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Feliciano EJG, Ho FDV, Yee K, Paguio JA, Eala MAB, Robredo JPG, Ng K, Lim J, Pyone KT, Peralta CA, Flores JA, Yao JS, Santos PMG, Ang CDU, Lasco G, Chan JSK, Tse G, Tangco ED, Kingham TP, Chitapanarux I, Bhoo-Pathy N, Legaspi GD, Dee EC. Cancer disparities in Southeast Asia: intersectionality and a call to action. Lancet Reg Health West Pac 2023; 41:100971. [PMID: 38053740 PMCID: PMC10694578 DOI: 10.1016/j.lanwpc.2023.100971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/27/2023] [Accepted: 11/05/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Erin Jay G. Feliciano
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Department of Medicine, NYC H+H/Elmhurst, Icahn School of Medicine at Mt. Sinai, Queens, NY, USA
| | | | - Kaisin Yee
- SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
| | - Joseph A. Paguio
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Michelle Ann B. Eala
- University of the Philippines College of Medicine, Manila, Philippines
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Janine Patricia G. Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Kenrick Ng
- Department of Medical Oncology, St Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK
| | - Jasmine Lim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khin Thuzar Pyone
- Radiation Oncology Department, Yangon General Hospital Yangon, Myanmar
| | | | | | - J. Seth Yao
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Patricia Mae G. Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Daniel U. Ang
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Gideon Lasco
- Development Studies Program, Ateneo de Manila University, Quezon City, Philippines
- Department of Anthropology, University of the Philippines Diliman, Quezon City, Philippines
| | | | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Kent and Medway Medical School, Canterbury, UK
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Enrico D. Tangco
- Department of Radiation Oncology, The Medical City, Pasig City, Philippines
| | - T. Peter Kingham
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence Based Practice, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gerardo D. Legaspi
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines Manila, Philippine General Hospital, Metro Manila, Philippines
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Yee K, Tan HK. The role of academic medical centres in advancing global health equity in Southeast Asia. Lancet Reg Health West Pac 2023; 39:100933. [PMID: 37810419 PMCID: PMC10550574 DOI: 10.1016/j.lanwpc.2023.100933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Kaisin Yee
- SingHealth Duke-NUS Global Health Institute, Singapore
- International Collaboration Office, SingHealth, Singapore
- MOH Office for Healthcare Transformation, Singapore
| | - Hiang Khoon Tan
- SingHealth Duke-NUS Global Health Institute, Singapore
- International Collaboration Office, SingHealth, Singapore
- Surgery Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
- Department of Head and Neck Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
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Dee EC, Ho FDV, Yee K, Lin VK. Survivorship Care for People With Cancer in the Indo-Pacific: The Imperative to Harness Political Determinants, International Exchange, and Technological Innovation. JCO Glob Oncol 2023; 9:e2300052. [PMID: 37290023 PMCID: PMC10497291 DOI: 10.1200/go.23.00052] [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: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Edward Christopher Dee
- Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Frances Dominique V. Ho, BSc, College of Medicine, University of the Philippines, Manila, Philippines; Kaisin Yee, BSc, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore; and Vivian K. Lin, DrPH, MPH, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Frances Dominique V. Ho
- Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Frances Dominique V. Ho, BSc, College of Medicine, University of the Philippines, Manila, Philippines; Kaisin Yee, BSc, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore; and Vivian K. Lin, DrPH, MPH, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Kaisin Yee
- Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Frances Dominique V. Ho, BSc, College of Medicine, University of the Philippines, Manila, Philippines; Kaisin Yee, BSc, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore; and Vivian K. Lin, DrPH, MPH, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Vivian K. Lin
- Edward Christopher Dee, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Frances Dominique V. Ho, BSc, College of Medicine, University of the Philippines, Manila, Philippines; Kaisin Yee, BSc, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore; and Vivian K. Lin, DrPH, MPH, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
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Peh HP, Yee K, Mantaring EJN. Changes in telepractice use and perspectives among speech and language therapists in Singapore through the COVID-19 pandemic. Int J Lang Commun Disord 2023; 58:802-812. [PMID: 36412089 DOI: 10.1111/1460-6984.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/01/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Much has been written about the changes in use and perspectives of telepractice among speech and language therapists (SLTs) during the global COVID-19 pandemic. However, no long-term study has been done to examine whether there is a permanent shift in attitudes towards telepractice as the world adjusts to new norms and endemic COVID-19. AIMS To compare the speech telepractice use and perspectives of SLTs at two time points of the pandemic: during and after the height of the pandemic. METHODS & PROCEDURES Two online surveys were distributed a year apart among SLTs in Singapore. The first survey was disseminated during an initial lockdown period in 2020 and the second survey was done in 2021 when Singapore was starting to reduce strict quarantine and safe-distancing regulations. These surveys were distributed via communication channels of the local speech therapy association. A total of 115 and 71 responses to the survey were collected in 2020 and 2021, respectively. Responses were captured and analysed using descriptive statistics and statistical analysis while qualitative content analysis was used to derive key themes from open-ended questions. OUTCOMES & RESULTS Telepractice use across all age groups and client types peaked at the height of the pandemic. Even as lockdown measures were eased, telepractice utilization was still higher than what it was before the pandemic. Dysphagia management was the only area where SLTs reduced their use of telepractice during the stabilization phase. After more experience with telepractice during the height of the pandemic, SLTs acknowledged the benefit of being able to use a wide range of media through telepractice and were less worried about not having the resources or knowledge to set up telepractice. SLTs also reported increased confidence in providing telepractice, which was reflected in their willingness to continue to provide telepractice even after the pandemic ends. CONCLUSIONS & IMPLICATIONS The increase in use of telepractice during this pandemic is likely to be sustained as a majority of respondents believed they would continue to provide this mode of service delivery even after the pandemic ends. However, clinicians will still have to assess for client suitability, as clients with more complex medical or behavioural issues may still require in-person therapy. Additionally, dysphagia management via telepractice will still be limited given that swallow presentations may be more variable. Lastly, although generic resources are helpful for clinicians, the long-term sustainability of telepractice can be boosted by the sharing of resources that are suitable for the local context. WHAT THIS PAPER ADDS What is already known on this subject Current studies have examined telepractice use and perspectives of SLTs before and during the COVID-19 pandemic. Despite the evidence for the efficacy of telepractice, uptake was low due to perceived lack of training and resources. Although more clinicians provided telepractice during the pandemic, many still doubted its efficacy over in-person therapy and most studies concluded that longer term studies are required to ascertain if SLTs will continuing providing telepractice after the pandemic. What this paper adds to existing knowledge This study shows that there is a definitive shift in perspectives in favour of telepractice after the pandemic, as clinicians continued to provide telepractice across most service areas even without lockdown restrictions. The previous challenges of insufficient resources, knowledge and privacy concerns were reduced with more experience in providing telepractice. Although client suitability remained a major barrier, more clinicians saw benefits of easy access to therapy and range of resources used as benefits that they could harness from telepractice. What are the potential or actual clinical implications of this work? A majority of respondents stated that they are more confident in providing telepractice and would want to continue providing this service delivery mode after the pandemic, so more training and resources suitable for the local contexts can be provided by national associations to sustain this. More research and resources can be gathered to make telepractice more efficacious for dysphagia management and clients who may be deemed unsuitable for telepractice.
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Affiliation(s)
- Hui Peng Peh
- Department of Speech Therapy, Singapore General Hospital, Singapore, Singapore
| | - Kaisin Yee
- Department of Speech Therapy, Singapore General Hospital, Singapore, Singapore
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Getchell M, Mantaring EJ, Yee K, Pronyk P. Cost-effectiveness of sub-national geographically targeted vaccination programs: A systematic review. Vaccine 2023; 41:2320-2328. [PMID: 36781333 DOI: 10.1016/j.vaccine.2023.02.006] [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: 06/24/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/13/2023]
Abstract
Immunization is an essential component of national health plans. However, the growing number of new vaccine introductions, vaccination campaigns and increasing administrative costs create logistic and financial challenges, especially in resource-limited settings. Sub-national geographic targeting of vaccination programs is a potential strategy for governments to reduce the impact of infectious disease outbreaks while optimizing resource allocation and reducing costs, promoting sustainability of critically important national immunization plans. We conducted a systematic review of peer-reviewed literature to identify studies that investigated the cost-effectiveness of geographically targeted sub-national vaccination programs, either through routine immunization or supplementary immunization activities. A total of 16 studies were included in our review, covering nine diseases of interest: cholera, dengue, enterotoxigenic Escherichia coli (ETEC), hepatitis A, Japanese encephalitis, measles, rotavirus, Shigella and typhoid fever. All studies modelled cost-effectiveness of geographically targeted vaccination. Despite the variation in study design, disease focus and country context, studies generally found that in countries where a heterogenous burden of disease exists, sub-national geographic targeting of vaccination programs in areas of high disease burden was more cost-effective than a non-targeted strategy. Sensitivity analysis revealed that cost-effectiveness was most sensitive to variations in vaccine price, vaccine efficacy, mortality rate, administrative and operational costs, discount rate, and treatment costs. This systematic review identified several key characteristics related to geographic targeting of vaccination, including the vaccination strategy used, variations in modelling parameters and their impact on cost-effectiveness. Additional research and guidance is needed to support the appropriateness and feasibility of geographically targeted vaccination and to determine what country context would make this a viable complement to routine immunization programs.
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Affiliation(s)
- Marya Getchell
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | | | - Kaisin Yee
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Paul Pronyk
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
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Savona M, Mccloskey J, Griffiths E, Yee K, Al-Kali A, Zeidan A, Deeg H, Patel P, Sabloff M, Keating MM, Dao KH, Zhu N, Gabrail N, Fazal S, Maly J, Odenike O, Kantarjian H, Dezern A, O’Connell C, Roboz G, Busque L, Wells R, Amin H, Randhawa J, Leber B, Hao Y, Keer H, Azab M, Manero GG. Topic: AS08-Treatment/AS08a-Current treatment options - Hypomethylating agents. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106681.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Leitch H, Ezzat H, Merkeley H, Buckstein R, Zhu N, Nevill T, Olney H, Yee K, Leber B, Keating MM, Hilaire ES, Kumar R, Delage R, Geddes M, Storring J, Shamy A, Elemary M, Wells R. Topic: AS08-Treatment/AS08j-Supportive care - Iron overload. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106681.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yee K, Peh HP, Tan YP, Teo I, Tan EUT, Paul J, Rangabashyam M, Ramalingam MB, Chow W, Tan HK. Stressors and coping strategies of migrant workers diagnosed with COVID-19 in Singapore: a qualitative study. BMJ Open 2021; 11:e045949. [PMID: 33741672 PMCID: PMC7985935 DOI: 10.1136/bmjopen-2020-045949] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The health, psychological and socioeconomic vulnerabilities of low-wage migrant workers have been magnified in the COVID-19 pandemic, especially in high-income receiving countries such as Singapore. We aimed to understand migrant worker concerns and coping strategies during the COVID-19 pandemic to address these during the crisis and inform on comprehensive support needed after the crisis. METHODS In-depth semi-structured interviews were carried out with migrant workers diagnosed with COVID-19. The participants were recruited from a COVID-19 mass quarantine facility in Singapore through a purposive sampling approach. Interviews were transcribed verbatim and thematic analysis performed to derive themes in their collective experience during the crisis. RESULTS Three theme categories were derived from 27 interviews: migrant worker concerns during COVID-19, coping during COVID-19 and priorities after COVID-19. Major stressors in the crisis included the inability to continue providing for their families when work is disrupted, their susceptibility to infection in crowded dormitories, the shock of receiving the COVID-19 diagnosis while asymptomatic, as well as the isolating conditions of the quarantine environment. The workers coped by keeping in contact with their families, accessing healthcare, keeping updated with the news and continuing to practise their faith and religion. They looked forward to a return to normalcy after the crisis with keeping healthy and having access to healthcare as new priorities. CONCLUSION We identified coping strategies employed by the workers in quarantine, many of which were made possible through the considered design of care and service delivery in mass quarantine facilities in Singapore. These can be adopted in the set-up of other mass quarantine facilities around the world to support the health and mental well-being of those quarantined. Our findings highlight the importance of targeted policy intervention for migrant workers, in areas such as housing and working environments, equitable access to healthcare, and social protection during and after this crisis.
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Affiliation(s)
- Kaisin Yee
- COVID-19 Community Care Facilities, SingHealth, Singapore
- Speech Therapy Department, Singapore General Hospital, Singapore
| | - Hui Peng Peh
- COVID-19 Community Care Facilities, SingHealth, Singapore
- Speech Therapy Department, Singapore General Hospital, Singapore
| | - Yee Pin Tan
- COVID-19 Community Care Facilities, SingHealth, Singapore
- Division of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
| | - Irene Teo
- Division of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Emily U Tong Tan
- COVID-19 Community Care Facilities, SingHealth, Singapore
- Department of Medical Social Services, Singapore General Hospital, Singapore
| | | | - Mahalakshmi Rangabashyam
- Division of Surgery and Surgical Oncology, Singapore General Hospital, National Cancer Centre Singapore, Singapore
| | | | - Weien Chow
- COVID-19 Community Care Facilities, SingHealth, Singapore
- Department of Cardiology, Changi General Hospital, Singapore
| | - Hiang Khoon Tan
- COVID-19 Community Care Facilities, SingHealth, Singapore
- Division of Surgery and Surgical Oncology, Singapore General Hospital, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore
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Dubowitz JA, Cata JP, De Silva AP, Braat S, Shan D, Yee K, Hollande F, Martin O, Sloan EK, Riedel B. Volatile anaesthesia and peri-operative outcomes related to cancer: a feasibility and pilot study for a large randomised control trial. Anaesthesia 2021; 76:1198-1206. [PMID: 33440019 DOI: 10.1111/anae.15354] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/14/2022]
Abstract
Published data suggest that the type of general anaesthesia used during surgical resection for cancer may impact on patient long-term outcome. However, robust prospective clinical evidence is essential to guide a change in clinical practice. We explored the feasibility of conducting a randomised controlled trial to investigate the impact of total intravenous anaesthesia with propofol vs. inhalational volatile anaesthesia on postoperative outcomes of patients undergoing major cancer surgery. We undertook a randomised, double-blind feasibility and pilot study of propofol total intravenous anaesthesia or volatile-based maintenance anaesthesia during cancer resection surgery at three tertiary hospitals in Australia and the USA. Patients were randomly allocated to receive propofol total intravenous anaesthesia or volatile-based maintenance anaesthesia. Primary outcomes for this study were successful recruitment to the study and successful delivery of the assigned anaesthetic treatment as per randomisation arm. Of the 217 eligible patients approached, 146 were recruited, a recruitment rate of 67.3% (95%CI 60.6-73.5%). One hundred and forty-five patients adhered to the randomised treatment arm, 99.3% (95%CI 96.2-100%). Intra-operative patient characteristics and postoperative complications were comparable between the two intervention groups. This feasibility and pilot study supports the viability of the protocol for a large, randomised controlled trial to investigate the effect of anaesthesia technique on postoperative cancer outcomes. The volatile anaesthesia and peri-operative outcomes related to cancer (VAPOR-C) study that is planned to follow this feasibility study is an international, multicentre trial with the aim of providing evidence-based guidelines for the anaesthetic management of patients undergoing major cancer surgery.
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Affiliation(s)
- J A Dubowitz
- Department of Anaesthesia, Peri-operative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J P Cata
- Department of Anesthesiology and Peri-operative Medicine, Division of Anesthesiology and Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A P De Silva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, Australia
| | - S Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, Australia
| | - D Shan
- Department of Anaesthesia, Peri-operative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K Yee
- Department of Anaesthesia, Peri-operative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - F Hollande
- Department of Clinical Pathology and University of Melbourne Centre for Cancer Research, Melbourne, Australia
| | - O Martin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - E K Sloan
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, Australia
| | - B Riedel
- Department of Anaesthesia, Peri-operative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
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Yee K, Wong SM, Teo I, Loy J, Roche E, Tan YP, Tan HK, Tan NC, Iyer NG. Validity and reliability of the MD Anderson dysphagia inventory in English and Chinese in head and neck cancer patients. Asia Pac J Clin Oncol 2020; 16:372-379. [DOI: 10.1111/ajco.13384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/13/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Kaisin Yee
- Speech Therapy Department Singapore General Hospital Singapore
| | - Seng Mun Wong
- Speech Therapy Department Singapore General Hospital Singapore
| | - Irene Teo
- Division of Supportive and Palliative Care National Cancer Centre Singapore Singapore
- Lien Centre for Palliative Care Duke‐NUS Medical School Singapore
| | - Jamie Loy
- Speech Therapy Department Singapore General Hospital Singapore
| | - Elizabeth Roche
- Speech Therapy Department Singapore General Hospital Singapore
| | - Yee Pin Tan
- Division of Supportive and Palliative Care National Cancer Centre Singapore Singapore
| | - Hiang Khoon Tan
- Division of Surgery and Surgical Oncology Singapore General Hospital/National Cancer Centre Singapore
| | - Ngian Chye Tan
- Division of Surgery and Surgical Oncology Singapore General Hospital/National Cancer Centre Singapore
| | - N Gopalakrishna Iyer
- Division of Surgery and Surgical Oncology Singapore General Hospital/National Cancer Centre Singapore
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Chahal R, Alexander M, Yee K, Jun CMK, Dagher JG, Ismail H, Riedel B, Burbury K. Impact of a risk‐stratified thromboprophylaxis protocol on the incidence of postoperative venous thromboembolism and bleeding. Anaesthesia 2020; 75:1028-1038. [DOI: 10.1111/anae.15077] [Citation(s) in RCA: 4] [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] [Accepted: 04/03/2020] [Indexed: 12/13/2022]
Affiliation(s)
- R. Chahal
- Department of Cancer Anaesthesia, Peri‐operative and Pain Medicine Peter MacCallum Cancer Centre Melbourne Vic. Australia
- Centre for Integrated Critical Care University of Melbourne Vic. Australia
| | - M. Alexander
- Peter MacCallum Cancer Centre Melbourne Vic. Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Vic. Australia
| | - K. Yee
- Department of Cancer Anaesthesia, Peri‐operative and Pain Medicine Peter MacCallum Cancer Centre Melbourne Vic. Australia
| | - C. M. K. Jun
- Department of Medicine and Radiology University of Melbourne Vic. Australia
| | - J. G. Dagher
- Department of Medicine and Radiology University of Melbourne Vic. Australia
| | - H. Ismail
- Department of Cancer Anaesthesia, Peri‐operative and Pain Medicine Peter MacCallum Cancer Centre Melbourne Vic. Australia
- Centre for Integrated Critical Care University of Melbourne Vic. Australia
| | - B. Riedel
- Department of Cancer Anaesthesia, Peri‐operative and Pain Medicine Peter MacCallum Cancer Centre Melbourne Vic. Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Vic. Australia
| | - K. Burbury
- Peter MacCallum Cancer Centre Melbourne Vic. Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Vic. Australia
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Starkman R, Alibhai S, Wells RA, Geddes M, Zhu N, Keating MM, Leber B, Chodirker L, Sabloff M, Christou G, Leitch HA, St-Hilaire E, Finn N, Shamy A, Yee K, Storring J, Nevill T, Delage R, Elemary M, Banerji V, Lenis M, Kirubananthaan A, Mamedov A, Zhang L, Rockwood K, Buckstein R. An MDS-specific frailty index based on cumulative deficits adds independent prognostic information to clinical prognostic scoring. Leukemia 2019; 34:1394-1406. [PMID: 31811236 DOI: 10.1038/s41375-019-0666-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/30/2019] [Accepted: 11/17/2019] [Indexed: 12/21/2022]
Abstract
The frailty index (FI) is based on the principle that the more deficits an individual has, the greater their risk of adverse outcomes. It is expressed as a ratio of the number of deficits present to the total number of deficits considered. We developed an MDS-specific FI using a prospective MDS registry and assessed its ability to add prognostic power to conventional prognostic scores in MDS. The 42 deficits included in this FI included measurements of physical performance, comorbidities, laboratory values, instrumental activities of daily living, quality of life and performance status. Of 644 patients, 440 were eligible for FI calculation. The median FI score was 0.25 (range 0.05-0.67), correlated with age and IPSS/IPSS-R risk scores and discriminated overall survival. With a follow-up of 20 months, survival was 27 months (95% CI 24-30.4). By multivariate analysis, age >70, FI, transfusion dependence, and IPSS were significant covariates associated with OS. The incremental discrimination improvement of the frailty index was 37%. We derived a prognostic score with five risk groups and distinct survivals ranging from 7.4 months to not yet reached. If externally validated, the MDS-FI could be used as a tool to refine the risk stratification of current clinical prognostication models.
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Affiliation(s)
- R Starkman
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S Alibhai
- Geriatric Medicine/Oncology, University Health Network, Toronto, ON, Canada
| | - R A Wells
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Geddes
- Hematology/Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - N Zhu
- Hematology/Oncology, University of Alberta Hospital, Edmonton, AB, Canada
| | - M M Keating
- Hematology/Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - B Leber
- Hematology/Oncology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - L Chodirker
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Sabloff
- Hematology/Oncology, University of Ottawa, Ottawa, ON, Canada
| | - G Christou
- Hematology/Oncology, University of Ottawa, Ottawa, ON, Canada
| | - H A Leitch
- Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - E St-Hilaire
- Hematology/Oncology, Dr. Georges-L-Dumont University Centre, Moncton, NB, Canada
| | - N Finn
- Hematology/Oncology, Dr. Georges-L-Dumont University Centre, Moncton, NB, Canada
| | - A Shamy
- Hematology/Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - K Yee
- Hematology/Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - J Storring
- Hematology/Oncology, McGill University Health Centre-Royal Victoria Hospital, Montreal, QC, Canada
| | - T Nevill
- Hematology/Oncology, Vancouver General Hospital, Vancouver, BC, Canada
| | - R Delage
- Hematology/Oncology, Centre de recherche du CHU de Quebec-Universite Laval, Quebec City, QC, Canada
| | - M Elemary
- Hematology, Saskatoon Cancer Centre, Saskatoon, SK, Canada
| | - V Banerji
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - M Lenis
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Kirubananthaan
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Mamedov
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Zhang
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - K Rockwood
- Geriatric Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - R Buckstein
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Cornhill A, Dykstra S, Mikami Y, Flewitt J, Seib M, Yee K, Faris P, Hansen R, Lydell C, Howarth A, Heydari B, White J. 4179Feasibility and validation of routine CMR-based phenotyping for the prediction of heart failure admission or death in patients with systolic dysfunction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Standardized patient phenotyping using cardiovascular magnetic resonance (CMR) imaging has been shown to be of clinical value for prediction of adverse events in patients with heart failure and reduced ejection fraction (HFrEF). Studies have validated the prognostic capacity of function (LV, RV and LA) and replacement fibrosis burden in patients with ischemic and non-ischemic cardiomyopathy. The translation and validation of routine CMR-based phenotyping into clinical practice has yet to be demonstrated in prospective studies.
Purpose
This study was designed to explore feasibility and prognostic value of routine CMR-based patient phenotyping in a high-volume clinical referral center for patients with HFrEF.
Methods
One thousand three hundred and ninety-three consecutive patients with chronic HFrEF were prospectively recruited between January 2015 and June 2018. Chronic HFrEF was defined by LVEF≤50% by CMR, with no recent (within 90 days) acute myocardial infarction or myocarditis diagnosis. Patients with congenital heart disease and those without LGE CMR protocol were excluded. All patients underwent standardized CMR protocols with multi-chamber volumetric analysis and regional myocardial fibrosis coding. Pharmacy, ECG, laboratory and patient reported data was used for statistical modelling. A minimum three-month follow-up was mandated to identify the composite clinical outcome of heart failure hospitalization or death.
Results
The cohort had a median age of 61 years with 23% being female. The median follow-up was 737 days with 146 patients (10.5%) experiencing the composite outcome. Numerous imaging and non-imaging variables were significantly different between patients with and without the composite outcome, including: median LVEF (32% vs 39%, p<0.0001), RVEF (46% vs 51% p<0.0001), LV mass (77g/m2 vs. 65g/m2, p<0.0001), digoxin (19% vs. 9%, p<0.0001) and diuretic (63% vs 41%, p<0.0001) use. Presence of replacement fibrosis (HR=2.09, p=0.001), particularly midwall striae (HR=2.01, p<0.0001), diffuse (HR=3.88, p<0.0001) and RV insertion site fibrosis (HR=1.54, p=0.022) patterns, were significantly associated with the combined endpoint. A stepwise multivariable model was applied using all eligible variables and resulted in robust accuracy for prediction of the combined outcome with a concordance index of 0.751 (Figure 1).
Conclusions
This study demonstrates the feasibility and prognostic value of automated patient phenotyping that captures patient reported data, imaging, and administrative data for risk prediction modelling in HFrEF. The incremental application of machine learning is being explored.
Acknowledgement/Funding
J White: Early Investigator Award (Heart and Stroke Foundation of Alberta), Calgary Health Trust
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Affiliation(s)
- A Cornhill
- University of Calgary Foothills Hospital, Calgary, Canada
| | - S Dykstra
- University of Calgary Foothills Hospital, Calgary, Canada
| | - Y Mikami
- University of Calgary Foothills Hospital, Calgary, Canada
| | - J Flewitt
- University of Calgary Foothills Hospital, Calgary, Canada
| | - M Seib
- University of Calgary Foothills Hospital, Calgary, Canada
| | - K Yee
- University of Calgary Foothills Hospital, Calgary, Canada
| | - P Faris
- University of Calgary Foothills Hospital, Calgary, Canada
| | - R Hansen
- University of Calgary Foothills Hospital, Calgary, Canada
| | - C Lydell
- University of Calgary Foothills Hospital, Calgary, Canada
| | - A Howarth
- University of Calgary Foothills Hospital, Calgary, Canada
| | - B Heydari
- University of Calgary Foothills Hospital, Calgary, Canada
| | - J White
- University of Calgary Foothills Hospital, Calgary, Canada
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14
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Kiong KL, Tan NC, Skanthakumar T, Teo CEH, Soo KC, Tan HK, Roche E, Yee K, Iyer NG. Salivary fistula: Blue dye testing as part of an algorithm for early diagnosis. Laryngoscope Investig Otolaryngol 2017; 2:363-368. [PMID: 29299509 PMCID: PMC5743154 DOI: 10.1002/lio2.112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/18/2017] [Accepted: 09/06/2017] [Indexed: 11/10/2022] Open
Abstract
Objective Orocutaneous and pharyngocutaneous fistula (OPCF) is a debilitating complication of head and neck surgery for squamous cell carcinoma (SCC), resulting in delayed adjuvant treatment and prolonged hospitalization. As yet, there is no established test that can help in prompt and accurate diagnosis of OPCF. This study aims to determine the accuracy of bedside blue dye testing and its role as part of an algorithm for early diagnosis. We also analyze the risk factors predisposing to OPCF. Study Design Retrospective cohort study from 2012 to 2014. Methods Patients with head and neck SCC who underwent major resection and reconstruction, at risk of OPCF, were included. Results of blue‐dye and video‐fluoroscopic swallow‐studies (VFSS) testing for OPCF were recorded. For the patients that were noted to develop OPCF, the length of time to diagnosis of fistula and subsequent mode of management were examined. Results Of the 93 patients in this study, 25 (26.9%) developed OPCF. Advanced T‐classification (T3/T4) was the only significant predisposing risk factor (p = 0.013). The sensitivity and specificity of the bedside blue dye testing was found to be 36.4% and 100%, respectively. The test positive patients were diagnosed with OPCF at a median of postoperative day (POD) 9.5 as compared to POD 13 for the test negative patients (p = 0.001). Early diagnosis was associated with faster fistula resolution with treatment. Conclusion Blue dye testing is a simple bedside test that can assist in the early diagnosis of OPCF in patients, allowing treatment to be instituted earlier with improved outcomes. Level of Evidence 3
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Affiliation(s)
| | | | | | | | - Khee Chee Soo
- the Division of Surgical Oncology National Cancer Centre Singapore
| | | | - Elizabeth Roche
- Department of Speech Therapy Singapore General Hospital Singapore
| | - Kaisin Yee
- Department of Speech Therapy Singapore General Hospital Singapore
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15
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Bhimji A, Bhaskaran A, Singer LG, Kumar D, Humar A, Pavan R, Lipton J, Kuruvilla J, Schuh A, Yee K, Minden MD, Schimmer A, Rotstein C, Keshavjee S, Mazzulli T, Husain S. Aspergillus galactomannan detection in exhaled breath condensate compared to bronchoalveolar lavage fluid for the diagnosis of invasive aspergillosis in immunocompromised patients. Clin Microbiol Infect 2017; 24:640-645. [PMID: 28970160 DOI: 10.1016/j.cmi.2017.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Exhaled breath condensate (EBC) is a noninvasive means of sampling the airways that has shown significant promise in the diagnosis of many disorders. There have been no reports of its usefulness in the detection of galactomannan (GM), a component of the cell wall of Aspergillus. The suitability of EBC for the detection of GM for the diagnosis of invasive aspergillosis (IA) using the Platelia Aspergillus enzyme-linked immunosorbent assay was investigated. METHODS Prospective, cross-sectional study of lung transplant recipient and haemotologic malignancy patients at a university centre. EBC samples were compared to concomitant bronchoalveolar lavage (BAL) samples among lung transplant recipients and healthy controls. EBC was collected over 10 minutes using a refrigerated condenser according to the European Respiratory Society/American Thoracic Society recommendations, with the BAL performed immediately thereafter. RESULTS A total of 476 EBC specimens with 444 matched BAL specimens collected from lung transplant recipients (n = 197) or haemotologic malignancy patients (n = 133) were examined. Both diluted and untreated EBC optical density (OD) values (0.0830, interquartile range (IQR) 0.0680-0.1040; and 0.1130, IQR 0.0940-0.1383), respectively, from all patients regardless of clinical syndrome were significantly higher than OD values in healthy control EBCs (0.0508, IQR 0.0597-0.0652; p < 0.0001). However, the OD index values did not correlate with the diagnosis of IA (44 samples were associated with IA). Furthermore, no significant correlation was found between EBC GM and the matched BAL specimen. CONCLUSIONS GM is detectable in EBC; however, no correlation between OD index values and IA was noted in lung transplant recipients.
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Affiliation(s)
- A Bhimji
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - A Bhaskaran
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - L G Singer
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - D Kumar
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - A Humar
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - R Pavan
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - J Lipton
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - J Kuruvilla
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - A Schuh
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - K Yee
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - M D Minden
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - A Schimmer
- Department of Medicine, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| | - C Rotstein
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - S Keshavjee
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - T Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - S Husain
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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16
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Garcia-Manero G, Sekeres MA, Egyed M, Breccia M, Graux C, Cavenagh JD, Salman H, Illes A, Fenaux P, DeAngelo DJ, Stauder R, Yee K, Zhu N, Lee JH, Valcarcel D, MacWhannell A, Borbenyi Z, Gazi L, Acharyya S, Ide S, Marker M, Ottmann OG. A phase 1b/2b multicenter study of oral panobinostat plus azacitidine in adults with MDS, CMML or AML with ⩽30% blasts. Leukemia 2017; 31:2799-2806. [PMID: 28546581 PMCID: PMC5729337 DOI: 10.1038/leu.2017.159] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 12/15/2022]
Abstract
Treatment with azacitidine (AZA), a demethylating agent, prolonged overall survival (OS) vs conventional care in patients with higher-risk myelodysplastic syndromes (MDS). As median survival with monotherapy is <2 years, novel agents are needed to improve outcomes. This phase 1b/2b trial (n=113) was designed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of panobinostat (PAN)+AZA (phase 1b) and evaluate the early efficacy and safety of PAN+AZA vs AZA monotherapy (phase 2b) in patients with higher-risk MDS, chronic myelomonocytic leukemia or oligoblastic acute myeloid leukemia with <30% blasts. The MTD was not reached; the RP2D was PAN 30 mg plus AZA 75 mg/m2. More patients receiving PAN+AZA achieved a composite complete response ([CR)+morphologic CR with incomplete blood count+bone marrow CR (27.5% (95% CI, 14.6–43.9%)) vs AZA (14.3% (5.4–28.5%)). However, no significant difference was observed in the 1-year OS rate (PAN+AZA, 60% (50–80%); AZA, 70% (50–80%)) or time to progression (PAN+AZA, 70% (40–90%); AZA, 70% (40–80%)). More grade 3/4 adverse events (97.4 vs 81.0%) and on-treatment deaths (13.2 vs 4.8%) occurred with PAN+AZA. Further dose or schedule optimization may improve the risk/benefit profile of this regimen.
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Affiliation(s)
- G Garcia-Manero
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M A Sekeres
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - M Egyed
- Kaposi Mor County Teaching Hospital, Kasposvár, Hungary
| | | | - C Graux
- Mont-Godinne University Hospital, Yvoir, Belgium
| | | | - H Salman
- Augusta University, Augusta, GA, USA
| | - A Illes
- University of Debrecen, Debrecen, Hungary
| | - P Fenaux
- Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | | | - R Stauder
- Innsbruck Medical University, Innsbruck, Austria
| | - K Yee
- Princess Margaret Cancer Centre, Toronto, Canada
| | - N Zhu
- University of Alberta Hospital, Edmonton, Canada
| | - J-H Lee
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | | | - A MacWhannell
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - L Gazi
- Novartis Pharma AG, Basel, Switzerland
| | - S Acharyya
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Ide
- Novartis Pharmaceuticals Corporation, Cambridge, MA, USA
| | - M Marker
- Novartis Pharma S.A.S., Rueil-Malmaison, France
| | - O G Ottmann
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
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17
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Yee K, Lau K, Tseng C, Lau E. Interactive effect of depressive symptoms and nap on valence judgment in individuals with insomnia. Sleep Med 2015. [DOI: 10.1016/j.sleep.2015.02.1523] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Haroon N, Guggino G, Zhang Z, Yee K, Abdullah H, Alessandro R, Raimondo S, Triolo G, Ciccia F. OP0204 Autophagy and Unfolded Protein Response: A Fine Balance that can Influence the Pathogenesis of Ankylosing Spondylitis and Inflammatory Bowel Disease. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5321] [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: 11/04/2022]
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19
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Stathis A, Quesnel B, Amorim S, Thieblemont C, Zucca E, Raffoux E, Dombret H, Peng Y, Palumbo A, Vey N, Thomas X, Michallet M, Gomez-Roca C, Recher C, Karlin L, Yee K, Rezai K, Preudhomme C, Facon T, Herait P. 5LBA Results of a first-in-man phase I trial assessing OTX015, an orally available BET-bromodomain (BRD) inhibitor, in advanced hematologic malignancies. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70726-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Roboz G, Ravandi F, Kropf P, Yee K, O'Connell C, Griffiths E, Stock W, Garcia-Manero G, Jabbour E, Daver N, Pemmaraju N, Issa J, Walsh K, Rizzieri D, Lunin S, Naim S, Hao Y, Azab M, Kantarjian H. Comparison of Efficacy and Safety of 5-Day and 10-Day Schedules of Sgi-110, a Novel Subcutaneous (Sc) Hypomethylating Agent (Hma), in the Treatment of Relapsed/Refractory Acute Myeloid Leukemia (R/R Aml). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu339.4] [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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Stoch SA, Friedman E, Maes A, Yee K, Xu Y, Larson P, Fitzgerald M, Chodakewitz J, Wagner JA. Effect of Different Durations of Ketoconazole Dosing on the Single-Dose Pharmacokinetics of Midazolam: Shortening the Paradigm. J Clin Pharmacol 2013; 49:398-406. [DOI: 10.1177/0091270008331133] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sharma S, Halliwell R, Dexter M, Mudaliar Y, Yee K. Acute Subdural Haematoma in the Presence of an Intrathecal Catheter Placed for the Prevention of Post-Dural Puncture Headache. Anaesth Intensive Care 2010; 38:939-41. [DOI: 10.1177/0310057x1003800521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 31-year-old term primigravid woman had an intrathecal catheter placed following a dural puncture during attempted epidural analgesia during labour. After 23 hours she developed sudden loss of consciousness and an urgent brain computed tomography scan demonstrated a large left hyper-acute subdural haematoma. Craniotomy revealed active bleeding from a ruptured left temporal bridging vein. She was extubated 12 hours after surgery and was discharged home 11 days later without neurological deficit. Although subdural haematoma is a recognised complication of dural puncture, it has not been reported in the presence of an intrathecal catheter. An intrathecal catheter may not always prevent cerebrospinal fluid efflux, so subdural haematoma remains a potential complication of inadvertent dural puncture.
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Affiliation(s)
- S. Sharma
- Department of Anaesthesia, Westmead Hospital, Sydney, New South Wales, Australia
| | - R. Halliwell
- Department of Anaesthesia, Westmead Hospital, Sydney, New South Wales, Australia
| | - M. Dexter
- Department of Anaesthesia, Westmead Hospital, Sydney, New South Wales, Australia
- Consultant Neurosurgeon, Department of Neurosurgery
| | - Y. Mudaliar
- Department of Anaesthesia, Westmead Hospital, Sydney, New South Wales, Australia
- Consultant Intensivist
| | - K. Yee
- Department of Anaesthesia, Westmead Hospital, Sydney, New South Wales, Australia
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Sacks L, Yee K, Huijbregts M, Miller PA, Aggett T, Salbach NM. Validation of the activity inventory of the Chedoke-McMaster stroke assessment and the clinical outcome variables scale to evaluate mobility in geriatric clients. J Rehabil Med 2010; 42:90-2. [DOI: 10.2340/16501977-0477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kohli R, Xu W, Brandwein J, Minden MD, Schimmer A, Schuh AC, Lipton JH, Yee K, Messner HA, Gupta V. Long-term outcomes in adult patients below the age of 55 years with acute lymphoblastic leukemia treated with chemotherapy or allogeneic BM transplant in first CR. Bone Marrow Transplant 2009; 45:1256-8. [DOI: 10.1038/bmt.2009.324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Seven of one hundred twenty-one patients with chronic myeloid leukemia (CML) treated with imatinib mesylate developed subdural hematomas. All had advanced disease and were treated initially at a dose of 600 mg per day. Three patients had thrombocytopenia (platelet < 10 x 10(9)/l), one had leukocytosis (white blood cell count > 150 x 10(9)/l) and three had neither around the time of diagnosis of the subdural hematomas. Four patients required surgical evacuation. One patient, in blast crisis, died as a consequence of the subdural hematoma. Three patients survived but died of progressive CML. The remaining three patients having recommenced imatinib, are alive and well, and one has achieved a major cytogenetic response. Subdural hematomas must be considered even in mildly symptomatic patients receiving imatinib regardless of their peripheral blood counts. Patients who survive can be cautiously restarted on imatinib. Further studies are required to study the potential relationship between imatinib mesylate and subdural hematomas.
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MESH Headings
- Aged
- Antineoplastic Agents/adverse effects
- Benzamides
- Blast Crisis/chemically induced
- Blast Crisis/drug therapy
- Female
- Hematoma, Subdural/chemically induced
- Hematoma, Subdural/complications
- Hematoma, Subdural/drug therapy
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukocytosis/chemically induced
- Male
- Middle Aged
- Piperazines/adverse effects
- Pyrimidines/adverse effects
- Remission Induction
- Risk Factors
- Thrombocytopenia/chemically induced
- Treatment Outcome
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Affiliation(s)
- K W Song
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario Canada
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Abstract
Live bird markets (LBM) are essential for marketing poultry in many developing countries, and they are a preferred place for many people to purchase poultry for consumption throughout the world. Live bird markets are typically urban and have a permanent structure in which birds can be housed until they are sold. Live bird markets bring together a mixture of bird species that meet the preferences of their customers and that are commonly produced by multiple suppliers. The mixture of species, the lack of all-in-all-out management, and multiple suppliers are all features that make LBM potential sources of avian influenza viruses (AIV), especially for their supply flocks. Live bird markets have been linked to many outbreaks of avian influenza internationally and in the United States. Avian influenza virus is endemic in many, but not all, LBM systems. For instance, AIV has not been isolated from the Southern California LBM system since December 2005, although the risk of new introductions remains. The California LBM system is much smaller than the New York system, handles fewer birds, and has fewer bird suppliers, which, combined with recent avian influenza prevention and control plans, have enabled it to be AIV free for nearly 3 yr.
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Affiliation(s)
- C Cardona
- Department of Population Health and Reproduction, Veterinary Medicine Extension, University of California, Davis 95616, USA.
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Gupta V, Xu W, Keng C, Alibhai SMH, Brandwein J, Schimmer A, Schuh A, Yee K, Minden MD. The outcome of intensive induction therapy in patients ⩾70 years with acute myeloid leukemia. Leukemia 2007; 21:1321-4. [PMID: 17344911 DOI: 10.1038/sj.leu.2404655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lappas M, Yee K, Permezel M, Rice GE. Lipopolysaccharide and TNF-α Activate the Nuclear Factor Kappa B Pathway in the Human Placental JEG-3 Cells. Placenta 2006; 27:568-75. [PMID: 16122789 DOI: 10.1016/j.placenta.2005.06.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Revised: 05/31/2005] [Accepted: 06/03/2005] [Indexed: 11/22/2022]
Abstract
Up-regulation of pro-inflammatory cytokines, cyclooxygenase (COX-2) and prostaglandins is a critical factor driving human term labour and inflammation-associated preterm labour. Nuclear factor kappa B (NF-kappaB) is activated in response to a number of inflammatory mediators, including cytokines and lipopolysaccharide (LPS). The aim of this study was (i) to investigate if TNF-alpha and LPS activate the NF-kappaB pathway; and (ii) to use short interfering RNA (siRNA) against inhibitor kappaB kinase (IKK)-beta to confirm the role of the NF-kappaB pathway in the regulation of pro-inflammatory mediators in human placental JEG-3 cells. JEG-3 cells (3 independent experiments) were (i) incubated in the presence or absence of 10 microg/ml LPS or 20 ng/ml TNF-alpha, or (ii) transfected with 100 nM IKK-beta siRNA. Incubation of JEG-3 cells with LPS and TNF-alpha increased the expression of cytoplasmic IKK-beta and phosphorylated IkappaB-alpha, and nuclear NF-kappaB proteins p50 and p65. This was associated with a concurrent increase in COX-2 protein, and IL-6 and PGF2alpha release from JEG-3 cells. Treatment of cells with BAY 11-7082 at 50 microM significantly inhibited basal, LPS- and TNF-alpha-induced NF-kappaB and COX-2 expression, and IL-6 and PGF2alpha release. Transfection of JEG-3 cells with IKK-beta siRNA significantly decreased IL-6 and PGF2alpha release. The data presented in this study demonstrate that pro-inflammatory mediators regulate the NF-kappaB transcription pathway in human JEG-3 cells, and the IKK-beta/NF-kappaB pathway is a regulator of inflammatory mediators in placental JEG-3 cells.
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Affiliation(s)
- M Lappas
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 126 Clarendon Street, East Melbourne, Victoria 3002, Australia.
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Feldman E, Giles F, Roboz G, Yee K, Curcio T, Rivera VM, Albitar M, Laliberte R, Bedrosian CL. A phase 2 clinical trial of AP23573, an mTOR inhibitor, in patients with relapsed or refractory hematologic malignancies. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6631] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Feldman
- Weill Cornell Medcl Ctr, New York, NY; UT MD Anderson Cancer Ctr, Houston, TX; ARIAD Pharmaceuticals, Inc., Cambridge, MA; Quest Diagnostics, Inc., San Juan Capistrano, CA
| | - F. Giles
- Weill Cornell Medcl Ctr, New York, NY; UT MD Anderson Cancer Ctr, Houston, TX; ARIAD Pharmaceuticals, Inc., Cambridge, MA; Quest Diagnostics, Inc., San Juan Capistrano, CA
| | - G. Roboz
- Weill Cornell Medcl Ctr, New York, NY; UT MD Anderson Cancer Ctr, Houston, TX; ARIAD Pharmaceuticals, Inc., Cambridge, MA; Quest Diagnostics, Inc., San Juan Capistrano, CA
| | - K. Yee
- Weill Cornell Medcl Ctr, New York, NY; UT MD Anderson Cancer Ctr, Houston, TX; ARIAD Pharmaceuticals, Inc., Cambridge, MA; Quest Diagnostics, Inc., San Juan Capistrano, CA
| | - T. Curcio
- Weill Cornell Medcl Ctr, New York, NY; UT MD Anderson Cancer Ctr, Houston, TX; ARIAD Pharmaceuticals, Inc., Cambridge, MA; Quest Diagnostics, Inc., San Juan Capistrano, CA
| | - V. M. Rivera
- Weill Cornell Medcl Ctr, New York, NY; UT MD Anderson Cancer Ctr, Houston, TX; ARIAD Pharmaceuticals, Inc., Cambridge, MA; Quest Diagnostics, Inc., San Juan Capistrano, CA
| | - M. Albitar
- Weill Cornell Medcl Ctr, New York, NY; UT MD Anderson Cancer Ctr, Houston, TX; ARIAD Pharmaceuticals, Inc., Cambridge, MA; Quest Diagnostics, Inc., San Juan Capistrano, CA
| | - R. Laliberte
- Weill Cornell Medcl Ctr, New York, NY; UT MD Anderson Cancer Ctr, Houston, TX; ARIAD Pharmaceuticals, Inc., Cambridge, MA; Quest Diagnostics, Inc., San Juan Capistrano, CA
| | - C. L. Bedrosian
- Weill Cornell Medcl Ctr, New York, NY; UT MD Anderson Cancer Ctr, Houston, TX; ARIAD Pharmaceuticals, Inc., Cambridge, MA; Quest Diagnostics, Inc., San Juan Capistrano, CA
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Kolomietz E, Marrano P, Yee K, Thai B, Braude I, Kolomietz A, Chun K, Minkin S, Kamel-Reid S, Minden M, Squire JA. Quantitative PCR identifies a minimal deleted region of 120 kb extending from the Philadelphia chromosome ABL translocation breakpoint in chronic myeloid leukemia with poor outcome. Leukemia 2003; 17:1313-23. [PMID: 12835719 DOI: 10.1038/sj.leu.2402969] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fluorescence in situ hybridization (FISH) analysis has shown previously that 10-15% of chronic myeloid leukemias (CML) have hemizygous deletions of variable sizes affecting regions that flank the ABL and BCR translocation breakpoints on the derivative chromosome 9, and these patients have a poor outcome. FISH studies using large commercial genomic probes have previously suggested that haploinsufficiency of sequences flanking either ABL or BCR modify the disease process of CML and lead to an unfavorable prognosis. In this present study, real-time quantitative PCR (Q-PCR) analysis was used to identify and map much smaller hemizygous microdeletions in a subset of CML patients that were not deleted using large genomic FISH probes. Microdeletions were identified by Q-PCR in 25 of 71 patients selected based on less favorable outcome (chronic phase duration of less than 96 months and a survival time of less than 84 months). In contrast, no microdeletion was detected in any of 18 CML samples selected from a group with a more favorable outcome. Detailed mapping of the 25 Q-PCR microdeletions showed that the minimal deleted region extended approximately 120 kb from the 5' end of the ABL gene in the centromeric direction on the derivative chromosome 9, and the region 3' to BCR on chromosome 22 was excluded. Of the four ESTs and/or genes that map to the 120 kb region, the putative tumor suppressor PRDM12 is the strongest candidate gene. The potential role for each sequence in modifying the clinical behavior of CML is presented.
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Affiliation(s)
- E Kolomietz
- Ontario Cancer Institute, Toronto, Ontario, Canada
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31
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Abstract
The mitogen-activated protein kinases (MAPKs) and the cyclin-dependent kinases (CDKs) are key mediators of cell proliferation in response to extracellular signals. Recent additions to each of these families and the identification of kinases with structural features of both have provided insights into fundamental processes, such as cell division and differentiation. To identify novel serine kinases with features of MAPKs or CDKs, a degenerate PCR-based amplification approach was undertaken. The 57- and 52-kDa isoforms of a novel protein kinase, termed NKIATRE, were molecularly cloned from rat brain and jejunum cDNA libraries. Like the MAPKs, NKIATRE has a Thr-Xaa-Tyr motif in kinase subdomain VIII. NKIATRE also shows close homology to the cyclin-dependent kinase class of protein kinases and the cdc2-related kinases NKIAMRE, KKIALRE, and KKIAMRE, containing both conserved inhibitory phosphorylation sites and a putative cyclin-binding domain. Two isoforms of NKIATRE that differ in their carboxy-terminal ends have been identified. A functional nuclear localization signal is specific to the longer 57-kDa alpha isoform. Sequence similarity to the putative human tumor suppressor gene NKIAMRE, which is lost in leukemic patients with chromosome 5q deletions, suggests that NKIATRE may have a role in restricting cell growth or maintaining differentiation.
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Affiliation(s)
- R Haq
- Institute of Medical Science, University of Toronto, Ontario, M5G 2M9, Canada
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Abstract
A novel mutation was detected using single-strand conformation polymorphism and heteroduplex analysis in a cystic fibrosis subject of mixed ancestry. Mutation 3410T-->C in exon 17b caused the novel missense mutation L1093P; the other chromosome has mutation N1303K. The 31-year-old subject is pancreatic insufficient, had an FEV(1) score that was 33% of normal prior to a heart/lung transplant, and sweat chloride values of 116 and 95 mM when tested at ages 1 and 11. Functional analysis using forskolin-stimulated efflux of (125)I in HEK cells transfected with an ABCC7 construct harboring the L1093P mutation confirmed that cAMP-mediated anion efflux was abnormal, but some function was preserved. Analysis of parental DNA established that N1303K was of English origin, while L1093P was of Greek, Irish or Native American (Cherokee) origin. Given the intensive screening for CF mutations in European populations, we hypothesize that L1093P is of Native American origin. Hum Mutat 15:208, 2000.
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Affiliation(s)
- K Yee
- Cystic Fibrosis Research Laboratory, Stanford University, Stanford, CA 94305-2130, USA
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Fleisher LA, Yee K, Lillemoe KD, Talamini MA, Yeo CJ, Heath R, Bass E, Snyder DS, Parker SD. Is outpatient laparoscopic cholecystectomy safe and cost-effective? A model to study transition of care. Anesthesiology 1999; 90:1746-55. [PMID: 10360875 DOI: 10.1097/00000542-199906000-00033] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is increasing pressure to perform traditional inpatient surgical procedures in an outpatient setting. The aim of the current trial was to determine the safety and cost savings of performing laparoscopic cholecystectomy in an outpatient setting using a "mock" outpatient setting. METHODS Patients who were scheduled for laparoscopic cholecystectomy by four attending surgeons and for whom operating time was available in the outpatient center were studied. All patients received a standardized anesthetic, including ondansetron, and were discharged from the outpatient postanesthesia care unit if appropriate. At discharge, all patients were admitted to a clinical research center where they were observed in a "mock home" setting and monitored for complications that would have necessitated readmission. A decision analysis was created assuming all patients underwent outpatient surgery with either direct admission or discharge to home and readmission if complications developed. RESULTS Of 99 patients who were enrolled in this study, 96 patients would have met the discharge criteria for home. No major complications were observed in these 96 patients. Eleven patients experienced postoperative nausea and vomiting, 3 of whom required an additional 24 h of hospital observation. In the decision model, the optimal strategy would be to perform the procedure on an outpatient basis and readmit patients only for complications, with an average baseline cost savings of $742/patient. CONCLUSIONS The results show that outpatient laparoscopic cholecystectomy is safe and cost-effective in selected patients, and that the mock home setting provides a means of studying the safety of transition of care.
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Affiliation(s)
- L A Fleisher
- Department of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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34
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Abstract
Cystic fibrosis is rare in non-Caucasian populations, and in such populations little is known about the spectrum of mutations and polymorphisms in the CFTR gene. We studied a 23-year-old patient of Chinese ethnicity with sweat chloride values of 104 mM/l, pancreatic sufficiency, an FEV1 60% of normal, sputum cultures positive for Staphylococcus aureus and Burkholderia cepacia, and a history of allergic bronchopulmonary aspergillosis. Genetic screening for 31 common CFTR mutations was negative, leading us to search for unknown mutations using single-strand conformation polymorphism and heteroduplex analysis (SSCP/HA). Two novel mutations were detected. In exon 4, a deletion of 8 bp (451458, deltaGCTTCCTA) causes a frameshift and immediately creates a stop codon. In exon 16, mutation 3041G-->A causes the missense change G970D. Functional analysis using an isotopic flux assay indicated that the G970D mutation retains partial function; western blotting indicated that the protein is glycosylated. The patient is heterozygous for the common polymorphisms (2694T/G) in exon 14a and (GATT)6/7 in intron 6a, indicating that these variants arose in ancestors common to Caucasians and Chinese.
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Affiliation(s)
- J A Wagner
- Department of Molecular Pharmacology, Stanford University School of Medicine, CA 94305-5332, USA
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Affiliation(s)
- K Yee
- Princess Margaret Hospital, Toronto, Ontario, Canada
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Lichty BD, Keating A, Callum J, Yee K, Croxford R, Corpus G, Nwachukwu B, Kim P, Guo J, Kamel-Reid S. Expression of p210 and p190 BCR-ABL due to alternative splicing in chronic myelogenous leukaemia. Br J Haematol 1998; 103:711-5. [PMID: 9858221 DOI: 10.1046/j.1365-2141.1998.01033.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The hallmark of chronic myelogenous leukaemia (CML) is the presence of the Philadelphia chromosome and its resultant fusion message, BCR-ABL, and fusion protein, p210. Patients with CML in blast crisis, or with Philadelphia positive acute lymphoblastic leukaemia (ALL), can have a smaller BCR-ABL fusion transcript possessing only the first exon of BCR fused to ABL. This smaller transcript encodes a 190 kD protein which is more strongly transforming than the p210 protein derived from the larger CML-associated transcript. We performed RT-PCR on samples from CML patients in chronic phase to determine the frequency and mechanism of p190 and p210 co-expression and to see if this correlated with clinical indices. We examined the peripheral blood or marrow of 67 patients with CML and found that 35 of them expressed both transcripts whereas the remainder expressed the p210-encoding transcript exclusively. Additional PCR products of an intermediate size were also frequently detected and have been isolated and sequenced. Data from two of these products indicate that they are the result of alternative splicing and include variable combinations of BCR exons. We believe that the expression of the p190-encoding transcript in the chronic phase of CML is also due to alternative splicing. A comparison of patients co-expressing the p190- and p210-encoding transcripts with those patients who expressed only the p210-encoding transcript detected significantly higher white blood cell (WBC) counts and blast cell counts at time of testing as well as significantly higher white blood cell counts at diagnosis.
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Affiliation(s)
- B D Lichty
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario Cancer Institute, Princess Margaret Hospital, Canada
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Goodis HE, White JM, Marshall GW, Yee K, Fuller N, Gee L, Marshall SJ. Effects of Nd: and Ho:yttrium-aluminium-garnet lasers on human dentine fluid flow and dental pulp-chamber temperature in vitro. Arch Oral Biol 1997; 42:845-54. [PMID: 9460538 DOI: 10.1016/s0003-9969(97)00076-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dentine specimens were prepared from freshly extracted third molars and initial permeability measured. Each specimen was subjected to Nd:yttrium-aluminium-garnet (YAG) (1.06 or 1.32 microns wavelength) or Ho:YAG (2.10 microns wavelength) laser energy while temperatures in the pulp chambers were recorded. Permeability was again measured and the surfaces examined by scanning electron microscopy. Six crown segments were used for each laser variable and eight permeability measurements were taken before and eight after laser exposure, while temperature was recorded during treatment. All wavelengths reduced permeability but temperature rises were high enough to have caused pulpal damage, indicating that shorter treatment times and lower power settings may be necessary if used in vivo.
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Affiliation(s)
- H E Goodis
- Division of Endodontics, University of California School of Dentistry, San Francisco 94143, USA
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Crump M, Yee K, Imrie K, Couban S, Stewart A, Saragosa R, Keating A. Platelet recovery after high-dose (HD) chemotherapy (C) is superior with peripheral blood stem cells (PBSC) mobilized by C + G-CSF compared to G-CSF alone. Eur J Cancer 1997. [DOI: 10.1016/s0959-8049(97)84833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Detrich HW, Kieran MW, Chan FY, Barone LM, Yee K, Rundstadler JA, Pratt S, Ransom D, Zon LI. Intraembryonic hematopoietic cell migration during vertebrate development. Proc Natl Acad Sci U S A 1995; 92:10713-7. [PMID: 7479870 PMCID: PMC40682 DOI: 10.1073/pnas.92.23.10713] [Citation(s) in RCA: 466] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Vertebrate hematopoietic stem cells are derived from vental mesoderm, which is postulated to migrate to both extra- and intraembryonic positions during gastrula and neurula stages. Extraembryonic migration has previously been documented, but the origin and migration of intraembryonic hematopoietic cells have not been visualized. The zebrafish and most other teleosts do not form yolk sac blood islands during early embryogenesis, but instead hematopoiesis occurs solely in a dorsal location known as the intermediate cell mass (IM) or Oellacher. In this report, we have isolated cDNAs encoding zebrafish homologs of the hematopoietic transcription factors GATA-1 and GATA-2 and have used these markers to determine that the IM is formed from mesodermal cells in a posterior-lateral position on the yolk syncytial layer of the gastrula yolk sac. Surprisingly, cells of the IM then migrate anteriorly through most of the body length prior to the onset of active circulation and exit onto the yolk sac. These findings support a hypothesis in which the hematopoietic program of vertebrates is established by variations in homologous migration pathways of extra- and intraembryonic progenitors.
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Affiliation(s)
- H W Detrich
- Department of Biology, Northeastern University, Boston, MA 02115, USA
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41
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Sánchez I, Hughes RT, Mayer BJ, Yee K, Woodgett JR, Avruch J, Kyriakis JM, Zon LI. Role of SAPK/ERK kinase-1 in the stress-activated pathway regulating transcription factor c-Jun. Nature 1994; 372:794-8. [PMID: 7997269 DOI: 10.1038/372794a0] [Citation(s) in RCA: 843] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The stress-activated protein kinases (SAPKs), which are distantly related to the MAP kinases, are the dominant c-Jun amino-terminal protein kinases activated in response to a variety of cellular stresses, including treatment with tumour-necrosis factor-alpha and interleukin-beta (refs 1, 2). SAPK phosphorylation of c-Jun probably activates the c-Jun transactivation function. SAPKs are part of a signal transduction cascade related to, but distinct from, the MAPK pathway. We have now identified a novel protein kinase, called SAPK/ERK kinase-1 (SEK1), which is structurally related to the MAP kinase kinases (MEKs). SEK1 is a potent activator of the SAPKs in vitro and in vivo. An inactive SEK1 mutant blocks SAPK activation by extracellular stimuli without interfering with the MAPK pathway. Although alternative mechanisms of SAPK activation may exist, as an immediate upstream activator of the SAPKs, SEK1 further defines a signalling cascade that couples cellular stress agonists to the c-Jun transcription factor.
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Affiliation(s)
- I Sánchez
- Diabetes Research Laboratory, Massachusetts General Hospital East, Charlestown
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42
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Abstract
The early embryonic events involved in the commitment of mesoderm to form blood have not been studied in detail for lack of molecular markers. We have studied the expression of the hematopoietic transcription factors GATA-1 and GATA-2 during Xenopus embryogenesis. During development GATA-1 expression is localized to the ventral region of the embryo and precedes the expression of embryonic globins. GATA-2 is highly expressed in the ventral region of the embryo by the end of gastrulation and later is expressed in the blood island region and the central nervous system. Lithium-induced dorsalization of embryos abrogates GATA-2 expression, and uv-induced ventralization of embryos leads to a radially symmetrical expression of GATA-2. Therefore, GATA-2 expression reflects the ventral character of the embryo. The expression of the GATA-binding proteins and globin in ventral marginal zone explants demonstrates that hematopoiesis is programmed as early as the blastula stage. GATA-1 and GATA-2 are also expressed in cultured animal cap explants, suggesting that these cells have hematopoietic potential. The developmental expression of GATA-1 and GATA-2 is consistent with their role in hematopoiesis in higher organisms and defines the ventral regions of the early embryo that give rise to hematopoietic progenitors. Our studies indicate that these genes will be useful in defining the inductive events that lead to the formation of hematopoietic mesoderm.
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Affiliation(s)
- C Kelley
- Department of Cell and Developmental Biology, Harvard Medical School, Cambridge, Massachusetts 02138
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Yee K, Bander M. Equations of motion for spinning particles in external electromagnetic and gravitational fields. Phys Rev D Part Fields 1993; 48:2797-2799. [PMID: 10016525 DOI: 10.1103/physrevd.48.2797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
Mitogen-activated protein (MAP) kinases comprise an evolutionarily conserved family of proteins that includes at least three vertebrate protein kinases (p42, p44, and p55 MAPK) and five yeast protein kinases (SPK1, MPK1, HOG1, FUS3, and KSS1). Members of this family are activated by a variety of extracellular agents that influence cellular proliferation and differentiation. In Saccharomyces cerevisiae, there are multiple physiologically distinct MAP kinase activation pathways composed of structurally related kinases. The recently cloned vertebrate MAP kinase activators are structurally related to MAP kinase activators in these yeast pathways. These similarities suggest that homologous kinase cascades are utilized for signal transduction in many, if not all, eukaryotes. We have identified additional members of the MAP kinase activator family in Xenopus laevis by a polymerase chain reaction-based analysis of embryonic cDNAs. One of the clones identified (XMEK2) encodes a unique predicted protein kinase that is similar to the previously reported activator (MAPKK) in X. laevis. XMEK2, a highly expressed maternal mRNA, is developmentally regulated during embryogenesis and expressed in brain and muscle. Expression of XMEK2 in yeast cells suppressed the growth defect associated with loss of the yeast MAP kinase activator homologs, MKK1 and MKK2. Partial sequence of a second cDNA clone (XMEK3) identified yet another potential MAP kinase activator. The pattern of expression of XMEK3 is distinct from that of p42 MAPK and XMEK2. The high degree of amino acid sequence similarity of XMEK2, XMEK3, and MAPKK suggests that these three are related members of an amphibian family of protein kinases involved in the activation of MAP kinase. Discovery of this family suggests that multiple MAP kinase activation pathways similar to those in yeast cells exist in vertebrates.
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Affiliation(s)
- B M Yashar
- Department of Chemistry, University of North Carolina, Chapel Hill 27599
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48
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Yee K, Bishop TR, Mather C, Zon LI. Isolation of a novel receptor tyrosine kinase cDNA expressed by developing erythroid progenitors. Blood 1993; 82:1335-43. [PMID: 8394755] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Activation of distinct receptor tyrosine kinases (RTK), such as the products of the c-fms and c-kit proto-oncogenes, profoundly affects hematopoietic development. We have isolated a novel RTK cDNA, called met-related kinase (MRK), which is expressed on early erythroid progenitors. MRK is also expressed in many hematopoietic cell lines, and is not lineage restricted. Several regions within the catalytic domain of MRK have amino acid similarity to the c-met proto-oncogene and v-sea oncogene. Specific polyclonal anti-MRK antisera detects an 84-Kd polypeptide in COS cells transfected with an expression vector containing the MRK cDNA. Further studies of this novel RTK will provide potential insight into its role during hematopoiesis.
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Affiliation(s)
- K Yee
- Division of Hematology, Children's Hospital of Boston, Harvard Medical School, MA 02115
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49
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Affiliation(s)
- D L Bourke
- Baltimore Veterans Affairs Medical Center, Maryland
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50
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Zon LI, Yamaguchi Y, Yee K, Albee EA, Kimura A, Bennett JC, Orkin SH, Ackerman SJ. Expression of mRNA for the GATA-binding proteins in human eosinophils and basophils: potential role in gene transcription. Blood 1993; 81:3234-41. [PMID: 8507862] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The expression of the hematopoietic transcription factors GATA-1, GATA-2, and GATA-3 was studied in eosinophils and basophils. Eosinophils express mRNA for GATA-1, GATA-2, and GATA-3. Basophils express GATA-2 and GATA-3. Treatment of HL-60 eosinophilic sublines with either interleukin-5 or butyric acid increased the expression of GATA-1 mRNA concomitant with the expression of eosinophil-specific genes, whereas levels of GATA-2 mRNA remained relatively constant. The presence of mRNA for these proteins in eosinophils and basophils suggests that gene transcription in these lineages may be regulated by GATA-binding proteins.
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Affiliation(s)
- L I Zon
- Division of Hematology, Children's Hospital, Boston, MA 02115
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