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Davis TME, Tan E, Davis WA. Prevalence and prognostic significance of cardiac autonomic neuropathy in community-based people with type 2 diabetes: the Fremantle Diabetes Study Phase II. Cardiovasc Diabetol 2024; 23:102. [PMID: 38500197 PMCID: PMC10949593 DOI: 10.1186/s12933-024-02185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/01/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND There is a paucity of contemporary data on the prevalence and prognostic significance of cardiac autonomic neuropathy (CAN) from community-based cohorts with type 2 diabetes assessed using gold standard methods. The aim of this study was to assess these aspects of CAN in the longitudinal observational Fremantle Diabetes Study Phase II (FDS2). METHODS FDS2 participants were screened at baseline using standardised cardiovascular reflex tests (CARTs) of heart rate variation during deep breathing, Valsalva manoeuvre and standing. CAN (no/possible/definite) was assessed from the number of abnormal CARTs. Multinomial regression identified independent associates of CAN status. Cox proportional hazards modelling determined independent baseline predictors of incident heart failure (HF) and ischaemic heart disease (IHD), and all-cause mortality. RESULTS Of 1254 participants assessed for CAN, 86 (6.9%) were outside CART age reference ranges and valid CART data were unavailable for 338 (27.0%). Of the remaining 830 (mean age 62.3 years, 55.3% males, median diabetes duration 7.3 years), 51.0%, 33.7% and 15.3% had no, possible or definite CAN, respectively. Independent associates of definite CAN (longer diabetes duration, higher body mass index and resting pulse rate, antidepressant and antihypertensive therapies, albuminuria, distal sensory polyneuropathy, prior HF) were consistent with those reported previously. In Kaplan-Meier analysis, definite CAN was associated with a lower likelihood of incident IHD and HF versus no/possible CAN (P < 0.001) and there was a graded increase in all-cause mortality risk from no CAN to possible and definite CAN (P < 0.001). When CAN category was added to the most parsimonious models, it was not a significant independent predictor of IHD (P ≥ 0.851) or HF (P ≥ 0.342). Possible CAN (hazard ratio (95% CI) 1.47 (1.01, 2.14), P = 0.046) and definite CAN (2.42 (1.60, 3.67), P < 0.001) increased the risk of all-cause mortality versus no CAN. CONCLUSIONS Routine screening for CAN in type 2 diabetes has limited clinical but some prognostic value.
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Affiliation(s)
- Timothy M E Davis
- Medical School, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia.
- Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals, Murdoch, WA, Australia.
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, VIC, Australia.
| | - Eva Tan
- Medical School, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia
| | - Wendy A Davis
- Medical School, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, VIC, Australia
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Stor MLE, Horbach SER, Lokhorst MM, Tan E, Maas SM, van Noesel CJM, van der Horst CMAM. Genetic mutations and phenotype characteristics in peripheral vascular malformations: A systematic review. J Eur Acad Dermatol Venereol 2023. [PMID: 38037869 DOI: 10.1111/jdv.19640] [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] [Received: 01/27/2023] [Accepted: 08/29/2023] [Indexed: 12/02/2023]
Abstract
Vascular malformations (VMs) are clinically diverse with regard to the vessel type, anatomical location, tissue involvement and size. Consequently, symptoms and disease impact differ significantly. Diverse causative mutations in more and more genes are discovered and play a major role in the development of VMs. However, the relationship between the underlying causative mutations and the highly variable phenotype of VMs is not yet fully understood. In this systematic review, we aimed to provide an overview of known causative mutations in genes in VMs and discuss associations between the causative mutations and clinical phenotypes. PubMed and EMBASE libraries were systematically searched on November 9th, 2022 for randomized controlled trials and observational studies reporting causative mutations in at least five patients with peripheral venous, lymphatic, arteriovenous and combined malformations. Study quality was assessed with the Newcastle-Ottawa Scale. Data were extracted on patient and VM characteristics, molecular sequencing method and results of molecular analysis. In total, 5667 articles were found of which 69 studies were included, reporting molecular analysis in a total of 4261 patients and 1686 (40%) patients with peripheral VMs a causative mutation was detected. In conclusion, this systematic review provides a comprehensive overview of causative germline and somatic mutations in various genes and associated phenotypes in peripheral VMs. With these findings, we attempt to better understand how the underlying causative mutations in various genes contribute to the highly variable clinical characteristics of VMs. Our study shows that some causative mutations lead to a uniform phenotype, while other causal variants lead to more varying phenotypes. By contrast, distinct causative mutations may lead to similar phenotypes and result in almost indistinguishable VMs. VMs are currently classified based on clinical and histopathology features, however, the findings of this systematic review suggest a larger role for genotype in current diagnostics and classification.
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Affiliation(s)
- M L E Stor
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - S E R Horbach
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - M M Lokhorst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - E Tan
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - S M Maas
- Department of Clinical Genetics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - C J M van Noesel
- Department of Pathology, Molecular Diagnostics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
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Zeng J, Zhou T, Xu Y, Lin Q, Tan E, Zhang Y, Wu X, Zhang J, Liu X. The fusion of multiple scale data indicates that the carbon sink function of the Qinghai-Tibet Plateau is substantial. Carbon Balance Manag 2023; 18:19. [PMID: 37695559 PMCID: PMC10494389 DOI: 10.1186/s13021-023-00239-9] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The Qinghai-Tibet Plateau is the "sensitive area" of climate change, and also the "driver" and "amplifier" of global change. The response and feedback of its carbon dynamics to climate change will significantly affect the content of greenhouse gases in the atmosphere. However, due to the unique geographical environment characteristics of the Qinghai-Tibet Plateau, there is still much controversy about its carbon source and sink estimation results. This study designed a new algorithm based on machine learning to improve the accuracy of carbon source and sink estimation by integrating multiple scale carbon input (net primary productivity, NPP) and output (soil heterotrophic respiration, Rh) information from remote sensing and ground observations. Then, we compared spatial patterns of NPP and Rh derived from the fusion of multiple scale data with other widely used products and tried to quantify the differences and uncertainties of carbon sink simulation at a regional scale. RESULTS Our results indicate that although global warming has potentially increased the Rh of the Qinghai-Tibet Plateau, it will also increase its NPP, and its current performance is a net carbon sink area (carbon sink amount is 22.3 Tg C/year). Comparative analysis with other data products shows that CASA, GLOPEM, and MODIS products based on remote sensing underestimate the carbon input of the Qinghai-Tibet Plateau (30-70%), which is the main reason for the severe underestimation of the carbon sink level of the Qinghai-Tibet Plateau (even considered as a carbon source). CONCLUSIONS The estimation of the carbon sink in the Qinghai-Tibet Plateau is of great significance for ensuring its ecological barrier function. It can deepen the community's understanding of the response to climate change in sensitive areas of the plateau. This study can provide an essential basis for assessing the uncertainty of carbon sources and sinks in the Qinghai-Tibet Plateau, and also provide a scientific reference for helping China achieve "carbon neutrality" by 2060.
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Affiliation(s)
- Jingyu Zeng
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Tao Zhou
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China.
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China.
| | - Yixin Xu
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Qiaoyu Lin
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - E Tan
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Yajie Zhang
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Xuemei Wu
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Jingzhou Zhang
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
| | - Xia Liu
- Key Laboratory of Environmental Change and Natural Disasters of Chinese Ministry of Education, Beijing Normal University, Beijing, 100875, China
- State Key Laboratory of Earth Surface Processes and Resource Ecology (ESPRE), Beijing Normal University, Beijing, 100875, China
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Tan E, Wang MQW, Leong S, Chou H, Too CW. Neurological pain relief interventional radiology procedures. Clin Radiol 2023; 78:254-264. [PMID: 35773096 DOI: 10.1016/j.crad.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/29/2022] [Indexed: 11/24/2022]
Abstract
Neurological interventions have taken on a significant role in interventional radiology (IR) practice. Indications fall under three main categories: (1) intraprocedural pain management, (2) cancer pain palliation, and (3) chronic non-cancer pain control. Short-term regional anaesthesia can be achieved with local anaesthetics, while longer-term pain control can be attained with radiofrequency neuromodulation (pulsed or otherwise) or thermal/chemical neurolysis. This review article summarises the therapeutic options, applications, and techniques of commonly used peripheral nerve and plexus interventions in IR.
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Affiliation(s)
- E Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - M Q W Wang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - S Leong
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - H Chou
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - C W Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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David RJ, Tan E, Teo MK. Trial of dexamethasone for chronic subdural hematoma. Br J Neurosurg 2023; 37:241. [PMID: 33606591 DOI: 10.1080/02688697.2021.1886245] [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] [Indexed: 10/22/2022]
Affiliation(s)
- R J David
- North Bristol NHS Trust, Westbury on Trym, UK
| | - E Tan
- North Bristol NHS Trust, Westbury on Trym, UK
| | - M K Teo
- North Bristol NHS Trust, Westbury on Trym, UK
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Turmel N, Hentzen C, Tan E, Haddad R, Chesnel C, Le Breton F, Amarenco G. Aqua: A new questionnaire assessing anticholinergic side effects in neurogenic population (Aqua: Anticholinergic side effects questionnaire). Prog Urol 2022; 32:751-755. [PMID: 35729028 DOI: 10.1016/j.purol.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
AIMS Validate a new questionnaire to assess the side effects secondary to anticholinergics in neurogenic population suffering from Adult neurogenic lower urinary tract dysfunction (ANLUTD). METHODS We conducted a prospective, monocentric study in a Neuro-urology Department of a University Hospital between February 2015 and April 2020. To allow a full psychometric validation of a questionnaire, the study protocol included 3 steps: qualitative interviews, feasibility study and validation study. The primary outcome was good psychometric properties defined with good internal consistency reliability (Cronbach's α>0.7) and good test-retest reliability (intraclass correlation coefficient (ICC)>0.7). RESULTS we included 64 patients with ANLUTD secondary to neurogenic disorders. Feasibility study demonstrate very good acceptation and comprehension for 97% of patients. Validation study showed good internal consistency with Cronbach's α=0,69 and very good ICC=0,73. AQUA is composed with 8 items scoring 0 (no side effect) to 2 (major side effect) for a total score between 0 to 16. Time to fulfill is very quick. Mean score in our population was 4,1 (sd 2,9). CONCLUSION AQUA is the first validated tool to assess side effects secondary to antimuscarinic treatment for neurogenic population suffering from ANLUTD. LEVEL OF PROOF 2.
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Affiliation(s)
- N Turmel
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de médecine physique et réadaptation, hôpital Danielle Casanova, 11, rue Danielle Casanova, 93200 St Denis, France.
| | - C Hentzen
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - E Tan
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - R Haddad
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - C Chesnel
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - F Le Breton
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Amarenco
- Sorbonne université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de Neuro urologie et explorations urodynamiques, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
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Tan E, Tuffet S, Rousseau A, Fautrel B, Rannou F, Berenbaum F, Sellam J, Courties A. POS1111 WHAT DOES GRIP STRENGTH REFLECT IN HAND OSTEOARTHRITIS? RESULTS FROM THE DIGICOD COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAmong the general population over 60 years-old, the decrease in grip strength is a marker of morbidity and mortality: its measurement during follow-up consultations is considered as a predictive marker of good health status or the patient’s overall fragility (1). However, hand osteoarthritis (HOA), which can modulate grip strength and is also associated with comorbidities is never taken into account, while it is a very common disease.ObjectivesThe objectives of this study are to describe grip strength in a symptomatic HOA population, to investigate painful osteoarthritic joints associated with decreased grip strength, and to determine whether decreased grip strength is independently associated with comorbidities in this population.MethodsDIGICOD is a hospital-based observational cohort including patients with radiographic features of HOA of at least 2 joints or radiographic thumb base OA. Inflammatory rheumatism or crystal arthropathy were excluded. The data at baseline were used for the analysis. Grip strength was the higher score of 3 repeated measures using a Jamar dynamometer. Baseline grip strength of the dominant hand was compared in the cohort between men and women (Student’s T test) and was described by age (by 10-year age groups using Kruskal-Wallis test). In this cross-sectional study, factors associated with a decreased grip strength were investigated using univariate and then multivariate linear regression analysis (with adjustment on age, BMI and variables with p ≤ 0.2 in univariate analysis) with stratification by sex. Results were presented by beta coefficients and their 95% confidence intervals. A first analysis focused on the association of grip strength with local factors: painful locations in the dominant hand by row and radiographic severity according to the total Kellgren-Lawrence (KL) score. The second analysis assessed the patient-level association between decreased grip strength and general characteristics, including cumulative comorbidities and markers of radio-clinical severity of hand OA, namely the AUSCAN pain score and total KL score. A sensitivity analysis was performed to look for association between grip strength and each comorbidity.Results394 patients were analyzed, including 329 women (mean ± SD of the dominant hand’s grip strength of 21.6 ± 6.9 kg) and 65 men (34.9 ± 9.8 kg) with a mean age of 66.9 ± 7.3 years. Grip strength decreased with age (p<0.001) and was lower for women (p<0.0001).Among women, locally, decreased grip strength was independently associated with painful involvement of at least 2 metacarpophalangeal joints (MCPs) (estimated coefficient [95% CI] -3.6 [-6.2; -1.0] kg versus no painful MCPs) but not with proximal and distal interphalangeal joints, and with a high KL total sum score (-0.06 [-0.10; -0.01] kg per additional point). At the patient-level, decreased grip strength was not associated with comorbidities but with radio-clinical severity (p<0.05), i.e. a higher KL total sum score and AUSCAN pain score.Among men, neither radiographic severity nor painful locations were independently associated with a decrease of grip strength. Conversely, decreased grip strength was associated with at least 3 comorbidities (-8.5 [-15.5; -1.43] kg versus a single comorbidity being OA), independently of radiographic severity. The study of comorbidities individually did not show any particular association with grip strength.ConclusionIn this cohort of symptomatic HOA, the decrease of grip strength reflects the radio-clinical severity of hand OA among women, whereas among men, it is independently associated with the accumulation of comorbidities. The presence of hand OA should be considered for further studies investigation the relationship between grip strength and morbi-mortality.References[1]Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. CIA. oct 2019;Volume 14:1681‑91.Graph 1.Grip strength according to the number of comorbidities among men and womenDisclosure of InterestsNone declared
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Desprez C, Turmel N, Chesnel C, Sheikh Ismael S, Tamiatto M, Tan E, Haddad R, Le Breton F, Leroi AM, Hentzen C, Amarenco G. Fecal incontinence subtype assessment (FI-SA): A new tool to distinguish among subtypes of fecal incontinence in a neurogenic population. Clin Res Hepatol Gastroenterol 2022; 46:101900. [PMID: 35259498 DOI: 10.1016/j.clinre.2022.101900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/01/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Two subtypes of fecal incontinence (FI) are defined in the literature (urge and passive FI). The pertinence of this classification is unknown due to conflicting findings and heterogeneity of definitions. However, no questionnaire is available to clearly classify patients among subtypes. The objective of the present study was to develop and validate a new tool (Fecal incontinence subtype assessment, FI-SA) in order to better classify patients among the different subtypes of FI. METHODS A prospective monocentric study was conducted in consecutive patients with FI according to Rome IV criteria. To validate psychometric properties of the FI-SA questionnaire, a literature review and qualitative interviews were performed and discussed with an expert panel. A feasibility study was realized to assess acceptability and comprehension of items. The reproducibility was investigated in a validation study. RESULTS Comprehension and acceptability were excellent in 90% of patients in the feasibility study (n = 30). Validation study (n = 100) showed a good reproducibility with an intra-class correlation coefficient of 0.91 and 0.89 for questions 1 and 2. Time to fill the questionnaire was 40.0 s. 98.0% patients were classified among subtypes of FI: 34.0% passive FI, 32.0% urge FI and 32.0% mixed FI. CONCLUSION FI-SA is the first questionnaire to classify patients among subtypes of FI with good psychometric characteristics and the first questionnaire introducing the concept of mixed FI. FI-SA could help to determine the pertinence of this classification of FI in the management of these patients.
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Affiliation(s)
- C Desprez
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Rouen University Hospital, Digestive physiology Department, 76000 Rouen, France.
| | - N Turmel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Casanova Hospital, 93200 Saint-Denis, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - S Sheikh Ismael
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; ELSAN, Clinique Le Floride, 66420 Le Barcarès, France
| | - M Tamiatto
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - E Tan
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - R Haddad
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - F Le Breton
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - A-M Leroi
- Rouen University Hospital, Digestive physiology Department, 76000 Rouen, France
| | - C Hentzen
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
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Loo G, De Leon J, Seow SC, Boey E, Soh R, Tan E, Gan HH, Lee JY, Teo JTL, Yeo C, Kojodjojo P, Tan VH. Acute procedural outcomes of his bundle pacing with or without electrophysiology mapping system: a multicenter study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
His bundle pacing (HBP) is associated with improved clinical outcomes compared to right ventricular apical pacing. However, it can be technically challenging and may result in prolonged fluoroscopy and procedural time.
Purpose
We sought to compare the feasibility of performing HBP with or without electrophysiology mapping (EP) system, focusing on evaluating acute procedural success, complication rates and short-term outcomes.
Methods
HBP patients at 3 hospitals were recruited between August 2018 to December 2020. HBP was performed with EP mapping system in 1 center, and without EP mapping in the other 2 centers. Acute procedural success was defined as either selective or non-selective His bundle capture with a threshold of less than or equal to 1.5V at 1ms at the end of procedure implantation.
Results
A total of 233 patients were recruited, of which HBP was performed with EP mapping in 77 patients (33.0%) and without EP mapping in 156 patients (67.0%). Both groups were similar in age (73.2 ± 11.0 years vs 75.3 ± 9.5 years, p = 0.125) and male sex (58.4% vs 48.1%, p = 0.136). There were more patients with ischemic heart disease (45.5% vs 22.4%, p < 0.01) and reduced left ventricular ejection fraction ≤ 40% (28.6% vs 10.9%, p < 0.01) in the group with EP mapping. The indications for HBP was for high-grade atrioventricular block (55.8%), sick sinus syndrome (35.6%) and cardiac resynchronization therapy (CRT) (8.6%). There were more patients who required CRT in the center with EP mapping (18.2% vs 3.8%, p < 0.01). HBP was successful in 39 patients (50.6%) with EP mapping and 93 patients (59.6%) without EP mapping (p= 0.382). The median R wave at implant was similar in both groups [4.0 (2.9 – 6.2) mV vs 4.3 (4.3 – 7.0) mV, p = 0.808]. Impedance at implant (607 ± 195 ohms vs 547 ± 166 ohms, p < 0.01) and selective His bundle bipolar threshold at implant [1.25 (0.75-1.75) V vs 0.7 (0.5 – 1.25) V, p = 0.01] was higher in patients with EP mapping while non-selective His bundle bipolar threshold at implant [1.75 (1.0 – 3.0) V vs 1.5 (0.9 – 2.2) V, p = 0.133] and paced QRS duration (116.4 ± 25.4 ms vs 114.4 ± 24.2 ms, p =0.655) were similar. There were no differences in procedural or fluoroscopy time between groups (111 ± 36.9 min vs 107 ± 40.7 min, p = 0.479; and 10.3 ± 8.9 min vs 12.1± 14.0 min, p = 0.328 respectively). There was a similar rate of acute procedural complications (5.2% vs 1.3%, p = 0.076) and patients requiring wound or lead revision (6.8% vs 1.9%, p = 0.115) after a median follow up duration of 205 days (67-397). The prevalence of new onset paroxysmal atrial fibrillation (11.7% vs 4.2%, p = 0.037) and all cause mortality (12.3% vs 3.2%, p = 0.029) was increased in patients who underwent HBP with EP mapping.
Conclusion
HBP in centers with or without EP mapping showed similar acute procedure success and complication rates. The use of EP mapping system was not shown to affect procedural or fluoroscopy duration.
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Affiliation(s)
- G Loo
- Changi General Hospital, Cardiology, Singapore, Singapore
| | - J De Leon
- National University Hospital, Cardiology, Singapore, Singapore
| | - S C Seow
- National University Hospital, Cardiology, Singapore, Singapore
| | - E Boey
- Ng Teng Fong Hospital, Cardiology, Singapore, Singapore
| | - R Soh
- National University Hospital, Cardiology, Singapore, Singapore
| | - E Tan
- National University Hospital, Cardiology, Singapore, Singapore
| | - H H Gan
- Ng Teng Fong Hospital, Cardiology, Singapore, Singapore
| | - J Y Lee
- National University Hospital, Cardiology, Singapore, Singapore
| | - J T L Teo
- Changi General Hospital, Cardiology, Singapore, Singapore
| | - C Yeo
- Changi General Hospital, Cardiology, Singapore, Singapore
| | - P Kojodjojo
- Ng Teng Fong Hospital, Cardiology, Singapore, Singapore
| | - V H Tan
- Changi General Hospital, Cardiology, Singapore, Singapore
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10
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Sun L, Tan E. Neglected cutaneous skin malignancy: A patient with concurrent giant basal cell carcinoma and melanoma. Skin Health and Disease 2021; 1:e68. [PMID: 35663778 PMCID: PMC9060086 DOI: 10.1002/ski2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/18/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
Background Giant basal cell carcinomas (BCCs) are a rare subtype of BCC that grow to be greater than 5 cm in diameter. With the increase in size, there is a corresponding increase in metastatic rate and state of local invasion, with a clinical morphology that can be hard to differentiate from other subtypes of cutaneous malignancy. Although histologically equivalent to their common sub‐centimetre counterparts, giant BCCs can precipitate significant systematic medical morbidity as well as psychological trauma, and can be a real surgical reconstructive challenge to clinicians. Aims To add breadth to the existing cases in the literature, as well as a fresh patient perspective on the psychological challenges in a patient with Giant BCC. Materials & Methods A case from the Waikato Hospital, New Zealand referred to the Plastic and Reconstructive Department is carefully photographed, ordered, and presented. Results We present a case of a 15 cm giant BCC of the back existing alongside a neglected thick exophytic melanoma of the elbow in a patient who had been too embarrassed to approach healthcare professionals. These skin lesions were an incidental discovery by the general practitioner after the patient presented with symptoms of shortness of breath. Discussion Neglected skin cancers can fungate and be clinically morphologically confusing. Photographs of examples of these tumours can hone clinician awareness of the existance of Giant BCCs. Conclusion Giant BCCs are an entity yet to receive standardized treatment stratification. Prompt diagnosis and staging scans mean an expedited path to wide local excision and reconstruction, resulting in timely resolution of patients' immediate morbidity from their oncological disease burden.
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Affiliation(s)
- L. Sun
- Department of Plastic Surgery Waikato Hospital Hamilton New Zealand
| | - E. Tan
- Department of Plastic Surgery Waikato Hospital Hamilton New Zealand
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11
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Tan E, Zammit A. 1351 Primary Pituitary Abscess Presenting as An Isolated Bitemporal Hemianopia. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Pituitary abscesses are rare yet life-threatening entities. Most common presenting features are headache, hypopituitarism, and visual changes. Majority of patients are found to have a predisposing risk factor, such as a pre-existing pituitary lesion, recent pituitary surgery or irradiation, or a primary source of infection. We present the case of a 53-year-old male with a spontaneous pituitary abscess, who presented with an isolated bitemporal hemianopia, but was otherwise asymptomatic with no known risk factors. Magnetic resonance imaging showed a sellar and suprasellar mass, thought to be a pituitary macroadenoma. He underwent endoscopic transsphenoidal adenectomy and cystic fluid was seen intraoperatively. Microbiology analysis showed Staphylococcus Aureus, and a course of intravenous ceftriaxone was commenced. Histopathology reported no evidence of adenoma and impression was of a pituitary abscess. Following transsphenoidal resection and commencement of antibiotic therapy, the bitemporal hemianopia resolved. We therefore report a rare case of primary pituitary abscess and emphasise the importance of including this condition as a differential diagnosis in any patient with a visual deficit or new pituitary lesion.
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Affiliation(s)
- E Tan
- Southmead Hospital, Bristol, United Kingdom
| | - A Zammit
- Southmead Hospital, Bristol, United Kingdom
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12
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Tan A, Lai G, Saw S, Chua K, Takano A, Ong B, Koh T, Jain A, Tan W, Ng Q, Kanesvaran R, Rajasekaran T, Kalshnikova E, Shchegrova S, H. -Ta, Lin J, Renner D, Sethi H, Zimmermann B, Aleshin A, Lim W, Tan E, Skanderup A, Ang M, Tan D. MA07.06 Circulating Tumor DNA for Monitoring Minimal Residual Disease and Early Detection of Recurrence in Early Stage Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.144] [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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13
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Jin W, Tan E, Ghartey-Kwansah G, Jia Y, Xi G. Expression of 20-hydroxyecdysone-related genes during gonadal development of Teleogryllus emma (Orthoptera: Gryllidae). Arch Insect Biochem Physiol 2021; 108:e21824. [PMID: 34272758 DOI: 10.1002/arch.21824] [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] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
Insect gonads develop under endocrine signals. In this study, we assessed the characters of partial complementary DNAs encoding the Teleogryllus emma orthologs of 20-hydroxyecdysone (20E)-related genes (RXR, E75, HR3, Hsc70, and Hsp90) and analyzed their expression patterns in both nymph and adult crickets. 20E treatment suppressed expression of TeEcR, TeRXR, TeE75, TeHR3, TeHsc70, and TeHsp90. Temporal expression analysis demonstrated that TeERR and 20E-related genes were expressed in four stages of gonadal development from the fourth-instar nymph stage to the adult stage. The expression pattern of these genes differed in testicular and ovarian development. TeRXR, HR3, TeHsc70, and TeHsp90 were irregularly expressed in gonads of the same developmental stages, while mRNAs encoding TeERR, TeEcR, and TeE75 accumulated in higher levels in ovaries than in testes. RNA interference (RNAi) of TeEcR expression led to decrease of the expression levels of TeEcR, TeRXR, TeHR3, and TeHsc70, while it enhanced TeE75 and TeHsp90 expressions. These results demonstrate that the TeERR and 20E-related genes help regulate gonadal development, while TeEcR appears to inhibit TeE75 expression, TeE75 inhibits HR3 expression. Hsc70 indirectly regulated the expression of the primary and secondary response genes E74A, E75B, and HR3. Hsp90 regulated Usp expression with no direct regulatory relationship with EcR.
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Affiliation(s)
- Wenjie Jin
- State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining, China
- College of Eco-Environmental Engineering, Qinghai University, Xining, China
- Laboratory of Animal Reproduction and Development, College of Life Science, Shaanxi Normal University, Xi'an, China
| | - E Tan
- Laboratory of Animal Reproduction and Development, College of Life Science, Shaanxi Normal University, Xi'an, China
| | - George Ghartey-Kwansah
- Laboratory of Animal Reproduction and Development, College of Life Science, Shaanxi Normal University, Xi'an, China
| | - Yishu Jia
- Laboratory of Animal Reproduction and Development, College of Life Science, Shaanxi Normal University, Xi'an, China
| | - Gengsi Xi
- Laboratory of Animal Reproduction and Development, College of Life Science, Shaanxi Normal University, Xi'an, China
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14
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Gao JM, Garioch JJ, Fadhil M, Tan E, Shah N, Moncrieff M. Planning slow Mohs excision margins for lentigo maligna: a retrospective nonrandomized cohort study comparing reflectance confocal microscopy margin mapping vs. visual inspection with dermoscopy. Br J Dermatol 2021; 184:1182-1183. [PMID: 33377177 DOI: 10.1111/bjd.19764] [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: 08/19/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- J M Gao
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
| | - J J Garioch
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Fadhil
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - E Tan
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - N Shah
- Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - M Moncrieff
- Norwich Medical School, University of East Anglia, Norwich, UK.,Department of Plastic Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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15
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Tan W, Chua B, Yin D, Tan S, Tan D, Ang M, Kanesvaran R, Jain A, Rajasekaran T, Lai G, Toh C, Tan E, Ng Q, Lim W. P76.46 First-Line Osimertinib in Asian Patients with Advanced EGFR-Mutant Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1103] [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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16
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Yuan J, Lim E, Ma S, Chua K, Lee Y, Lim M, Yeo X, Phua C, Takano A, Aung Z, Lim K, Tan E, Tan D, Chew G, Tam W. P69.05 Molecular and Cellular Heterogeneity Underpin Treatment Response Across a Spectrum of EGFR-Mutant Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1011] [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: 12/01/2022]
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17
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Tan A, Lai G, Tan G, Seet A, Takano A, Alvarez J, Skanderup A, Tan W, Ang M, Kanesvaran R, Ng Q, Jain A, Rajasekaran T, Lim W, Tan E, Lim K, Tan D. FP14.13 Molecular Characterisation and Clinical Outcomes in RET Rearranged Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.156] [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: 11/29/2022]
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18
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Tan A, Ong B, Koh T, Chen J, Oo H, Lai G, Tan W, Ang M, Kanesvaran R, Ng Q, Jain A, Rajasekaran T, Zhai W, Skanderup A, Lim K, Tan E, Lim W, Tan D, Takano A. P38.03 Immunohistochemical, Histologic and Genomic Characterisation of Early Stage Pulmonary Invasive Mucinous Adenocarcinoma. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.784] [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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19
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Ma J, Tan S, Yin D, Tran A, Tan D, Ang M, Takano A, Lim K, Kanesvaran R, Jain A, Rajasekaran T, Tan E, Lim D, Ng Q, Tan W. P76.88 Real-World Data of Osimertinib in Patients with Metastatic EGFRm+ NSCLC who Progressed on First-Line EGFR TKIs. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1145] [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: 11/29/2022]
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20
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Lai G, Alvarez J, Yeo J, Sim N, Tan A, Zhou S, Suteja L, Lim T, Rohatgi N, Yeong J, Takano A, Lim K, Gogna A, Too C, Zhuang K, Jain A, Tan W, Kanesvaran R, Ng Q, Ang M, Rajasekaran T, Wang L, Toh C, Lim W, Tam W, Ginhoux F, Tan S, Skanderup A, Tan D, Tan E. OA01.06 Randomised Phase 2 Study of Nivolumab (N) Versus Nivolumab and Ipilimumab (NI) Combination in EGFR Mutant NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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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21
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Saw S, Lai G, Zhou S, Chen J, Ang M, Chua K, Kanesvaran R, Ng Q, Jain A, Tan W, Rajasekaran T, Lim D, Fong K, Takano A, Cheng X, Lim K, Koh T, Ong B, Tan E, Skanderup A, Tan D. OA06.05 Molecular and Clinical Features Associated with Relapse in Early Stage EGFR-Mutated NSCLC: A Single Institution Knowledge Bank. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.293] [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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22
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Tan A, Chua K, Teng Y, Takano A, Alvarez J, Nahar R, Rohatgi N, Lai G, Aung Z, Yeong J, Lim K, Naeini M, Kassam I, Jain A, Tan W, Gogna A, Too C, Kanesvaran R, Ng Q, Ang M, Rajasekaran T, Devanand A, Phua G, Tan B, Lee Y, Wang L, Teo A, Khng A, Lim M, Suteja L, Toh C, Lim W, Iyer N, Tam W, Tan E, Zhai W, Hillmer A, Skanderup A, Tan D. MA13.08 Genomic and Transcriptomic Features of Distinct Resistance Trajectories in EGFR Mutant Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.269] [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: 11/17/2022]
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23
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Alvarez J, Chua K, Sim N, Abedi M, Chen J, Tan A, Lai G, Takano A, Lim W, Tan E, Lim K, Zhai W, Tan D, Skanderup A. P59.08 THOR: Multi-Ethnic, Open Access Thoracic Cancer Genomics Resource. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.959] [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: 11/25/2022]
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24
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Tan E, Chan S, Oi W, Chong J, Prickett T, Leong K, Yeo P, Ong H, Jaufeerally F, Yap J, Sim D, Ng T, Ling L, Lam C, Richards A. Atrial fibrillation and the prognostic performance of biomarkers in heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Consideration of circulating biomarkers for risk stratification in heart failure (HF) is recommended in authoritative international guidelines but the influence of atrial fibrillation (AF) on the prognostic performance of many markers is unclear. Therefore we investigated the interactions between AF and biomarkers in prediction of important clinical outcomes in HF.
Methods
NT-proBNP, pro-atrial natriuretic peptide (MR-proANP), C-type natriuretic peptide (CNP), NT-proCNP, high-sensitivity troponin-T, high-sensitivity troponin-I, mid-regional-propeptide adrenomedullin (MR-proADM), co-peptin (PAVP), growth differentiation factor-15 (GDF-15), sST2, Galectin-3 and procalcitonin levels were measured in a prospectively designed, multicenter, longitudinal study of adults with HF. AF was defined as a documented history of AF based on medical records, and/or presence of AF/atrial flutter on baseline 12-lead ECG. The primary outcome considered was the composite of HF-hospitalization or all-cause mortality on prospective follow-up at 2-years. Cox proportional-hazards models were used in the prognostic evaluation of biomarkers, and each was tested for interaction with AF.
Results
Among 1,099 patients with HF (mean age 62±12 years, 28% female, mean left ventricular ejection fraction 35±16%), 261 (24%) patients had AF. Median levels of NT-proBNP, GDF-15, ST2, MR-proADM, proANP and CNP were higher in AF (p<0.05). Above-median levels of all 12 biomarkers were independently associated with increased risk of the primary outcome. Significant interactions with AF were detected for Galectin-3 and sST2. Galectin-3 (>7.7ng/mL) was associated with increased HF-hospitalizations (adjusted hazard ratio [AHR] 1.75, 95% C.I. 1.10–2.77) and all-cause mortality (AHR 1.95, 95% C.I. 1.04–3.63) only among patients with AF. The prognostic performance of sST2 (>35.6ng/mL) was also stronger in AF especially for the primary outcome (AF: AHR 2.06 95% C.I. 1.32–3.21; non-AF: AHR 1.49 95% C.I. 1.18–1.88) and HF-hospitalization (AF: AHR 1.65, 95% C.I. 1.01–2.69; non-AF: AHR 1.32, 95% C.I. 1.02–1.71). The association of Galectin-3 with the composite outcome was not modified by HF type (HFpEF vs HFrEF) (p for 3-way interaction=0.61) except for sST2 (p for 3-way interaction=0.018) where the association appeared stronger in patients with HFpEF and AF (HR 3.12, 95% C.I. 1.26–7.78) compared to those with HFrEF and AF (HR 1.83, 95% C.I. 1.01–3.33) although numbers of events in each subgroup were small. Notably, no such interactions were observed for the most frequently measured prognostic markers in HF including NT-proBNP and the high-sensitivity cardiac troponins.
Conclusion
AF modified the prognostic utility of guideline-endorsed HF-biomarkers, wherein prognostic associations of Galectin-3 and ST2 were limited to, or stronger in, patients with AF. Application of markers for prognostic purposes in HF requires consideration of the presence or absence of AF.
Figure 1
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): National Medical Research Council of Singapore
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Affiliation(s)
- E Tan
- National University Heart Centre, Singapore, Singapore
| | - S.P Chan
- National University Heart Centre, Singapore, Singapore
| | - W.L Oi
- National University of Singapore, Singapore, Singapore
| | - J.P.C Chong
- National University of Singapore, Singapore, Singapore
| | - T Prickett
- University of Otago Christchurch, Christchurch, New Zealand
| | - K.T.G Leong
- Changi General Hospital, Singapore, Singapore
| | - P.S.D Yeo
- Tan Tock Seng Hospital, Singapore, Singapore
| | - H.Y Ong
- Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - J Yap
- National Heart Centre Singapore, Singapore, Singapore
| | - D Sim
- National Heart Centre Singapore, Singapore, Singapore
| | - T.P Ng
- National University of Singapore, Singapore, Singapore
| | - L.H Ling
- National University Heart Centre, Singapore, Singapore
| | - C.S.P Lam
- National Heart Centre Singapore, Singapore, Singapore
| | - A.M Richards
- National University Heart Centre, Singapore, Singapore
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25
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Henderson A, Paterson DL, Chatfield MD, Tambyah PA, Lye DC, De PP, Lin RTP, Chew KL, Yin M, Lee TH, Yilmaz M, Cakmak R, Alenazi TH, Arabi YM, Falcone M, Bassetti M, Righi E, Ba R, Kanj SS, Bhally H, Iredell J, Mendelson M, Boyles TH, Looke DFM, Runnegar NJ, Miyakis S, Walls G, Ai Khamis M, Zikri A, Crowe A, Ingram PR, Daneman NN, Griffin P, Athan E, Roberts L, Beatson SA, Peleg AY, Cottrell KK, Bauer MJ, Tan E, Chaw K, Nimmo GR, Harris-Brown T, Harris PNA. Association between minimum inhibitory concentration, beta-lactamase genes and mortality for patients treated with piperacillin/tazobactam or meropenem from the MERINO study. Clin Infect Dis 2020; 73:e3842-e3850. [PMID: 33106863 DOI: 10.1093/cid/ciaa1479] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial. METHODS Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations. RESULTS 320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam non-susceptible breakpoint (MIC > 16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% CI 2.8 - 87.2). The absolute risk increase for 30-day mortality for patients treated with piperacillin/tazobactam compared with meropenem was 9% (95% CI 3% - 15%) and 8% (95% CI 2% - 15%) for the original PA population and the post-hoc MA populations, which reduced to 5% (95% CI -1% - 10%) after excluding strains with piperacillin/tazobactam MIC values > 16 mg/L. Isolates co-harboring ESBL and OXA-1 genes were associated with elevated piperacillin/tazobactam MICs and the highest risk increase in 30-mortality of 14% (95% CI 2% - 28%). CONCLUSION After excluding non-susceptible strains, the 30-day mortality difference was from the MERINO trial was less pronounced for piperacillin/tazobactam. Poor reliability in susceptibility testing performance for piperacillin/tazobactam and the high prevalence of OXA co-harboring ESBLs suggests meropenem remains the preferred choice for definitive treatment of ceftriaxone non-susceptible E. coli and Klebsiella.
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Affiliation(s)
- A Henderson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD
| | - D L Paterson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - M D Chatfield
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - P A Tambyah
- Department of Infectious Diseases, National University Hospital, Singapore
| | - D C Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Hospital, Singapore
| | - P P De
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
| | - R T P Lin
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - K L Chew
- Division of Microbiology, National University Hospital, Singapore
| | - M Yin
- Department of Infectious Diseases, National University Hospital, Singapore
| | - T H Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - M Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - R Cakmak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - T H Alenazi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Y M Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - M Falcone
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino Genoa, Italy
| | - E Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Udine, Italy.,Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Rogers Ba
- Monash University, Centre for Inflammatory Diseases, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Victoria, Australia
| | - S S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - H Bhally
- Department of Medicine and Infectious Diseases, North Shore Hospital, Auckland
| | - J Iredell
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, Australia
| | - M Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - T H Boyles
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - D F M Looke
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD.,University of Queensland, Brisbane, Australia
| | - N J Runnegar
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD.,University of Queensland, Brisbane, Australia
| | - S Miyakis
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - G Walls
- Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand
| | - M Ai Khamis
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - A Zikri
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - A Crowe
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia.,Department of Microbiology, St Vincent's Hospital, Melbourne, Australia
| | - P R Ingram
- School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch , Australia.,Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia
| | - N N Daneman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - P Griffin
- University of Queensland, Brisbane, Australia.,Department of Medicine and Infectious Diseases, Mater Hospital and Mater Medical Research Institute, Brisbane, Australia.,QIMR Berghofer, Brisbane, Queensland, Australia
| | - E Athan
- Department of Infectious Diseases, Barwon Health and Deakin University, Geelong, Victoria, Australia
| | - L Roberts
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia
| | - S A Beatson
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia
| | - A Y Peleg
- Infection & Immunity Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia.,Department of Microbiology, Monash University, Clayton, Australia
| | - K K Cottrell
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - M J Bauer
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - E Tan
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - K Chaw
- Department of Microbiology, Pathology Queensland, Toowoomba Laboratory, Australia.,Department of Microbiology, Mater Pathology, Australia.,Infectious Diseases Department, Redcliffe Hospital, Australia
| | - G R Nimmo
- Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - T Harris-Brown
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - P N A Harris
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Wong B, Tan E, McLean-Tooke A. Pulmonary granulomas in a patient with positive ANCA and history of tuberculosis: case report. BMC Pulm Med 2020; 20:219. [PMID: 32795275 PMCID: PMC7427886 DOI: 10.1186/s12890-020-01258-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/05/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Granulomatous polyangiitis (GPA) is a rare multisystem autoimmune disease of unknown aetiology that is pathologically characterised by necrotising vasculitis, tissue necrosis and granulomatous inflammation, typically in the presence of anti-neutrophil cytoplasmic antibodies (ANCA). However infectious diseases may induce high titre ANCA and mimic vasculitis. Tuberculosis may share many clinical features with GPA including fever, arthralgia, granulomatous inflammation and pulmonary lesions and patients. CASE PRESENTATION A 39 year old patient was admitted with ocular irritation and redness, arthralgia and multiple new pulmonary lesions. The past medical history was significant for two episodes of tuberculosis previously requiring prolonged treatment. ANCA antibodies were positive and CT showed multiple pulmonary lesions including cavitatory lesions. After extensive investigation, the patient was treated for GPA with high dose immune suppression with good clinical response. CONCLUSIONS Here we review the diagnostic considerations between differentiating GPA and tuberculosis in patients from endemic regions. It is recommended that biopsies of lung lesions, sputum microscopy and multidisciplinary team input are sought as part of the workup when these two differentials are being considered.
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Affiliation(s)
- B Wong
- Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia.
| | - E Tan
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia
| | - A McLean-Tooke
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia
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Tan E, Kim D, Imanirad I, Carballido E, Zhou J, Schell M, Jimenez MM, Kim R. P-47 A phase I/II study of pembrolizumab in combination with ibrutinib for advanced, refractory microsatellite stable colorectal cancers. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.129] [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: 10/23/2022] Open
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Muto J, Fukuda S, Shirakata Y, Tsuda T, Tan E, Dai X, Shiraishi K, Mori H, Murakami M, Higashiyama S, Sayama K. 796 Effect of novel disaccharide for construction of living skin equivalents. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.811] [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: 10/24/2022]
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Bhat A, Makarious D, Mahajan V, Husen Y, Tan E, Burdusel C, Gan G, Lee L, Chow C, Tan T. 720 Characterisation of Recent Trends in Cardiovascular Risk Factors in Young Patients With Ischaemic Stroke. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.727] [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: 11/25/2022]
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Wu Y, Tu H, Feng J, Shi M, Zhao J, Wang Y, Chang J, Wang J, Cheng Y, Zhu J, Tan E, Zhang Y, Lee V, Yang C, Su W, Lam D, Srinivasa B, Rajappa S, Ho C, Lam K, Hu Y, Bondarde S, Liu X, Pang K, Tian Y, Cseh A, Huang D, Zhou C. P2.01-99 A Phase IIIb Open-Label Study of Afatinib in EGFR TKI-Naïve Patients with EGFR Mutation-Positive NSCLC: Final Analysis. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tan E, Sandroussi C. Pancreatic resection in elderly patients over the age of 70 with primary pancreatic cancer: a retrospective analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.095] [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: 11/14/2022] Open
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Turmel N, Hentzen C, Miget G, Chesnel C, Charlanes A, Le Breton F, Tan E, Amarenco G. [Urethral pain during clean intermittent self catheterization: Retrospective analysis of 77 patients]. Prog Urol 2019; 29:360-365. [PMID: 31109758 DOI: 10.1016/j.purol.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Clean self-intermittent catheterization (CIC) is the gold standard of the therapeutic approach of chronic urinary retention. Usually, CIC are safe, effective but in some cases catheterization can determine urethral pain during catheter insertion or withdrawal leading to poor adherence and compliance. To determine prevalence of pain during CIC and verify its impact on adherence to treatment. METHOD Retrospective study with evaluation of pain during CIC one month following CIC teaching session by means specific and validated questionnaires: ICDQ (Intermittent Catheterization Difficulties Questionnaire), InCasaq (Intermittent Catheterization Satisfaction Questionnaire), I-CAS (Intermittent Catheterization Adherence Scale). RESULTS Seventy-seven patients were recruited and 28 (36%) described pain during CIC. There is a strong relationship between pain and poor adherence (P<0.01). Female patients had a higher risk of urethral pain during CIC and in contrary BMI>25kg/m2 seems to be a protective factor of pain. CONCLUSION In this series, urethral pain was associated with low compliance and adherence to CIC. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Turmel
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France.
| | - C Hentzen
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - G Miget
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - C Chesnel
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - A Charlanes
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - F Le Breton
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - E Tan
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - G Amarenco
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
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De Silva DPN, Tan E, Mizuno N, Hosoya S, Reza MS, Watabe S, Kinoshita S, Asakawa S. Transcriptomic analysis of immunoglobulin novel antigen receptor (IgNAR) heavy chain constant domains of brownbanded bamboo shark (Chiloscyllium punctatum). Fish Shellfish Immunol 2019; 84:370-376. [PMID: 30291985 DOI: 10.1016/j.fsi.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 06/08/2023]
Abstract
Cartilaginous fish are the evolutionarily oldest group of animals which possess antibodies, T cell receptors and major histocompatibility complex (MHC). The immunoglobulin novel antigen receptor (IgNAR) found in cartilaginous fish is a heavy chain homodimer which lacks light chain. The presence of non-canonical cysteine molecules and lack of CDR2 region make it more significant. To synthesize active binding domains based on variable region of IgNAR (VNAR), knowledge on the constant region dynamics play a significant role. The IgNAR exhibit species variations in its primary sequence features; hence, this study was conducted to determine the IgNAR heavy chain constant domain of the brownbanded bamboo shark (Chiloscyllium punctatum). Peripheral blood leukocytes (PBL) isolated from adult bamboo sharks were used to synthesize a cDNA library. A total of four billion residues of two million sequences (average length 218.41 bp) were obtained. Assembled sequences were aligned with published cartilaginous fish IgNAR constant region sequences. Transcriptome analysis revealed two distinct types of IgNAR in the brownbanded bamboo shark. Also, constant-1 domain sequences displayed 13 unique sequences which may reflect the least number of IgNAR gene clusters. The phylogenetic analysis revealed the closest relationship with the nurse shark (Ginglymostoma cirratum) followed by the wobbegong shark (Orectolobus maculatus) which belong to the same order Orectolobiformes. Analysis of the constant domains of the brownbanded bamboo shark IgNAR revealed an evolutionarily conserved nature and this knowledge can be used to design primers for VNAR cloning. Furthermore, knowledge on the structural features in IgNAR constant domains that increase the stability could be useful in the process of stabilizing human immunoglobulins.
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Affiliation(s)
- D P N De Silva
- Laboratory of Aquatic Molecular Biology and Biotechnology, Department of Aquatic Bioscience, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - E Tan
- Laboratory of Aquatic Molecular Biology and Biotechnology, Department of Aquatic Bioscience, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - N Mizuno
- Fisheries Laboratory, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 2971-4 Bentenjima, Nishi-ku, Hamamatsu, Shizuoka, 431-0214, Japan
| | - S Hosoya
- Fisheries Laboratory, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 2971-4 Bentenjima, Nishi-ku, Hamamatsu, Shizuoka, 431-0214, Japan
| | - Md S Reza
- School of Marine Biosciences, Kitasato University, Kanagawa, Japan
| | - S Watabe
- School of Marine Biosciences, Kitasato University, Kanagawa, Japan
| | - S Kinoshita
- Laboratory of Aquatic Molecular Biology and Biotechnology, Department of Aquatic Bioscience, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - S Asakawa
- Laboratory of Aquatic Molecular Biology and Biotechnology, Department of Aquatic Bioscience, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan.
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Schauer A, Wood BA, Tan E, Tai A, McLean-Tooke A, Crawford J, Harvey NT. Multiple skin lesions on a background of hypergammaglobulinaemia. Clin Exp Dermatol 2018; 44:787-790. [PMID: 30474260 DOI: 10.1111/ced.13837] [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] [Accepted: 08/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A Schauer
- Princess Margaret Hospital, Perth, WA, Australia
| | - B A Wood
- Dermatopathology Group, Department of Anatomical Pathology, PathWest, Perth, WA, Australia.,Division of Pathology and Laboratory Medicine, Medical School, University of WA, Perth, WA, Australia
| | - E Tan
- Department of Dermatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - A Tai
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - A McLean-Tooke
- Department of Immunology, PathWest, QEII Medical Centre, Perth, WA, Australia
| | - J Crawford
- Department ofHaematology, PathWest, QEII Medical Centre, Perth, WA, Australia
| | - N T Harvey
- Dermatopathology Group, Department of Anatomical Pathology, PathWest, Perth, WA, Australia.,Division of Pathology and Laboratory Medicine, Medical School, University of WA, Perth, WA, Australia
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Henderson A, Tan E, McCarthy KL, Paterson DL. Activity of ceftolozane/tazobactam against a collection of Pseudomonas aeruginosa isolates from bloodstream infections in Australia. Pathology 2018; 50:748-752. [PMID: 30392710 DOI: 10.1016/j.pathol.2018.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 01/22/2023]
Abstract
Pseudomonas aeruginosa is a common pathogen causing nosocomial infection. In particular, bloodstream infection (BSI) is associated with a high rate of morbidity and mortality. Ceftolozane/tazobactam is a new β-lactam/β-lactamase antimicrobial with activity against P. aeruginosa as well as multidrug resistant (MDR) Gram negative Enterobacteriaceae. Ceftolozane/tazobactam has frequently been used in salvage therapy for MDR P. aeruginosa infections. The aim of this study was to determine the activity of ceftolozane/tazobactam against P. aeruginosa isolates from BSIs collected from three clinical microbiology laboratories in Queensland, Australia, with a high proportion of isolates demonstrating β-lactam resistance. Antimicrobial susceptibility testing was performed by broth microdilution using custom made sensititre plates sourced from ThermoFisher Scientific. In addition to ceftolozane/tazobactam, we also tested piperacillin/tazobactam, ceftazidime, cefepime, meropenem, doripenem, imipenem, aztreonam, ciprofloxacin, levofloxacin, gentamicin, amikacin, tobramycin and colistin. Overall, ceftolozane/tazobactam was the most active agent tested [(MIC50/90 = 1/2 μg/mL, 96% susceptible (S)]. Against 44 isolates with resistance to at least one other β-lactam agent, 40 were susceptible to ceftolozane/tazobactam. Three ceftolozane/tazobactam resistant isolates were susceptible to colistin, with one of those isolates also susceptible to levofloxacin but not to any other antimicrobials tested. One ceftolozane/tazobactam resistant isolate was susceptible only to meropenem and doripenem but was non-susceptible to imipenem. An association was found between fluoroquinolone resistance and aminoglycoside resistance but not with β-lactam resistance. In summary, ceftolozane/tazobactam was active against most strains tested, including those resistant to other β-lactams. Laboratories should consider testing P. aeruginosa against ceftolozane/tazobactam in suspected MDR or extensively drug resistant (XDR) infections.
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Affiliation(s)
- A Henderson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia; Infection Management Services, Princess Alexandra Hospital, Brisbane, Qld, Australia.
| | - E Tan
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
| | - K L McCarthy
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
| | - D L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
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Wu Y, Tu H, Feng J, Shi M, Zhao J, Wang Y, Chang J, Wang J, Cheng Y, Zhu J, Tan E, Li K, Zhang Y, Lee V, Yang C, Su W, Lam D, Srinivasa B, Rajappa S, Ho C, Lam K, Hu Y, Bondarde S, Liu X, Huang D, Wang Y, Pang K, Zhou C. P1.01-98 A Phase IIIb Trial of Afatinib in EGFRm+ NSCLC: Analyses of Outcomes in Patients with Brain Metastases or Dose Reductions. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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40
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Kwang L, Lau D, Liew A, Ju Y, Lim E, Lai G, Nahar R, Teng Y, Chua K, Alvarez J, Lim M, Leong H, Chong F, Toh D, Quah H, Suteja L, Wang L, Lim K, Lim W, Tan E, Zhai W, Tam W, Iyer N, Tan D. P2.13-21 MET Addiction Can be Circumvented Through EGFR Inhibition Via AXL in MET-Amplified Primary Resistant EGFR-Mutant NSCLCX. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1416] [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: 11/25/2022]
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41
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Halmos B, Tan E, Soo R, Cadranel J, Lee M, Foucher P, Hsia T, Hochmair M, Griesinger F, Hida T, Kim E, Melosky B, Märten A, Carcereny E. P1.01-28 Impact of Afatinib Dosing on Safety and Efficacy Real-World in Patients with EGFR Mutation-Positive Advanced NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.584] [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: 10/28/2022]
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Bonaros N, Laborde F, Pfeiffer S, Misfeld M, Tan E, Zembala M, Casselman F, Harringer W, Andreas M, Oberwalder P, Bechtel M, Goisis G, Chiaro M, Haverich A. P761Sutureless valve implantation for surgical treatment of low flow low gradient aortic stenosis. Results from the CAVALIER-Trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Bonaros
- Innsbruck Medical University, Innsbruck, Austria
| | - F Laborde
- Institut Mutualiste Montsouris, Cardiac Surgery, Paris, France
| | - S Pfeiffer
- Klinikum Nürnberg - Süd, Nürnberg, Cardiac Surgery, Nurnberg, Germany
| | - M Misfeld
- Heart Center of Leipzig, Cardiac Surgery, Leipzig, Germany
| | - E Tan
- Heart Center of Leipzig, Cardiac Surgery, Leipzig, Germany
| | - M Zembala
- Silesian Center for Heart Diseases (SCHD), Cardiac Surgery, Zabrze, Poland
| | - F Casselman
- Olv Hospital Aalst, Cardiac Surgery, Aalst, Belgium
| | - W Harringer
- Klinikum Braunschweig, Cardiac Surgery, Braunschweig, Germany
| | - M Andreas
- Medical University of Vienna, Cardiac Surgery, Vienna, Austria
| | - P Oberwalder
- Medical University of Graz, Cardiac Surgery, Graz, Austria
| | - M Bechtel
- BG University Hospital Bergmannsheil, Bochum, Germany
| | | | | | - A Haverich
- Hannover Medical School, Cardiac Surgery, Hannover, Germany
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Tan E, Chan SP, Krishnan SK, Tan HC, Yeo TC, Low A, Lee RCH, Loh JPY, Loh PH, Tay ELW, Chan KH, Richards AM, Chan MY. P4619Accelerated accrural of ischaemic events after stopping dual antiplatelet therapy at 12 months in a real-world acute myocardial infarction cohort. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Tan
- National University Heart Centre, Singapore, Singapore
| | - S P Chan
- National University of Singapore, Singapore, Singapore
| | - S K Krishnan
- National University Heart Centre, Singapore, Singapore
| | - H C Tan
- National University Heart Centre, Singapore, Singapore
| | - T C Yeo
- National University Heart Centre, Singapore, Singapore
| | - A Low
- National University Heart Centre, Singapore, Singapore
| | - R C H Lee
- National University Heart Centre, Singapore, Singapore
| | - J P Y Loh
- National University Heart Centre, Singapore, Singapore
| | - P H Loh
- National University Heart Centre, Singapore, Singapore
| | - E L W Tay
- National University Heart Centre, Singapore, Singapore
| | - K H Chan
- National University Heart Centre, Singapore, Singapore
| | - A M Richards
- National University Heart Centre, Singapore, Singapore
| | - M Y Chan
- National University Heart Centre, Singapore, Singapore
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Cai S, Robinson K, Tan E, Tey H, Reversade B, Zhong F. 901 Inflammasome signaling and translocation of apoptotic speck-like protein containing a caspase activation and recruitment domain (ASC) in psoriatic keratinocytes. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.913] [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: 11/16/2022]
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Bhat A, Tan E, Gan G, Fernandez F, Tan T. Comparison of clinical and echocardiographic parameters of left heart size and function between young patients with stroke in sinus rhythm versus atrial fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.256] [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: 11/28/2022]
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Ramage L, Yen C, Qiu S, Simillis C, Kontovounisios C, Tan E, Tekkis P. Does a missed obstetric anal sphincter injury at time of delivery affect short-term functional outcome? Ann R Coll Surg Engl 2018; 100:26-32. [PMID: 29022787 PMCID: PMC5838671 DOI: 10.1308/rcsann.2017.0140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/05/2017] [Indexed: 12/15/2022] Open
Abstract
Introduction This study aimed to ascertain whether missed obstetric anal sphincter injury at delivery had worse functional and quality of life outcomes than primary repair immediately following delivery. Materials and methods Two to one propensity matching was undertaken of patients presenting to a tertiary pelvic floor unit with ultrasound evidence of missed obstetric anal sphincter injury within 24 months of delivery with patients who underwent primary repair at the time of delivery by parity, grade of injury and time to assessment. Outcomes compared included Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score, Short Form-36, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire and anorectal physiology results. Results Thirty-two missed anal sphincter injuries were matched two to one with sixty-two patients who underwent primary repair of an anal sphincter defect. Mean time to follow-up was 9.31 ± 6.79 months. Patients with a missed anal sphincter injury had suffered more incontinence, as seen in higher the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ; 30.56% ± 14.41% vs. 19.75% ± 15.65%, P = 0.002) and Wexner scores (6.00 ± 3.76 vs. 3.67 ± 4.06, P = 0.009). They also had a worse BBUSQ urinary domain score (28.25% ± 14.9% vs. 17.01 ± 13.87%, P = 0.001) and worse physical functioning as measured by the Short Form-36 questionnaire (P = 0.045). There were no differences in other outcomes compared, including anorectal physiology and sexual function. Discussion In the short-term, patients with a missed obstetric anal sphincter injury had significantly worse faecal incontinence and urinary function scores, however quality of life and sexual function were largely comparable between groups. Conclusions Longer-term follow-up is needed to assess the effects of missed obstetric anal sphincter injury over time.
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Affiliation(s)
- L Ramage
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust , London , UK
| | - C Yen
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust , London , UK
| | - S Qiu
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust , London , UK
| | - C Simillis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust , London , UK
| | - C Kontovounisios
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust , London , UK
- Department of Colorectal Surgery, Royal Marsden NHS Foundation Trust , London , UK
| | - E Tan
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust , London , UK
- Department of Colorectal Surgery, Singapore General Hospital , Republic of Singapore
| | - P Tekkis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust , London , UK
- Department of Colorectal Surgery, Royal Marsden NHS Foundation Trust , London , UK
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Gagnaire B, Adam-Guillermin C, Festarini A, Cavalié I, Della-Vedova C, Shultz C, Kim SB, Ikert H, Dubois C, Walsh S, Farrow F, Beaton D, Tan E, Wen K, Stuart M. Effects of in situ exposure to tritiated natural environments: A multi-biomarker approach using the fathead minnow, Pimephales promelas. Sci Total Environ 2017; 599-600:597-611. [PMID: 28494285 DOI: 10.1016/j.scitotenv.2017.04.210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/14/2017] [Accepted: 04/27/2017] [Indexed: 06/07/2023]
Abstract
Aquatic ecosystems are chronically exposed to radionuclides as well as other pollutants. Increased concentrations of pollutants in aquatic environments can present a risk to exposed organisms, including fish. The goal of this study was to characterize the effects of tritium, in the context of natural environments, on the health of fathead minnow, Pimephales promelas. Fish were exposed to tritium (activity concentrations ranging from 2 to 23,000Bq/L) and also to various concentrations of several metals to replicate multiple-stressor environments. Fish were exposed for 60days, then transferred to the tritium background site where they stayed for another 60days. Tritium, in the forms of tritiated water (HTO) and organically bound tritium (OBT), and a series of fish health indicators were measured in fish tissues at seven time points throughout the 120days required to complete the exposure and the depuration phases. Results showed effects of environmental exposure following the increase of tritium activity and metals concentrations in water. The internal dose rates of tritium, estimated from tissue HTO and OBT activity concentrations, were consistently low (maximum of 0.2μGy/h) compared to levels at which population effects may be expected (>100μGy/h) and no effects were observed on survival, fish condition, gonado-somatic, hepato-somatic, spleno-somatic and metabolic indices (RNA/DNA, proteins/DNA and protein carbonylation (in gonads and kidneys)). Using multivariate analyses, we showed that several biomarkers (DNA damages, MN frequency, gamma-H2AX, SFA/MUFA ratios, lysosomal membrane integrity, AChE, SOD, phagocytosis and esterase activities) were exclusively correlated with fish tritium internal dose rate, showing that tritium induced genotoxicity, DNA repair activity, changes in fatty acid composition, and immune, neural and antioxidant responses. Some biomarkers were responding to the presence of metals, but overall, more biomarkers were linked to internalized tritium. The results are discussed in the context of multiple stressors involving metals and tritium.
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Affiliation(s)
- B Gagnaire
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-ENV/SERIS/LECO, Cadarache, Saint-Paul-lez-Durance 13115, France.
| | - C Adam-Guillermin
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-ENV/SERIS/LECO, Cadarache, Saint-Paul-lez-Durance 13115, France
| | - A Festarini
- Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
| | - I Cavalié
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-ENV/SERIS/LECO, Cadarache, Saint-Paul-lez-Durance 13115, France
| | - C Della-Vedova
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-ENV/SERIS/LRTE, Cadarache, Saint-Paul-lez-Durance 13115, France
| | - C Shultz
- Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
| | - S B Kim
- Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
| | - H Ikert
- Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
| | - C Dubois
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-ENV/SERIS/LECO, Cadarache, Saint-Paul-lez-Durance 13115, France; Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
| | - S Walsh
- Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
| | - F Farrow
- Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
| | - D Beaton
- Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
| | - E Tan
- Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
| | - K Wen
- Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
| | - M Stuart
- Canadian Nuclear Laboratories (formerly Atomic Energy of Canada Limited), Chalk River Laboratories, 286 Plant Road, Chalk River, ON K0J 1J0, Canada
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Hirsh V, Tan E, Wu Y, Sequist L, Zhou C, Schuler M, Geater S, Mok T, Hu C, Yamamoto N, Feng J, O’Byrne K, Lu S, Huang Y, Sebastian M, Okamoto I, Dickgreber N, Shah R, Palmer M, Märten A, Massey D, Samuelsen C, Yang J. P3.01-075 Afatinib Dose Adjustment: Effect on Safety, Efficacy and Patient-Reported Outcomes in the LUX-Lung 3/6 Trials in EGFRm+ NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1516] [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: 10/18/2022]
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49
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Park K, Tan E, O’Byrne K, Zhang L, Boyer M, Mok T, Hirsh V, Yang J, Schuler M, Yamamoto N, Sequist L, Wu Y, Zhou C, Ehrnrooth E, Märten A, Tang W, Paz-Ares L. P3.01-039 Sequential Afatinib-Osimertinib Therapy in EGFR Mutation-Positive (EGFRm+) NSCLC: Analysis of Time on Treatment and OS. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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50
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Schuler M, Yang J, Sequist L, Wu Y, Zhou C, Geater S, Mok T, Tan E, Hu C, Yamamoto N, Feng J, O’Byrne K, Lu S, Hirsh V, Huang Y, Ellis S, Samuelsen C, Märten A, Fan J, Park K, Paz-Ares L. P3.01-026 Analysis of Long-Term Response to First-Line Afatinib in the LUX-Lung 3, 6 and 7 Trials in Advanced EGFRm+ NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1467] [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: 11/29/2022]
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