = 0.013), green food consumption, and TPS, AOR= 1.47 (P < 0.05).
Conclusions
In general, higher income, gross personal income, social class, wellbeing, and green food consumption seemed to produce greater odds of participating in all physical activities.
Key messages
These findings suggest the need for other social determinants to be thoroughly investigated. There is also a need for older adults to be well provided for so these determinants of health can improve their quality of life.
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Affiliation(s)
- M Ikpeme
- Faculty of Medicine, Imperial College London, London, UK
- FACE, University of Hull, Hull, UK
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - D Pang
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Zhang J, Shao G, Liu Z, Liuru T, Liang Y, Kong F, Pang D. P02.01 CT Integrated Bronchoscopy Manual Spraying Pigment Labeling to Localize of Small Pulmonary Nodules. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.264] [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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21
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Malik K, Eseonu KC, Pang D, Fakouri B, Panchmatia JR. Is Preexisting Cervical Degeneration a Risk Factor for Poor Prognosis in Whiplash-Associated Disorder? Int J Spine Surg 2021; 15:710-717. [PMID: 34281955 PMCID: PMC8375694 DOI: 10.14444/8093] [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: 11/20/2022] Open
Abstract
BACKGROUND The term whiplash describes the acceleration-deceleration mechanism of injury to the cervical spine. Whiplash injuries present with a variety of clinical and psychological manifestations, collectively termed as whiplash-associated disorders (WADs). Although largely self-limiting, some patients may experience long-lasting symptoms. This review aimed to summarize the current literature regarding the predictive value of cervical degeneration in the prognosis of patients with WAD. METHODS A comprehensive search of the literature was performed. Nine studies were identified, including 894 patients, with an age range between 16 and 76 years. RESULTS A statistically significant association was found between moderate facet joint degeneration and nonrecovery. Although no association was established between isolated disc degeneration and nonrecovery, total cervical degeneration (facet joint + disc degeneration) was shown to correlate with nonrecovery.All included studies demonstrated the lack of correlation between preexisting disc degeneration and clinical outcomes. Four studies showed a significant correlation between cervical degeneration and poor prognosis following whiplash injury. A significantly higher proportion of patients who remained symptomatic at 2 years following a whiplash injury had preexisting degenerative changes. CONCLUSIONS This review highlights the presence of significant variability in the existing literature concerning WAD in terms of study methodology, definitions of cervical degeneration, and outcome measures. Degenerative changes of the facet joint lead to alterations in its biomechanics. Several cadaveric, biomechanical, and clinical studies have demonstrated facet joints as a source of pain in patients with chronic WAD. We present moderate evidence to suggest that preexisting facet joint degeneration is a negative prognostic indicator for long-lasting symptoms in WAD. Conversely, preexisting disc degeneration is not associated with chronicity of WAD symptoms. We propose facet joint instability due to facet joint capsule rupture as a potential mechanism for nonrecovery. Further studies are needed to inform our knowledge of the long-term sequelae of WAD among patients with preexisting cervicalspine degeneration.
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Affiliation(s)
- Khalid Malik
- Speciality Registrar, Trauma and Orthopaedics, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - K. C. Eseonu
- Senior Spinal Fellow, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - D. Pang
- Consultant Pain Physician, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - B. Fakouri
- Consultant Spine Surgeon and Lead for Spine Surgery, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - J. R. Panchmatia
- Consultant Spine Surgeon, Guy's & St. Thomas' Hospitals, London, United Kingdom
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Riandini T, Pang D, Toh MPHS, Tan CS, Liu DYK, Choong AMTL, Chandrasekar S, Tai ES, Tan KB, Venkataraman K. Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore. Diabetologia 2021; 64:1538-1549. [PMID: 33885933 PMCID: PMC8187215 DOI: 10.1007/s00125-021-05441-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Diabetes progression and complication risk are different in Asian people compared with those of European ancestry. In this study, we sought to understand the epidemiology of diabetes-related lower extremity complications (DRLECs: symptomatic peripheral arterial disease, ulceration, infection, gangrene) and amputations in a multi-ethnic Asian population. METHODS This was a retrospective observational study using data obtained from one of three integrated public healthcare clusters in Singapore. The population consisted of individuals with incident type 2 diabetes who were of Chinese, Malay, Indian or Other ethnicity. We examined incidence, time to event and risk factors of DRLECs and amputation. RESULTS Between 2007 and 2017, of the 156,593 individuals with incident type 2 diabetes, 20,744 developed a DRLEC, of whom 1208 underwent amputation. Age- and sex-standardised incidence of first DRLEC and first amputation was 28.29/1000 person-years of diabetes and 8.18/1000 person-years of DRLEC, respectively. Incidence of both was highest in individuals of Malay ethnicity (DRLEC, 36.09/1000 person-years of diabetes; amputation, 12.96/1000 person-years of DRLEC). Median time from diabetes diagnosis in the public healthcare system to first DRLEC was 30.5 months for those without subsequent amputation and 10.9 months for those with subsequent amputation. Median time from DRLEC to first amputation was 2.3 months. Older age (p < 0.001), male sex (p < 0.001), Malay ethnicity (p < 0.001), Indian ethnicity (p = 0.014), chronic comorbidities (nephropathy [p < 0.001], heart disease [p < 0.001], stroke [p < 0.001], retinopathy [p < 0.001], neuropathy [p < 0.001]), poorer or missing HbA1c (p < 0.001), lower (p < 0.001) or missing (p = 0.002) eGFR, greater or missing BMI (p < 0.001), missing LDL-cholesterol (p < 0.001) at diagnosis, and ever-smoking (p < 0.001) were associated with higher hazard of DRLEC. Retinopathy (p < 0.001), peripheral vascular disease (p < 0.001), poorer HbA1c (p < 0.001), higher (p = 0.009) or missing (p < 0.001) LDL-cholesterol and missing BMI (p = 0.008) were associated with higher hazard of amputation in those with DRLEC. Indian ethnicity (p = 0.007) was associated with significantly lower hazard of amputation. CONCLUSIONS/INTERPRETATION This study has revealed important ethnic differences in risk of diabetes-related lower limb complications, with Malays most likely to progress to DRLEC. Greater research efforts are needed to understand the aetiopathological and sociocultural processes that contribute to the higher risk of lower extremity complications among these ethnic groups.
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Affiliation(s)
- Tessa Riandini
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Deanette Pang
- Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Matthias P H S Toh
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Daveon Y K Liu
- Information Management, Group Health Informatics, National Healthcare Group, Singapore, Republic of Singapore
| | - Andrew M T L Choong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore, Republic of Singapore
| | - Sadhana Chandrasekar
- Department of Vascular Surgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore.
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Magliano DJ, Chen L, Islam RM, Carstensen B, Gregg EW, Pavkov ME, Andes LJ, Balicer R, Baviera M, Boersma-van Dam E, Booth GL, Chan JCN, Chua YX, Fosse-Edorh S, Fuentes S, Gulseth HL, Gurevicius R, Ha KH, Hird TR, Jermendy G, Khalangot MD, Kim DJ, Kiss Z, Kravchenko VI, Leventer-Roberts M, Lin CY, Luk AOY, Mata-Cases M, Mauricio D, Nichols GA, Nielen MM, Pang D, Paul SK, Pelletier C, Pildava S, Porath A, Read SH, Roncaglioni MC, Lopez-Doriga Ruiz P, Shestakova M, Vikulova O, Wang KL, Wild SH, Yekutiel N, Shaw JE. Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings. Lancet Diabetes Endocrinol 2021; 9:203-211. [PMID: 33636102 PMCID: PMC10984526 DOI: 10.1016/s2213-8587(20)30402-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time. METHODS In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time. FINDINGS Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions. INTERPRETATION The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources. FUNDING US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.
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Affiliation(s)
- Dianna J Magliano
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Lei Chen
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Rakibul M Islam
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Elise Boersma-van Dam
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yi Xian Chua
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Sandrine Fosse-Edorh
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Sonsoles Fuentes
- Department of Non-Communicable Diseases and Trauma, Santé Publique France, Saint-Maurice, France
| | - Hanne L Gulseth
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Romualdas Gurevicius
- Center of Health Information, Institute of Hygiene, Vilnius, Lithuania; Faculty of Public Governance and Business, Mykolas Romeris University, Vilnius, Lithuania
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Thomas R Hird
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - György Jermendy
- 3rd Medical Department, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Mykola D Khalangot
- Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences, Kyiv, Ukraine; Endocrinology Department, Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Zoltán Kiss
- 2nd Department of Medicine and Nephrological Center, Medical Faculty, University of Pécs, Pécs, Hungary
| | - Victor I Kravchenko
- Komisarenko Institute of Endocrinology and Metabolism, National Academy of Medical Sciences, Kyiv, Ukraine
| | - Maya Leventer-Roberts
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Department of Pediatrics and Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chun-Yi Lin
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Manel Mata-Cases
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; DAP-Cat Group, Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, Barcelona, Spain; DAP-Cat Group, Institut Català de la Salut, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Gregory A Nichols
- Science Programs Department, Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Mark M Nielen
- Department of General Practice, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Deanette Pang
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine Pelletier
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Riga, Latvia
| | - Avi Porath
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel; Faculty of Health, Ben Gurion University, Beer-Sheva, Israel
| | | | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Paz Lopez-Doriga Ruiz
- Department for Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Olga Vikulova
- Diabetes Institute, Endocrinology Research Center, Moscow, Russia
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Naama Yekutiel
- Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jonathan E Shaw
- Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, Latrobe University, Bundoora, VIC, Australia
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Zhang F, Pang D, Kong F. P03.06 Nausea in Patients Had Thoracomy: A Pilot Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.379] [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: 10/21/2022]
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Zhang J, Shao G, Luo Q, Zhang F, Chen W, Wang W, Li S, Pang D, Kong F. P11.02 Patient Reported Outcome Measures (PROM) after Thoracic Surgery: A Pilot Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.495] [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: 10/21/2022]
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Pang D, Chen W, Zhang J, Yang L, Shao G, Liuru T, Xu L, Xu W, Zhao C, Luo M, Ma L, Zhang F, Liang Z, Li S, Kong F. P07.08 IDO Immune Suppression and Post Surgical Toxicity in Patients with Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tian ZZ, Pang D, Liu HN, Zhou L, Zheng YY. [Effect of enhanced recovery after surgery for elderly patients with hemiarthroplasty for the treatment of femoral neck fracture]. Zhonghua Yi Xue Za Zhi 2020; 100:2903-2907. [PMID: 32993248 DOI: 10.3760/cma.j.cn112137-20200308-00647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical effect of enhanced recovery after surgery (ERAS) for the elderly patients with femoral neck fracture. Methods: A total of 92 elderly patients with femoral neck fracture who received hemiarthroplasty from July 2018 to December 2018 in Beijing Jishuitan Hospital were enrolled in this study. The average age of the participants was (75±6) years, including 31 males and 61 females, and 72(78.3%) of the patients complicated with comorbidity. According to the perioperative management method, the patients were divided into the observational group (47 cases with ERAS) and the control group (45 cases with normal management). The data related to operation, hospitalization, complication and nursing satisfaction were compared between the 2 groups. The visual analogue scale (VAS) was used for pain evaluation. The Harris scores for hip joint and EQ-5D index scores were applied to evaluate the clinical outcomes. The follow-up were performed periodically for 3 months. The measurement data in accordance with normal distribution and homogeneity of variance were compared with t test. Results: All the surgeries completed successfully and no patient died during perioperative period. Compared with the control group, the operation rate in 48 hours (χ(2)=17.781, P<0.01), bed days (Z=-4.987, P<0.01), and medical costs (Z=-4.315, P<0.01) favored that in the observational group. The incidence of complication and nursing satisfaction showed no significant difference between the two groups (31.1% vs 14.9%, 86.7% vs 95.7%, χ(2)=3.432, 1.380, both P>0.05). The perioperative VAS score was lower in the observational group. The Harris scores were higher in the observational group after 1 months (t=4.458, P<0.01), however the quality of life for 2 groups was similar at all time points (t=1.293, 1.227, both P>0.05). Conclusion: ERAS can improve hip function and reduce the hospital stays and medical costs for patients underwent HA operation.
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Affiliation(s)
- Z Z Tian
- Department of General Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China
| | - D Pang
- School of Nursing, Peking University, Beijing 100191, China
| | - H N Liu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - L Zhou
- Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Y Y Zheng
- Department of General Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China
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Kang M, Pang D. Commissioning and beam characterization of the first gantry-mounted accelerator pencil beam scanning proton system. Med Phys 2020; 47:3496-3510. [PMID: 31840264 DOI: 10.1002/mp.13972] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/29/2019] [Accepted: 12/05/2019] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To present and discuss beam characteristics and commissioning process of the first gantry-mounted accelerator single room pencil beam scanning (PBS) proton system. METHODS The Mevion HYPERSCAN employs a design configuration with a synchrocyclotron mounted on the gantry to eliminate the traditional beamline and a nozzle that contains the dosimetry monitoring chambers, the energy modulator (Energy Selector (ES)), and an Adaptive Aperture (AA). To characterize the beam, we measured the integrated depth dose (IDDs) for 12 energies, from highest energy of 227 MeV down to 28 MeV with a range difference ~ 2 cm between the adjacent energies, using a large radius Bragg peak chamber; single-spot profiles in air at five locations along the beam central axis using radiochromic EBT3 film and cross compared with a scintillation detector; and determined the output using a densely packed spot map. To access the performance of AA, we measured interleaf leakage and the penumbra reduction effect. Monte Carlo simulation using TOPAS was performed to study spot size variation along the beam path, beam divergence, and energy spectrum. RESULTS This proton system is calibrated to deliver 1 Gy dose at 5 cm depth in water using the highest beam energy by delivering 1 MU/spot to a 10 × 10 cm2 map with a 2.5 mm spot spacing. The spot size in air varies from 4 mm to 26 mm from 227 MeV to 28 MeV at the isocenter plane with the nozzle retracted 23.6 cm from isocenter. The beam divergence of 28 MeV beam is ~ 52.7 mrad, which is nearly 22 times that of 227 MeV proton beam. The binary design of the ES has resulted in shifts of the effective SSD toward the isocenter as the energy is modulated lower. The peaks of IDD curves have a constant 80%-80% width of 8.4 mm at all energies. The interleaf leakage of the AA is less than 1.5% at the highest energy; and the AA can reduce the penumbra by 2 mm to 13 mm for the 227 and 28 MeV energies at isocenter plane in air. CONCLUSIONS The unique design of the HYPERSCAN proton system has yielded beam characteristics significantly different from that of other proton systems in terms of the Bragg peak shapes, spot sizes, and the penumbra sharpening effect of the AA. The combination of the ES and AA has made PBS implementation possible without using beam transport line and range shifter devices. Different considerations may be required in treatment planning optimization to account for different design and beam characteristics.
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Affiliation(s)
- M Kang
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - D Pang
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
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Masannat YA, Agrawal A, Maraqa L, Fuller M, Down SK, Tang SSK, Pang D, Kontos M, Romics L, Heys SD. Multifocal and multicentric breast cancer, is it time to think again? Ann R Coll Surg Engl 2020; 102:62-66. [PMID: 31891668 PMCID: PMC6937617 DOI: 10.1308/rcsann.2019.0109] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Accepted: 06/16/2019] [Indexed: 11/22/2022] Open
Abstract
Multifocal multicentric breast cancer has traditionally been considered a contraindication to breast conserving surgery because of concerns regarding locoregional control and risk of disease recurrence. However, the evidence supporting this practice is limited. Increasingly, many breast surgeons are advocating breast conservation in selected cases. This short narrative review summarises current evidence on the role of surgery in multifocal multicentric breast cancer and shows that when technically feasible the option of breast conservation is oncologically safe.
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Affiliation(s)
- YA Masannat
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - A Agrawal
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - L Maraqa
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Fuller
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - SK Down
- James Paget University Hospitals NHS Foundation Trust, Great, UK
- University of East Anglia, Norwich Medical School, Athens, Greece
| | - SSK Tang
- St George’s University Hospitals NHS Foundation Trust, London, UK
| | - D Pang
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - M Kontos
- National and Kapodistrian University of Athens, Athens, Greece
| | - L Romics
- New Victoria Hospital and Queen Elizabeth University Hospital, Glasgow, UK
| | - SD Heys
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
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Quan J, Pang D, Li TK, Choi CH, Siu SC, Tang SY, Wat NM, Woo J, Lau ZY, Tan KB, Leung GM. Risk Prediction Scores for Mortality, Cerebrovascular, and Heart Disease Among Chinese People With Type 2 Diabetes. J Clin Endocrinol Metab 2019; 104:5823-5830. [PMID: 31287503 DOI: 10.1210/jc.2019-00731] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/02/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Risk scores for cardiovascular and mortality outcomes have not been commonly applied in Chinese populations. OBJECTIVE To develop and externally validate a set of parsimonious risk scores [University of Hong Kong-Singapore (HKU-SG)] to predict the risk of mortality, cerebrovascular disease, and ischemic heart disease among Chinese people with type 2 diabetes and compare HKU-SG risk scores to other existing ones. DESIGN Retrospective population-based cohorts drawn from Hong Kong Hospital Authority health records from 2006 to 2014 for development and Singapore Ministry of Health records from 2008 to 2016 for validation. Separate five-year risk scores were derived using Cox proportional hazards models for each outcome. SETTING Study participants were adults with type 2 diabetes aged 20 years or over, consisting of 678,750 participants from Hong Kong and 386,425 participants from Singapore. MAIN OUTCOME MEASURES Performance was evaluated by discrimination (Harrell C-index), and calibration plots comparing predicted against observed risks. RESULTS All models had fair external discrimination. Among the risk scores for the diabetes population, ethnic-specific risk scores (HKU-SG and Joint Asia Diabetes Evaluation) performed better than UK Prospective Diabetes Study and Risk Equations for Complications Of type 2 Diabetes models. External validation of the HKU-SG risk scores for mortality, cerebrovascular disease, and ischemic heart disease had corresponding C-indices of 0.778, 0.695, and 0.644. The HKU-SG models appeared well calibrated on visual plots, with predicted risks closely matching observed risks. CONCLUSIONS The HKU-SG risk scores were developed and externally validated in two large Chinese population-based cohorts. The parsimonious use of clinical predictors compared with previous risk scores could allow wider implementation of risk estimation in diverse Chinese settings.
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Affiliation(s)
- Jianchao Quan
- Division of Health Economics, Policy and Management, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | | | - Tom K Li
- Division of Health Economics, Policy and Management, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | | | - Shing Chung Siu
- Department of Medicine & Rehabilitation, Tung Wah Eastern Hospital, Hong Kong, China
| | | | | | - Jean Woo
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - Gabriel M Leung
- Division of Health Economics, Policy and Management, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Shao Z, Pang D, Yang H, Li W, Wang S, Cui S, Liao N, Wang Y, Wang C, Chang YC, Wang H, Kang SY, Jiang Z, Li J, Zhou J, Althaus B, Mao Y, Eng-Wong J. Abstract P6-17-17: Pertuzumab, trastuzumab, and docetaxel for HER2-positive early or locally advanced breast cancer in the neoadjuvant setting: Efficacy and safety analysis of a randomized phase III study in Asian patients (PEONY). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Pertuzumab and trastuzumab (P and H; F. Hoffmann-La Roche Ltd, Basel, CH) bind to distinct HER2 subdomains and have complementary modes of anticancer activity in HER2-positive breast cancer (BC). A global Phase II study (NeoSphere) reported that neoadjuvant treatment with P+H+docetaxel (D) significantly increased breast pathologic complete response (bpCR) vs H+D in patients (pts) with early/locally advanced/inflammatory HER2-positive BC (Gianni et al. Lancet Oncol 2012). PEONY (NCT02586025), a randomized, multicenter, double-blind, placebo-controlled, Phase III trial conducted in an Asian population (mainland China, Taiwan, Korea, Thailand), primarily compared the efficacy, safety, and tolerability of P+H+D vs placebo (Pla)+H+D in the neoadjuvant setting. We present data from the primary analysis.
Methods
Pts with centrally confirmed HER2-positive early (T2–3, N0–1)/locally advanced (T2–3, N2 or N3; T4, any N) BC were randomized 2:1 to 4 cycles of P+H+D or Pla+H+D every 3 weeks, before surgery: P, 840 mg loading/420 mg maintenance doses (or Pla); H, 8 mg/kg loading/6 mg/kg maintenance; D, 75 mg/m2. Post-surgery, pts received 3 cycles of fluorouracil, epirubicin, and cyclophosphamide followed by 13 cycles of P+H or Pla+H for up to 1 year (total of 17 HER2-targeted therapy cycles). The primary endpoint was total pCR rate (tpCR; absence of any residual invasive cancer in the breast and lymph nodes [ypT0/is, ypN0]) assessed by independent review committee (IRC) when pts completed surgery with a tpCR assessment. Missing/invalid assessments were considered residual disease.
Results
A total of 329 pts were randomized: 219 to P, 110 to Pla. Baseline characteristics were well balanced. Most pts had early BC (69.6%) and were from mainland China (79.3%). In the intention-to-treat population, the tpCR rate by IRC was 39.3% in the P arm and 21.8% in the Pla arm; a clinically and statistically significant difference of 17.5% (95% CI 6.9–28.0; p=0.0014). The local pathologist-assessed tpCR rates were 39.3% and 20.9%, respectively. A consistent treatment benefit of P vs Pla was observed in subgroups. Incidences of grade ≥3 adverse events (Aes) were 48.6% in the P arm and 41.8% in the Pla arm. Of the most common grade 3 Aes (≥3% of pts), neutropenia was higher in the P arm (38.1% vs 32.7%). Of the most common any-grade Aes (≥5%), diarrhea was higher in the P arm (38.5% vs 16.4%). No heart failure (New York Heart Association Functional Classification III or IV) or significant left ventricular ejection fraction decline events (≥10 percentage points from baseline and to <50%) were observed during neoadjuvant therapy.
Conclusions
PEONY met its primary endpoint: P+H+D resulted in a clinically meaningful and statistically significant improvement in the tpCR rate by IRC vs Pla+H+D for the neoadjuvant treatment of HER2-positive early/locally advanced BC in Asian pts. Safety data were in line with the known P safety profile and generally comparable between treatment arms. Results were similar to NeoSphere, and confirm that P+H+D provides superior anticancer activity to H+D alone.
Citation Format: Shao Z, Pang D, Yang H, Li W, Wang S, Cui S, Liao N, Wang Y, Wang C, Chang Y-C, Wang H, Kang SY, Jiang Z, Li J, Zhou J, Althaus B, Mao Y, Eng-Wong J. Pertuzumab, trastuzumab, and docetaxel for HER2-positive early or locally advanced breast cancer in the neoadjuvant setting: Efficacy and safety analysis of a randomized phase III study in Asian patients (PEONY) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-17.
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Affiliation(s)
- Z Shao
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - D Pang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - H Yang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - W Li
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - S Wang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - S Cui
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - N Liao
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - Y Wang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - C Wang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - Y-C Chang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - H Wang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - SY Kang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - Z Jiang
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - J Li
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - J Zhou
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - B Althaus
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - Y Mao
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
| | - J Eng-Wong
- Fudan University Shanghai Cancer Center, Shanghai, China; Harbin Medical University Cancer Hospital, Harbin, China; Zhejiang Cancer Hospital, Hangzhou, China; The First Hospital of Jilin University, Changchun, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Henan Cancer Hospital, Zhengzhou, China; Guangdong General Hospital, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Fujian Medical University Union Hospital, Fujian, China; Mackay Memorial Hospital, Taipei City, Taiwan; China Medical University Hospital, Taichung City, Taiwan; Ajou University School of Medicine, Suwon, Republic of Korea; The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese People's Liberation Army), Beijing, China; Roche Product Development, Shanghai, China; Genentech, Inc., South San Francisco, CA
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Chi C, Pang D, Aris IM, Teo WT, Li SW, Biswas A, Yong EL, Chong YS, Tan K, Kramer MS. Trends and predictors of cesarean birth in Singapore, 2005-2014: A population-based cohort study. Birth 2018; 45:399-408. [PMID: 29453821 DOI: 10.1111/birt.12341] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rates of cesarean birth have continued to rise in many high-income countries. We examined the temporal trends and predictors of cesarean birth in Singapore. METHODS Linked hospitalization and Birth Registry data were used to examine all live births to Singaporean citizens and permanent residents between January 1, 2005 and December 31, 2014 (n = 342 932 births). We calculated cesarean rates and age-adjusted average annual percent change (AAPC) in those rates and used sequential multivariable regression modeling to assess the contribution of changes in predictors to the change in cesarean rates over time. RESULTS The overall cesarean rate in Singapore rose from 32.2% in 2005 to 37.4% in 2014. Among singleton, cephalic, term pregnancies, the two major predictions of cesarean were nulliparity and previous cesarean, each accounting for just over one-third of all cesareans. Higher AAPC was observed in nulliparous women of Indian ethnicity (0.74% [95% confidence interval 0.68-0.80]) compared with Chinese (0.62% [0.60-0.65]) or Malay women (0.63% [0.59-0.68]), and in women who delivered in private hospitals (0.62% [0.60-0.64]) compared with those delivered under subsidized care in public hospitals (0.58% [0.52-0.63]). Parity and education had the largest influences on cesarean birth trend (attenuation of AAPC from 0.62% [0.59-0.66] to 0.39% [0.38-0.40] after adjustment). CONCLUSION Cesarean birth has continued to rise at a steady rate in Singapore. Strategies to curb this temporal increase include avoidance of medically unnecessary primary cesarean and attempts at trial of labor and vaginal delivery among women with a history of prior cesarean.
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Affiliation(s)
- Claudia Chi
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Deanette Pang
- Policy Research & Evaluation Division, Ministry of Health, Singapore City, Singapore
| | - Izzuddin M Aris
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Wei Ting Teo
- Policy Research & Evaluation Division, Ministry of Health, Singapore City, Singapore
| | - Sarah Weiling Li
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore.,Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Eu Leong Yong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore.,Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore.,Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Kelvin Tan
- Policy Research & Evaluation Division, Ministry of Health, Singapore City, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
| | - Michael S Kramer
- Faculty of Medicine, Pediatrics and Epidemiology and Biostatistics, McGill University, Montreal, Canada
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Pang D, Yan T, Trevisi E, Krizsan S. Effect of grain- or by-product-based concentrate fed with early- or late-harvested first-cut grass silage on dairy cow performance. J Dairy Sci 2018; 101:7133-7145. [DOI: 10.3168/jds.2018-14449] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022]
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Xiao X, Zhang L, Chen X, Cui L, Zhu H, Pang D, Yang Y, Wang Q, Wang M, Gao C. Surgical Management of Renal Cell Carcinoma Extending Into Venous System: A 20-Year Experience. Scand J Surg 2017; 107:158-165. [PMID: 29141518 DOI: 10.1177/1457496917738922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The purpose of this study is to report our 20-year experience with the surgical management of renal cell carcinoma extending into the inferior vena cava using a novel classification system. MATERIALS AND METHODS We retrospectively reviewed the data of 103 patients (69 males, 34 females, mean age: 52.9 ± 12.6 years) with renal cell carcinoma involving the venous system treated between 1993 and 2014. The inferior vena cava tumor thrombus was classified into five levels: 0 (renal vein, n = 12), 1 (infrahepatic, n = 33), 2a (low retrohepatic, n = 26), 2b (high retrohepatic, n = 19), and 3 (supradiaphragmatic, n = 13). Clinical data were summarized, and overall survival, cancer-specific survival, and disease-free survival were examined by Cox regression analysis. RESULTS All patients underwent radical surgery. Complete resections of the renal tumor and thrombus were achieved in 101 patients (98.1%). Two intraoperative and one postoperative in-hospital deaths (2.9%) occurred. In total, 19 patients (18.8%) had a total of 29 postoperative complications. Mean follow-up time was 46 months (range, 1-239 months). The 5- and 10-year overall survival rates were 62.9% and 56.0%, respectively. Metastasis, rather than thrombus level, was a significant risk factor associated with overall survival (hazard ratio = 4.89, 95% confidence interval: 2.24-10.67, p < 0.001). CONCLUSION Our novel classification system can be used to select the optimal surgical approach and method for patients with renal cell carcinoma and venous thrombus. Its use is associated with prolonged survival and relatively few complications. Metastasis is an independent risk factor of overall survival.
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Affiliation(s)
- X Xiao
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China.,2 Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - L Zhang
- 2 Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - X Chen
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - L Cui
- 3 Department of Urology, General Hospital of Civil Aviation Administration of China, Beijing, China
| | - H Zhu
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - D Pang
- 1 Department of Urology, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Y Yang
- 2 Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Q Wang
- 4 Department of Cardiac Surgery, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - M Wang
- 5 Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - C Gao
- 6 Department of Cardiac Surgery, Chinese PLA General Hospital, Beijing, China
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Quan J, Zhang H, Pang D, Chen BK, Johnston JM, Jian W, Lau ZY, Iizuka T, Leung GM, Fang H, Tan KB, Eggleston K. Avoidable Hospital Admissions From Diabetes Complications In Japan, Singapore, Hong Kong, And Communities Outside Beijing. Health Aff (Millwood) 2017; 36:1896-1903. [DOI: 10.1377/hlthaff.2017.0479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jianchao Quan
- Jianchao Quan is a clinical assistant professor in the Division of Health Economics, Policy, and Management, School of Public Health, University of Hong Kong, in China
| | - Huyang Zhang
- Huyang Zhang is a PhD student in the China Center for Health Development Studies at Peking University, Beijing, in China
| | - Deanette Pang
- Deanette Pang is a research analyst in the Policy, Research, and Evaluation Division in the Singapore Ministry of Health
| | - Brian K. Chen
- Brian K. Chen is an associate professor in the Arnold School of Public Health, University of South Carolina, in Columbia
| | - Janice M. Johnston
- Janice M. Johnston is an associate professor in the Division of Health Economics, Policy, and Management, School of Public Health, University of Hong Kong
| | - Weiyan Jian
- Weiyan Jian is an associate professor in the Department of Health Policy and Administration, School of Public Health, Peking University
| | - Zheng Yi Lau
- Zheng Yi Lau is the assistant director of the Policy, Research, and Evaluation Division in the Singapore Ministry of Health
| | - Toshiaki Iizuka
- Toshiaki Iizuka is a professor in the Graduate School of Economics, University of Tokyo, in Japan
| | - Gabriel M. Leung
- Gabriel M. Leung is a professor in the Division of Health Economics, Policy, and Management, School of Public Health, University of Hong Kong
| | - Hai Fang
- Hai Fang is a professor in the China Center for Health Development Studies at Peking University
| | - Kelvin B. Tan
- Kelvin B. Tan is the director of the Policy, Research, and Evaluation Division in the Singapore Ministry of Health, and an adjunct assistant professor at Saw Swee Hock School of Public Health, National University of Singapore
| | - Karen Eggleston
- Karen Eggleston is a senior fellow at the Freeman Spogli Institute for International Studies (FSI) and deputy director of the FSI’s Shorenstein Asia-Pacific Research Center, both at Stanford University, in California; and a faculty research fellow at the National Bureau of Economic Research, in Cambridge, Massachusetts
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Steagall PV, Monteiro BP, Ruel HLM, Beauchamp G, Luca G, Berry J, Little S, Stiles E, Hamilton S, Pang D. Perceptions and opinions of Canadian pet owners about anaesthesia, pain and surgery in small animals. J Small Anim Pract 2017; 58:380-388. [DOI: 10.1111/jsap.12674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/05/2016] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- P. V. Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe Quebec J2S 2M2 Canada
| | - B. P. Monteiro
- Department of Biomedical Sciences, Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe Quebec J2S 2M2 Canada
| | - H. L. M. Ruel
- Department of Clinical Sciences, Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe Quebec J2S 2M2 Canada
| | - G. Beauchamp
- Department of Public Health, Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe Quebec J2S 2M2 Canada
| | - G. Luca
- Department of Clinical Sciences, Faculty of Veterinary Medicine; Université de Montréal; Saint-Hyacinthe Quebec J2S 2M2 Canada
| | - J. Berry
- Douglas Animal Hospital; Fredericton New Brunswick E3G 7J2 Canada
| | - S. Little
- Bytown Cat Hospital; Ottawa Ontario K1K 1G6 Canada
| | - E. Stiles
- Sherwood Park Animal Hospital; Montreal Quebec H9W 2E4 Canada
| | - S. Hamilton
- Atlantic Veterinary College; University of Prince Edward Island; Charlottetown Prince Edward Island C1A 4P3 Canada
| | - D. Pang
- Faculty of Veterinary Medicine; University of Calgary; Calgary Alberta T2N 1N4 Canada
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Janowski E, Timofeeva O, Chasovskikh S, Goldberg M, Kim A, Banovac F, Pang D, Dritschilo A, Unger K. Yttrium-90 radioembolization for colorectal cancer liver metastases in KRAS wild-type and mutant patients: Clinical and ccfDNA studies. Oncol Rep 2016; 37:57-65. [PMID: 28004119 PMCID: PMC5355723 DOI: 10.3892/or.2016.5284] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/18/2016] [Indexed: 12/22/2022] Open
Abstract
Patients with unresectable, chemo-refractory colorectal cancer liver metastases (CRCLM) have limited local treatment options. We report our institutional experience on the efficacy of resin-based yttrium-90 (90Y) radioembolization for the treatment of CRCLM and our findings on associated circulating cell-free DNA (ccfDNA) studies. A total of 58 patients treated with 90Y for CRCLM at the Medstar Georgetown University Hospital had a median survival of 6 months [95% confidence interval (CI), 4.55–7.45 months] after treatment, with a 12-month survival rate of 33%. The median survival from treatment stratified by mutational status was longer in the wild-type (WT) as compared to the KRAS mutant patients at 7 vs. 5 months, but did not achieve statistical significance (p=0.059). Median tumor local control duration after 90Y treatment was 2 months (95% CI, 0.34–3.66 months) for the entire cohort and was longer in the WT vs. the mutant patients (2 vs. 1 month, respectively, p=0.088). Plasma was prospectively collected from a subset of 9 patients both before and after single lobe treatment, and ccfDNA concentration and fragmentation index (FI) were measured using quantitative PCR and atomic-force microscopy (AFM). In the WT and KRAS mutant patients, DNA FI was reduced from a median of 0.73–0.65 after treatment. A reduction in DNA FI after single lobe treatment was associated with an improved overall survival (p=0.046). Analysis by AFM of paired pre- and post-treatment samples from KRAS mutant and WT patients revealed a larger average decrease in fragment size in the WT patients (p=0.013). 90Y radioembolization extends local control for CRCLM, however, KRAS mutant tumors may be more radio-resistant to treatment. Changes in the FI of patients following treatment were noted and may be evaluated in a larger study for relevance as a biomarker of response.
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Affiliation(s)
- E Janowski
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - O Timofeeva
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - S Chasovskikh
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - M Goldberg
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - A Kim
- Department of Interventional Radiology, Georgetown University Hospital, Washington, DC, USA
| | - F Banovac
- Department of Interventional Radiology, Vanderbilt University Hospital, Nashville, TN, USA
| | - D Pang
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - A Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - K Unger
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
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Wu B, Kusters M, Kunze-busch M, Dijkema T, McNutt T, Sanguineti G, Pang D. MO-G-201-01: A Multi-Institutional Study Investigating the Performance of a Knowledge-Based Planning System Against Pinnacle Auto-Planning Engine in SIB-IMRT for the Head-And-Neck Cancer. Med Phys 2016. [DOI: 10.1118/1.4957367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yan K, Campbell L, Rashid A, Wu B, Pang D, Gurka M, Collins S, Unger K. Patient Specific Model Predictive of Gastrointestinal Toxicity Following Stereotactic Body Radiation Therapy (SBRT) for Pancreatic Cancer: Preliminary Factor Study. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhao L, Zhang S, An X, Tan W, Pang D, Ouyang H. Toxicological effects of benzo[a]pyrene on DNA methylation of whole genome in ICR mice. Cell Mol Biol (Noisy-le-grand) 2015; 61:115-119. [PMID: 26522067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 10/27/2015] [Indexed: 06/05/2023]
Abstract
It has been well known that alterations in DNA methylation - an important regulator of gene transcription - lead to cancer. Therefore a change in the level of DNA methylation of whole genome has been considered as a biomarker of carcinogenesis. Previously, a large number of experimental results in genetic toxicology have showed that benzo[a]pyrene could cause DNA mutation and fragmentation. However, there was little to no studies on alterations in DNA methylation of genome directly result from exposure to benzo[a]pyrene. In this paper, possible mechanisms of alterations in whole genomic DNA methylation by benzo[a]pyrene were investigated using ICR mice after benzo[a]pyrene exposure. The blood, liver, pancreas, skin, lung and bladder of ICR mice were removed and checked after a fixed time interval (6 hours) of benzo[a]pyrene exposure, and whole genomic DNA methylation level was determined by high performance liquid chromatography (HPLC). The results exhibited tissue specificity, that is, the level of whole genomic DNA methylation decreases significantly in blood and liver, rather than pancreas, lung, skin and bladder of ICR mice. This study investigated the direct relationship between aberrant DNA methylation level and benzo[a]pyrene exposure, which might be helpful to clarify the toxicological mechanism of benzo[a]pyrene in epigenetic perspectives.
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Affiliation(s)
- L Zhao
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Veterinary Medicine, Center for Animal Embryo Engineering of Jilin Province Jilin China
| | - S Zhang
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Center for Animal Embryo Engineering of Jilin Province Jilin China
| | - X An
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Center for Animal Embryo Engineering of Jilin Province Jilin China
| | - W Tan
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Center for Animal Embryo Engineering of Jilin Province Jilin China
| | - D Pang
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Center for Animal Embryo Engineering of Jilin Province Jilin China
| | - H Ouyang
- Jilin University Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Sciences, Center for Animal Embryo Engineering of Jilin Province Jilin China hongsheng_ouyang@sina.com
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Sun S, Liang X, Zhang X, Liu T, Shi Q, Song Y, Jiang Y, Wu H, Jiang Y, Lu X, Pang D. Phosphoglycerate kinase-1 is a predictor of poor survival and a novel prognostic biomarker of chemoresistance to paclitaxel treatment in breast cancer. Br J Cancer 2015; 112:1332-9. [PMID: 25867275 PMCID: PMC4402453 DOI: 10.1038/bjc.2015.114] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 02/07/2023] Open
Abstract
Background: Phosphoglycerate kinase-1 (PGK1) has been recently documented in various malignancies; however, the molecular mechanisms of the variable PGK1 expression and its clinical significance in terms of survival status remain unclear. Methods: Real-time quantitative PCR (real-time qPCR) and western blotting were used to verify PGK1 expression in 46 fresh breast cancer tissues and matched normal tissues. A tissue microarray (TMA) comprising 401 breast cancer tissues and 123 matched normal tissues was investigated by immunohistochemistry for PGK1 expression. Then, the correlation between PGK1 expression and the clinicopathologic features was analysed. Results: PGK1 mRNA and protein expression were significantly increased in breast cancer tissues compared with that in normal breast tissues. High PGK1 expression was significantly associated with higher histologic grade (P=0.009) and positive status of ER (P=0.004), Her-2 (P=0.026) and P53 (P=0.012). High levels of PGK1 expression were associated with worse overall survival (OS, P=0.02). Furthermore, patients who underwent paclitaxel chemotherapy with high levels PGK1 expression had shorter OS than did those with low levels of PGK1 expression (P<0.001). Multivariate analysis indicated that PGK1 (P=0.001) was an independent predictor in the patients treated with paclitaxel. Conclusions: PGK1 is a prognostic biomarker of chemoresistance to paclitaxel treatment in breast cancer.
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Affiliation(s)
- S Sun
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - X Liang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - X Zhang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - T Liu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Q Shi
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Y Song
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Y Jiang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - H Wu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Y Jiang
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - X Lu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - D Pang
- 1] Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China [2] North China Translational Medicine Research and Cooperation Center (NTMRC), Harbin 150081, China
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Li J, Shao Z, Yang S, Jiang J, Wang C, Liu Y, Fu P, Pang D, Sheng Y. P082 CBCSG-10, the addition of capecitabine to adjuvant chemotherapy in triple-negative breast cancer. Breast 2015. [DOI: 10.1016/s0960-9776(15)70127-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cook EJ, Randhawa G, Large S, Guppy A, Chater AM, Pang D. Young people's use of NHS Direct: a national study of symptoms and outcome of calls for children aged 0-15. BMJ Open 2013; 3:e004106. [PMID: 24327365 PMCID: PMC3863119 DOI: 10.1136/bmjopen-2013-004106] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 10/31/2013] [Accepted: 11/05/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES National Health Service (NHS) Direct provides 24/7 expert telephone-based healthcare information and advice to the public in England. However, limited research has explored the reasons to why calls are made on behalf of young people, as such this study aimed to examine call rate (CR) patterns in younger people to enable a better understanding of the needs of this population in England. SETTING NHS Direct, England, UK. PARTICIPANTS AND METHODS CRs (expressed as calls/100 persons/annum) were calculated for all calls (N=358 503) made to NHS Direct by, or on behalf of, children aged 0-15 during the combined four '1-month' periods within a year (July 2010, October 2010, January 2011 and April 2011). χ² Analysis was used to determine the differences between symptom, outcome and date/time of call. RESULTS For infants aged <1, highest CRs were found for 'crying' for male (n=14, 440, CR=13.61) and female (n=13 654, CR=13.46) babies, which is used as a universal assessment applied to all babies. High CRs were also found for symptoms relating to 'skin/hair/nails' and 'colds/flu/sickness' for all age groups, whereby NHS Direct was able to support patients to self-manage and provide health information for these symptoms for 59.7% and 51.4% of all cases, respectively. Variations in CRs were found for time and age, with highest peaks found for children aged 4-15 in the 15:00-23:00 period and in children aged <1 in the 7:00-15:00 period. CONCLUSIONS This is the first study to examine the symptoms and outcome of calls made to NHS Direct for and on behalf of young children. The findings revealed how NHS Direct has supported a range of symptoms through the provision of health information and self-care support which provides important information about service planning and support for similar telephone-based services.
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Affiliation(s)
- E J Cook
- Department of Psychology, University of Bedfordshire, Luton, Bedfordshire, UK
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Rashid A, Pang D, Karam S. SU-E-T-272: Cochlea Dose Tolerance for Acoustic Neuroma Patients Treated with CyberKnife Stereotactic Radiosurgery. Med Phys 2013. [DOI: 10.1118/1.4814706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Wu B, Pang D, Gatti J, Lei S, Colin S, McNutt T, Kole T, Collins S, Dritschilo A. SU-E-T-670: Using Overlap Volume Histogram Analysis of a Prior Plan Dataset to Generate Clinically Acceptable Plans for CyberKnife Robotic Radiosurgery Treatment of Localized Prostate Cancer. Med Phys 2013. [DOI: 10.1118/1.4815097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Wu B, Pang D, Sanguineti G, Taylor R, McNutt T. SU-C-211-03: Using OVH and IMRT Plan Data to Automate VMAT Planning: A Head-And-Neck Study. Med Phys 2012. [DOI: 10.1118/1.4734602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Zhou Y, Tang X, Song Q, Ji Y, Wang H, Wang H, Jiao H, Ouyang H, Pang D. Identification and characterization of pig embryo microRNAs by Solexa sequencing. Reprod Domest Anim 2012; 48:112-20. [PMID: 22646905 DOI: 10.1111/j.1439-0531.2012.02040.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
MicroRNAs (miRNAs) are a class of small, non-coding RNAs of approximately 22 nucleotides in length that regulate gene expression by binding to the 3'-untranslated regions of target mRNAs. It is now clear that miRNAs are involved in many biological processes, including proliferation, differentiation and regulation of gene expression during early embryonic development. The miRBase 16.0 (2010) shows that there are 175, 673, 408 and 1048 annotated miRNAs for Caenorhabditis elegans, Mus musculus, Rattus norvegicus and Homo sapiens, respectively. However, there are only 211 miRNAs described for Sus scrofa. In particular, the full set of miRNAs and their expression patterns are still poorly understood in the embryo. Therefore, we combined Solexa sequencing with computational techniques to analyse the sequences and relative expression levels of S. scrofa miRNAs at embryonic day 33 (E33). Of the distinct miRNAs identified, 76 previously known miRNAs and 194 candidate miRNAs were identified in head, and 77 known miRNAs and 130 predicted candidate miRNAs were identified in organ region. Furthermore, we performed additional investigation for identifying the potential target mRNAs using PicTar and TargetScan. Concurrent function analysis suggested that highly expressed miRNAs are mostly involved in the development of nerves, cerebrum, muscle and organs. Our results provide useful information for the investigation into embryonic miRNAs of pig and provide a valuable resource for investigators interested in the regulation of embryonic development in pigs and other animals.
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Affiliation(s)
- Y Zhou
- College of Animal Science and Veterinary Medicine, Jilin University, Changchun, China
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48
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Littlejohn C, Pang D, Power C, Macfarlane G, Jones G. Is there an association between preterm birth or low birthweight and chronic widespread pain? Results from the 1958 Birth Cohort Study. Eur J Pain 2012; 16:134-9. [DOI: 10.1016/j.ejpain.2011.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C. Littlejohn
- Aberdeen Pain Research Collaboration (Epidemiology Group); Institute of Applied Health Sciences; University of Aberdeen, School of Medicine and Dentistry; Polwarth Building, Foresterhill; Aberdeen; AB25 2ZD; UK
| | - D. Pang
- Aberdeen Pain Research Collaboration (Epidemiology Group); Institute of Applied Health Sciences; University of Aberdeen, School of Medicine and Dentistry; Polwarth Building, Foresterhill; Aberdeen; AB25 2ZD; UK
| | - C. Power
- MRC Centre of Epidemiology for Child Health/Centre for Paediatric Epidemiology and Biostatistics; UCL Institute of Child Health; London; WC1N 1EH; UK
| | - G.J. Macfarlane
- Aberdeen Pain Research Collaboration (Epidemiology Group); Institute of Applied Health Sciences; University of Aberdeen, School of Medicine and Dentistry; Polwarth Building, Foresterhill; Aberdeen; AB25 2ZD; UK
| | - G.T. Jones
- Aberdeen Pain Research Collaboration (Epidemiology Group); Institute of Applied Health Sciences; University of Aberdeen, School of Medicine and Dentistry; Polwarth Building, Foresterhill; Aberdeen; AB25 2ZD; UK
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Wu B, Sanguineti G, Simari P, Kazhdan M, Pang D, Taylor R, Mcnutt T. On the Feasibility of using Overlap Volume Histogram and DVH Data of Prior IMRT Plans to Guide Smart Arc-based Volumetric Modulated Arc Therapy Treatment Planning. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jiao J, Yuan T, Zhou Y, Xie W, Zhao Y, Zhao J, Ouyang H, Pang D. Analysis of myostatin and its related factors in various porcine tissues. J Anim Sci 2011; 89:3099-106. [PMID: 21571901 DOI: 10.2527/jas.2010-3827] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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] Open
Abstract
Myostatin is expressed in skeletal muscle tissue where it functions to suppress myoblast proliferation and myofiber hypertrophy. Recently, myostatin was detected in the tendon, mammary gland, and adipose tissue of mice. We sought to determine whether myostatin is expressed in the liver, spleen, lung, and kidney of pigs. Real-time PCR and Western blots demonstrated that myostatin, follistatin, decorin, and activin receptor IIB (ActRIIB) mRNA and proteins were expressed in skeletal muscle, heart muscle, and adipose tissue, and also in liver, spleen, lung, kidney, and cultured fibroblasts. The relative abundance of myostatin was closely related to follistatin and decorin in porcine tissues. Immunohistochemical analysis further demonstrated the presence of myostatin, follistatin, and decorin in the skeletal muscle, adipose tissue, heart muscle, liver, spleen, lung, and kidney of pigs. These results suggest that myostatin could be associated with certain functions of the internal organs, such as energy metabolism or fibrosis. We conclude that myostatin is a factor broadly expressed in the internal organs and muscle tissues of pigs.
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Affiliation(s)
- J Jiao
- Jilin Province Animal Embryo Engineering Key Laboratory, College of Animal Science and Veterinary Medicine, Jilin University, Changchun, Jilin, 130062, China
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