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Tan HZ, Sprangers B. Proton pump inhibitors and adverse kidney outcomes during immune checkpoint blockade: time to sound the alarm? Clin Kidney J 2023; 16:1709-1713. [PMID: 37915924 PMCID: PMC10616439 DOI: 10.1093/ckj/sfad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Indexed: 11/03/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have significantly altered the treatment landscape for cancer in the last decade. However, their benefits are often offset by therapy-limiting immune-related adverse events (irAEs). Acute interstitial nephritis (AIN) is the most common renal irAE, but the exact mechanisms underlying its development are poorly understood. ICI-induced immune activation against drug-derived antigens, leading to an inflammatory response within the kidney interstitium, has been postulated, evidenced by current observations of a higher incidence of ICI-associated AIN in patients receiving AIN-inducing drugs such as proton pump inhibitors (PPIs). The role of PPIs in this specific context has garnered significant attention, given their ubiquitous use and sometimes misuse. In this issue of CKJ Miao et al. summarise and synthesize the best available evidence to clarify the interactions of PPIs with ICIs in the development of AIN and other adverse kidney outcomes. The sum of evidence provided appear to implicate PPIs in the development of clinically significant short- and long-term kidney-related adverse effects in patients on immune checkpoint blockade, although causality cannot be proven. In this editorial we discuss the key practical implications of these findings and emphasize the need for further quality studies to delineate the true relationship of ICIs and PPIs in the development of AIN.
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Affiliation(s)
- Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Ben Sprangers
- Biomedical Research Institute, Department of Immunology and Infection, UHasselt, Diepenbeek, Belgium
- Department of Nephrology, Ziekenhuis Oost Limburg, Genk, Belgium
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Ting IPL, Tan HZ, Teo HG, Kiing JW, Muniandy P. Spectrum of cutaneous granulomatous lesions: A 5-year experience in a tertiary care centre in Sarawak. Med J Malaysia 2023; 78:184-189. [PMID: 36988528] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Granulomatous skin lesions can have various histopathological features leading to diagnostic confusion. The study aimed to determine the frequency and pattern of different granulomatous skin lesions. MATERIALS AND METHODS This was a 5-year retrospective study done between April 2017 and March 2022 at Dermatology Department, Sarawak General Hospital. Subjects with a clinicopathological diagnosis of granulomatous diseases were included in the analysis. RESULTS A total of 1718 skin biopsies were done during the study periods, with 49 (2.8%) confirmed granulomatous skin lesions. Most patients were aged 40-60 with a male predominance of 51%. Most of the skin biopsy samples were taken from the upper limb (36%). In this study, epitheloid granuloma was the commonest subtype (21, 43%) followed by suppurative granuloma (12, 24%), tuberculoid granuloma (8, 16%) and foreign body granuloma (5, 10%). The commonest aetiology of granulomatous skin lesions in our study was infections (30, 61%) followed by foreign body inoculation (8, 16%). Fungal infection was the most common infective cause, followed by cutaneous tuberculosis. CONCLUSION The major cause of granulomatous dermatoses in developing countries is still infections, fungal and tuberculosis being the leading causes.
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Affiliation(s)
- I P L Ting
- Sarawak General Hospital, Dermatology Department, Kuching, Sarawak, Malaysia.
| | - H Z Tan
- Sarawak General Hospital, Dermatology Department, Kuching, Sarawak, Malaysia
| | - H G Teo
- Sarawak General Hospital, Dermatology Department, Kuching, Sarawak, Malaysia
| | - J W Kiing
- Sarawak General Hospital, Dermatology Department, Kuching, Sarawak, Malaysia
| | - P Muniandy
- Sarawak General Hospital, Dermatology Department, Kuching, Sarawak, Malaysia
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Tan MSH, Choo JCJ, Tan PH, Kwek JL, Lim CC, Mok IY, Toh AJ, Tan HZ. Anti-glomerular basement membrane glomerulonephritis following COVID-19 infection without clinically evident pneumonia. Int Urol Nephrol 2023:10.1007/s11255-023-03490-8. [PMID: 36739354 PMCID: PMC9899105 DOI: 10.1007/s11255-023-03490-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/24/2023] [Indexed: 02/06/2023]
Affiliation(s)
- Mabel Si Hua Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jason Chon Jun Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Puay Hoon Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Jia Liang Kwek
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Irene Yanjia Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - April Jiapei Toh
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
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Lim CC, Mok I, Huang Z, Tan HZ, Choo J. Counselling for Kidney Biopsy and Immunosuppression in Glomerulonephritis Using Simulation. Glomerular Dis 2022; 3:29-31. [PMID: 36816425 PMCID: PMC9936759 DOI: 10.1159/000528816] [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: 09/30/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
not applicable for letter in response to recent publication in this journal
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Affiliation(s)
- Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Irene Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Zhihua Huang
- Nursing, Singapore General Hospital, Singapore, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore,*Jason Choo,
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Lim CC, Choo J, Tan HZ, Mok I, Woo KT. Reduced-dose steroid for Asians with Immunoglobulin A nephropathy at risk of progressive kidney disease may reduce metabolic complications. Nephrology (Carlton) 2022; 27:1003-1004. [PMID: 36196528 DOI: 10.1111/nep.14114] [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: 06/14/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Irene Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Keng Thye Woo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
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Cai J, Lim CC, Tan HZ, Choo JCJ, Tan PH. The Case | Hematuria, proteinuria, and renal insufficiency in metastatic prostate cancer. Kidney Int 2022; 102:945-946. [PMID: 36150772 DOI: 10.1016/j.kint.2022.03.003] [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: 01/19/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Jiashen Cai
- Department of Renal Medicine, Singapore General Hospital, Singapore.
| | - Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Jason C J Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
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Abstract
BACKGROUND Kidney biopsy is important to guide the management of allograft dysfunction but has a risk of complications. This review aimed to determine the incidence and risk factors of complications after kidney allograft biopsy. METHODS This is a systematic review and meta-analysis of randomized controlled trials, cohort studies, or case-control studies indexed on PubMed, Embase, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry, and ClinicalTrials.gov, limited to the English language, from January 2000 to December 2020, including adult and pediatric kidney allograft biopsies. Primary outcomes were gross hematuria, bleeding requiring transfusion, and major complications (requiring interventions such as blood transfusion or surgical or radiological interventions). RESULTS The review included 72 studies (40 082 biopsies). The quality of included studies was suboptimal. Pooled rates of gross hematuria, bleeding requiring transfusion, and major complications were 3.18% [95% confidence interval (95% CI), 2.31-4.19], 0.31% (95% CI, 0.15-0.52) and 0.89% (95% CI, 0.61-1.22), respectively. Gross hematuria rates were lower in high-income compared with middle-income countries (2.59% versus 6.44%, P < 0.01) and biopsies performed by radiology as compared with nephrology departments (1.25% versus 3.71%, P < 0.01). Blood transfusion rates were lower in pediatrics than adults (0.0% versus 0.65%, P < 0.01). Major complications were lower in biopsies performed by specialists as compared with trainees (0.02% versus 3.64%, P < 0.01). Graft loss and mortality were extremely rare. Limitations included missing data, few randomized controlled trials, and possible publication bias. CONCLUSIONS The risk of complications after kidney allograft biopsy was low. Given the low quality of included studies, risk factors for complications should be further examined in future studies.
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Affiliation(s)
- Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | | | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | - Terence Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
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Yeo F, Hui Ho R, Choo J, Zhuan Tan H, Mok I, Lim C. MO1047: Patient Reported Outcomes in Glomerulonephritis. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac091.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Glomerulonephritis and its treatment may be associated with disease or treatment-related complications causing significant symptom burden and hospitalizations affecting physical function and quality of life (QoL). Patient-centered care harnessing patient-reported outcome measures (PROMs) can guide physicians to optimize patients’ functional well-being. Few studies have described health-related QoL (HRQOL) in patients with glomerulonephritis. We aimed to describe the HRQOL and determinants of HRQOL among patients with active glomerulonephritis.
METHOD
This was a cross-sectional study of adults with active glomerulonephritis recruited at the Singapore General Hospital Glomerulonephritis Disease Management Clinics between July 2020 and July 2021. HRQOL was assessed using the Short-Form Health Survey (SF-36) and Patient-Reported Outcome Measurement Informative System (PROMIS). Socio-demographic and clinical data were collected. Multivariate linear regression was used to determine predictors of HRQOL.
RESULTS
A total of 60 patients with glomerulonephritis (13 minimal change disease, 9 primary focal segmental glomerulosclerosis, 8 membranous nephropathy, 15 lupus nephritis, 8 IgA nephropathy and 7 other glomerulonephritis) with median age 44.5 years old (IQR 32–57) participated. Most (83%) had received immunosuppressants within 60 days of study enrolment. The scores for general health and energy were lower than other health domains of SF-36 such as physical functioning (Table 1). Health domain scores of those with nephrotic presentations (minimal change disease, FSGS and membranous nephropathy) and nephritic presentations (lupus nephritis and IgA nephropathy) were not significantly different. In the multivariable model accounting for age, gender, eGFR, ethnicity, hematuria, edema and immunosuppressant use (Table 2), age correlated positively with emotional role and social functioning while ethnicity influenced the pain scores. Hematuria was associated with lower physical role scores while eGFR correlated positively with social functioning. Calcineurin inhibitor use was associated with higher global physical health scores.
CONCLUSION
Sociodemographic, clinical and treatment may affect SF-36 and PROMIS HRQOL scores in patients with glomerulonephritis.
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Lim C, Hong Liew Z, Zhuan Tan H, Mok I, Jie Leeu J, Choo J. MO1043: Influenza Vaccine Awareness and Acceptance Among Individuals with Glomerulonephritis and Renal Vasculitis During the Corononavirus Disease 2019 Pandemic. Nephrol Dial Transplant 2022. [PMCID: PMC9383804 DOI: 10.1093/ndt/gfac091.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIMS Patients with glomerulonephritis may have an increased risk of influenza infection and morbidity, but vaccine coverage remained low with little data on acceptance in glomerulonephritis. We aimed to assess influenza vaccine awareness among patients with glomerulonephritis and identify determinants of vaccine acceptance. METHOD Single-center cross-sectional study of patients with glomerulonephritis who completed a survey in the clinic or over the telephone between June and August 2021. Sociodemographic data, health literacy measured by HLS-EU-47 questionnaire, influenza and the coronavirus disease (COVID-19) vaccine awareness and determinants of vaccine acceptance according to the World Health Organization framework. RESULTS Among 86 patients who completed the survey, influenza vaccine awareness was lower than COVID-19 vaccine awareness (75.6% versus 100%). After adjusting for the survey type, use of English language at home and at healthcare settings, higher income and professional or executive occupation were significantly associated with influenza vaccine awareness, while older age and lower education level were associated with reduced awareness. The healthcare provider was the most frequent information source and > 90% trusted that healthcare providers and the government considered the patients’ best interests and gave correct information. Only half thought their medical condition and medications would affect their vaccine decision while a quarter to half did not understand how the vaccine worked and thought there were better ways to protect against infection. CONCLUSION Healthcare providers can actively identify and advocate influenza vaccines to the unaware and overcome potential barriers to reduce influenza infections and morbidity in glomerulonephritis.
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Affiliation(s)
- Cynthia Lim
- Singapore General Hospital, Singapore, Singapore
| | | | | | - Irene Mok
- Singapore General Hospital, Singapore, Singapore
| | - Jun Jie Leeu
- Lee Kong Chian School of Medicine HQ Building, Singapore, Singapore
| | - Jason Choo
- Singapore General Hospital, Singapore, Singapore
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Zhuan Tan H, Nagarajan C, Si Yun Tan M, Lim C, Koniman R, Choo J. MO114: Incidence and Spectrum of Biopsy-Proven Dysproteinemic Kidney Diseases: A Single-Centre Experience. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac066.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
We aimed to evaluate the incidence and clinical features of patients with biopsy-proven dysproteinemic kidney diseases (group 1), as well as spectrum of biopsy-proven kidney diseases of patients with monoclonal gammopathy (MG) or abnormal free light chain (FLC) ratio (group 2) at our institution.
METHOD
This was a single-centre retrospective study of all patients who had native kidney biopsies at the Singapore General Hospital between October 2015 and December 2021. Demographic, clinical, laboratory and histological data were retrieved from electronic medical records to identify patients with biopsy-proven dysproteinemic kidney diseases (group 1) and patients with positive MG and/or abnormal FLC (κ to λ) ratio who underwent kidney biopsy (group 2). Patients were considered to have MG if they tested positive on any of the following tests: serum protein electrophoresis, serum immunofixation, urine protein electrophoresis or urine immunofixation. Abnormal FLC ratio is defined as a ratio outside the range of 0.27–1.65 in patients with eGFR ≥60 mL/min/m2 or 0.37–3.10 in patients with eGFR <60 mL/min/m2.
RESULTS
Out of 1066 patients who underwent kidney biopsy between October 2015 and December 2021, 25 (2.3%) patients were diagnosed with dysproteinemic kidney diseases (group 1). The median age of the patients at diagnosis was 65.6 years (IQR 58.6, 68.2), and majority was male (17/25; 68.0%). Haematological diagnoses present in this cohort include multiple myeloma (5/25; 20.0%), chronic lymphocytic leukaemia (2/25; 8.0%), Waldenstrom's macroglobulinaemia (2/25; 8.0%) and mantle cell lymphoma (1/25; 4.0%).
Two-thirds of the patients had acute kidney injury (AKI) at time of biopsy (17/25; 68.0%). All patients presented with proteinuria, and nephrotic syndrome was noted in approximately half of the patients (15/25; 60.0%). Hypocomplementemia was present in a third (7/21; 33.3%) of the patients who had complement levels performed prior to biopsy, with low C3 and low C3/C4 observed in 5 and 2 patients, respectively. The most common histological lesion is immunoglobulin-related amyloidosis (8/25; 32.0%), followed by proliferative glomerulonephritis with monoclonal immune deposits (PGNMID) (6/25; 24.0%) and light-chain cast nephropathy (4/25; 16.0%). Sixteen (64%) patients fulfilled criteria for monoclonal gammopathy of renal significance (MGRS). All patients with PGNMID had undetectable MG and normal FLC ratio at diagnosis.
Among these 1066 patients who underwent kidney biopsy, 396 patients had serum/urine electrophoresis, serum/urine immunofixation and/or FLC performed prior to biopsy. A total of 44 (11.1%) patients with detectable MG and/or abnormal FLC ratio were identified (group 2), 5 of whom had previously known haematological conditions. Dysproteinemic kidney diseases were diagnosed in 14 (31.8%) patients. Amongst patients with non-dysproteinemic diagnosis, diabetic/hypertensive nephropathy was the most frequent (15/30; 50.0%). Majority of the remaining patients had a variety of glomerulonephritides and renal vasculitides (10/30; 33.3%), or tubulointerstitial diseases (2/30; 6.7%). In univariate analysis, non-diabetic status (P < .001), presence of AKI (P = .032) and abnormal FLC ratio (P = .005) increased the likelihood of diagnosing dysproteinemic kidney disease in this group of patients.
CONCLUSION
AKI and proteinuria are common in dysproteinemia kidney diseases. Non-diabetic status, presence of AKI and abnormal FLC ratio increased the likelihood of diagnosing dysproteinemic kidney disease.
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Affiliation(s)
- Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Melinda Si Yun Tan
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Cynthia Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Riece Koniman
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
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Tan HZ, Loh AHL, Kaushik M, Tan SN, Choo JCJ. Immune-complex membranoproliferative glomerulonephritis in liver cirrhosis secondary to Caroli's disease: a multi-hit process? Int Urol Nephrol 2022; 54:3041-3042. [PMID: 35353325 DOI: 10.1007/s11255-022-03189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore.
| | - Alwin Hwai Liang Loh
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Manish Kaushik
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Sye Nee Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Jason Chon Jun Choo
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
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Tan HZ, Mok IYJ, Fong N, Huang Z, Choo JCJ, Lim CC. Cardiovascular risk assessment in lupus nephritis and ANCA-associated vasculitis in real-world nephrology practice. Clin Kidney J 2022; 15:1626-1627. [PMID: 35892028 PMCID: PMC9308086 DOI: 10.1093/ckj/sfac064] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Irene Y J Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Nigel Fong
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Zhihua Huang
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Nursing Division, Singapore General Hospital, Singapore
| | - Jason C J Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore
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Wang P, Pu WJ, Tan HZ, Wang P, Chen XQ. [Morphological and molecular identification of trematode isloates from laying ducks in Nanchang City]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2022; 34:59-65. [PMID: 35266358 DOI: 10.16250/j.32.1374.2021114] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To identify the species of trematodes isolated from laying ducks in Nanchang City using morphological and molecular approaches. METHODS Trematodes were isolated from the hepatobiliary duct, gallbladder and large intestine of market-sold laying ducks in Nanchang City. Following morphological characterization, total DNA was extracted from all trematode specimens, and internal transcribed spacer region (ITS) and cytochrome C oxidase subunit 1 (Cox1) genes were amplified using PCR assay and sequenced. Sequence alignment was performed using the Blast software, and homology and phylogenetic analyses were done in the trematode isolates based on ITS and Cox1 gene sequences. RESULTS The morphological characteristics of two trematode isolates from the large intestine of laying ducks were similar to those of Echinostoma revolutum and E. miyagawai, and the morphological characteristics of eight trematode samples isolated from the hepatobiliary duct and gallbladder of laying ducks were similar to those of Amphimerus anatis. The ITS and Cox1 gene sequences of the two trematode isolates from the large intestine of laying ducks had 99.3% and 98.9%-99.4% homology with E. miyagawai, and the phylogenetic analysis showed that two trematode isolates had the closest genetic relationship with E. miyagawai based on ITS and Cox1 gene sequences. The ITS gene sequences of eight trematode isolates from the hepatobiliary duct and gallbladder of laying ducks shared 95.1%-95.5% with Opisthorchis sudarikovi and Clonorchis sinensis, while the Cox1 gene sequences of eight trematode isolates from the hepatobiliary duct and gallbladder of laying ducks shared 86.3%-86.4% and 85.5%-85.7% with O. viverrini and O. sudarikovi. ITS gene sequence-based phylogenetic analysis showed that the duck-derived trematode isolates had the closest genetic relationship with C. sinensis, and Cox1 gene sequence-based phylogenetic analysis showed that the duck-derived trematode isolates had the closest genetic relationship with Metorchis orientalis and O. viverrini. CONCLUSIONS The trematode isolates from the large intestine of laying ducts in Nanchang City may be E. miyagawai, and the trematode isolates from the hepatobiliary duct and gallbladder may be an unidentified trematode species of the family Opisthorchiidae.
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Affiliation(s)
- P Wang
- College of Animal Science and Technology, Jiangxi Agricultural University, Nanchang, Jiangxi 330045, China
| | - W J Pu
- College of Animal Science and Technology, Jiangxi Agricultural University, Nanchang, Jiangxi 330045, China
| | - H Z Tan
- College of Animal Science and Technology, Jiangxi Agricultural University, Nanchang, Jiangxi 330045, China
| | - P Wang
- College of Animal Science and Technology, Jiangxi Agricultural University, Nanchang, Jiangxi 330045, China
| | - X Q Chen
- College of Animal Science and Technology, Jiangxi Agricultural University, Nanchang, Jiangxi 330045, China
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14
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Tan HZ, Zhu L, chan JJ, Rajasekaran TD, Choo JCJ. Hypothyroidism-induced kidney dysfunction: an under-recognized phenomenon in patients on immune checkpoint inhibitors. Clin Kidney J 2022; 15:1431-1433. [PMID: 35756745 PMCID: PMC9217634 DOI: 10.1093/ckj/sfac043] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Ling Zhu
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Jack Junjie chan
- Department of Medical Oncology, National Cancer Center Singapore, Singapore
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15
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Liew ZH, Leeu JJ, Tan HZ, Mok IYJ, Choo JCJ, Lim CC. COVID-19 vaccine acceptance among patients with glomerulonephritis. Nephrology (Carlton) 2022; 27:543-545. [PMID: 35114736 DOI: 10.1111/nep.14026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Zhong Hong Liew
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jun Jie Leeu
- Lee Kong Chian School of Medicine, National Technological University, Singapore, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Irene Y J Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jason C J Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
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Lim CC, Mok IY, Leeu JJ, Liew ZH, Tan HZ, Chin YM, Teng WL, Yeo F, Tan CS, Choo JC. A Descriptive Evaluation of Health Literacy and Determinants of COVID-19 Vaccine Acceptance among Patients with IgA Nephropathy with High Vaccine Uptake. Glomerular Dis 2022; 2:132-138. [PMID: 36747611 PMCID: PMC9059031 DOI: 10.1159/000522158] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/28/2021] [Indexed: 01/19/2023]
Abstract
Aims Shared decision-making regarding COVID-19 vaccination in IgA nephropathy involves the ability to handle health information regarding potential benefits and risk of flare, but few studies have evaluated health literacy in the context of vaccination. We aimed to evaluate the health literacy and COVID-19 vaccination uptake and acceptance in IgA nephropathy. Methods Single-center cross-sectional study of 126 consecutive patients with IgA nephropathy. Health literacy was assessed using the HLS-EU-47 questionnaire. Determinants of vaccine acceptance such as contextual influences, individual and group influences, and vaccine-specific issues were adapted from the World Health Organization framework. Results Forty-eight patients (38.1%) with IgAN nephropathy completed the survey between June and August 2021. The participants' median age was 40.5 (31.6, 52.8) years with median disease duration of 2.8 (1.3, 4.3) years. The median general health literacy index was 31.74 (29.88, 35.82) with significantly greater difficulty in the competency of appraising health information and in the domain of disease prevention (p < 0.001). Forty-five patients (93.8%) received at least one dose of COVID-19 vaccine between January and August 2021. Among the 3 unvaccinated patients, 2 intended to receive the vaccination while and 1 did not intend to get vaccinated. There was a high level of trust and belief that their government and healthcare providers had their best interests at heart and that the healthcare providers were honest about the vaccine's risk and benefits, although 31.2% did not understand how the vaccine works and 22.9% believed that there were other ways to prevent infection. Most thought there was adequate safety information, were confident in the system for tracking adverse events and had no issues with access to the vaccine. Conclusion Participants with IgA nephropathy had high health literacy scores and low vaccine hesitancy. The determinants for vaccine acceptance can potentially guide efforts to optimize vaccination coverage.
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Affiliation(s)
- Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore,*Cynthia Ciwei Lim,
| | - Irene Y.J. Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jun Jie Leeu
- Lee Kong Chian School of Medicine, National Technological University, Singapore, Singapore
| | - Zhong Hong Liew
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yok Mooi Chin
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Wei Ling Teng
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Fiona Yeo
- Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jason C.J. Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
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Tan HZ, Lee JJX, Choo CJJ, Loh AHL. Immune checkpoint inhibitor-induced acute tubulointerstitial nephritis. Kidney Res Clin Pract 2021; 41:128-131. [PMID: 34974649 PMCID: PMC8816405 DOI: 10.23876/j.krcp.21.216] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/08/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
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Wu YY, Yang L, Chen L, Xiao F, Tan HZ, Hu GQ. [Comparison of training models for master of public health between China and other countries]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:2208-2213. [PMID: 34954988 DOI: 10.3760/cma.j.cn112338-20200830-01108] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
With the accelerating globalization and the implementation of "Belt and Road" initiative proposed by our government, communication and exchanges between China and foreign countries have become more and more frequent than before, and much more international students have chosen to study in China's universities as candidates of master of public health (MPH). However, because China only launched the MPH program in recent years, with the training models being highly similar to the program of master of science in China but quite different from those of main international MPH programs, hindering China's MPH program to become an international one. This paper systematically evaluated existing training models of MPH programs both at home and abroad through literature review and identified major differences and deficiencies of China's MPH program compared to those from other countries: (1) requirement for medical background only; (2) comparatively longer period to complete the program; (3) incomplete curriculum; (4) overemphasizing scientific research competencies but somewhat neglecting practical abilities; and (5) limited career choices, and put forward some suggestions to improve the MPH program of China, including removing requirement for medical background only, shortening the period of MPH program, improving the curriculum of MPH program, and enhancing the training of practical abilities.
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Affiliation(s)
- Y Y Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - L Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - L Chen
- Department of Occupational Health and Environmental Sanitation, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - F Xiao
- Department of Toxicology, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - H Z Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - G Q Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China
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Yu Y, Zhao F, Chen J, Zou Y, Wang YM, Liu SB, Tan HZ. Research Note: Effect of dietary cottonseed meal and soybean oil concentration on digesta passage time and amino acids digestibility in roosters. Poult Sci 2021; 100:101446. [PMID: 34607146 PMCID: PMC8496179 DOI: 10.1016/j.psj.2021.101446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
Two experiments were conducted to study the effect of dietary cottonseed meal (CM) and soybean oil (SO) on passage time of digesta and standardized ileal digestibility (SID) of amino acids (AA). The experimental design was a 2 × 2 factorial arrangement evaluating the levels of CM (20 or 40 %) and SO (0 or 10 %). Experiment 1 estimated the effect of CM and SO on the passage time of digesta. Twenty-five Chinese yellow-feathered roosters (BW = 2.61 ± 0.08 kg; 26-wk-old) were individually weighed and allocated to 5 diets in 5 randomized complete blocks by initial BW. Experimental diet 1 contained 20% CM and 0 SO, diet 2 contained 20% CM and 10% SO, diet 3 contained 40% CM and 0% SO, diet 4 contained 40% CM and 10% SO, and a nitrogen-free diet was also fed. Passage time through the total digestive tract was determined by time-relative cumulation of dry excreta. Experiment 2 estimated the effect of CM and SO on SID of AA in CM. Thirty Chinese yellow-feathered roosters (BW = 2.91 ± 0.05 kg; 26-wk-old) were allocated to the 5 experimental diets in 6 randomized complete blocks by initial BW to determine the SID of AA. Increasing CM concentration significantly reduced the time for 50% relative cumulation of dry excreta (P < 0.05). Adding 10% SO tended to increase the time for 50% relative cumulation of dry excreta (0.05 < P < 0.10) relative to diets without SO. Dietary CM and SO did not affect the SID of indispensable AA or dispensable AA of CM significantly, but increasing dietary CM tended to reduce the SID of Lys (0.05 < P < 0.10). Increasing SO tended to reduce the SID of Met (0.05 < P < 0.10). There were no significant interactive effects of SO and CM (P > 0.10). These results suggest passage time is increased with dietary SO, and reduced with dietary CM, but digestibility of AA in CM was not significantly affected by dietary CM and SO.
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Affiliation(s)
- Y Yu
- The State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - F Zhao
- The State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China.
| | - J Chen
- The State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Y Zou
- Wen's Food Group Co. Ltd., Guangdong 527439, China
| | - Y M Wang
- The State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - S B Liu
- Wen's Food Group Co. Ltd., Guangdong 527439, China
| | - H Z Tan
- Wen's Food Group Co. Ltd., Guangdong 527439, China
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20
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Lin HJ, Wang XL, Tian MY, Li XL, Tan HZ. [Machine learning and its epidemiological applications]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:1689-1694. [PMID: 34814602 DOI: 10.3760/cma.j.cn112338-20200722-00970] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
As an important branch of artificial intelligence, machine learning is widely used in various fields. Machine learning has similarity to classical statistical methods, but can solve many problems which are difficult for traditional statistics, so it is one of the important tools in epidemiological research. This paper introduced 9 common algorithms of machine learning and summarized their characteristics and applications in epidemiological research. Readers could choose appropriate machine learning method according to the research purpose for the better application of machine learning in epidemiological research.
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Affiliation(s)
- H J Lin
- Xiangya School of Public Health, Central South University, Hunan Key Laboratory of Clinical Epidemiology, Changsha 410078, China
| | - X L Wang
- Xiangya School of Public Health, Central South University, Hunan Key Laboratory of Clinical Epidemiology, Changsha 410078, China
| | - M Y Tian
- Xiangya School of Public Health, Central South University, Hunan Key Laboratory of Clinical Epidemiology, Changsha 410078, China
| | - X L Li
- Xiangya School of Public Health, Central South University, Hunan Key Laboratory of Clinical Epidemiology, Changsha 410078, China
| | - H Z Tan
- Xiangya School of Public Health, Central South University, Hunan Key Laboratory of Clinical Epidemiology, Changsha 410078, China
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21
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Lim CC, Mok IY, Tan HZ, Tan C, Yeo F, Choo JC. Health Literacy in Glomerulonephritis and Renal Vasculitis Attending Nephrology Clinics. Glomerular Dis 2021; 1:129-134. [PMID: 36751495 PMCID: PMC9677738 DOI: 10.1159/000517886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/12/2021] [Indexed: 11/19/2022]
Abstract
Aims Glomerulonephritis is one of the leading causes of progressive chronic kidney disease worldwide and treatment requires shared decision-making to improve self-care and plan immunosuppressant therapy. However, information on health literacy (HL) in patients with glomerulonephritis is scanty. We aimed to assess HL in our multiethnic population with glomerulonephritis. Methods Single-center cross-sectional study of patients with glomerulonephritis receiving induction immunosuppressants at the ambulatory nephrology clinic and who completed the anonymized self-administered HLS-EU-47 questionnaire. The standardized HL index and domain item mean scores were compared with participant sociodemographic characteristics. Results Among 65 patients who attend the clinics over a month, 27 agreed to participate in the survey. After excluding responses with significant missing information, we included 23 participants (16 Chinese, 4 Malay, 2 Indian, and 1 other ethnicity) in the analysis. The median age was 39 (interquartile range 27, 60 years). The median general HL index was 26.2 (19.8, 29.8). The item mean scores were 2.64 (2.43, 2.77), 2.45 (2.09, 2.72), 2.33 (2.17, 2.58), and 2.50 (2.25, 2.75) for the domains of accessing, understanding, appraising, and applying health-care-related information, respectively. Male patients had significantly higher HL indices and higher scores for accessing and appraising health information, while higher personal income was significantly associated with higher score for applying health knowledge. Conclusion Patients with glomerulonephritis had lowest HL in the domain of appraising health information. Further research on targeted interventions to improve the HL in appraising treatment options and vaccinations in patients with glomerulonephritis is required.
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Affiliation(s)
- Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore,*Cynthia Ciwei Lim,
| | - Irene Y.J. Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Claire Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Fiona Yeo
- Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Jason C.J. Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
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22
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Lim CC, Tan HZ, Tan CS, Healy H, Choo J, Franca Gois PH. Desmopressin acetate to prevent bleeding in percutaneous kidney biopsy: a systematic review. Intern Med J 2021; 51:571-579. [PMID: 32040251 DOI: 10.1111/imj.14774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/05/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kidney biopsy is the gold standard for diagnosing kidney disease but may result in bleeding, especially in uraemia. DDAVP (1-deamino-8-d-arginine vasopressin) may reduce uraemic bleeding but guidelines on its use are lacking. AIM To evaluate whether DDAVP reduced bleeding complications after percutaneous kidney biopsies. METHODS We searched CENTRAL, PubMed, Embase, LILACS, WHO Trials Registry and ClinicalTrials.gov until May 2019 for randomised controlled trials (RCT), quasi-RCT and prospective cohort studies that compared DDAVP with placebo or no intervention, prior to native or allograft kidney biopsy. The primary outcome was post-biopsy bleeding. Secondary outcome was adverse events related to DDAVP. RESULTS Abstracts of 270 identified papers were examined and 24 selected for evaluation. Two studies, one RCT and one prospective cohort that collectively evaluated 738 native kidney biopsies, met the inclusion criteria. One enrolled individuals with serum creatinine ≤1.5 mg/dL (132 μmol/L) and/or estimated glomerular filtration rate ≥60 mL/min/1.73 m2 while the other evaluated biopsies with serum creatinine >150 μmol/L. DDAVP was administered as a single subcutaneous dose of 0.3 μg/kg in both studies. Data were not pooled for meta-analysis due to clinical heterogeneity. GRADE quality of evidence from these two studies was low for DDAVP preventing any bleeding complication after native kidney biopsy. Low quality evidence suggested that adverse effects were not increased in DDAVP therapy. No prospective studies evaluated DDAVP in transplant kidney biopsies. CONCLUSION Currently available prospective data are insufficient to support the routine use of DDAVP prior to percutaneous kidney biopsies hence high quality trials are required.
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Affiliation(s)
- Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Helen Healy
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Pedro Henrique Franca Gois
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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23
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Tan HZ, Tan RY, Choo JCJ, Lim CC, Tan CS, Loh AHL, Tien CSY, Tan PH, Woo KT. Is COVID-19 vaccination unmasking glomerulonephritis? Kidney Int 2021; 100:469-471. [PMID: 34033857 PMCID: PMC8141343 DOI: 10.1016/j.kint.2021.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore.
| | - Ru Yu Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | | | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | | | - Puay Hoon Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Keng Thye Woo
- Department of Renal Medicine, Singapore General Hospital, Singapore
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24
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Lim CC, Choo JCJ, Tan HZ, Mok IYJ, Chin YM, Chan CM, Woo KT. Changes in metabolic parameters and adverse kidney and cardiovascular events during glomerulonephritis and renal vasculitis treatment in patients with and without diabetes mellitus. Kidney Res Clin Pract 2021; 40:250-262. [PMID: 34024087 PMCID: PMC8237120 DOI: 10.23876/j.krcp.20.174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/17/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cardiovascular disease causes significant morbidity and mortality in patients with glomerulonephritis, which is increasingly diagnosed in older individuals who may have diabetes mellitus (DM). We evaluated the impact of DM on metabolic profile, renal and cardiovascular outcomes during treatment and follow-up of individuals with glomerulonephritis. METHODS We performed a retrospective cohort study of 601 consecutive adults with biopsy-proven glomerulonephritis for factors associated with kidney failure, hospitalization for cardiovascular events, and death. Biopsies with isolated diabetic nephropathy were excluded. RESULTS The median patient age was 49.8 years (36.7-60.9 years) with estimated glomerular filtration rate of 56.7 mL/min/1.73 m2 (27.7-93.2 mL/min/1.73 m2). DM was present in 25.4%. The most frequent diagnoses were minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS) (29.5%), lupus nephritis (21.3%), immunoglobulin A (IgA) nephropathy (19.1%), and membranous nephropathy (12.1%). The median follow-up was 38.8 months (interquartile range [IQR], 26.8-55.8 months). Among 511 individuals with lupus nephritis, anti-neutrophil cytoplasmic antibody-associated vasculitis, MCD/FSGS, membranous nephropathy, and IgA nephropathy, 52 (10.2%) developed kidney failure at a median 16.4 months (IQR, 2.3-32.2 months), while 29 (5.7%) had cardiovascular-related hospitalizations at 12.9 months (IQR, 4.8-31.8 months) and 31 (6.1%) died at 13.5 months (IQR, 2.5-42.9 months) after diagnosis. Cox regression analysis found that baseline DM was independently associated with kidney failure (adjusted hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.06-4.05, p = 0.03) and cardiovascular-related hospitalization (adjusted HR, 2.69; 95% CI, 1.21-5.98, p = 0.02) but not with mortality. CONCLUSION DM was strongly associated with kidney failure and hospitalization for cardiovascular events in patients with biopsy-proven glomerulonephritis.
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Affiliation(s)
- Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Jason C J Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Irene Y J Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yok Mooi Chin
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Keng Thye Woo
- Department of Renal Medicine, Singapore General Hospital, Singapore
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Lim CC, Tan RY, Choo JCJ, Tan HZ, Mok I, Chin YM, Tan CS. Estimation of risk for major bleeding in native kidney biopsies in patients with multiple risk factors. Int Urol Nephrol 2021; 54:343-348. [PMID: 33913059 DOI: 10.1007/s11255-021-02874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 04/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Individuals undergoing kidney biopsy are increasingly older and may have concurrent illnesses that cause deranged hematological and renal parameters that are associated with post-biopsy bleeding. We aimed to develop a clinical risk model to quantify bleeding risks in high-risk individuals with multiple risk factors. METHODS Single-center retrospective cohort study of consecutive adults with serum creatinine ≥ 2 mg/dL (176 µmol/L) and had ultrasound-guided percutaneous native kidney biopsies between June 2011 and July 2015 in our tertiary referral center. The primary outcome was major bleeding, defined as need for red cell transfusion, radiological or surgical intervention, or if bleeding led to death within 7 days after kidney biopsy. RESULTS Among 184 native kidney biopsies with serum creatinine ≥ 2 mg/dL, median age was 54.1 years and eGFR was 18.8 ml/min/1.73 m2. Major bleeding occurred in 19 biopsies (10.3%). Multivariate analysis accounting for age, weight, hemoglobin, platelet, prothrombin time and urea found that higher hemoglobin (adjusted OR 0.51, 95% CI 0.33-0.79, p = 0.003) and platelet (adjusted OR 0.99, 95% CI 0.98-0.99, p = 0.01) were independently associated with reduced major bleeding. A risk model that included (1) age ≥ 62 years old, (2) hemoglobin < 10 g/dL and (3) platelets ≤ 216 × 109/L as categorical variables predicted major bleeding post-biopsy. CONCLUSION We developed a risk model that included multiple risk factors to quantify bleeding risks in native kidney biopsies with renal impairment.
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Affiliation(s)
- Cynthia C Lim
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore.
| | - Ru Yu Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Jason C J Choo
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Irene Mok
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Yok Mooi Chin
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
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26
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Tan HZ, Phang CC, Wu SY, Sim MH, Law MM, Foo MWY, Htay H. Improving influenza and pneumococcal vaccination uptake among incident peritoneal dialysis patients: a quality improvement initiative. Int Urol Nephrol 2021; 53:2167-2175. [PMID: 33675479 DOI: 10.1007/s11255-021-02817-7] [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: 09/24/2020] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Influenza and pneumococcal vaccination rates among peritoneal dialysis (PD) patients remain suboptimal, despite availability of vaccinations and health recommendations. AIM The primary aim was to improve influenza and pneumococcal vaccination rates among incident PD patients at our center to 80%. A secondary aim was to develop a sustainable workflow for vaccination in PD patients. DESIGN A quality improvement (QI) initiative to increase vaccination rate among incident PD patients was conducted in a tertiary care hospital in Singapore from Jul 2017 to Dec 2018. Key drivers and barriers to success were identified through root cause analysis. Change ideas focusing on improving opportunities, access and enhancement of reminder systems were implemented using Plan-Do-Study-Act methodology. Vaccination rates were monitored at 3-month intervals. RESULTS Total of 249 patients were eligible for vaccination. The baseline vaccination rate for influenza, pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) were 63%, 54% and 14%, respectively. Root-cause analyses revealed several practice-related barriers, including lack of physician recommendation, time constraints and ineffective reminder systems. Multifaceted interventions, such as the provision of vaccination at non-traditional clinical settings, physician audit and feedback, utilisation of reminder tools, successfully increased influenza, PCV13 and PPSV23 vaccination rates to 86%, 85% and 63%, respectively. CONCLUSION A robust influenza and pneumococcal vaccination program implemented using a standardized QI methodology and multidisciplinary approach is effective in improving and sustaining influenza and pneumococcal vaccination uptake among PD patients.
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Affiliation(s)
- Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore.
| | - Chee Chin Phang
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Sin Yan Wu
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Mui Hian Sim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | | | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
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Salvamani S, Tan HZ, Thang WJ, Ter HC, Wan MS, Gunasekaran B, Rhodes A. Understanding the dynamics of COVID-19; implications for therapeutic intervention, vaccine development and movement control. Br J Biomed Sci 2020; 77:168-184. [PMID: 32942955 DOI: 10.1080/09674845.2020.1826136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The COVID-19 disease is caused by the SARS-CoV-2 virus, which is highly infective within the human population. The virus is widely disseminated to almost every continent with over twenty-seven million infections and over ninety-thousand reported deaths attributed to COVID-19 disease. SARS-CoV-2 is a single stranded RNA virus, comprising three main viral proteins; membrane, spike and envelope. The clinical features of COVID-19 disease can be classified according to different degrees of severity, with some patients progressing to acute respiratory distress syndrome, which can be fatal. In addition, many infections are asymptomatic or only cause mild symptoms. As there is no specific treatment for COVID-19 there is considerable endeavour to raise a vaccine against SARS-CoV-2, in addition to engineering neutralizing antibody interventions. In the absence of an effective vaccine, movement controls of varying stringencies have been imposed. Whilst enforced lockdown measures have been effective, they may be less effective against the current strain of SARS-CoV-2, the G614 clade. Conversely, other mutations of the virus, such as the Δ382 variant could reduce the clinical relevance of infection. The front runners in the race to develop an effective vaccine focus on the SARS-Co-V-2 Spike protein. However, vaccines that produce a T-cell response to a wider range of SARS-Co-V-2 viral proteins, may be more effective. Population based studies that determine the level of innate immunity to SARS-CoV-2, from prior exposure to the virus or to other coronaviruses, will have important implications for government imposed movement control and the strategic delivery of vaccination programmes.
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Affiliation(s)
- S Salvamani
- Division of Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University , Kuala Lumpur, Malaysia
| | - H Z Tan
- Division of Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University , Kuala Lumpur, Malaysia
| | - W J Thang
- Division of Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University , Kuala Lumpur, Malaysia
| | - H C Ter
- Division of Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University , Kuala Lumpur, Malaysia
| | - M S Wan
- Division of Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University , Kuala Lumpur, Malaysia
| | - B Gunasekaran
- Dept of Biotechnology, Faculty of Applied Sciences, UCSI University , Kuala Lumpur, Malaysia
| | - A Rhodes
- Division of Applied Biomedical Sciences and Biotechnology, School of Health Sciences, International Medical University , Kuala Lumpur, Malaysia.,Dept of Pathology, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
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Yu Y, Zhao F, Chen J, Zou Y, Zeng SL, Liu SB, Tan HZ. Sensitivity of in vitro digestible energy determined with computer-controlled simulated digestion system and its accuracy to predict dietary metabolizable energy for roosters. Poult Sci 2020; 100:206-214. [PMID: 33357683 PMCID: PMC7772654 DOI: 10.1016/j.psj.2020.09.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/03/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
Two experiments were conducted to validate the sensitivity and accuracy of in vitro digestible energy (IVDE) determined with a computer-controlled simulated digestion system (CCSDS) to predict metabolizable energy (ME) of diets for roosters. In experiment 1, soybean hulls were added to a basal diet (calibration diet 1) at 2.06, 4.12, 6.17, 8.23, 10.28, 12.32, or 14.37% of the diets (calibration diets 2–8) to produce an interval of approximately 80 kcal ME/kg. The sensitivity was measured by comparing the determined and actual IVDE of the diets. With these data, a linear model was developed to predict ME from IVDE. In experiment 2, validation diets were identical except they were composed of different cereal ingredients. For each diet, the correlations and ratios between IVDE and ME were analyzed to test the sensitivity of IVDE to predict ME across different ingredients. In experiment 1, a slope of 0.9899 was calculated in a linear regression of determined IVDE on actual IVDE (R2 = 0.9998; P < 0.01). The ratio of determined IVDE to actual IVDE was 0.9878. The ratio of IVDE to apparent metabolizable energy (AME) and to nitrogen-corrected AME (AMEn) was 1.03 and 1.05, respectively. The linear models to predict ME from IVDE were AME = 0.8449 × IVDE + 451 (R2 = 0.9812, residual standard deviation [RSD] = 28 kcal/kg; P < 0.01) and AMEn = 0.8357 × IVDE + 436 (R2 = 0.9821, RSD = 27 kcal/kg; P < 0.01). In experiment 2, a significant simple correlation was observed between the IVDE and AME or AMEn of validation diets (r > 0.97; P < 0.01). The ratio of IVDE to AME and to AMEn was 1.04 and 1.05, respectively. Predicted and determined AME or AMEn of 8 validation diets differed by less than 100 kcal/kg. The regression of determined AME or AMEn against predicted AME or AMEn (R2 ≥ 0.9466; P < 0.01) resulted in an overlapped line where Y = X. These results suggest the IVDE determined with CCSDS is highly sensitive and can be used to accurately predict the ME of diets for roosters across a wide range of cereal grains.
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Affiliation(s)
- Y Yu
- The State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - F Zhao
- The State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China.
| | - J Chen
- The State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Y Zou
- Wen's Food Group Co. Ltd., Yunfu, Guangdong 527439, China
| | - S L Zeng
- The State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - S B Liu
- Wen's Food Group Co. Ltd., Yunfu, Guangdong 527439, China
| | - H Z Tan
- Wen's Food Group Co. Ltd., Yunfu, Guangdong 527439, China
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Lim CC, Gardner D, Ng RZ, Chin YM, Tan HZ, Mok IY, Choo JC. Synergistic impact of pre-diabetes and immunosuppressants on the risk of diabetes mellitus during treatment of glomerulonephritis and renal vasculitis. Kidney Res Clin Pract 2020; 39:172-179. [PMID: 32541094 PMCID: PMC7321669 DOI: 10.23876/j.krcp.20.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/09/2020] [Accepted: 04/26/2020] [Indexed: 01/27/2023] Open
Abstract
Background Glomerulonephritis is often treated with kidney-saving, but potentially diabetogenic immunosuppressants such as glucocorticosteroids and calcineurin inhibitors. Unfortunately, there are little data on dysglycemia before and after diagnosis and during treatment of glomerulonephritis. We aimed to evaluate the occurrence and risk factors for pre-diabetes and incident diabetes among non-diabetic patients with glomerular disease with or without treatment with immunosuppressants. Methods A single-center, retrospective cohort study was performed on 229 non-diabetic immunosuppressant-naïve adults diagnosed with glomerulonephritis and renal vasculitis. Patients with known diabetes and prior immunosuppressant treatment were excluded. Outcomes of new-onset pre-diabetes and new-onset diabetes were defined according to American Diabetic Association criteria. Results Pre-diabetes was present pre-biopsy in 74 of the 229 patients (32.3%). During the median follow-up of 34.0 (23.3-47.5) months, 29 patients (12.7%) developed new-onset diabetes and 58 (25.3%) had new-onset pre-diabetes. Immunosuppressive therapy in patients with pre-existing pre-diabetes was associated with increased odds of new-onset diabetes compared to those without either risk factor (26.0% versus 5.0%; odds ratio, 6.67; 95% confidence interval [CI], 1.41 to 31.64), P = 0.02). Conclusion New-onset diabetes after immunosuppressant treatment occurred in one-quarter of patients with glomerulonephritis and pre-existing pre-diabetes. Physicians should screen for pre-diabetes when planning treatment with immunosuppressants, as its presence significantly increases the risk of diabetes mellitus.
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Affiliation(s)
| | - Daphne Gardner
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Rui Zhi Ng
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yok Mooi Chin
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Irene Yj Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Jason Cj Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
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Lim C, Mok I, Tan HZ, Teng EWL, Chue XP, Ang WM, Chin YM, Foo M, Choo J. P0449SERUM PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 (PCSK9) IN NON-DIABETIC ASIANS WITH NEPHROTIC SYNDROME. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Nephrotic syndrome is associated with hypercholesterolemia, while its treatment, often involving high-dose glucocorticosteroids, may cause hyperglycemia. Proprotein convertase subtilisin /kexin type 9 (PCSK9) regulates plasma cholesterol and is associated with post-transplant diabetes. Although a potential therapeutic target in nephrotic syndrome, the relationships between PCSK9 and lipid parameters are not well established. We aimed to characterize serum PCSK9 and metabolic parameters among individuals with nephrotic syndrome.
Method
Single-center prospective cohort study of non-diabetic adults newly-diagnosed with nephrotic syndrome and subsequently treated with immunosuppressant. Fasting serum PCSK9 was measured using ELISA at diagnosis. Clinical history, blood pressure, body mass index (BMI), waist-to-hip ratio (WHR) and biochemistry (fasting glucose and lipid, HbA1c and fasting serum PCSK9) were obtained at diagnosis and at 3 months during immunosuppression therapy. Spearman’s correlation was used to evaluate for associations between PCSK9 and glycemic and lipid parameters.
Results
Among 15 adults with nephrotic syndrome, the majority was female (60%) and Chinese (80%). Median age was 40 (IQR 26, 51) years. The most frequent diagnoses were minimal change disease or focal segmental nephrosclerosis (n=7) and lupus nephritis (n=5); the minority had IgA nephropathy, membranous nephropathy or vasculitis. At diagnosis, median eGFR was 97.9 (59.5, 120.9) ml/min/1.73 m2, UPCR 7.6 (6.1, 10.4) g/g, LDL-cholesterol 4.6 (3.1, 6.7) mmol/L and fasting serum PCSK9 317.6 (276.8, 470.1) ng/ml. PCSK9 correlated positively with hypertriglyceridemia (r=0.55, p=0.03) at baseline.
Most patients (n=14, 93%) were treated with prednisolone (monotherapy or in combination with other immunosuppressant) and 1 received tacrolimus monotherapy. At 3 months, the majority (n= 11, 73%) had achieved clinical remission.
Fasting serum PCSK9 was higher at 3 months [median 430.6 (283.1, 496.0) ng/ml] compared to baseline, although the difference was not statistically significant. At 3 months, PCSK9 correlated positively with age (r=0.58, p=0.03), LDL-cholesterol (r=0.90, p=0.04) and change in BMI (r=0.72, p=0.01).
Conclusion
PCSK9 is associated with metabolic parameters at diagnosis and during the treatment course in patients with nephrotic syndrome treated with immunosuppressant.
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Affiliation(s)
- Cynthia Lim
- Singapore General Hospitla, Renal Medicine, Singapore, Singapore
| | - Irene Mok
- Singapore General Hospitla, Renal Medicine, Singapore, Singapore
| | - Hui Zhuan Tan
- Singapore General Hospitla, Renal Medicine, Singapore, Singapore
| | - Esther W L Teng
- Singapore General Hospitla, Renal Medicine, Singapore, Singapore
| | - Xiu Ping Chue
- Singapore General Hospital, Research Efficiency Enhancement Program, Division of Medicine, Singapore, Singapore
| | - Wei Mian Ang
- Singapore General Hospital, Research Efficiency Enhancement Program, Division of Medicine, Singapore, Singapore
| | - Yok Mooi Chin
- Singapore General Hospitla, Renal Medicine, Singapore, Singapore
| | - Marjorie Foo
- Singapore General Hospitla, Renal Medicine, Singapore, Singapore
| | - Jason Choo
- Singapore General Hospitla, Renal Medicine, Singapore, Singapore
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Tan HZ, Lim C, Foo M, Tan CS, Choo J. P0474UTILITY OF NATIVE KIDNEY BIOPSY IN OLDER ADULTS: SAFETY AND DIAGNOSES. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0474] [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] Open
Abstract
Abstract
Background and Aims
Population aging is an increasing phenomenon worldwide and consequently more are developing kidney diseases which may necessitate diagnostic kidney biopsy. However, older patients may be at increased risk for complications such as bleeding. We aimed to examine the utility and safety of native kidney biopsies among our older adults.
Method
This was a single-centre retrospective study of older adults (≥60 years) who had native kidney biopsies at the Singapore General Hospital between June 2011 and March 2015. Demographic data, co-morbid illnesses, clinical presentation at kidney biopsy, as well as laboratory results before and after kidney biopsy, were retrieved from electronic medical records. Patient outcomes were recorded until their last visit or death before 30th March 2017. End stage renal disease (ESRD) was defined as estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m2 or need for renal replacement therapy persisting >3 months. All post biopsy bleeding events were documented, with major bleeding defined as the need for transfusion and/or intervention; or if bleeding was either a direct or contributory cause of death.
Results
Older adults accounted for 153 of 545 (28.1%) native renal biopsies performed. The indications for biopsy in older adults included microscopic hematuria with proteinuria (51.0%), nephrotic syndrome (32.0%) and isolated proteinuria (17.0%). One hundred and ten patients (71.9%) had eGFR <60ml/min/1.72m2 at biopsy and a significantly higher proportion of older patients (85.5% vs 62.4%, p<0.001) had eGFR <30ml/min/1.72m2. Compared to the younger individuals <60 years old, older patients were more likely to be hypertensive (86.3% vs 58.4%, p<0.001) and diabetic (49.0% vs 28.1%, p<0.001).
Post biopsy, major bleeding was more frequent among older adults compared with younger adults (13.3% vs 5.7% respectively; p=0.04), although overall bleeding episodes between older and younger adults were not significantly different (15.9% vs 22.9% respectively; p=0.18).
Among older adults, minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS) was the most frequent diagnosis (23.5%), followed by membranous nephropathy (20.9%) and IgA nephropathy (9.8%), whereas MCD/FSGS (26.5%), lupus nephritis (24.5%) and IgA nephropathy (19.6%) were the top three diagnoses amongst younger adults. Co-existing glomerulonephritis (GN) with diabetic nephropathy and isolated diabetic nephropathy were seen in 12 (7.8%) and 20 (13.1%) elderly patients respectively. The majority (124 patients, 81.0%) of biopsies in older adults had histological diagnoses of glomerulonephritis that were potentially amendable to treatment although only 90 (58.8%) patients subsequently received immunosuppressants.
Among older adults with biopsy-proven glomerulonephritis, median follow up was similar between those treated and not treated with immunosuppressants (30.4 [27.3, 53.7] months versus 38.8 [30.7, 51.9] months, p=0.12). Among older adults with GN, ESRD was less frequent among those treated with immunosuppressants, compared to those who did not receive immunosuppressants, although the difference did not reach statistical significance (10.3% versus 18.9%, p=0.24). However, the combined endpoint of ESRD or mortality were similar (24.1% vs 21.6%, p=0.76).
Conclusion
Our findings support the utility of renal biopsy for diagnosis and to guide clinical care. Older adults undergoing kidney biopsy should be counselled and monitored for bleeding complications.
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Affiliation(s)
- Hui Zhuan Tan
- Singapore General Hospital, Renal Medicine, Singapore, Singapore
| | - Cynthia Lim
- Singapore General Hospital, Renal Medicine, Singapore, Singapore
| | - Marjorie Foo
- Singapore General Hospital, Renal Medicine, Singapore, Singapore
| | - Chieh Suai Tan
- Singapore General Hospital, Renal Medicine, Singapore, Singapore
| | - Jason Choo
- Singapore General Hospital, Renal Medicine, Singapore, Singapore
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Woo KT, Chan CM, Lim C, Choo J, Chin YM, Teng EWL, Mok I, Kwek JL, Tan CS, Tan HZ, Loh AHL, Choong HL, Tan HK, Lee GSL, Lee E, Wong KS, Tan PH, Foo M. The Value of Renal Biopsy in Non-Insulin-Dependent Diabetes Mellitus in Singapore over the Past Two Decades. Kidney Dis (Basel) 2020; 6:284-298. [PMID: 32923458 DOI: 10.1159/000505624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/23/2019] [Indexed: 12/31/2022]
Abstract
Objective This study on the prevalence of diabetic nephropathy (DN) and coexistence of non-diabetic renal disease (NDRD) in a cohort of 255 non-insulin-dependent diabetes mellitus (NIDDM) patients aims to determine the value of performing renal biopsies in these patients and elucidate the factors which could affect their progression to end-stage renal disease (ESRD). Methods Among 255 NIDDM patients, 93 had DN alone, 69 had NDRD alone, and the remaining 93 had DN plus NDRD (mixed group). The indications for renal biopsy were based on clinical suspicion of superimposed NDRD, including heavy or rapidly increasing proteinuria, renal impairment even though diabetes is of relatively short duration, rapidly declining renal function, and presence of hematuria with dysmorphic red blood cells suggesting presence of glomerulonephritis. Results The following were predictors of ESRD: high systolic BP at biopsy, longer duration of diabetes, heavy proteinuria, and presence of diabetic retinopathy. Comparing patients in the NDRD group with the DN group and the mixed group, the NDRD group had lower serum creatinine and higher eGFR with lower urinary proteinuria and higher serum albumin at presentation and on follow-up. Kimmelstiel-Wilson nodules were associated with a poorer prognosis leading to a higher occurrence of ESRD among patients with DN. Conclusion Renal biopsy is of value in indicating the prognosis of NIDDM patients with DN based on the diabetic lesions. For NIDDM patients with atypical course and suspicion of associated NDRD, a renal biopsy would enable us to diagnose the underlying NDRD and offer appropriate therapy. Most nephrologists would consider renal biopsy for an NIDDM patient based on clinical indications like atypical clinical course and suspicion of an associated NDRD, but they would not perform a routine renal biopsy like for a CKD patient, unless it is for a research indication.
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Affiliation(s)
- Keng Thye Woo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Cynthia Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jason Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yoke Mooi Chin
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Irene Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jia Liang Kwek
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Alwin H L Loh
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Hui Lin Choong
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Han Kim Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Grace S L Lee
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Evan Lee
- Department of Renal Medicine, National University of Singapore, Singapore, Singapore
| | - Kok Seng Wong
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Marjorie Foo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
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Tan HZ, Choo JCJ, Tan BH, Mok IYJ, Lim CC. Cytomegalovirus preventive strategies in lupus nephritis and renal vasculitis treated with immunosuppressants. Lupus 2020; 29:351-352. [PMID: 31986963 DOI: 10.1177/0961203320902532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- H Z Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - J C J Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - B H Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - I Y J Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - C C Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore
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Wang XL, Tian MY, Zhang N, Gao H, Tan HZ. [A sequential conditional mean model for assessing total effects of exposure in longitudinal data]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:111-114. [PMID: 32062952 DOI: 10.3760/cma.j.issn.0254-6450.2020.01.020] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In prospective cohort study, multi follow up is often necessary for study subjects, and the observed values are correlated with each other, usually resulting in time-dependent confounding. In this case, the data generally do not meet the application conditions of traditional multivariate regression analysis. Sequential conditional mean model (SCMM) is a new approach that can deal with time-dependent confounding. This paper mainly summarizes the basic theory, steps and characteristics of SCMM.
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Affiliation(s)
- X L Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - M Y Tian
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - N Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China; Hunan Provincial People's Hospital/the First Affiliated Hospital of Hunan Normal University, Changsha 410016, China
| | - H Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - H Z Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China
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Li SS, Tan HZ, Xu YW, Wu ZY, Wu JY, Zhao XK, Wang LD, Long L, Li EM, Xu LY, Zhang JJ. [The association between the whole blood riboflavin level and the occurrence, development and prognosis of esophageal squamous cell carcinoma]. Zhonghua Yu Fang Yi Xue Za Zhi 2019; 53:1124-1129. [PMID: 31683399 DOI: 10.3760/cma.j.issn.0253-9624.2019.11.010] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: To investigate the association between the whole blood riboflavin level and the occurrence, development and prognosis of esophageal squamous cell carcinoma (ESCC) in China. Methods: From March 2014 to September 2018, ESCC patients from three hospitals (the Affiliated Hospital of Medical College of Shantou University, Shantou Central Hospital in Southern Chaoshan area and First Affiliated Hospital of Zhengzhou University in Northern Taihang Mountain) were selected as a case group; non-esophageal patients who had a physical examination were selected as a control group. The case and control group were paired by age (±5 years) and a 1:1 ration. A total of 1 528 subjects were enrolled including 764 patients in the case group and 764 patients in the control group. About 3-5 ml venous blood samples were collected, and the erythrocyte glutathione reductase activity coefficient (GRAC) was measured to assess the whole blood riboflavin level. A multivariate conditional logistic regression model was used to analyze the association between the GRAC and the risk of ESCC. The association between the GRAC and the prognosis of ESCC was analyzed by using Cox proportional risk regression model based on 288 patients with complete survival data. They were divided into two groups, the high GRAC group (GRAC≥7.87) group and the low GRAC group (GRAC<7.87) according to the strongest correlation between the total survival time, survival outcome and GRAC (GRAC=7.87). Results: Among the 1 528 patients, 958 patients were from Southern Chaoshan area, including 479 patients in the case group with an average age about (59.90±9.34) years and 479 patients in the control group with an average age about (59.55±8.77) years. Other 570 patients were from Northern Taihang Mountain area, including 285 patients in the case group with an average age (58.39±5.19) years and 285 patients in the control group with an average age about (58.74±4.57) years. The multivariate conditional logistic regression showed that the OR (95%CI) of the GRAC and the risk of ESCC was 1.009 (0.998-1.019). The Cox proportional hazard regression model analysis showed that the HR (95%CI) of the high GRAC group was 1.712 (1.034-2.824) compared with the low GRAC group in the 50-70 years group. Conclusion: The whole blood riboflavin level might not be associated with the occurrence of ESCC. The high whole blood riboflavin level would be more beneficial to the prognosis of ESCC patients aged 50-70 years.
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Affiliation(s)
- S S Li
- Department of Preventive Medicine, Sichuan Nursing Vocational College, Chengdu 610000, China
| | - H Z Tan
- Shantou University Medical College/Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou 515041, China
| | - Y W Xu
- Shantou University Medical College/Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou 515041, China
| | - Z Y Wu
- Department of Oncologic Surgery, Shantou Central Hospital/Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou 515041, China
| | - J Y Wu
- Shantou University Medical College/Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou 515041, China
| | - X K Zhao
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - L D Wang
- Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - L Long
- Shantou University Medical College/Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou 515041, China
| | - E M Li
- Shantou University Medical College/Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou 515041, China
| | - L Y Xu
- Shantou University Medical College/Key Laboratory of Molecular Biology in High Cancer Incidence Coastal Chaoshan Area of Guangdong Higher Education Institutes, Shantou 515041, China
| | - J J Zhang
- Department of Public Health, Shantou University Medical College, Shantou 515041, China
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Wu SL, Zhou J, Li X, Huang LT, Zhang JY, Guo CH, Long SS, Tan HZ. [Application of parametric g-formula in causal analysis]. Zhonghua Liu Xing Bing Xue Za Zhi 2019; 40:1310-1313. [PMID: 31658536 DOI: 10.3760/cma.j.issn.0254-6450.2019.10.025] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
At present, traditional methods on statistics have limitations in controlling time- varying confounding. This paper introduces an analysis method, parametric g-formula, which would adjust time-varying confounding, and also exemplifies the steps of its implementation for purpose to provide a new reference for researchers to deal with long-term observational data.
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Affiliation(s)
- S L Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, China
| | - J Zhou
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, China
| | - X Li
- Institute of Pediatric Research, Hunan Children's Hospital, Changsha 410007, China
| | - L T Huang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, China
| | - J Y Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, China
| | - C H Guo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, China
| | - S S Long
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, China
| | - H Z Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, China
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Guo CH, Wu SL, Ma SJ, Zhang JY, Long SS, Tan HZ. [A new mediation analysis method for multiple mediators]. Zhonghua Liu Xing Bing Xue Za Zhi 2019; 40:1155-1158. [PMID: 31594164 DOI: 10.3760/cma.j.issn.0254-6450.2019.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Mediation analysis is mainly used to explore the causal mechanism between independent variable X and dependent variable Y. It determines whether mediator M plays a role and evaluate the role's degree in the causal path by decomposing the causal path between the independent variable X and the dependent variable Y. However, the classical mediation analysis is generally used for single mediator. This paper introduces a new mediation analysis method for multiple mediators.
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Affiliation(s)
- C H Guo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, China
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Peh RPK, Tan HZ, Liew ZH, Low JR, Foo M, Lim CC. Images of the month 3: Bilateral group B Streptococcus endophthalmitis – more than meets the eye. Clin Med (Lond) 2019; 19:416-417. [DOI: 10.7861/clinmed.2019-0187] [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: 11/27/2022]
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Liu P, Tan HZ, Li H, Choo JCJ, Lim CC. Infection mitigation a necessity in lupus patients. Clin Rheumatol 2018; 38:261-262. [PMID: 30349984 DOI: 10.1007/s10067-018-4346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/14/2018] [Accepted: 10/17/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Peiyun Liu
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore.
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Huihua Li
- Health Services Research Unit, Singapore General Hospital, 226 Outram Road, Blk A, Level 4, Singapore, 169039, Singapore
| | - Jason Chon Jun Choo
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
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Tan HZ, Kwek JL, Fook-Chong SMC, Chan CM, Choo JCJ. SP435RENAL OUTCOMES OF TYPE 2 DIABETIC PATIENTS WITH NON DIABETIC KIDNEY DISEASES. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp435] [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: 11/14/2022] Open
Affiliation(s)
| | - Jia Liang Kwek
- Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Choong Meng Chan
- Renal Medicine, Singapore General Hospital, Singapore, Singapore
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Abstract
Background There are limited studies documenting infection epidemiology in lupus nephritis (LN) patients. We aimed to study infection incidences and risk characteristics and ascertain possible predictors of infective outcomes in a multiethnic Asian population. Methods This retrospective study from 2006 to 2012 included newly diagnosed LN patients. We collected admissions, immunosuppression, and infection data until end-stage renal failure, death, last follow-up, or the year 2015. The infection incidence rates were evaluated and a generalized linear latent and mixed models (GLLAMM) analysis was carried out to evaluate potential predictors of infection. Results Our cohort of 101 patients consisted of mainly Chinese (75.2%), females (78.2%), and a median age of 38 years (IQR 26-49). The median time of follow-up was 72.8 months (IQR 49.5-94.0). Six out of 14 patient deaths were infection related. Seventy-eight out of 200 admissions, with a total of 102 episodes of infection, occurred in 46 patients. The incidence of infection rates leading to admissions was 10.3 per 100 person-years and the incidence of infection episodes rates was 17.6 per 100 person-years. Cytomegalovirus (CMV) was the most common organism identified. Univariate GLLAMM analysis showed Malay compared to Chinese ethnicity (HR 2.833 (95% CI 1.088-7.373)), use of oral cyclophosphamide (HR 6.618 (95% CI 1.015-43.154)) and rituximab (HR 3.967 (95% CI 1.157-13.603)) as predictors of infection-related admissions. Malay ethnicity and rituximab remained significant in the multivariate GLLAMM analysis. Conclusions Our study highlights substantial infection incidences in patients with LN and its contribution to deaths.
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Affiliation(s)
- P Liu
- 1 Department of Renal Medicine, 37581 Singapore General Hospital , Singapore
| | - H Z Tan
- 1 Department of Renal Medicine, 37581 Singapore General Hospital , Singapore
| | - H Li
- 2 Division of Research, 37581 Singapore General Hospital , Singapore
| | - C C Lim
- 1 Department of Renal Medicine, 37581 Singapore General Hospital , Singapore
| | - J C J Choo
- 1 Department of Renal Medicine, 37581 Singapore General Hospital , Singapore
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Li FY, Tan HZ, Ren GH, Jiang Q, Wang HL. [Research of prevalence of schistosomiasis in Hunan province, 1984-2015]. Zhonghua Liu Xing Bing Xue Za Zhi 2017; 38:350-353. [PMID: 28329938 DOI: 10.3760/cma.j.issn.0254-6450.2017.03.015] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the prevalence of schistosomiasis in Hunan province, and provide scientific evidence for the control and elimination of schistosomiasis. Methods: The changes of infection rates of Schistosoma (S.) japonicum among residents and cattle in Hunan from 1984 to 2015 were analyzed by using dynamic trend diagram; and the time regression model was used to fit the infection rates of S. japonicum, and predict the recent infection rate. Results: The overall infection rates of S. japonicum in Hunan from 1984 to 2015 showed downward trend (95.29% in residents and 95.16% in cattle). By using the linear regression model, the actual values of infection rates in residents and cattle were all in the 95% confidence intervals of the value predicted; and the prediction showed that the infection rates in the residents and cattle would continue to decrease from 2016 to 2020. Conclusion: The prevalence of schistosomiasis was in decline in Hunan. The regression model has a good effect in the short-term prediction of schistosomiasis prevalence.
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Affiliation(s)
- F Y Li
- Xiangya School of Public Health, Central South University, Changsha 410008, China; Department of Prevention and Control, Hunan Institute for Schistosomiasis Control, Yueyang 414000, China
| | - H Z Tan
- Xiangya School of Public Health, Central South University, Changsha 410008, China
| | - G H Ren
- Department of Prevention and Control, Hunan Institute for Schistosomiasis Control, Yueyang 414000, China
| | - Q Jiang
- Department of Prevention and Control, Hunan Institute for Schistosomiasis Control, Yueyang 414000, China
| | - H L Wang
- Department of Prevention and Control, Hunan Institute for Schistosomiasis Control, Yueyang 414000, China
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Tan HZ, Kwek JL, Fook-Chong S, Chan CM, Choo JCJ. SP441VALIDATION OF A DIFFERENTIAL DIAGNOSTIC MODEL OF DIABETIC KIDNEY DISEASE AND NON-DIABETIC KIDNEY DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx149.sp441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lim CC, Liu PY, Tan HZ, Lee P, Chin YM, Mok IYJ, Chan CM, Choo JCJ. Severe infections in patients with lupus nephritis treated with immunosuppressants: A retrospective cohort study. Nephrology (Carlton) 2017; 22:478-484. [DOI: 10.1111/nep.12809] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/29/2016] [Accepted: 05/03/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Cynthia C Lim
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Pei Yun Liu
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Peishan Lee
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Yok Mooi Chin
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Irene YJ Mok
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Choong Meng Chan
- Department of Renal Medicine; Singapore General Hospital; Singapore
| | - Jason CJ Choo
- Department of Renal Medicine; Singapore General Hospital; Singapore
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Dai WJ, Chen L, Tan HZ, Lai ZW, Hu SM, Li Y, Liu AZ. [Influence of social support and coping style on chronic post-traumatic stress disorder after floods]. Zhonghua Liu Xing Bing Xue Za Zhi 2016; 37:214-7. [PMID: 26917518 DOI: 10.3760/cma.j.issn.0254-6450.2016.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore the long-term prognosis and influence of social support and coping style of patients with post-traumatic stress disorder (PTSD) after suffering from floods. METHODS Patients suffered PTSD due to Dongting lake flood in 1998 were selected through cluster random sampling. PTSD scale civilian version (PCL-C) was used to examine and diagnose the participants in this study. PTSD was then evaluated by the social support rating scale (SSRS) and the simple coping style questionnaire (SCSQ). RESULTS Among all the 120 subjects, 14(11.67%) of them were diagnosed as having PTSD. Compared with the rehabilitation group, scores on subjective support, objective support, total social support and positive coping, total of coping style from the non-rehabilitation group all appeared significant low (P<0.05). Data from the multivariate logistic regression showed that social support (OR=0.281, 95% CI: 0.117-0.678) and coping style (OR= 0.293, 95% CI: 0.128-0.672) were protective factors of the chronic PTSD after the floods while disaster experience (OR=1.626, 95%CI: 1.118-2.365) appeared as a risk factor. CONCLUSION Chronic PTSD developed after the floods called for attention. Better social support, positive coping style could significantly improve the long-term prognosis of patients with PTSD after the floods.
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Affiliation(s)
- W J Dai
- School of Public Health, Central-south University, Changsha 410008, China
| | - L Chen
- Emergency Management, Zhuhai Center for Disease Control and Prevention, Zhuhai 519000, China; School of Public Health, Central-south University, Changsha 410008, China
| | - H Z Tan
- School of Public Health, Central-south University, Changsha 410008, China
| | - Z W Lai
- School of Public Health, Central-south University, Changsha 410008, China
| | - S M Hu
- School of Public Health, Central-south University, Changsha 410008, China
| | - Y Li
- School of Public Health, Central-south University, Changsha 410008, China
| | - A Z Liu
- School of Public Health, Central-south University, Changsha 410008, China
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Wu F, Zuo JJ, Yu QP, Zou SG, Tan HZ, Xiao J, Liu YH, Feng DY. Effect of skeletal muscle fibers on porcine meat quality at different stages of growth. Genet Mol Res 2015. [PMID: 26214468 DOI: 10.4238/2015.july.14.13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In this study, we examined changes in meat quality and content of muscle types during porcine growth. The influence of the longissimus dorsi muscle fiber composition on meat quality and the correlation between 2 fiber-typing methods (histochemistry and real-time quantitative polymerase chain reaction) were examined. Type IIx and type IIb fibers accounted for most of the total number of fibers; the proportion of these fibers increased during porcine growth (75.42, 80.09, and 79.88%, respectively, at 3 different stages of growth). There was a strong positive correlation between the 2 fiber-typing methods; the correlation coefficients of type I, IIa, and IIx+IIb fiber contents were 0.65, 0.88, and 0.92, respectively. The a* value of meat color was significantly lower at 98 days and negatively correlated with white fiber content (r = -0.69, P < 0.01). Water-holding capacity decreased during porcine growth. The drip loss parameter was positively correlated with type IIx+IIb fiber content (r = 0.55, P < 0.05). Decreased pH was strongly positively correlated with type IIx+IIb fiber content (r = 0.61, P < 0.01) and negatively correlated with type IIa fiber content (r = -0.44, P < 0.05). Therefore, we found that the composition of muscle fibers influenced the establishment of meat quality and its alteration during the early postmortem period.
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Affiliation(s)
- F Wu
- College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
| | - J J Zuo
- College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
| | - Q P Yu
- College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
| | - S G Zou
- National Engineering Research Center for Breeding Swine Industry, Guangzhou, Guangdong, China
| | - H Z Tan
- National Engineering Research Center for Breeding Swine Industry, Guangzhou, Guangdong, China
| | - J Xiao
- College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
| | - Y H Liu
- College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
| | - D Y Feng
- College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
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Zhao F, Ren LQ, Mi BM, Tan HZ, Zhao JT, Li H, Zhang HF, Zhang ZY. Developing a computer-controlled simulated digestion system to predict the concentration of metabolizable energy of feedstuffs for rooster. J Anim Sci 2014; 92:1537-47. [PMID: 24663164 DOI: 10.2527/jas.2013-6636] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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] Open
Abstract
Four experiments were conducted to evaluate the effectiveness of a computer-controlled simulated digestion system (CCSDS) for predicting apparent metabolizable energy (AME) and true metabolizable energy (TME) using in vitro digestible energy (IVDE) content of feeds for roosters. In Exp. 1, the repeatability of the IVDE assay was tested in corn, wheat, rapeseed meal, and cottonseed meal with 3 assays of each sample and each with 5 replicates of the same sample. In Exp. 2, the additivity of IVDE concentration in corn, soybean meal, and cottonseed meal was tested by comparing determined IVDE values of the complete diet with values predicted from measurements on individual ingredients. In Exp. 3, linear models to predict AME and TME based on IVDE were developed with 16 calibration samples. In Exp. 4, the accuracy of prediction models was tested by the differences between predicted and determined values for AME or TME of 6 ingredients and 4 diets. In Exp. 1, the mean CV of IVDE was 0.88% (range = 0.20 to 2.14%) for corn, wheat, rapeseed meal, and cottonseed meal. No difference in IVDE was observed between 3 assays of an ingredient, indicating that the IVDE assay is repeatable under these conditions. In Exp. 2, minimal differences (<21 kcal/kg) were observed between determined and calculated IVDE of 3 complete diets formulated with corn, soybean meal, and cottonseed meal, demonstrating that the IVDE values are additive in a complete diet. In Exp. 3, linear relationships between AME and IVDE and between TME and IVDE were observed in 16 calibration samples: AME = 1.062 × IVDE - 530 (R(2) = 0.97, residual standard deviation [RSD] = 146 kcal/kg, P < 0.001) and TME = 1.050 × IVDE - 16 (R(2) = 0.97, RSD = 148 kcal/kg, P < 0.001). Differences of less than 100 kcal/kg were observed between determined and predicted values in 10 and 9 of the 16 calibration samples for AME and TME, respectively. In Exp. 4, differences of less than 100 kcal/kg between determined and predicted values were observed in 3 and 4 of the 6 ingredient samples for AME and TME, respectively, and all 4 diets showed the differences of less than 25 kcal/kg between determined and predicted AME or TME. Our results indicate that the CCSDS is repeatable and additive. This system accurately predicted AME or TME on 17 of the 26 samples and may be a promising method to predict the energetic values of feed for poultry.
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Affiliation(s)
- F Zhao
- The State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
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Wang XQ, Chen X, Tan HZ, Zhang DX, Zhang HJ, Wei S, Yan HC. Nutrient density and slaughter age have differential effects on carcase performance, muscle and meat quality in fast and slow growing broiler genotypes. Br Poult Sci 2013; 54:50-61. [PMID: 23444854 DOI: 10.1080/00071668.2012.745927] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
1. A 2 × 2 factorial design was used to investigate the differences in carcase, muscle and meat characteristics between fast and slow growing genotypes fed on low nutrient (LND) or high nutrient diets (HND) at their respective slaughter ages. 2. The birds were randomly assigned to treatments with 5 replicates of 145 birds for Wens Yellow-Feathered Chicken (WYFC, 5·75 birds/m(2)) or 115 birds for White Recessive Rock Chicken (WRRC, 7·25 birds/m(2)), according to the commercial recommendations for the two breeds and were fed on HND or LND. Birds were slaughtered at 63 d and 105 d of age. 3. The results showed WRRC had higher carcase yield and meat yield than that of WYFC, lower fat content, higher moisture content and lower cooking loss. The meat from WRRC was less tender and contained lower levels of polyunsaturated fatty acids (PUFA). 4. Birds fed on HND had higher breast meat yield, myofiber area and protein content in the breast muscle and lower fat content than birds fed on LND. The thigh muscle of birds fed on HND had higher levels of PUFA. Age had a positive effect on carcase parameters, but a negative effect on pH, meat tenderness and cooking loss, and the two genotypes exhibited different responses to the influence of nutrient density and age. 5. Genotype and age had the largest effect on carcase performance and meat quality. LND benefited meat quality and WRRC had larger responses in meat yield and shear force when fed on HND.
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Affiliation(s)
- X Q Wang
- Guangdong Provincial Key Laboratory of Agro-Animal Genomics and Molecular Breeding/College of Animal Science, South China Agricultural University and Key Laboratory of Chicken Genetics, Breeding and Reproduction, Ministry of Agriculture, Guangzhou, P.R. China
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Kocsis MB, Cholewiak SA, Traylor RM, Adelstein BD, Hirleman ED, Tan HZ. Discrimination of real and virtual surfaces with sinusoidal and triangular gratings using the fingertip and stylus. IEEE Trans Haptics 2013; 6:181-192. [PMID: 24808302 DOI: 10.1109/toh.2012.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Two-interval two-alternative forced-choice discrimination experiments were conducted separately for sinusoidal and triangular textured surface gratings from which amplitude (i.e., height) discrimination thresholds were estimated. Participants (group sizes: n = 4 to 7) explored one of these texture types either by fingertip on real gratings (Finger real), by stylus on real gratings (Stylus real), or by stylus on virtual gratings (Stylus virtual). The real gratings were fabricated from stainless steel by an electrical discharge machining process while the virtual gratings were rendered via a programmable force-feedback device. All gratings had a 2.5-mm spatial period. On each trial, participants compared test gratings with 55, 60, 65, or 70 μm amplitudes against a 50-μm reference. The results indicate that discrimination thresholds did not differ significantly between sinusoidal and triangular gratings. With sinusoidal and triangular data combined, the average (mean + standard error) for the Stylus-real threshold (2.5 ± 0.2 μm) was significantly smaller (p <; 0.01) than that for the Stylus-virtual condition (4.9 ± 0.2 μm). Differences between the Finger-real threshold (3.8 ± 0.2 μm) and those from the other two conditions were not statistically significant. Further studies are needed to better understand the differences in perceptual cues resulting from interactions with real and virtual gratings.
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Ren LQ, Zhao F, Tan HZ, Zhao JT, Zhang JZ, Zhang HF. Effects of dietary protein source on the digestive enzyme activities and electrolyte composition in the small intestinal fluid of chickens. Poult Sci 2012; 91:1641-6. [PMID: 22700510 DOI: 10.3382/ps.2011-02081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An experiment was conducted to investigate the effects of dietary protein source on the digestive enzymes and electrolyte composition of digesta fluid in the duodenum, jejunum, and ileum of chickens. A 2 × 3 factorial and completely randomized design that used 2 types of diets that differed only in their protein source [a corn-soybean meal-miscellaneous meal diet (CSMD) and a corn-miscellaneous meal diet (CMD)] and 3 types of cannulated roosters (duodenal, jejunal, and ileal cannulations) was adopted. The experiments included 5 replicates for each of the 6 treatments, and each replicate involved 3 cannulated chickens. The digesta samples were collected for 1 h every 4 h between 09:30 and 18:30 h on d 31, 33, and 35 of the experiment. The amylase, lipase, trypsin, and chymotrypsin activities and the electrolyte composition in the duodenal, jejunal, and ileal fluid were determined. In general, no significant differences between the 2 dietary groups were observed for the mean of duodenal, jejuna, and ileal amylase, trypsin, chymotrypsin, and lipase, respectively. However, the duodenal amylase activity was lower in the CMD group than the CSMD group (P < 0.05), which was probably related to the lower duodenal pH value that was observed in this group (P < 0.01). A higher jejunal Mg(2+) concentration was observed in chickens that were fed the CMD (P < 0.05), whereas the differences in the Na(+), K(+), Cl(-), and Ca(2+) concentrations in the small intestine were not significant between the 2 diets (P > 0.05). In conclusion, the digestive enzymes and electrolytes in the small intestinal fluid of chickens adapted to the protein source of the diet, and each segment of the small intestine displayed different modifications.
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Affiliation(s)
- L Q Ren
- Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing, China
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