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Caglic I, Sushentsev N, Syer T, Lee KL, Barrett T. Biparametric MRI in prostate cancer during active surveillance: is it safe? Eur Radiol 2024:10.1007/s00330-024-10770-z. [PMID: 38656709 DOI: 10.1007/s00330-024-10770-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
Active surveillance (AS) is the preferred option for patients presenting with low-intermediate-risk prostate cancer. MRI now plays a crucial role for baseline assessment and ongoing monitoring of AS. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations aid radiological assessment of progression; however, current guidelines do not advise on MRI protocols nor on frequency. Biparametric (bp) imaging without contrast administration offers advantages such as reduced costs and increased throughput, with similar outcomes to multiparametric (mp) MRI shown in the biopsy naïve setting. In AS follow-up, the paradigm shifts from MRI lesion detection to assessment of progression, and patients have the further safety net of continuing clinical surveillance. As such, bpMRI may be appropriate in clinically stable patients on routine AS follow-up pathways; however, there is currently limited published evidence for this approach. It should be noted that mpMRI may be mandated in certain patients and potentially offers additional advantages, including improving image quality, new lesion detection, and staging accuracy. Recently developed AI solutions have enabled higher quality and faster scanning protocols, which may help mitigate against disadvantages of bpMRI. In this article, we explore the current role of MRI in AS and address the need for contrast-enhanced sequences. CLINICAL RELEVANCE STATEMENT: Active surveillance is the preferred plan for patients with lower-risk prostate cancer, and MRI plays a crucial role in patient selection and monitoring; however, current guidelines do not currently recommend how or when to perform MRI in follow-up. KEY POINTS: Noncontrast biparametric MRI has reduced costs and increased throughput and may be appropriate for monitoring stable patients. Multiparametric MRI may be mandated in certain patients, and contrast potentially offers additional advantages. AI solutions enable higher quality, faster scanning protocols, and could mitigate the disadvantages of biparametric imaging.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Nikita Sushentsev
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Tom Syer
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Kang-Lung Lee
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tristan Barrett
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom.
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom.
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Stanzione A, Lee KL, Sanmugalingam N, Rajendran I, Sushentsev N, Caglič I, Barrett T. Expect the unexpected: investigating discordant prostate MRI and biopsy results. Eur Radiol 2024:10.1007/s00330-024-10702-x. [PMID: 38503918 DOI: 10.1007/s00330-024-10702-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES To evaluate discrepant radio-pathological outcomes in biopsy-naïve patients undergoing prostate MRI and to provide insights into the underlying causes. MATERIALS AND METHODS A retrospective analysis was conducted on 2780 biopsy-naïve patients undergoing prostate MRI at a tertiary referral centre between October 2015 and June 2022. Exclusion criteria were biopsy not performed, indeterminate MRI findings (PI-RADS 3), and clinically insignificant PCa (Gleason score 3 + 3). Patients with discrepant findings between MRI and biopsy results were categorised into two groups: MRI-negative/Biopsy-positive and MRI-positive/Biopsy-negative (biopsy-positive defined as Gleason score ≥ 3 + 4). An expert uroradiologist reviewed discrepant cases, retrospectively re-assigning PI-RADS scores, identifying any missed MRI targets, and evaluating the quality of MRI scans. Potential explanations for discrepancies included MRI overcalls (including known pitfalls), benign pathology findings, and biopsy targeting errors. RESULTS Patients who did not undergo biopsy (n = 1258) or who had indeterminate MRI findings (n = 204), as well as those with clinically insignificant PCa (n = 216), were excluded, with a total of 1102 patients analysed. Of these, 32/1,102 (3%) were classified as MRI-negative/biopsy-positive and 117/1102 (11%) as MRI-positive/biopsy-negative. In the MRI-negative/Biopsy-positive group, 44% of studies were considered non-diagnostic quality. Upon retrospective image review, target lesions were identified in 28% of cases. In the MRI-positive/Biopsy-negative group, 42% of cases were considered to be MRI overcalls, and 32% had an explanatory benign pathological finding, with biopsy targeting errors accounting for 11% of cases. CONCLUSION Prostate MRI demonstrated a high diagnostic accuracy, with low occurrences of discrepant findings as defined. Common reasons for MRI-positive/Biopsy-negative cases included explanatory benign findings and MRI overcalls. CLINICAL RELEVANCE STATEMENT This study highlights the importance of optimal prostate MRI image quality and expertise in reducing diagnostic errors, improving patient outcomes, and guiding appropriate management decisions in the prostate cancer diagnostic pathway. KEY POINTS • Discrepancies between prostate MRI and biopsy results can occur, with higher numbers of MRI-positive/biopsy-negative relative to MRI-negative/biopsy-positive cases. • MRI-positive/biopsy-negative cases were mostly overcalls or explainable by benign biopsy findings. • In about one-third of MRI-negative/biopsy-positive cases, a target lesion was retrospectively identified.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131, Naples, Italy
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nimalan Sanmugalingam
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
| | - Ishwariya Rajendran
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
| | - Iztok Caglič
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Hills Road, Box 218, Cambridge, CB2 0QQ, UK.
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Barrett T, Lee KL, Illerstam F, Thomsen HS, Jhaveri KS, Løgager V. Interactive training workshop to improve prostate mpMRI knowledge: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship. Insights Imaging 2024; 15:27. [PMID: 38270689 PMCID: PMC10810764 DOI: 10.1186/s13244-023-01574-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/05/2023] [Indexed: 01/26/2024] Open
Abstract
PURPOSE Prostate MRI is established for the investigation of patients presenting with suspected early prostate cancer. Outcomes are dependent on both image quality and interpretation. This study assessed the impact of an educational intervention on participants' theoretical knowledge of the technique. METHODS Eighty-one clinicians from two centers with varying experience in prostate MRI participated. Baseline knowledge was assessed with 10 written and image-based multiple-choice questions (MCQs) prior to a course including didactic lectures and hands-on interactive workshops on prostate MRI interpretation. Post-course, participants completed a second 10-question MCQ test, matched by format, themes, and difficulty, to assess for any improvement in knowledge and performance. Results were assessed using the Wilcoxon rank sum test, and the Wilcoxon signed-rank test for paired data. RESULTS Thirty-nine participants, including 25/49 (51.0%) and 14/32 (43.8%) at each center completed both assessments, with their results used for subsequent evaluation. Overall, there was a significant improvement from pre- (4.92 ± 2.41) to post-course scores (6.77 ± 1.46), p < 0.001 and at both Copenhagen (5.92 ± 2.25 to 7.36 ± 1.25) and Toronto (3.14 ± 1.51 to 5.71 ± 1.20); p = 0.005 and p = 0.002, respectively. Participants with no prostate MRI experience showed the greatest improvement (3.77 ± 1.97 to 6.18 ± 1.5, p < 0.001), followed by intermediate level (< 500 MRIs reported) experience (6.18 ± 1.99 to 7.46 ± 1.13, p = 0.058), then advanced (> 500 MRIs reported) experience (6.83 ± 2.48 to 7.67 ± 0.82, p = 0.339). CONCLUSIONS A dedicated prostate MRI teaching course combining didactic lectures and hands-on workshops significantly improved short-term theoretical knowledge of the technique for clinicians with differing levels of experience. CRITICAL RELEVANCE STATEMENT A dedicated teaching course significantly improved theoretical knowledge of the technique particularly for clinicians with less reporting experience and a lower baseline knowledge. The multiple-choice questions format mapped improved performance and may be considered as part of future MRI certification initiatives. KEY POINTS • Prostate MRI knowledge is important for image interpretation and optimizing acquisition sequences. • A dedicated teaching course significantly improved theoretical knowledge of the technique. • Improved performance was more apparent in clinicians with less reporting experience and a lower baseline knowledge.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
| | - Kang-Lung Lee
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Henrik S Thomsen
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, 3-957, Toronto, ON, M5G 2M9, Canada
| | - Vibeke Løgager
- Department of Radiology, Herlev Gentofte University Hospital, Herlev, Denmark
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Rajendran I, Lee KL, Thavaraja L, Barrett T. Risk stratification of prostate cancer with MRI and prostate-specific antigen density-based tool for personalized decision making. Br J Radiol 2024; 97:113-119. [PMID: 38263825 PMCID: PMC11027333 DOI: 10.1093/bjr/tqad027] [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: 07/04/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES MRI is now established for initial prostate cancer diagnosis; however, there is no standardized pathway to avoid unnecessary biopsy in low-risk patients. Our study aimed to test previously proposed MRI-focussed and risk-adapted biopsy decision models on a real-world dataset. METHODS Single-centre retrospective study performed on 2055 biopsy naïve patients undergoing MRI. Diagnostic pathways included "biopsy all", "MRI-focussed" and two risk-based MRI-directed pathways. Risk thresholds were based on prostate-specific antigen (PSA) density as low (<0.10 ng mL-2), intermediate (0.10-0.15 ng mL-2), high (0.15-0.20 ng mL-2), or very high-risk (>0.20 ng mL-2). The outcome measures included rates of biopsy avoidance, detection of clinically significant prostate cancer (csPCa), missed csPCa, and overdiagnosis of insignificant prostate cancer (iPCa). RESULTS Overall cancer rate was 39.9% (819/2055), with csPCa (Grade-Group ≥2) detection of 30.3% (623/2055). In men with a negative MRI (Prostate Imaging-Reporting and Data System, PI-RADS 1-2), the risk of cancer was 1.2%, 2.6%, 9.0%, and 12.9% in the low, intermediate, high, and very high groups, respectively; for PI-RADS score 3 lesions, the rates were 10.5%, 14.3%, 25.0%, and 33.3%, respectively. MRI-guided pathway and risk-based pathway with a low threshold missed only 1.6% csPCa with a biopsy-avoidance rate of 54.4%, and the risk-based pathway with a higher threshold avoided 62.9% (1292/2055) of biopsies with 2.9% (61/2055) missed csPCa detection. Decision curve analysis found that the "risk-based low threshold" pathway has the highest net benefit for probability thresholds between 3.6% and 13.9%. CONCLUSION Combined MRI and PSA-density risk-based pathways can be a helpful decision-making tool enabling high csPCa detection rates with the benefit of biopsy avoidance and reduced iPCa detection. ADVANCES IN KNOWLEDGE This real-world dataset from a large UK-based cohort confirms that combining MRI scoring with PSA density for risk stratification enables safe biopsy avoidance and limits the over-diagnosis of insignificant cancers.
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Affiliation(s)
- Ishwariya Rajendran
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Liness Thavaraja
- School of Medicine, Addenbrooke’s Hospital, Cambridge CB2 0SP, United Kingdom
| | - Tristan Barrett
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, United Kingdom
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Abstract
Prostate MR imaging quality has improved dramatically over recent times, driven by advances in hardware, software, and improved functional imaging techniques. MRI now plays a key role in prostate cancer diagnostic work-up, but outcomes of the MRI-directed pathway are heavily dependent on image quality and optimization. MR sequences can be affected by patient-related degradations relating to motion and susceptibility artifacts which may enable only partial mitigation. In this Review, we explore issues relating to prostate MRI acquisition and interpretation, mitigation strategies at a patient and scanner level, PI-QUAL reporting, and future directions in image quality, including artificial intelligence solutions.
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Affiliation(s)
- Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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Lin JY, Lu CF, Hu YS, Yang HC, Liu YT, Loo JK, Lee KL, Liao CY, Chang FC, Liou KD, Lin CJ. Magnetic resonance radiomics-derived sphericity correlates with seizure in brain arteriovenous malformations. Eur Radiol 2024; 34:588-599. [PMID: 37553487 DOI: 10.1007/s00330-023-09982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/14/2023] [Accepted: 05/29/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES Angioarchitectural analysis of brain arteriovenous malformations (BAVMs) is qualitative and subject to interpretation. This study quantified the morphology of and signal changes in the nidal and perinidal areas by using MR radiomics and compared the performance of MR radiomics and angioarchitectural analysis in detecting epileptic BAVMs. MATERIALS AND METHODS From 2010 to 2020, a total of 111 patients with supratentorial BAVMs were retrospectively included and grouped in accordance with the initial presentation of seizure. Patients' angiograms and MR imaging results were analyzed to determine the corresponding angioarchitecture. The BAVM nidus was contoured on time-of-flight MR angiography images. The perinidal brain parenchyma was contoured on T2-weighted images, followed by radiomic analysis. Logistic regression analysis was performed to determine the independent risk factors for seizure. ROC curve analysis, decision curve analysis (DCA), and calibration curve were performed to compare the performance of angioarchitecture-based and radiomics-based models in diagnosing epileptic BAVMs. RESULTS In multivariate analyses, low sphericity (OR: 2012.07, p = .04) and angiogenesis (OR: 5.30, p = .01) were independently associated with a high risk of seizure after adjustment for age, sex, temporal location, and nidal volume. The AUC for the angioarchitecture-based, MR radiomics-based, and combined models was 0.672, 0.817, and 0.794, respectively. DCA confirmed the clinical utility of the MR radiomics-based and combined models. CONCLUSIONS Low nidal sphericity and angiogenesis were associated with high seizure risk in patients with BAVMs. MR radiomics-derived tools may be used for noninvasive and objective measurement for evaluating the risk of seizure due to BAVM. CLINICAL RELEVANCE STATEMENT Low nidal sphericity was associated with high seizure risk in patients with brain arteriovenous malformation and MR radiomics may be used as a noninvasive and objective measurement method for evaluating seizure risk in patients with brain arteriovenous malformation. KEY POINTS • Low nidal sphericity was associated with high seizure risk in patients with brain arteriovenous malformation. • The performance of MR radiomics in detecting epileptic brain arteriovenous malformations was more satisfactory than that of angioarchitectural analysis. • MR radiomics may be used as a noninvasive and objective measurement method for evaluating seizure risk in patients with brain arteriovenous malformation.
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Affiliation(s)
- Jih-Yuan Lin
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
| | - Yong-Sin Hu
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
- Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, No. 127, Su-Yuan Rd., Hsin-Chuang Dist., New Taipei City, 24213, Taiwan
| | - Huai-Che Yang
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei City, Taiwan
| | - Yo-Tsen Liu
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei City, Taiwan
- Brain Research Centre, National Yang Ming Chiao Tung University College of Medicine, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
| | - Jing Kai Loo
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
| | - Kang-Lung Lee
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
| | - Chien-Yi Liao
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX, USA
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
| | - Kang-Du Liou
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei City, Taiwan
| | - Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, 11217, Taipei City, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou District, Taipei City, 112, Taiwan.
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Sanmugalingam N, Sushentsev N, Lee KL, Caglic I, Englman C, Moore CM, Giganti F, Barrett T. The PRECISE Recommendations for Prostate MRI in Patients on Active Surveillance for Prostate Cancer: A Critical Review. AJR Am J Roentgenol 2023; 221:649-660. [PMID: 37341180 DOI: 10.2214/ajr.23.29518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations were published in 2016 to standardize the reporting of MRI examinations performed to assess for disease progression in patients on active surveillance for prostate cancer. Although a limited number of studies have reported outcomes from use of PRECISE in clinical practice, the available studies have demonstrated PRECISE to have high pooled NPV but low pooled PPV for predicting progression. Our experience in using PRECISE in clinical practice at two teaching hospitals has highlighted issues with its application and areas requiring clarification. This Clinical Perspective critically appraises PRECISE on the basis of this experience, focusing on the system's key advantages and disadvantages and exploring potential changes to improve the system's utility. These changes include consideration of image quality when applying PRECISE scoring, incorporation of quantitative thresholds for disease progression, adoption of a PRECISE 3F sub-category for progression not qualifying as substantial, and comparisons with both the baseline and most recent prior examinations. Items requiring clarification include derivation of a patient-level score in patients with multiple lesions, intended application of PRECISE score 5 (i.e., if requiring development of disease that is no longer organ-confined), and categorization of new lesions in patients with prior MRI-invisible disease.
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Affiliation(s)
- Nimalan Sanmugalingam
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Kang-Lung Lee
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Cameron Englman
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
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Lee KL, Kessler DA, Dezonie S, Chishaya W, Shepherd C, Carmo B, Graves MJ, Barrett T. Assessment of deep learning-based reconstruction on T2-weighted and diffusion-weighted prostate MRI image quality. Eur J Radiol 2023; 166:111017. [PMID: 37541181 DOI: 10.1016/j.ejrad.2023.111017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/29/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE To evaluate the impact of a commercially available deep learning-based reconstruction (DLR) algorithm with varying combinations of DLR noise reduction settings and imaging parameters on quantitative and qualitative image quality, PI-RADS classification and examination time in prostate T2-weighted (T2WI) and diffusion-weighted (DWI) imaging. METHOD Forty patients were included. Standard-of-care (SoC) prostate MRI sequences including T2WI and DWI were reconstructed without and with different DLR de-noising levels (low, medium, high). In addition, faster T2WI(Fast) and DWI(Fast) sequences, and a higher resolution T2WI(HR) sequence were evaluated. Quantitative analysis included signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and apparent diffusion coefficient (ADC) values. Two radiologists performed qualitative analysis, independently evaluating imaging datasets using 5-point scoring scales for image quality and artifacts. PI-RADS category assignment was also performed by the more experienced radiologist. RESULTS All DLR levels resulted in significantly higher SNR and CNR compared to the DLR(off) acquisitions. DLR allowed the acquisition time to be reduced by 33% for T2WI(Fast) and 49% for DWI(Fast) compared to SoC, without affecting image quality, whilst T2WI(HR) with DLR allowed for a 73% increase in spatial resolution in the phase encode direction compared to SoC. The inter-reader agreement for image quality and artifact scores was substantial for all subjective measurements on T2WI and DWI. The T2WI(Fast) protocol with DLR(medium) and DWI(Fast) with DLR(low) received the highest qualitative quality score. CONCLUSION DLR can reduce T2WI and DWI acquisition time and increase SNR and CNR without compromising image quality or altering PI-RADS classification.
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Affiliation(s)
- Kang-Lung Lee
- Department of Radiology, University of Cambridge, United Kingdom; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | | | - Wellington Chishaya
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Christopher Shepherd
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Bruno Carmo
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Martin J Graves
- Department of Radiology, University of Cambridge, United Kingdom; Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Tristan Barrett
- Department of Radiology, University of Cambridge, United Kingdom.
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Kuo Y, Lee KL, Chen YL, Weng CY, Chang FC, Chen TJ, Wu HM, Wu CH. Working from home: Changes in radiologist reporting behavior in response to the COVID-19 pandemic. J Chin Med Assoc 2023; 86:859-864. [PMID: 37462444 DOI: 10.1097/jcma.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Remote reporting is an important preventive measure against coronavirus disease 2019 (COVID-19) for radiology departments; it reduces the chance of cross-infections between coworkers. The purpose of this study was to evaluate how the preferred locations that radiologists filed reports from changed in response to COVID-19 by measuring the use of internal teleradiology workstations. METHODS Data were obtained from the radiological information system (RIS) database at our institution, which recorded the reporting workstation for each radiological examination. The reporting activities in 2021 were divided into computed radiography (CR) and computed tomography (CT)/magnetic resonance imaging (MRI) groups. The Wilcoxon signed-rank test was used to measure differences in the use of off-site workstations in prepandemic, midpandemic, and postpandemic periods. RESULTS There were statistically significant increases in the number of reports filed from off-site workstations for each attending physician from the prepandemic period to the midpandemic period in both the CR (15.1%-25.4%, p = 0.041) and CT/MRI (18.9%-28.7%, p = 0.006) groups. There was no significant difference noted between the prepandemic and postpandemic periods for either the CR (15.1% vs 18.4%, p = 0.727) or CT/MRI group (18.9% vs 23.3%, p = 0.236). CONCLUSION In response to the COVID-19 outbreak, radiologists used internal teleradiology to report CR and CT/MRI examinations significantly more frequently. In contrast to the predictions of previous studies, the use of internal teleradiology returned to baseline levels after the pandemic was under control.
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Affiliation(s)
- Yu Kuo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kang-Lung Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Yi-Lun Chen
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Yao Weng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Office of the Superintendent, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan, ROC
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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10
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Kuo Y, Lee KL, Chen YL, Weng CY, Chang FC, Chen TJ, Wu HM, Wu CH. Recommendations for additional magnetic resonance imaging in abdominal computed tomography. J Chin Med Assoc 2023; 86:240-245. [PMID: 36346207 DOI: 10.1097/jcma.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Reporting the findings from radiologic images is an important method for radiologists to communicate with referring physicians. The purpose of this study was to evaluate the effectiveness of the recommendations for additional imaging (RAIs) after abdominal computed tomography (CT) studies for abdominal magnetic resonance (MR) imaging. METHODS The institutional review board approved this retrospective study, which includes data collected from the radiology information system (RIS) database of a tertiary medical referral center. Associations between abdominal CT and subsequent abdominal MR were recorded. The effectiveness of RAIs in an abdominal report was determined. The influence of the wording and the location of the RAIs were also analyzed. RESULTS The presence of RAIs in an abdominal CT report for an abdominal MR examination was more likely to result in a subsequent MR examination within 120 days (36.7% vs. 4.0%). RAIs were also associated with a reduction in the time interval between the CT and MR examinations (29.0 days vs. 39.0 days). The most effective recommendations included wording that advocated for further evaluation and were mentioned in both the context and conclusion of the report. CONCLUSION RAIs have a significant influence on clinical decisions. Radiologists should be aware of the power of RAIs and be prudent and conscientious when making recommendations in radiology reports.
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Affiliation(s)
- Yu Kuo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei,Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kang-Lung Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Lun Chen
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei,Taiwan, ROC
| | - Ching-Yao Weng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Office of the Superintendent, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan, ROC
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei,Taiwan, ROC
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11
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Buckels EJ, Hsu HL, Buchanan CM, Matthews BG, Lee KL. Genetic ablation of the preptin-coding portion of Igf2 impairs pancreatic function in female mice. Am J Physiol Endocrinol Metab 2022; 323:E467-E479. [PMID: 36459047 DOI: 10.1152/ajpendo.00401.2021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Preptin is a 34-amino acid peptide derived from the E-peptide of pro-insulin-like growth factor 2 and is co-secreted with insulin from β-cells. Little is understood about the effects of endogenous preptin on whole body glucose metabolism. We developed a novel mouse model in which the preptin portion of Igf2 was genetically ablated in all tissues, hereafter referred to as preptin knockout (KO), and tested the hypothesis that the removal of preptin will lead to a decreased insulin response to a metabolic challenge. Preptin KO and wild-type (WT) mice underwent weekly fasting blood glucose measurements, intraperitoneal insulin tolerance tests (ITT) at 9, 29, and 44 wk of age, and an oral glucose tolerance test (GTT) at 45 wk of age. Preptin KO mice of both sexes had similar Igf2 exon 2-3 mRNA expression in the liver and kidney compared with WT mice, but Igf2 exon 3-4 (preptin) expression was not detectable. Western blot analysis of neonatal serum indicated that processing of pro-IGF2 translated from the KO allele may be altered. Preptin KO mice had similar body weight, body composition, β-cell area, and fasted glucose concentrations compared with WT mice in both sexes up to 47 wk of age. Female KO mice had a diminished ability to mount an insulin response following glucose stimulation in vivo. This effect was absent in male KO mice. Although preptin is not essential for glucose homeostasis, when combined with previous in vitro and ex vivo findings, these data show that preptin positively impacts β-cell function.NEW & NOTEWORTHY This is the first study to describe a model in which the preptin-coding portion of the Igf2 gene has been genetically ablated in mice. The mice do not show reduced size at birth associated with Igf2 knockout suggesting that IGF2 functionality is maintained, yet we demonstrate a change in the processing of mature Igf2. Female knockout mice have diminished glucose-stimulated insulin secretion, whereas the insulin response in males is not different to wild type.
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Affiliation(s)
- E J Buckels
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, New Zealand
| | - H-L Hsu
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
| | - C M Buchanan
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, New Zealand
| | - B G Matthews
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, New Zealand
| | - K L Lee
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, New Zealand
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12
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Chew N, Zhang A, Kong G, Lee KL, Ng CH, Chong B, Ngiam N, Loh PH, Kuntjoro I, Wong R, Kong W, Yeo TC, Poh KK. Prognostically distinct phenotypes of metabolic health beyond obesity in aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1608] [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: 11/13/2022] Open
Abstract
Abstract
Background
Whilst current evidence are in favour of metabolic health and non-obesity in the reduction of incident cardiovascular disease, little is known regarding the prognosis across the metabolic phenotypes once cardiovascular disease occurs. This study examined the prognosis of patients with significant aortic stenosis (AS) based on the presence of metabolic health and obesity.
Methods
This retrospective cohort on consecutive patients presenting with moderate-to-severe AS to a tertiary hospital between 2010 and 2015. Patients were allocated into 4 groups based on obesity and metabolic health: metabolically healthy obese (MHO), metabolically healthy non-obese (MHNO), metabolically unhealthy obese (MUO) and metabolically unhealthy non-obese (MUNO). Metabolic health was defined in accordance to Program Adult Treatment Panel III criteria. The primary outcome was all-cause mortality. Cox regression examined independent associations between mortality and metabolic phenotypes, adjusting for aortic valve area, ejection fraction, age, sex, chronic kidney disease and AVR as a time-dependent covariate.
Results
Of 727 patients, the majority (51.6%) were MUNO, followed by MUO (32.7%), MHNO (11.4%), and MHO (4.3%). MHNO had the highest mortality (43.0%), followed by the MUNO (37.5%), MUO (30.0%) and MHO (6.9%) groups (p=0.001). Compared to MHNO, MHO (HR 0.159, 95% CI 0.038–0.668, p=0.012) and MUO (HR 0.614, 95% CI 0.403–0.937, p=0.024) were independently associated with lower all-cause mortality rates, after adjusting for confounders. In obese patients, metabolic health had favourable survival compared to metabolically unhealthy (p=0.015), but this protective impact of metabolic health was not observed in overweight or normal weight individuals. Obesity had favourable survival compared to overweight and normal weight, in both metabolically health (p=0.002) and unhealthy (p=0.007) patients,
Conclusion
MHO patients with AS have the most favourable prognosis whilst the seemingly healthy MHNO group had the worst survival. There should be a paradigm shift towards prioritising metabolic health rather than weight reduction in patients with significant AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - A Zhang
- National University Health System , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - K L Lee
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - B Chong
- National University of Singapore , Singapore , Singapore
| | - N Ngiam
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre , Singapore , Singapore
| | - R Wong
- National University Heart Centre , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
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13
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Yu HY, Li CP, Huang YH, Hsu SJ, Wang YP, Hsieh YC, Fang WL, Huang KH, Li AFY, Lee RC, Lee KL, Wu YH, Lai IC, Yang WC, Hung YP, Wang YC, Chen SH, Chen MH, Chao Y. Microsatellite Instability, Epstein-Barr Virus, and Programmed Cell Death Ligand 1 as Predictive Markers for Immunotherapy in Gastric Cancer. Cancers (Basel) 2022; 14:218. [PMID: 35008382 PMCID: PMC8750088 DOI: 10.3390/cancers14010218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/17/2022] Open
Abstract
Immunotherapy benefits selected cases of gastric cancer (GC), but the correlation between biomarkers and prognosis is still unclear. Fifty-two patients with GC who underwent immunotherapy were enrolled from June 2016 to December 2020. Their clinical features and biomarkers-microsatellite instability-high (MSI-H), programmed cell death ligand 1 (PD-L1) combined positive score (CPS), and Epstein-Barr encoding region (EBER)-were analyzed. Eight patients had MSI-H, five patients had EBER, 29 patients had CPS ≥ 1, and 20 patients had no biomarker. The overall response rates (ORRs) of the MSI-H, EBER, PD-L1 CPS ≥ 1, and all-negative group were 75%, 60%, 44.8%, and 15%, respectively. Compared with that of the all-negative group, progression-free survival (PFS) was better in the MSI-H (p = 0.018), CPS ≥ 5 (p = 0.012), and CPS ≥ 10 (p = 0.006) groups, but not in the EBER (p = 0.2) and CPS ≥ 1 groups (p = 0.35). Ten patients had combined biomarkers, CPS ≥ 1 with either MSI-H or EBER. The ORRs were 66.7% for CPS ≥ 1 and MSI-H and 75% for CPS ≥ 1 and EBER. PFS was better in patients with combined biomarkers (p = 0.01). MSI-H, EBER, and CPS are useful biomarkers for predicting the efficacy of immunotherapy.
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Affiliation(s)
- Hung-Yuan Yu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-Y.Y.); (C.-P.L.); (Y.-H.H.); (S.-J.H.); (Y.-P.W.); (Y.-C.H.)
- Hospitalist Ward, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
| | - Chung-Pin Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-Y.Y.); (C.-P.L.); (Y.-H.H.); (S.-J.H.); (Y.-P.W.); (Y.-C.H.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-Y.Y.); (C.-P.L.); (Y.-H.H.); (S.-J.H.); (Y.-P.W.); (Y.-C.H.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
| | - Shao-Jung Hsu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-Y.Y.); (C.-P.L.); (Y.-H.H.); (S.-J.H.); (Y.-P.W.); (Y.-C.H.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
| | - Yen-Po Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-Y.Y.); (C.-P.L.); (Y.-H.H.); (S.-J.H.); (Y.-P.W.); (Y.-C.H.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
| | - Yun-Cheng Hsieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (H.-Y.Y.); (C.-P.L.); (Y.-H.H.); (S.-J.H.); (Y.-P.W.); (Y.-C.H.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
| | - Wen-Liang Fang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Kuo-Hung Huang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Anna Fen-Yau Li
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Department of Pathology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Rheun-Chuan Lee
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Kang-Lung Lee
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Yuan-Hung Wu
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Department of Oncology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - I-Chun Lai
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Department of Oncology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Wan-Chin Yang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Department of Oncology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Yi-Ping Hung
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Department of Oncology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Yu-Chao Wang
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Shu-Hui Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Ming-Huang Chen
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Department of Oncology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Yee Chao
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (W.-L.F.); (K.-H.H.); (A.F.-Y.L.); (R.-C.L.); (K.-L.L.); (Y.-H.W.); (I.-C.L.); (W.-C.Y.); (Y.-P.H.)
- Department of Oncology, Taipei Veterans General Hospital, Taipei 112201, Taiwan
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14
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Kwok KM, Lee KL, Lam SY, Liong T, Wong HM, Lam PY, Chow EY, Law KI. Rotational thromboelastometry as a powerful tool to detect hyperfibrinolysis in a bleeding patient: a case report. Hong Kong Med J 2021; 27:370-372. [PMID: 34706990 DOI: 10.12809/hkmj208971] [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: 11/05/2022] Open
Affiliation(s)
- K M Kwok
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - K L Lee
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - S Y Lam
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - T Liong
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - H M Wong
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - P Y Lam
- Intensive Care Department, United Christian Hospital, Hong Kong
| | - E Y Chow
- Pathology Department, United Christian Hospital, Hong Kong
| | - K I Law
- Intensive Care Department, United Christian Hospital, Hong Kong
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15
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Cheung C, Ng CY, Lee KL, Wu KX, Chioh FWJ, Tan K, Siau A, Muthiah MD, Chen QF, Tan NS, Ng HH, Dan YY. Endothelial-T cell crosstalk contributes to vascular injury in fatty liver disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Cardiovascular complications are often the fundamental causes of death in non-alcoholic fatty liver disease (NAFLD) patients. While there are known systemic mediators in NAFLD that may induce vascular inflammation, the mechanism of endothelial dysfunction remain understudied. In this work, we harnessed the replicative potential of blood outgrowth endothelial cells (BOECs) to develop personalized cell lines from NAFLD patients and healthy controls. Our transcriptomic analysis showed that the top interactome network enriched in NAFLD BOECs comprised of several C-C and C-X-C chemokine ligands involved in immune cell chemotaxis. We previously reported T cell infiltration in mouse model of non-alcoholic steatohepatitis, and here, we confirmed enhanced endothelial chemokine signatures in arterial histological sections. To elucidate endothelial-immune crosstalk, we performed single-cell analysis on human peripheral blood mononuclear cells and found T cell intensification in NAFLD patients compared to healthy controls. Our immunoprofiling by flow cytometry further revealed that NAFLD patients possessed higher levels CD8+ memory cells. Functionally, T cells, instead of monocytes, adhered more pronouncedly to NAFLD BOECs. In evaluating the CXCL12-CXCR4 axis in chemotaxis, CXCR4 antagonist (AMD3100) substantially modulated the migration of patient-derived CD8+ T cells towards NAFLD BOECs, which was not observed in healthy endothelial-T cell chemotaxis coculture. Finally, we validated NAFLD-associated endothelial dysfunction by enumerating two folds more circulating endothelial cells, a biomarker of vascular injury, in the blood samples of NAFLD patients than healthy controls. Our work provides insights for translation to restore blood vessel health and potentially mitigate adverse vascular events in NAFLD.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Industrial Alignment Fund Pre-Positioning grant from the Agency for Science, Technology and Research, Singapore Endothelial-T cell crosstalk in NAFLD
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Affiliation(s)
- C Cheung
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - C Y Ng
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - K L Lee
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - K X Wu
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - F W J Chioh
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - K Tan
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - A Siau
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - M D Muthiah
- National University Health System, Singapore, Singapore
| | - Q F Chen
- Agency for Science, Technology and Research, Singapore, Singapore
| | - N S Tan
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - H H Ng
- Agency for Science, Technology and Research, Singapore, Singapore
| | - Y Y Dan
- National University Health System, Singapore, Singapore
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16
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Joynt GM, Leung AKH, Ho CM, So D, Shum HP, Chow FL, Yeung AWT, Lee KL, Tang GKY, Yan WW. Admission triage tool for adult intensive care unit admission in Hong Kong during the COVID-19 outbreak. Hong Kong Med J 2021; 28:64-72. [PMID: 33518531 DOI: 10.12809/hkmj209033] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intensive care is expensive, and the numbers of intensive care unit (ICU) beds and trained specialist medical staff able to provide services in Hong Kong are limited. The most recent increase in coronavirus disease 2019 (COVID-19) infections over July to August 2020 resulted in more than 100 new cases per day for a prolonged period. The increased numbers of critically ill patients requiring ICU admission posed a capacity challenge to ICUs across the territory, and it may be reasonably anticipated that should a substantially larger outbreak occur, ICU services will be overwhelmed. Therefore, a transparent and fair prioritisation process for decisions regarding patient ICU admission is urgently required. This triage tool is built on the foundation of the existing guidelines and framework for admission, discharge, and triage that inform routine clinical practice in Hospital Authority ICUs, with the aim of achieving the greatest benefit for the greatest number of patients from the available ICU resources. This COVID-19 Crisis Triage Tool is expected to provide structured guidance to frontline doctors on how to make triage decisions should ICU resources become overwhelmed by patients requiring ICU care, particularly during the current COVID-19 pandemic. The triage tool takes the form of a detailed decision aid algorithm based on a combination of established prognostic scores, and it should increase objectivity and transparency in triage decision making and enhance decision-making consistency between doctors within and across ICUs in Hong Kong. However, it remains an aid rather than a complete substitute for the carefully considered judgement of an experienced intensive care clinician.
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Affiliation(s)
- G M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - A K H Leung
- Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong
| | - C M Ho
- Department of Intensive Care, Tuen Mun Hospital, Hong Kong
| | - D So
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong
| | - H P Shum
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - F L Chow
- Department of Intensive Care, Caritas Medical Centre, Hong Kong
| | - A W T Yeung
- Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals, Hong Kong
| | - K L Lee
- Department of Intensive Care, United Christian Hospital, Hong Kong
| | - G K Y Tang
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong
| | - W W Yan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong
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17
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Abstract
BACKGROUND Primary pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare subtype of lung cancer. Both small-cell lung cancer (SCLC) and LELC often manifest as a centrally located tumor with lymphadenopathy. This retrospective study investigated and compared the initial computed tomography (CT) features and subsequent survival outcomes of LELC and SCLC. METHODS A total of 50 patients with a confirmed diagnosis of LELC were enrolled and matched at a ratio of 1:1 with patients with SCLC according to the tumor stage. Utilizing a consensus approach, two radiologists reviewed pretreatment CT images. Survival outcomes were analyzed. RESULTS Well-defined tumors were significantly more common in the LELC group (LELC: 42% vs SCLC: 24%, p = 0.005). Based on the comparisons of the primary tumor with the muscles, LELC tumors exhibited a significantly higher percentage of attenuation on contrast-enhanced CT scans (21.6% ± 29% vs -14.2% ± 37%, p < 0.001). The prevalence of vascular or bronchial encasement (18% vs 40%, p = 0.028), background emphysematous changes (10% vs 60%, p < 0.001), and tumors located in upper lobes (18% vs 64%, p < 0.001) was significantly lower in the LELC group. Female gender (70% vs 12%, p < 0.001), younger age (57.6 ± 12.0 years vs 68.0 ± 11.0 years, p < 0.001), and without a history of smoking (16% vs 88%, p < 0.001) were factors more commonly found in the LELC group. The patients with LELC had a better prognosis with significantly longer median survival than did the patients with SCLC (23.4 months vs 17.3 months, p = 0.01). CONCLUSION Because SCLC demonstrated a more aggressive disease progression, differentiating LELC from SCLC is crucial. In Epstein-Barr virus-endemic areas, the diagnosis of LELC should be considered when approaching a patient with the above-mentioned CT and clinical features.
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Affiliation(s)
- Kang-Lung Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Mei-Han Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Imaging – Diagnostic Radiology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Address correspondence. Dr. Mei-Han Wu, Department of Medical Imaging – Diagnostic Radiology, Cheng Hsin General Hospital, 45, Cheng Hsin Street, Taipei 112, Taiwan, ROC. E-mail address: (M.-H. Wu)
| | - Ying-Yu Jhang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Chen Yen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Chun Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
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18
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Tsai CK, Liu YC, Kuan AS, Lee KL, Yeh CM, Lee YT, Hsiao LT, Ko PS, Wang HY, Chen PM, Liu JH, Hong YC, Liu CJ, Gau JP. Risk and impact of invasive fungal infections in patients with multiple myeloma. Ann Hematol 2020; 99:1813-1822. [PMID: 32607596 DOI: 10.1007/s00277-020-04125-z] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/03/2020] [Indexed: 01/10/2023]
Abstract
Infection is associated with great morbidity and mortality in patients with multiple myeloma (MM), but evidence for invasive fungal infections (IFIs) is lacking. We aimed to investigate risk factors for IFI in MM patients and to determine its impact on patients' survival. We retrospectively analyzed MM patients at Taipei Veterans General Hospital in Taiwan between January 2002 and October 2018. MM was diagnosed according to the International Myeloma Working Group criteria. IFI was defined according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. All risk factors of IFI in MM patients were estimated using Cox regression models in the univariate and multivariate analyses. Of the 623 patients recruited, 22 (3.5%) were diagnosed with proven or probable IFI. Light chain disease (adjusted hazard ratio [HR] 6.74, 95% confidence interval [CI] 2.10-21.66), hemoglobin less than 8 g/dl (adjusted HR 3.34, 95% CI 1.32-8.42), serum albumin < 3.5 g/dl (adjusted HR 3.24, 95% CI 1.09-9.68), and having received allogeneic stem cell transplantation (allo-SCT) (adjusted HR 5.98, 95% CI 1.62-22.03) were significantly associated with IFI in the multivariate analysis. Contracting IFI was in turn associated with early mortality (adjusted HR 11.60, 95% CI 1.26-106.74). Light chain disease, anemia, hypoalbuminemia, and receiving allo-SCT were independent predictors of IFI in MM patients. The early mortality risk is much higher in those encountering IFI. Physicians must be aware of the rare but potentially lethal infections.
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Affiliation(s)
- Chun-Kuang Tsai
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
| | - Yao-Chung Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ai Seon Kuan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Division of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kang-Lung Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ting Lee
- Division of Hematology and Oncology, Department of Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Shen Ko
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Yuan Wang
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Min Chen
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan.,Chong Hin Loon Cancer and Biotherapy Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chung Hong
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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19
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Poole J, Russo AM, Cha YM, Monahan KH, Al-Khalidi HR, Silverstein AP, Bahnson TD, Mark DB, Lee KL, Packer DL. P2832Outcomes of catheter ablation for atrial fibrillation based on sex: data from the cabana trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1142] [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: 11/12/2022] Open
Abstract
Abstract
Background
Sex-specific outcomes may differ amongst patients receiving catheter ablation for atrial fibrillation (AF).
Purpose
Assess sex-specific outcomes in the patients randomized to catheter ablation or drug therapy in CABANA.
Methods
CABANA randomized 2204 pts with AF to catheter ablation or drug therapy (rate/rhythm-control). The outcomes of combined death, disabling stroke, severe bleeding, or cardiac arrest (intention to treat-ITT) or all-cause death were not different. But, ablation significantly improved combined death or CV hospitalization. This analysis compares clinical characteristics by sex and determines sex-specific hazard ratios based on a comparison of ablation vs drug therapy.
Results
Females were 37.3% of ablation and 37.0% of drug therapy patients. Females were older, more often white race, had less CAD, or sleep apnea, but had higher NYHA Class, higher CHA2DS2VASc, and more often had paroxysmal (v. persistent) AF, and prior AF hospitalization. (Table) HTN, CVA and diabetes were the same (Table).
For the CABANA primary endpoint, an ITT comparison of ablation vs. drug therapy, showed a female hazard ratio (HR) of 1.14 (95% confidence interval (CI) 0.70–1.86), and a male HR of 0.74, (95% CI 0.52–1.06). For all-cause mortality, the female HR was 0.75 (95% CI 0.41–1.40) and male HR was 0.91 (95% CI 0.59–1.40) and for all-cause mortality or CV hospitalization, the female HR was 0.90 (95% CI 0.75–1.09) and male HR was 0.79 (95% CI 0.69–0.92). All interaction p values were non-significant.
Recurrent AF (post 90-day blanking) was significantly reduced for both females and males: female HR 0.64 (95% CI 0.51–0.82), male HR 0.46 95% CI 0.39–0.56), p=0.035
Clinical Characteristics and Outcomes Baseline Characteristics Female (N=818) Male (N=1385) p-value Age: Median (Q1, Q3) 69 (65, 74) 66 (60, 71) <0.001 White 766 (93.9%) 1259 (91.0%) 0.015 CAD 92 (11.2%) 332 (24.0%) <0.001 NYHA ≥II 345 (42.4%) 433 (31.5%) <0.001 Sleep apnea 136 (16.6%) 372 (26.9%) <0.001 CHA2DS2-VASc: Median (Q1, Q3) 3 (3, 4) 2 (1, 3) <0.001 Paroxysmal AF 406 (49.6%) 540 (39.0%) <0.001 Persistent AF 412 (50.4%) 845 (61.0%) AF Hospitalization 353 (43.2%) 521 (37.7%) 0.011
Conclusion
Significant sex-specific outcomes differences were not observed. Sex should not be used as a determining factor in selecting patients for AF therapy.
Acknowledgement/Funding
NIH, St Jude Medical Foundation and Corporation, Biosense Webster Inc., Medtronic Corporation, and Boston Scientific Corporation
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Affiliation(s)
- J Poole
- University of Washington, Seattle, United States of America
| | - A M Russo
- Cooper University Hospital, Camden, United States of America
| | - Y M Cha
- Mayo Clinic, Rochester, United States of America
| | - K H Monahan
- Mayo Clinic, Rochester, United States of America
| | - H R Al-Khalidi
- Duke Clinical Research Institute, Durham, United States of America
| | - A P Silverstein
- Duke Clinical Research Institute, Durham, United States of America
| | - T D Bahnson
- Duke University Medical Center, Durham, United States of America
| | - D B Mark
- Duke University Medical Center, Durham, United States of America
| | - K L Lee
- Duke Clinical Research Institute, Durham, United States of America
| | - D L Packer
- Mayo Clinic, Rochester, United States of America
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20
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Poon WL, Lee KL, Chan K. P4427Cardiovascular outcomes among runners of a marathon race - a 17 years' experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0829] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Over the past 17 years (2002–2018), 898,831 people participated in the Hong Kong Standard Chartered Marathon (HKSCM).
Purpose
We aim to study the incidence of marathon-related sudden cardiac arrest (SCA) and non-fatal myocardial injury (NFMI).
Methods
All the HKSCM related admissions between 2002 and 2017 were retrieved from the accident and emergency department admission records. We reviewed the data of HKSCM runners admitted for SCA and NFMI.
Results
Fourteen and thirty-nine runners were admitted for SCA (Mean age 38±13 years-old, 12 men) and NFMI (Mean age 42±12 years-old; 34 men) respectively.
Among the SCA runners, the arrest rhythms could not be retrieved in 3 cases. In the remaining 11 SCA runners, the arrest rhythms were ventricular fibrillation (VF) (N=6), pulseless-electrical activity (PEA) (N=3), and asystole (N=2). Nine of the 14 SCA runners were successfully resuscitated. Only 2 out of the 14 SCA runners had significant atherosclerotic coronary artery disease (CAD) requiring coronary angioplasty. Among the SCA runners, the etiologies of cardiac arrest were myocardial infarction (MI) (N=2), ischemic cardiomyopathy with VF (N=1), idiopathic VF (N=3), malignant coronary anomaly (N=1), and idiopathic (N=5). Percutaneous coronary intervention (PCI) was performed in 2 SCA runner with MI. Implantable cardioverter-defibrillators were implanted in 1 resuscitated runner with VF. Postmortem examination of the 3 deceased runners showed significant CAD in two and was unrevealing in one.
Among the 39 NFMI runners, coronary angiograms (CAG) or CT coronary angiogram were performed in 14 cases (36%), which showed minor CAD or unremarkable findings in 7 runners, and significant CAD in 7 runners. PCI and coronary artery bypass were performed in 5 and 2 NFMI runners respectively. Only 8 out of 39 NFMI runners reported chest pain. Significant ischemic ECG changes were detected in 9 out of 39 NFMI runners. Invasive CAGs were not performed in the remaining NFMI runners due to low pre-test likelihood of CAD and normal non-invasive test results.
Conclusions
The incidence of SCA and mortality among HKSCM runners was 1.56 per 100,000 and 0.56 per 100,000 respectively. The incidence of NFMI was 4.3 per 100,000. Coronary artery disease, coronary anomaly and idiopathic VF were the commonest etiologies of SCA.
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Affiliation(s)
- W L Poon
- Ruttonjee Hospital, Hong Kong, Hong Kong
| | - K L Lee
- Ruttonjee Hospital, Hong Kong, Hong Kong
| | - K Chan
- The University of Hong Kong - Shenzhen Hospital, Medicine, Shenzhen, China
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21
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Monahan KH, Bunch TJ, Poole JE, Bahnson TD, Al-Khalidi HR, Silverstein AP, Mark DB, Lee KL, Packer DL. 484Impact of AF type on the outcome of atrial fibrillation ablation: insights from the CABANA trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0134] [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: 11/13/2022] Open
Abstract
Abstract
Background
Prior studies suggest that catheter ablation (ABL) for atrial fibrillation (AF) is a treatment option for patients (pts) with paroxysmal AF (PAF). Pts with persistent (Per) or long-standing persistent (LSP) were routinely excluded from most ABL based clinical trials. The effectiveness of ABL compared to drug therapy (MED) in relation to underlying AF type has not been evaluated in a large randomized clinical trial.
Objective
To assess the impact of AF type on clinical outcomes of ABL vs. MED in pts with AF.
Methods
The CABANA trial randomized 2204 pts with AF at 126 sites worldwide to ABL vs. MED with rate or rhythm control drugs. The primary endpoint was a composite of death, disabling stroke, severe bleeding, or cardiac arrest. Key secondary endpoints included mortality and recurrence of AF. Outcomes of ABL vs. MED were compared within subgroups defined by AF type using Intention-to-Treat (ITT) analyses.
Results
Of the 2204 pts, 946 had PAF, 1042 had Per and 215 presented with LSP. There were baseline differences among AF types in age, gender, HTN, LVH, CHF and NYHA Class. For the primary endpoint, there were no significant differences between ABL and MED in pts with PAF (hazard ratio (HR) 0.82; 95% confidence interval (CI) 0.51, 1.31), Per (HR 0.87; 95% CI 0.59, 1.28), or LSP (HR 1.01, 95% CI 0.39, 2.61). Likewise, there were no significant treatment differences in mortality; PAF (HR 0.84; 95% CI 0.46, 1.52), Per (HR 0.90; 95% CI 0.56, 1.46) and LSP (HR 0.67, 95% CI 0.23, 1.94). Post-blanking AF (time to first recurrence) was significantly reduced by ABL compared to MED across all AF types (PAF by 51%), (Per by 47%) and (LSP by 36%).
Clinical Characteristics and Outcomes Clinical Outcomes Comparing ABL vs. MED (HR and 95% CI) Interaction p-value Primary Endpoint 0.82 (0.51, 1.31) 0.87 (0.59, 1.28) 1.01 (0.39, 2.61) 0.925 Mortality 0.84 (0.46, 1.52) 0.90 (0.56, 1.46) 0.67 (0.23, 1.94) 0.881 Recurrent AF 0.49 (0.38, 0.62) 0.53 (0.43, 0.65) 0.64 (0.41, 1.01) 0.564
Conclusion
Pts with LSP have a lower proportion of women, and a higher proportion with manifestations of heart failure despite lower CHA2DS2VASc scores. By ITT analysis, there is no significant effect of ABL compared to MED in the primary endpoint or mortality in any AF group. However, ABL is more effective than MED for reducing recurrences of AF regardless of AF type, but with a greater effect in PAF vs Per vs LSP.
Acknowledgement/Funding
NIH, St Jude Medical Foundation and Corporation, Biosense Webster Inc., Medtronic Corporation, and Boston Scientific Corporation
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Affiliation(s)
- K H Monahan
- Mayo Clinic, Rochester, United States of America
| | - T J Bunch
- Intermountain Medical Center, Salt Lake City, United States of America
| | - J E Poole
- University of Washington, Seattle, United States of America
| | - T D Bahnson
- Duke University Medical Center, Durham, United States of America
| | - H R Al-Khalidi
- Duke Clinical Research Institute, Durham, United States of America
| | - A P Silverstein
- Duke Clinical Research Institute, Durham, United States of America
| | - D B Mark
- Duke University Medical Center, Durham, United States of America
| | - K L Lee
- Duke Clinical Research Institute, Durham, United States of America
| | - D L Packer
- Mayo Clinic, Rochester, United States of America
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22
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Lee KL, Chiu NC, Su CW, Tseng HS, Lee RC, Liu CA, Lin HH, Chen TJ, Chiou YY. Less barium enema, more colonoscopy: A 12-year nationwide population-based study in Taiwan. J Chin Med Assoc 2019; 82:312-317. [PMID: 30865106 DOI: 10.1097/jcma.0000000000000074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common and third most fatal cancer in Taiwan. To reduce incidence and mortality rates from cancer, including CRC, the Health Promotion Administration in Taiwan initiated the National Program on Cancer Prevention in 2005. For patients who have a positive fecal occult blood test, colonoscopy is recommended, and double-contrast barium enema (BE) is reserved as an alternative for those who cannot receive colonoscopy. In addition, single-contrast BE is sometimes used in pediatrics to evaluate colonic condition. This study evaluated the usage trends of BE and colonoscopy in Taiwan. METHODS Data from the National Health Insurance Research Database from 2001 to 2013 were used in this study. Patients who received BE and colonoscopy were identified using the procedure codes of the National Health Insurance program. Age-standardized, yearly rates of BE and colonoscopy procedures were calculated. RESULTS According to the data, the total number of colonoscopies increased 3.7-fold from 2001 to 2013. The compound annual growth rates for BE and colonoscopy were -5.36% and 10.47%, respectively, during the same period. The compound annual growth rates for BE and colonoscopy were -3.89% and 11.64% from 2005 to 2009, and -11.36% and 9.82% from 2010 to 2013, respectively. BE was conducted significantly more frequently than colonoscopy in patients who were aged <12 years and in female patients. CONCLUSION Professional association guidelines, national cancer prevention programs, patient and physician preferences, and increasing awareness and knowledge of CRC may all contribute to the increasing use of colonoscopy and the dramatic decline in the use of BE in Taiwan.
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Affiliation(s)
- Kang-Lung Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Nai-Chi Chiu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chien-Wei Su
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiuo-Shan Tseng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hung-Hsin Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yi-You Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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23
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Leung SC, Yung CY, Chan K, Lee KL, Lau YK. P992Efficacy of subclinical atrial fibrillation screening by AliveCor in patients with CHA2DS2-VASc score ≥2. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S C Leung
- Ruttonjee and Tang Shiu Kin Hospitals, Medicine, Hong Kong, China People's Republic of
| | - C Y Yung
- Ruttonjee and Tang Shiu Kin Hospitals, Medicine, Hong Kong, China People's Republic of
| | - K Chan
- Ruttonjee and Tang Shiu Kin Hospitals, Medicine, Hong Kong, China People's Republic of
| | - K L Lee
- Ruttonjee and Tang Shiu Kin Hospitals, Medicine, Hong Kong, China People's Republic of
| | - Y K Lau
- Ruttonjee and Tang Shiu Kin Hospitals, Medicine, Hong Kong, China People's Republic of
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24
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Lee KL, Chen TJ, Won GS, Chou YH, Chiou HJ, Wang HK, Lai YC, Lin YH, Wang J. The use of fine needle aspiration and trends in incidence of thyroid cancer in Taiwan. J Chin Med Assoc 2018; 81:164-169. [PMID: 29174930 DOI: 10.1016/j.jcma.2017.09.008] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 09/30/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Thyroid cancer is the most prevalent endocrine malignancy, and the incidence of thyroid cancer has increased worldwide. Fine needle aspiration (FNA) for cytology of thyroid tissue is used for differentiating thyroid cancers from benign thyroid nodules. Overuse of FNA may detect subclinical thyroid cancer and play a role in the increased incidence of thyroid cancer. The aim of this study was to evaluate trends in incidence of thyroid cancer and the use of palpation-guided FNA thyroid and ultrasound-guided FNA thyroid in Taiwan. METHODS By retrospectively analyzing a cohort dataset of one million people randomly sample to represent as NHI beneficiaries of Taiwan National Health Insurance Research Database from 2004 to 2010, patients who received palpation-guided and ultrasound-guided thyroid FNA were identified. Individuals who were diagnosed as having thyroid cancer were determined. Age-standardized, yearly rates of palpation-guided thyroid FNA and ultrasound-guided FNA, and age-standardized, yearly incidence rates of thyroid cancer were calculated. RESULTS In the study period, a total of 541 patients were newly diagnosed with thyroid cancer, 14,240 individuals received palpation-guided thyroid FNA, and 3823 individuals underwent ultrasound-guided thyroid FNA. There was a 94.8% increase in the age-standardized annual incidence rate of thyroid cancer. The age-standardized rates of palpation-guided thyroid FNA and ultrasound-guided thyroid FNA increased by 10.9% and 349.3%, respectively. CONCLUSION FNA for cytology of thyroid tissue, especially ultrasound-guided FNA, was conducted by physicians more frequently in Taiwan. Increased use of FNA, especially ultrasound-guided FNA for cytology of thyroid tissue, may attribute to the increased incidence of thyroid cancer in Taiwan.
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Affiliation(s)
- Kang-Lung Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ging-Shing Won
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC; Yuanpei University of Medical Technology, Hsinchu, Taiwan, ROC.
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Hsin-Kai Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Yi-Chen Lai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Yung-Hui Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Jane Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
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Kwok KM, Lee KL, Poon YS, Lam SY, Liong T, Wong HM, Chiu NK, Law KI. Portomesenteric vein thrombosis following laparoscopic sleeve gastrectomy in a Chinese patient. Hong Kong Med J 2017; 23:651-2. [PMID: 29226834 DOI: 10.12809/hkmj166321] [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] [Indexed: 11/05/2022] Open
Affiliation(s)
- K M Kwok
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - K L Lee
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - Y S Poon
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - S Y Lam
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - T Liong
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - H M Wong
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
| | - N K Chiu
- Department of Surgery, United Christian Hospital, Kwun Tong, Hong Kong
| | - K I Law
- Department of Intensive Care, United Christian Hospital, Kwun Tong, Hong Kong
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Lee KL, Ng HW, Tse ML, Lau FL. Daytime versus Night Time Intentional Drug Overdose: The Outcome is Different. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700406] [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: 11/16/2022] Open
Abstract
Introduction In drug overdose, it is generally perceived that the dosage can predict the clinical outcome. Are the dosages of intentional drug overdosing the same between day and night? If so, are these overdoses followed by similar clinical outcomes? Answers to these two questions might affect resource allocation and clinical judgment. The present study was performed to establish whether daytime patients and night time patients report similar drug doses, and see which group of patients would have a higher incidence of severe outcomes. Method A retrospective observational study on intentional drug overdose was performed. The reported numbers of total tablets ingested and the incidences of major outcomes, in terms of death and intensive care unit admissions, were compared between daytime and night time. Results A total of 400 patients were included. The reported number of ingested tablets in daytime had no statistical difference with that at night time. The numbers of severe outcomes had no differences between the patients presenting to the emergency department at daytime or night time. Yet overdosing at night time was more likely associated with severe outcomes. Conclusions We advise a higher index of suspicion at the emergency department on the reliability of the dosages reported by patients who overdose during night time. The larger number of severe outcomes may also be related to more toxic drug exposures in the night time. More resources in the community could be allocated to self-harm prevention at night time.
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Affiliation(s)
| | - HW Ng
- Hong Kong Poison Information Centre, K3A, United Christian Hospital, Accident & Emergency Department, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - ML Tse
- Hong Kong Poison Information Centre, K3A, United Christian Hospital, Accident & Emergency Department, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - FL Lau
- Hong Kong Poison Information Centre, K3A, United Christian Hospital, Accident & Emergency Department, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
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Chiu NC, Ho CH, Shen SH, Tsuei YC, Lee KL, Huang CY, Li HY, Chen TJ. Impact of hysterosalpingography after operative treatment for ectopic pregnancy in Taiwan: A 16-year Nationwide Population-Based Analysis. Medicine (Baltimore) 2017. [PMID: 28640130 PMCID: PMC5484238 DOI: 10.1097/md.0000000000007263] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
By retrieving records from Taiwan's National Health Insurance (NHI) system's database, the current study aimed to investigate the impacts of hysterosalpingography (HSG) to patients after ectopic pregnancy (EP) operations in Taiwan.In this retrospective cohort study, insurance claims data from 1997 to 2013, derived from a cohort of 1 million people randomly sampled to represent all NHI beneficiaries, were analyzed. Patients after ectopic pregnancy (EP) operations were identified via the inclusion of the corresponding NHI procedure codes. We further divided the patients into 2 groups by whether received subsequent HSG, EP-HSG, and EP-no-HSG. Patients with history of previous pregnancies (PP) and subsequent HSG were grouped as PP-HSG. We sought to evaluate the following pregnancies (FP) rate, interval to FP in EP-HSG compared with that in EP-no-HSG, and PP-HSG.EP-HSG had significantly higher FP rate odds ratio than EP-no-HSG (OR, 1.64; 95% CI, 1.24-2.16, P < .001). EP-HSG had lower FP rate odds ratio than that in PP-HSG, but no significant difference (33.1% vs 34.6%, P = .654). The INTERVAL(HSG-FP) in EP-HSG was no significantly different from that in PP-HSG (843.34 ± 82 days vs 644.72 ± 24.30 days, P = .077). There was significant positive correlation between FP after EP and number of HSG (r = 0.070, P < .001). There were significant negative correlation between FP and EP age (r = -0.270, P < .001), FP and INTERVAL(EP-HSG) (r = -0.212, P = .001). The multivariate analysis showed that INTERVAL(EP-HSG) less than 1 year is the predictor factor of INTERVAL(EP-FP) (hazard ratio: 1.422; 95% CI: 1.130-1.788; P = .003). It was evident that the longer the INTERVAL(EP-HSG), the lower the FP rate odds ratio; and the older the EP age, the lower the FP rate odds ratio. (OR, 95% CI; >1 year: 0.59, 0.41-0.86; >2 year: 0.42, 0.32-0.55; >25 years old: 0.47, 0.38-0.57; >30 years old: 0.29, 0.24-0.35; >35 years old: 0.12, 0.08-0.18, all P < .001).Receiving HSG after EP, short INTERVAL(EP-HSG), EP age less than 30 years old, had significant positive impacts on the FP. We encourage shortening the INTERVAL(EP-HSG), and the counseling of women on the most appropriate way to conceive thereafter.
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Affiliation(s)
| | - Chi-Hong Ho
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Beitou District, Taipei City, Taiwan, R.O.C; and School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | | | - Yu-Chuan Tsuei
- School of Medicine, National Yang-Ming University; School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan, R.O.C; and Department of Orthopaedics, Cheng Hsin General Hospital, Taipei City, Taiwan R.O.C
| | | | - Chen-Yu Huang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Beitou District, Taipei City, Taiwan, R.O.C; and School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Hsin-Yang Li
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Beitou District, Taipei City, Taiwan, R.O.C; and School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, R.O.C; and Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
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Lee KL, Chan YH, Lee TC, Goggins WB, Chan EYY. The development of the Hong Kong Heat Index for enhancing the heat stress information service of the Hong Kong Observatory. Int J Biometeorol 2016; 60:1029-39. [PMID: 26546311 DOI: 10.1007/s00484-015-1094-7] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 05/26/2023]
Abstract
This paper presents a study to develop a heat index, for use in hot and humid sub-tropical climate in Hong Kong. The study made use of hospitalization data and heat stress measurement data in Hong Kong from 2007 to 2011. The heat index, which is called Hong Kong Heat Index (HKHI), is calculated from the natural wet bulb temperature, the globe temperature, and the dry bulb temperature together with a set of coefficients applicable to the high humidity condition in the summer of Hong Kong. Analysis of the response of hospitalization rate to variation in HKHI and two other heat indices, namely Wet Bulb Globe Temperature (WBGT) and Net Effective Temperature (NET), revealed that HKHI performed generally better than WBGT and NET in reflecting the heat stress impact on excess hospitalization ratio in Hong Kong. Based on the study results, two reference criteria of HKHI were identified to establish a two-tier approach for the enhancement of the heat stress information service in Hong Kong.
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Affiliation(s)
- K L Lee
- Hong Kong Observatory, 134A Nathan Road, Tsim Sha Tsui, Kowloon, Hong Kong, China
| | - Y H Chan
- Hong Kong Observatory, 134A Nathan Road, Tsim Sha Tsui, Kowloon, Hong Kong, China.
| | - T C Lee
- Hong Kong Observatory, 134A Nathan Road, Tsim Sha Tsui, Kowloon, Hong Kong, China
| | - William B Goggins
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Emily Y Y Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
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Lee KL, Chen TJ, Jeng MJ, Lee YS, Tsao PC, Soong WJ. Laryngotracheobronchial anomalies in infants and the related risk factors of in-hospital mortality. J Chin Med Assoc 2016; 79:221-7. [PMID: 26809858 DOI: 10.1016/j.jcma.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 09/09/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Laryngotracheobronchial anomalies (LTBAs) may cause respiratory problems during early childhood, and increase the risk of hospitalization or mortality in diseased children. This study investigated the initial hospitalization age and risk factors for in-hospital mortality in infants diagnosed with LTBAs during their first 5 years of life. METHODS Hospitalized infants diagnosed with LTBAs were retrieved from Taiwan's National Health Insurance Research Database from 2003 to 2005. Their medical claim data were traced up to 59 months of age. The age distribution of all LTBA cases was analyzed, and then the enrolled infants were grouped into two age groups. Hospitalization-related comorbidities and risk factors for in-hospital mortality were also analyzed. RESULTS A total of 1272 LTBA cases were retrieved. Most of them (976, 76.7%) were initially hospitalized at an age of 0-3 months, and 47 infants (3.7%) died. These enrolled cases were grouped into early and late LTBA groups, with ages of 0-3 months and 4-11 months, respectively. Patients in the late LTBA group had significantly more acute airway infections/asthma and neurological diseases, more frequent hospitalizations, longer hospitalization stay, and higher in-hospital mortality than did the early LTBA group (p < 0.001). The adjusted odds ratios (aORs) for in-hospital mortality were significantly higher in the children aged 4-11 months [aOR = 2.50, 95% confidence intervals (CI): 1.36-4.60], or having perinatal disease (aOR = 2.00, 95% CI: 1.07-3.73), cardiovascular disease (aOR = 2.45, 95% CI: 1.30-4.60), other congenital anomalies (aOR = 2.42, 95% CI: 1.28-4.60), and neurological diseases (aOR = 2.32, 95% CI: 1.18-4.53). CONCLUSION Most infants with LTBAs were initially diagnosed and hospitalized when they were aged 3 months or younger. The risk factors for in-hospital mortality of the children with LTBAs included being diagnosed and treated at an age of 4 months and older, and the presence of perinatal disease, cardiovascular anomalies, other congenital anomalies, neurological diseases, and an age of 4 months and older.
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Affiliation(s)
- Kang-Lung Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Mei-Jy Jeng
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Pei-Chen Tsao
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Ghanem N, Jin JI, Kim SS, Choi BH, Lee KL, Ha AN, Song SH, Kong IK. The Anti-Müllerian Hormone Profile is Linked with theIn VitroEmbryo Production Capacity and Embryo Viability after Transfer but Cannot Predict Pregnancy Outcome. Reprod Domest Anim 2016; 51:301-10. [DOI: 10.1111/rda.12681] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/04/2016] [Indexed: 11/30/2022]
Affiliation(s)
- N Ghanem
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
- Department of Animal Production; Faculty of Agriculture Cairo University; Giza Egypt
| | - JI Jin
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - SS Kim
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - BH Choi
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - KL Lee
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - AN Ha
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - SH Song
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
| | - IK Kong
- Department of Animal Science; Division of Applied Life Science (BK21 Plus); Gyeongsang National University; Jinju Korea
- Institute of Agriculture and Life Science; Gyeongsang National University; Jinju Korea
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Leung AKH, Ng GWY, Sin KC, Au SY, Lai KY, Lee KL, Law KI. Acquired factor V inhibitor in a patient receiving venous-venous extracorporeal membrane oxygenation for Legionella pneumonia. Hong Kong Med J 2016; 21:175-8. [PMID: 25904567 DOI: 10.12809/hkmj134141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a rare complication of factor V deficiency in a patient having Legionella pneumonia. This patient also had other complications like severe acute respiratory distress syndrome, acute kidney injury, and septic shock that required venous-venous extracorporeal membrane oxygenation support. This is the first reported case of acquired factor V deficiency in a patient receiving extracorporeal membrane oxygenation for Legionella pneumonia. With the combined use of intravenous immunoglobulin, rituximab and plasma exchange, we achieved rapid clearance of the factor V inhibitor within 1 week so as to allow safe decannulation of extracorporeal membrane oxygenation.
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Affiliation(s)
- Anne K H Leung
- Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - George W Y Ng
- Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K C Sin
- Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - S Y Au
- Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K Y Lai
- Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K L Lee
- Intensive Care Unit, United Christian Hospital, Kwun Tong, Hong Kong
| | - K I Law
- Intensive Care Unit, United Christian Hospital, Kwun Tong, Hong Kong
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Liong T, Lee KL, Poon YS, Lam SY, Kwok KM, Ng WF, Lam TL, Law KI. Extrapulmonary involvement associated with Mycoplasma pneumoniae infection. Hong Kong Med J 2015; 21:569-72. [DOI: 10.12809/hkmj144403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ng I, Segal R, Lee KL, Ilyas S, Story D. A prospective audit of difficult airway equipment at University of Melbourne-affiliated hospitals. Anaesth Intensive Care 2015; 43:528. [PMID: 26099768] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Pan NY, Law CY, Tsang WK, Lee KL, Wong KC, Tam KF. Giant Cell Tumour of the Axial Skeleton: Report of Four Cases. Hong Kong J Radiol 2014. [DOI: 10.12809/hkjr1411064] [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: 11/05/2022] Open
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Abstract
Acute appendicitis complicating Amyand's hernia is an extremely rare condition, in which the appendix herniates into the inguinal sac and, subsequently, gets inflamed. The condition is difficult to diagnose clinically. Imaging is valuable for its diagnosis and detection of the associated complications. In this article, we will discuss the imaging features of acute appendicitis complicating Amyand's hernia and the results of a literature review on the condition.
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Affiliation(s)
- W K Tsang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - K L Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong
| | - K F Tam
- Department of Radiology, North District Hospital, Sheung Shui, Hong Kong
| | - S F Lee
- Department of Radiology, North District Hospital, Sheung Shui, Hong Kong
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Lui PY, Lee KL, Tam KY, Chan CC. Imaging in Salmonella spp. Infection. Hong Kong J Radiol 2014. [DOI: 10.12809/hkjr1413205] [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: 11/05/2022] Open
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Karpiuk T, Cherroret N, Lee KL, Grémaud B, Müller CA, Miniatura C. Coherent forward scattering peak induced by Anderson localization. Phys Rev Lett 2012; 109:190601. [PMID: 23215369 DOI: 10.1103/physrevlett.109.190601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Indexed: 06/01/2023]
Abstract
Numerical simulations show that, at the onset of Anderson localization, the momentum distribution of a coherent wave packet launched inside a random potential exhibits, in the forward direction, a novel interference peak that complements the coherent backscattering peak. An explanation of this phenomenon in terms of maximally crossed diagrams predicts that the signal emerges around the localization time and grows on the scale of the Heisenberg time associated with the localization volume. Together, coherent back and forward scattering provide evidence for the occurrence of Anderson localization.
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Affiliation(s)
- T Karpiuk
- Centre for Quantum Technologies, National University of Singapore, 3 Science Drive 2, Singapore 117543, Singapore
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Hsu CL, Lee KL, Jeng MJ, Chang KP, Yang CF, Tsao PC, Lee YS, Chen SJ, Soong WJ, Tang RB. Cranial ultrasonographic findings in healthy full-term neonates: a retrospective review. J Chin Med Assoc 2012; 75:389-95. [PMID: 22901723 DOI: 10.1016/j.jcma.2012.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [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: 03/12/2012] [Accepted: 04/15/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ultrasonography is a non-invasive diagnostic technique, and it has been used to detect intracranial lesions in neonates for a long time. Correspondingly, screening tests using cranial ultrasonography have been applied for early detection of intracranial lesions in full-term neonates during the past decade. METHODS We retrospectively reviewed the findings of cranial ultrasonographic screening tests in healthy full-term neonates between September 2004 and August 2009. The ultrasonographic findings were divided into the following categories: (a) nonsignificant (NS) group, including normal and normal variations, (b) minor anomaly group, including tiny cystic lesions, mild hemorrhage, or mild ventricular anomaly, and (c) major anomaly group, including significant anomaly of any intracranial pathology. The participants with major anomalies were further reviewed, and the following medical records of all enrolled patients were reviewed until they were 24 months of age. RESULTS There were a total of 3186 neonates who received cranial ultrasonographic screening examination during the 5-year period, and most of them (2982 cases, 93.6%) were assigned to the NS group. The most common normal variation was the presence of cavum septum pellucidum (1979 cases, 62.1%). Minor anomalies were found in 202 (6.3%) neonates, including 119 (3.7%) neonates with tiny cysts, and 59 (1.9%) neonates with mild intraventricular hemorrhage. Major anomalies were found in two (0.06%) neonates, including obstructive hydrocephalus and agenesis of the corpus callosum. Two other infants (0.06%) initially presented with minor anomaly or normal variation, but they were diagnosed as Moyamoya disease and neonatal seizure some months later. CONCLUSION The incidence of minor and major anomalies detected by cranial ultrasonographic screening examinations in healthy full-term neonates is 6.3% and 0.06%, respectively. Thus, cranial ultrasonographic screening testing may play a role in the early diagnosis of intracranial anomalies of otherwise healthy neonates. However, this examination cannot exclude or detect all cranial abnormalities, including many potential neurologic diseases of neonates, so continuing clinical diligence is still important for all infants.
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Affiliation(s)
- Chien-Lun Hsu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Dey SR, Deb GK, Ha AN, Lee JI, Bang JI, Lee KL, Kong IK. Coculturing denuded oocytes during the in vitro maturation of bovine cumulus oocyte complexes exerts a synergistic effect on embryo development. Theriogenology 2011; 77:1064-77. [PMID: 22153275 DOI: 10.1016/j.theriogenology.2011.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 10/03/2011] [Accepted: 10/08/2011] [Indexed: 11/25/2022]
Abstract
The present study examined the effect of coculturing cumulus oocyte complexes (COCs) and denuded oocytes (DOs) during in vitro maturation (IVM) on nuclear and cytoplasmic maturation, zona pellucida (ZP) hardening, the pattern of fertilization and glutathione peroxidase 1 (GPX1) gene expression in the oocyte. Furthermore, the rate of embryonic development and the quality of blastocysts were examined for both COCs and DOs. Three IVM conditions were studied: 1) the coculture of 12 COCs and 60 DOs, 2) COC control with 12 COCs, and 3) DO control with 60 DOs. The IVM was performed in a 120-μl droplet of TCM199-based IVM medium. Following IVM, in vitro fertilization (IVF) and in vitro culture (IVC) were conducted separately for the COCs and DOs (DO coculture) from the IVM coculture group. Coculturing COCs and DOs increased the percentage of oocytes reaching the blastocyst stage and the total number of cells per blastocyst in both the COC coculture (44.4 ± 8.6 vs 26.7 ± 9.7%, P < 0.01, and 137.9 ± 24.9 vs 121.7 ± 21.1, P < 0.05) and the DO coculture (20.5 ± 5.0 vs 11.1 ± 2.5%, P < 0.01, and 121.9 ± 27.5 vs 112.3 ± 33.2, P < 0.05) compared to their respective control groups. The synergistic effects of coculturing were detected as increased nuclear and cytoplasmic maturation, the prevention of ZP hardening, increased monospermic fertilization and increased expression of GPX1 in the oocytes in response to endogenous oocyte-secreted factors. In conclusion, coculturing COCs and DOs may be an effective culture system for both intact COCs and immature DOs.
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Affiliation(s)
- S R Dey
- Division of Applied Life Science (BK21 Program), Graduate School of Gyeongsang, National University, Republic of Korea
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Ng TL, Leong IS, Tang WL, Chan KF, Luk YW, Lao WC, Leung CM, Liu SY, Kho CS, Lee KL, Chan KK, Li MKW. Immunoglobulin G4-related sclerosing disease: experience with this novel entity in a local hospital. Hong Kong Med J 2011; 17:280-285. [PMID: 21813895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To review the site of involvement, clinical presentation, and treatment outcome of patients having immunoglobulin G4-related sclerosing disease in a local regional hospital. DESIGN Retrospective case series. SETTING Pamela Youde Nethersole Eastern Hospital, Hong Kong. PATIENTS All patients with a diagnosis of immunoglobulin G4-related sclerosing disease in the hospital diagnosed in the period from April 2008 to March 2010. RESULTS A total of 12 patients with involvement of various organs were identified. There was a male predominance (male-to-female ratio=5:1). The mean age at diagnosis was 65 years. The salivary glands, biliary tract, pancreas, and cervical lymph nodes were the commonest involved sites. The immunoglobulin G4 level was elevated in 83% of the patients. Patients usually appeared to respond well to steroid treatment. CONCLUSION Immunoglobulin G4-related sclerosing disease is a systemic disease and can involve various systems.
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Affiliation(s)
- T L Ng
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Chan KKC, Lee KL, Lam PKN, Law KI, Joynt GM, Yan WW. Hong Kong's experience on the use of extracorporeal membrane oxygenation for the treatment of influenza A (H1N1). Hong Kong Med J 2010; 16:447-454. [PMID: 21135421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To report Hong Kong's experience on the use of extracorporeal membrane oxygenation for the treatment of acute respiratory distress syndrome caused by influenza A (H1N1). DESIGN Multi-centred, retrospective observational study. SETTING Intensive care units in Hong Kong. PATIENTS Recipients of extracorporeal membrane oxygenation for confirmed influenza A (H1N1) infection from 1 May 2009 to 28 February 2010. MAIN OUTCOME MEASURE Hospital mortality. RESULTS During the study period, 120 patients were mechanically ventilated in intensive care units, among whom seven received veno-venous extracorporeal membrane oxygenation. The median (interquartile range) age of the latter patients was 42 (39-50) years, four had various chronic illnesses and one had a body mass index of greater than 30 kg/m². The median (interquartile range) time from symptom onset to hospital admission was 5 (4-7) days. Corresponding values for the duration of extracorporeal membrane oxygenation, mechanical ventilation, intensive care unit stay, and hospital stay were 6 (6-10), 19 (11-25), 19 (18-30), and 31 (25-55) days, respectively. One patient died (hospital mortality, 14%) and six made full recoveries. All seven patients received oseltamivir; in addition three received intravenous zanamivir, four received convalescent plasma, and one received hyperimmune immunoglobulin. Nosocomial infection was the commonest complication. There was no life- or limb-threatening complication directly attributable to extracorporeal membrane oxygenation. CONCLUSION In response to the pandemic of influenza A (H1N1), some intensive care units in Hong Kong were able to offer extracorporeal membrane oxygenation to selected cases. In this small series, patient outcomes were similar to those reported in other observational studies, indicating that intensive care units in Hong Kong are capable of successfully introducing this technology. However, the cost-effectiveness and optimal delivery of this strategy remain uncertain.
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Affiliation(s)
- K K C Chan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Najiah M, Lee KL, Noorasikin H, Nadirah M, Lee SW. Phenotypic and genotypic characteristics of Mycobacterium isolates from fighting fish Betta spp. in Malaysia. Res Vet Sci 2010; 91:342-5. [PMID: 20971487 DOI: 10.1016/j.rvsc.2010.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 08/25/2010] [Accepted: 09/20/2010] [Indexed: 10/18/2022]
Abstract
Mycobacteriosis due to mycobacteria is one of the most common bacterial diseases in ornamental fish. We describe here the phenotypic and genotypic characteristics of Mycobacterium isolates from fighting fish Betta spp. using ATCC Mycobacterium marinum, Mycobacterium fortuitum and Mycobacterium chelonae as references. A total of four isolates (M1, M2, M3, M4) were obtained from four out of 106 fish samples using selective agar, and identified to Mycobacterium genus using acid-fast staining and 16s rRNA gene-based genus specific polymerase chain reaction. DNA sequencing and NCBI-BLAST analysis further identified isolate M1 as M. marinum and isolates M2, M3, M4 as M. fortuitum. Morphological, physiological and biochemical tests were carried out for phenotypic characterizations. Universal M13 and wild-type phage M13 RAPD dendogram was generated to illustrate the genetic relationship of the isolates and reference strains.
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Affiliation(s)
- M Najiah
- Department of Fisheries Science and Aquaculture, Faculty of Agrotechnology and Food Science, Universiti Malaysia Terengganu (UMT), Mengabang Telipot, 21030 Terengganu, Malaysia.
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Abstract
Acute hepatitis A (AHA) is one of the most common infectious diseases; it is usually a self-limiting disease affecting the liver. Although extrahepatic manifestations are not common, some cases have been reported associated with acute renal failure. We reviewed the clinical features of patients with AHA complicated by acute renal failure (ARF group) and compared them with patients with noncomplicated AHA (non-ARF group). The medical records of 208 consecutive patients with AHA who were diagnosed between January 2003 and October 2008 were reviewed. We identified 15 patients (7.2%) with ARF associated with AHA. There were no differences between the ARF and non-ARF group with regard to gender and age. The peak value of alanine aminotransferase (ALT) (median: 6060 IU/L vs 1792 IU/L, P < 0.001), prothrombin time (PT) (International normalized ratio, median 1.72 vs 1.10, P < 0.001), and total bilirubin level (median: 9.6 mg/dL vs 6.3 mg/dL, P = 0.04) were significantly higher in the ARF than in the non-ARF group. Twelve patients (80%) recovered completely with haemodialysis (seven patients, 46.7%) or only conservative management (five patients, 33.3%), while one patient underwent liver transplantation because of fulminant hepatic failure, and two patients died because of fulminant hepatic failure. There were no deaths among patients with noncomplicated AHA in the non-ARF group. Five patients underwent kidney biopsy; two patients were diagnosed with acute tubular necrosis, two patients with acute interstitial nephritis with IgA nephropathy and one patient with acute tubulointerstitial nephritis. All patients in the ARF group had microscopic haematuria and proteinuria (100%vs 31.1%, P < 0.001). Urine sodium levels were more than 10 mEq/L in 10 patients. The findings of high urinary sodium concentrations, microscopic haematuria and proteinuria did not support the diagnosis of hepatorenal syndrome (HRS). Patients with AHA with ARF had higher ALT levels, more prolonged PTs, and higher total bilirubin levels. The prognosis for these patients was poorer than for those without ARF. However, the patients with ARF and nonfulminant AHA had recovered with proper treatment and should not be confused with patients that have HRS.
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Affiliation(s)
- Y J Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul Municipal Boramae Hospital, Seoul, Korea
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Chun J, Kim W, Kim BG, Lee KL, Suh KS, Yi NJ, Park KU, Kim YJ, Yoon JH, Lee HS. High viremia, prolonged Lamivudine therapy and recurrent hepatocellular carcinoma predict posttransplant hepatitis B recurrence. Am J Transplant 2010; 10:1649-59. [PMID: 20642687 DOI: 10.1111/j.1600-6143.2010.03162.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hepatitis B virus (HBV) recurrence following orthotopic liver transplantation (OLT) is generally preventable by prophylaxis with hepatitis B immunoglobulin (HBIG) and lamivudine (LAM). However, HBV recurrence sometimes develops despite prophylaxis. This study assessed posttransplant outcomes and identified predictors of HBV recurrence. We analyzed the outcomes of 209 consecutive patients positive for hepatitis B surface antigen who underwent OLT, who received either combination prophylaxis with HBIG and LAM (89.0%) or HBIG monoprophylaxis (11.0%). The median follow-up was 36.8 months (range, 1.0-84.4). Posttransplant HBV recurrence occurred in 22 patients (10.5%), including 13 patients with drug-resistant mutations. HBV recurrence was observed in six patients after hepatocellular carcinoma (HCC) recurrence. Independent predictors of HBV recurrence were recurrent HCC (p < 0.001), LAM therapy >1.5 years (p = 0.001) and high HBV DNA titers (> or =10(5) copies/mL) at OLT (p = 0.036). In conclusion, high viremia at OLT and prolonged exposure to LAM should be further stressed as main predictors of HBV recurrence.
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Affiliation(s)
- J Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea
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Liong T, Lee KL, Poon YS, Lam SY, Chan CP, Yue CS, Chu CM, Yuen KY, Law KI. The first novel influenza A (H1N1) fatality despite antiviral treatment and extracorporeal membrane oxygenation in Hong Kong. Hong Kong Med J 2009; 15:381-384. [PMID: 19801697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We report the first fatality caused by novel influenza A (H1N1) infection despite having the diagnosis confirmed and being given antiviral treatment after hospitalisation. This patient was also the first with influenza A (H1N1) to be supported with extracorporeal membrane oxygenation in Hong Kong. Although extracorporeal membrane oxygenation is an effective means of supporting patients with refractory hypoxaemia on high mechanical ventilatory support, it is labour-intensive and technically demanding. We also discuss the challenges faced when managing this case.
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Affiliation(s)
- T Liong
- Intensive Care Unit, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Lee KL, Graham CA, Lam JMY, Yeung JHH, Ahuja AT, Rainer TH. Impact on trauma patient management of installing a computed tomography scanner in the emergency department. Injury 2009; 40:873-5. [PMID: 19394016 DOI: 10.1016/j.injury.2008.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 11/12/2008] [Accepted: 12/01/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computed tomography (CT) plays a central diagnostic role for trauma patients. A 16-slice multi-detector CT scanner was installed in the emergency department (ED) of Prince of Wales Hospital in December 2004. The aims of this study were to evaluate the impact of the CT scanner within the ED on trauma management and to compare the utilisation patterns of trauma CT before and after the introduction of EDCT. METHODS Analysis of prospectively collected trauma registry data. All consecutive trauma cases admitted through the ED that underwent CT between June 2004 and June 2005 (6 months before and after EDCT installation) were included. A positive CT was defined as the identification (by a specialist radiologist) of a significant finding which was consistent with injury. RESULTS There were 226 and 202 trauma patients in the 6 months before and after EDCT installation, respectively. 111 (49.1%) patients underwent CT scanning before EDCT compared with 110 (54.5%) afterwards. 72 (65%) patients had CT scans performed before admission to definitive care compared with 99 (90%) after EDCT installed (p<0.0001, chi(2) test). Mean time from arrival to first CT was shorter after EDCT (102 min vs. 197 min, p=0.011). Mean trauma room length of stay increased after EDCT was implemented (106 min vs. 80 min; p<0.001). Median time to urgent operation (<6h) was less with EDCT (134 min before vs. 112 min after). No changes in median time to neurosurgical operation (138 min before vs. 148 min after); mean length of stay (12.8 days before vs. 12.5 days after); or mortality (8 patients before vs. 7 patients after). There were 203 scans (1.8/patient) done before EDCT compared with 226 scans (2.5/patient) after. There was no difference in the number of scans done by body region or the proportion of positive scans (32% before vs. 30% after). Logistic regression confirmed that after adjusting for injury severity and admission physiology, time to first CT was shorter (p=0.0307) but ED length of stay was increased (p<0.0001). CONCLUSION After the installation of EDCT, more trauma patients had CT scanning before definitive care, and scans were done sooner, with no significant increase in the number of unnecessary scans.
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Affiliation(s)
- K L Lee
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
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Abstract
BACKGROUND Amiodarone hydrochloride has been in use for two decades for the control of ventricular and supraventricular arrhythmias. Established and emerging evidence indicates that amiodarone has an antiarrhythmic efficacy superior to that of most other drugs. HYPOTHESIS The study was undertaken to evaluate the efficacy and acceptability of low-dose amiodarone therapy in the long-term management of supraventricular and ventricular tachyarrhythmias. METHODS A total of 124 patients with symptomatic drug-refractory or life-threatening arrhythmias managed with low-dose oral amiodarone therapy over a 10-year period was analyzed retrospectively. Of these, 45 patients (36%) had ventricular arrhythmias, 52 (42%) had atrial arrhythmias, and 27 (22%) had atrioventricular reentry tachycardia. Loading doses of amiodarone 600 mg daily for 1 week were administered for supraventricular arrhythmias and 600-1200 mg daily for 2 weeks for ventricular arrhythmias. Maintenance daily doses were 194 +/- 48 and 206 +/- 55 mg, respectively. Mean treatment duration was 32 +/- 28 months, with 326.3 patient years of therapy. RESULTS Of 39 patients with sustained ventricular tachyarrhythmias, the actuarial incidence of satisfactory arrhythmia control (absence of sudden cardiac death or nonfatal arrhythmia recurrence) was 78% at 1 year and 71% at 2 years. Satisfactory control of supraventricular arrhythmias (mean ventricular rate < 100/min with significant symptomatic improvement for sustained atrial arrhythmias and < 1 attack per year for paroxysmal atrial or atrioventricular arrhythmias) was achieved in 73, 65, and 62% of patients at 1, 2, and 3 years, respectively. The cumulative incidence of amiodarone-related adverse effects was 5.8 per 100 patient years, with drug withdrawal required in 12 patients (9.7%). Fifteen patients had thyroid dysfunction, 2 had hepatic toxicity, and 1 developed nonfatal pulmonary fibrosis. Overall, the incidence of successful use of amiodarone (satisfactory arrhythmia control and freedom from side effects) was 67, 59, and 53% at 1, 2, and 3 years, respectively. CONCLUSIONS The results of this study suggest that the efficacy of low-dose amiodarone therapy in the management of serious ventricular and supraventricular arrhythmias would be similar to those achieved with higher doses, but with a much more acceptable side effect profile.
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Affiliation(s)
- K L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong
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McVie-Wylie AJ, Lee KL, Qiu H, Jin X, Do H, Gotschall R, Thurberg BL, Rogers C, Raben N, O'Callaghan M, Canfield W, Andrews L, McPherson JM, Mattaliano RJ. Biochemical and pharmacological characterization of different recombinant acid alpha-glucosidase preparations evaluated for the treatment of Pompe disease. Mol Genet Metab 2008; 94:448-455. [PMID: 18538603 PMCID: PMC2774491 DOI: 10.1016/j.ymgme.2008.04.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/10/2008] [Accepted: 04/10/2008] [Indexed: 12/19/2022]
Abstract
Pompe disease results in the accumulation of lysosomal glycogen in multiple tissues due to a deficiency of acid alpha-glucosidase (GAA). Enzyme replacement therapy for Pompe disease was recently approved in Europe, the U.S., Canada, and Japan using a recombinant human GAA (Myozyme, alglucosidase alfa) produced in CHO cells (CHO-GAA). During the development of alglucosidase alfa, we examined the in vitro and in vivo properties of CHO cell-derived rhGAA, an rhGAA purified from the milk of transgenic rabbits, as well as an experimental version of rhGAA containing additional mannose-6-phosphate intended to facilitate muscle targeting. Biochemical analyses identified differences in rhGAA N-termini, glycosylation types and binding properties to several carbohydrate receptors. In a mouse model of Pompe disease, glycogen was more efficiently removed from the heart than from skeletal muscle for all enzymes, and overall, the CHO cell-derived rhGAA reduced glycogen to a greater extent than that observed with the other enzymes. The results of these preclinical studies, combined with biochemical characterization data for the three molecules described within, led to the selection of the CHO-GAA for clinical development and registration as the first approved therapy for Pompe disease.
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Affiliation(s)
- A J McVie-Wylie
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - K L Lee
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - H Qiu
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - X Jin
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - H Do
- Glycobiology Research Institute, Genzyme Corporation, Oklahoma City, OK 73104, USA
| | - R Gotschall
- Glycobiology Research Institute, Genzyme Corporation, Oklahoma City, OK 73104, USA
| | - B L Thurberg
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - C Rogers
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - N Raben
- Arthritis and Rheumatism Branch, NIAMS, National Institutes of Health, Bethesda, MD 20892, USA
| | - M O'Callaghan
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - W Canfield
- Glycobiology Research Institute, Genzyme Corporation, Oklahoma City, OK 73104, USA
| | - L Andrews
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - J M McPherson
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
| | - R J Mattaliano
- Biologics Research and Development, Genzyme Corporation, One Mountain Road, Framingham, MA 01701, USA
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Lau KCH, Yiu KKH, Lee KL, Ko RLY, Lam YM, Lam L, Lee SWL. A case of takotsubo cardiomyopathy: transient left ventricular apical ballooning. Hong Kong Med J 2006; 12:388-90. [PMID: 17028361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
A 78-year-old woman was admitted to hospital with central chest pain and the electrocardiographic and cardiac marker changes typical of acute anterior myocardial infarction. Coronary angiography revealed normal epicardial coronary arteries, and left ventriculography showed apical akinesis as well as basal hyperkinesis. This is a case of transient left ventricular apical ballooning or takotsubo cardiomyopathy, possibly attributable to catecholamine-mediated myocardial stunning.
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Affiliation(s)
- K C H Lau
- Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong
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Abstract
The DCA (Drug Control Authority), Malaysia has implemented the phase three registration of traditional medicines on 1 January 1992. As such, a total of 100 products in various pharmaceutical dosage forms of a herbal preparation found in Malaysia, containing tongkat Ali hitam, either single or combined preparations, were analyzed for the presence of a heavy toxic metal, mercury, using atomic absorption spectrophotometer, after performing a simple random sampling to enable each sample an equal chance of being selected in an unbiased manner. Results showed that 26% of these products possessed 0.53-2.35 ppm of mercury, and therefore, do not comply with the quality requirement for traditional medicines in Malaysia. The quality requirement for traditional medicines in Malaysia is not exceeding 0.5 ppm for mercury. Out of these 26 products, four products have already registered with the DCA, Malaysia whilst the rest, however, have not registered with the DCA, Malaysia.
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Affiliation(s)
- H H Ang
- School of Pharmaceutical Sciences, University Science Malaysia, Minden, Penang 11800, Malaysia.
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