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BinHumaid FS, Goel A, Gordon NS, Abbotts B, Cheng KK, Zeegers MP, James ND, Altaweel WM, Seyam RM, Meyer BF, Arnold R, Ward DG, Bryan RT. Circulating Tumour DNA Detection By The Urine-Informed Analysis Of Archival Serum Samples From Muscle-Invasive Bladder Cancer Patients. Eur Urol 2024; 85:508-509. [PMID: 38302315 DOI: 10.1016/j.eururo.2024.01.016] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/22/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Faisal S BinHumaid
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Anshita Goel
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Naheema S Gordon
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Ben Abbotts
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - K K Cheng
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Waleed M Altaweel
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Raouf M Seyam
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Brian F Meyer
- Centre for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Roland Arnold
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Douglas G Ward
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Richard T Bryan
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
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Zeng Z, Li Q, Caine ED, Takwoingi Y, Zhong B, Tong Y, Cheng KK, Gong W. Prevalence of and optimal screening tool for postpartum depression in a community-based population in China. J Affect Disord 2024; 348:191-199. [PMID: 38154584 DOI: 10.1016/j.jad.2023.12.046] [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: 04/12/2023] [Revised: 11/28/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Postpartum depression (PPD) is an important public health problem worldwide. China is planning to launch PPD screening in community settings, but there are questions on the community prevalence of PPD and validated screening tools. METHODS We sought to recruit all eligible new mothers during postnatal home visits in two districts of Changsha, China, and after informed consent, screened them for PPD using three self-administered questionnaires-the Edinburgh Postpartum Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), and Whooley Questions for Depression Screening. Video structured diagnostic interviews were performed online according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) by qualified specialists who were blinded to screening results. Optimal screening was determined based on the acceptability of scales and diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS Out of 3004 eligible women, 2730 (90.9 %) completed the screening questionnaires. Among those screened, the video structured diagnostic interview was administered to 1862 (68.2 %) and 62 (3.3 %) were diagnosed with a current depressive condition. The optimal screening approach involved combining Whooley Questions (at least one "yes") with EPDS (cutoff >10) in series, with sensitivity of 0.76 (95 % CI 0.63 to 0.85), specificity of 0.93 (0.92 to 0.94), PPV of 0.28 (0.21 to 0.36) and NPV of 0.99 (0.98 to 1.00). LIMITATIONS Due to the regional sample and exclusion of mothers with telephone contact rather than home visits, our findings may not be fully generalizable to the entire population. CONCLUSIONS The prevalence of PPD among women in this sample was substantially lower than those reported in previous studies in China, the majority of which used screen positivity in measuring prevalence. Combining Whooley Questions with EPDS in series is the most optimal screening approach in this population, though this would still result in a high number of false positives at current prevalence.
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Affiliation(s)
- Zhen Zeng
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Hunan 410078, China.
| | - Qiao Li
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Hunan 410078, China.
| | - Eric D Caine
- Department of Psychiatry, University of Rochester, Rochester, NY, USA.
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, B15 2TT Birmingham, UK; National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham National Health Service Foundation Trust and University of Birmingham, Birmingham, UK.
| | - Baoliang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, No. 89, Gongnongbing Road, Wuhan, Hubei Province 430012, China.
| | - Yongsheng Tong
- Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, 7 Nan Dian Road, Changping, Beijing 100096, China.
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, B15 2TT Birmingham, UK.
| | - Wenjie Gong
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Hunan 410078, China; Department of Psychiatry, University of Rochester, Rochester, NY, USA; Institute of Applied Health Research, University of Birmingham, B15 2TT Birmingham, UK.
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Fernandes G, Williams S, Adab P, Gale N, de Jong C, de Sousa JC, Cheng KK, Chi C, Cooper BG, Dickens AP, Enocson A, Farley A, Jolly K, Jowett S, Maglakelidze M, Maghlakelidze T, Martins S, Sitch A, Stamenova A, Stavrikj K, Stelmach R, Turner A, Pan Z, Pang H, Zhang J, Jordan RE. Engaging stakeholders to level up COPD care in LMICs: lessons learned from the "Breathe Well" programme in Brazil, China, Georgia, and North Macedonia. BMC Health Serv Res 2024; 24:66. [PMID: 38216986 PMCID: PMC10790249 DOI: 10.1186/s12913-023-10525-4] [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: 05/31/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Effective stakeholder engagement in health research is increasingly being recognised and promoted as an important pathway to closing the gap between knowledge production and its use in health systems. However, little is known about its process and impacts, particularly in low-and middle-income countries. This opinion piece draws on the stakeholder engagement experiences from a global health research programme on Chronic Obstructive Pulmonary Disease (COPD) led by clinician researchers in Brazil, China, Georgia and North Macedonia, and presents the process, outcomes and lessons learned. MAIN BODY Each country team was supported with an overarching engagement protocol and mentored to develop a tailored plan. Patient involvement in research was previously limited in all countries, requiring intensive efforts through personal communication, meetings, advisory groups and social media. Accredited training programmes were effective incentives for participation from healthcare providers; and aligning research findings with competing policy priorities enabled interest and dialogue with decision-makers. The COVID-19 pandemic severely limited possibilities for planned engagement, although remote methods were used where possible. Planned and persistent engagement contributed to shared knowledge and commitment to change, including raised patient and public awareness about COPD, improved skills and practice of healthcare providers, increased interest and support from clinical leaders, and dialogue for integrating COPD services into national policy and practice. CONCLUSION Stakeholder engagement enabled relevant local actors to produce and utilise knowledge for small wins such as improving day-to-day practice and for long-term goals of equitable access to COPD care. For it to be successful and sustained, stakeholder engagement needs to be valued and integrated throughout the research and knowledge generation process, complete with dedicated resources, contextualised and flexible planning, and commitment.
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Affiliation(s)
- Genevie Fernandes
- International Primary Care Respiratory Group, London, UK.
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Siân Williams
- International Primary Care Respiratory Group, London, UK
| | - Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Gale
- Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Corina de Jong
- International Primary Care Respiratory Group, London, UK
| | - Jaime Correia de Sousa
- International Primary Care Respiratory Group, London, UK
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- PT Government Associate Laboratory, ICVS/3B's, Braga/Guimarães, Portugal
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chunhua Chi
- Department of General Practice, Peking University First Hospital, Beijing, China
| | | | - Andrew P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Observational and Pragmatic Research Institute, Midview City, Singapore
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Maka Maglakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Tamaz Maghlakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Sonia Martins
- Family Medicine, ABC Medical School, São Paolo, Brazil
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Aleksandra Stamenova
- Faculty of Medicine, Institute of Social Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Katarina Stavrikj
- Center for Family Medicine, Faculty of Medicine, Ss.Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paolo, Brazil
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zihan Pan
- Department of General Practice, Peking University First Hospital, Beijing, China
| | - Hui Pang
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianxin Zhang
- Department of General Practice, Peking University First Hospital, Beijing, China
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Lo HY, Fung KFK, Yam F, Leung Y, Liu A, Cheng KK, Cho D, Kan EYL, Chao N. Height-based formulas for predicting intravascular length of tunnelled neck central venous catheter in paediatric population. Pediatr Surg Int 2023; 39:262. [PMID: 37668756 DOI: 10.1007/s00383-023-05537-4] [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] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Central venous catheter (CVC) placement is commonly performed in children. We aim to develop simple formulas to predict CVC intravascular length to minimise radiation exposure associated with the procedure. METHODS 124 paediatric patients who received tunnelled neck CVCs and subsequent CT thorax at Hong Kong Children's Hospital from January 2020 to July 2022 were reviewed retrospectively. Formula development cohorts were subdivided by insertion sites-9 right external jugular vein (REJV), 41 right internal jugular vein (RIJV), 14 left external jugular vein (LEJV), 10 left internal jugular vein (LIJV). Using measurements from CT by two radiologists, formulas predicting the CVC intravascular length based on height and insertion sites were developed using a linear regression model. These formulas were tested with validation cohorts (10 randomly selected cases in REJV and RIJV groups respectively). Validation cohorts were not available for LEJV and LIJV groups due to small sample sizes. RESULT The goodness-of-fit (R^2) of all formulas are above 0.8. In the validation cohorts, the REJV formula was predictive of intravascular CVC length within 1 cm in 70% of CVC with mean absolute difference of 0.63 cm (SD 0.48 cm), and the RIJV formula was predictive of intravascular CVC length within 1 cm in 80% of CVC with mean absolute difference of 0.67 cm (SD 0.53 cm). CONCLUSION Intravascular CVC length can be estimated using simple formulas based on height and insertion sites. Further prospective validation of the LEJV and LIJV formulas is needed.
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Affiliation(s)
- H Y Lo
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China.
| | - K F K Fung
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - F Yam
- Department of Paediatric Surgery, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Y Leung
- Department of Paediatric Surgery, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - A Liu
- Department of Paediatrics, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - K K Cheng
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China
| | - D Cho
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China
| | - E Y L Kan
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - N Chao
- Department of Paediatric Surgery, Hong Kong Children's Hospital, Hong Kong SAR, China
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Xue W, Cheng KK, Liu L, Li Q, Jin X, Yi J, Gong W. Barriers and facilitators for referring women with positive perinatal depression screening results in China: a qualitative study. BMC Pregnancy Childbirth 2023; 23:230. [PMID: 37020285 PMCID: PMC10074342 DOI: 10.1186/s12884-023-05532-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Timely screening and referral can improve the outcomes of perinatal depression (PND). However, uptake rates of referral after PND screening are low in China and the reasons are unclear. The aim of this article is to explore the barriers and facilitators for referring women with positive results of PND screening in the Chinese primary maternal health care system. METHODS Qualitative data were collected from four primary health centers located in four different provinces of China. Each of the four investigators conducted 30 days of participant observations in the primary health centers from May to August 2020. Data were collected via participant observations and semi-structured in-depth interviews with new mothers who had positive results of PND screening, their family members, and primary health providers. Two investigators analyzed qualitative data independently. A thematic analysis was conducted, and data were framed using the social ecological model. RESULTS A total of 870 hours of observation and 46 interviews were carried out. Five themes were identified: individual (new mothers' knowledge of PND, perceived need to seek help), interpersonal (new mothers' attitudes towards providers, family support), institutional (providers' perception of PND, lack of training, time constraints), community (accessibility to mental health services, practical factors), and public policy (policy requirements, stigma). CONCLUSIONS The likelihood of new mothers accepting PND referral is related to factors in five areas. Intervention strategies can be developed around these themes and may include educating new mothers and their families about PND, training primary health providers to improve their awareness of condition and indication for referral, building mental health support in routine postpartum home visits, and providing support through mobile technology.
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Affiliation(s)
- Wenqing Xue
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK
| | - Lu Liu
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China
| | - Qiao Li
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China
| | - Xin Jin
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China
| | - Jingmin Yi
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, 110 Xiangya Road, 410078, Changsha, Hunan, China.
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK.
- Department of Psychiatry, University of Rochester, 14642, Rochester, USA.
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Ward DG, Baxter L, Ott S, Gordon NS, Wang J, Patel P, Piechocki K, Silcock L, Sale C, Zeegers MP, Cheng KK, James ND, Bryan RT. Highly Sensitive and Specific Detection of Bladder Cancer via Targeted Ultra-deep Sequencing of Urinary DNA. Eur Urol Oncol 2023; 6:67-75. [PMID: 35410825 DOI: 10.1016/j.euo.2022.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/03/2022] [Accepted: 03/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is an unmet need for an accurate, validated, noninvasive test for diagnosing and monitoring bladder cancer (BC). Detection of BC-associated mutations in urinary DNA via targeted deep sequencing could meet this need. OBJECTIVE To test the ability of mutational analysis of urinary DNA to noninvasively detect BC within the context of haematuria investigations and non-muscle-invasive BC (NMIBC) surveillance. DESIGN, SETTING, AND PARTICIPANTS Capture-based ultra-deep sequencing was performed for 443 somatic mutations in 23 genes in 591 urine cell-pellet DNAs from haematuria clinic patients and 293 from NMIBC surveillance patients. Variant calling was optimised to minimise false positives using urine samples from 162 haematuria clinic patients without BC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The sensitivity and specificity for BC diagnosis were determined. RESULTS AND LIMITATIONS Mutational analysis of urinary DNA detected 144 of the 165 haematuria patients diagnosed with incident BC from two independent cohorts, yielding overall sensitivity of 87.3% (95% confidence interval [CI] 81.2-92.0%) at specificity of 84.8% (95% CI 79.9-89.0%). The sensitivity was 97.4% for grade 3, 86.5% for grade 2, and 70.8% for grade 1 BC. Among NMIBC surveillance patients, 25 out of 29 recurrent BCs were detected, yielding sensitivity of 86.2% (95% CI 70.8-97.7%) at specificity of 62.5% (95% CI 56.1-68.0%); a positive urine mutation test in the absence of clinically detectable disease was associated with a 2.6-fold increase in the risk of future recurrence. The low number of recurrences in the NMIBC surveillance cohort and the lower sensitivity for detecting grade 1 pTa BC are limitations. CONCLUSIONS Detection of mutations in a small panel of BC-associated genes could facilitate noninvasive BC testing and expedite haematuria investigations. Following further validation, the test could also play a role in NMIBC surveillance. PATIENT SUMMARY Identification of alterations in genes that are frequently mutated in bladder cancer appears to be a promising strategy for detecting disease from urine samples and reducing reliance on examination of the bladder via a telescopic camera inserted through the urethra.
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Affiliation(s)
- Douglas G Ward
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Laura Baxter
- Bioinformatics Research Technology Platform, University of Warwick, Coventry, UK
| | - Sascha Ott
- Bioinformatics Research Technology Platform, University of Warwick, Coventry, UK; University of Warwick Medical School, University of Warwick, Coventry, UK
| | - Naheema S Gordon
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Junhui Wang
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Prashant Patel
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kim Piechocki
- Nonacus Ltd., Birmingham Research Park, Birmingham, UK
| | - Lee Silcock
- Nonacus Ltd., Birmingham Research Park, Birmingham, UK
| | - Chris Sale
- Nonacus Ltd., Birmingham Research Park, Birmingham, UK
| | - Maurice P Zeegers
- Care and Public Health Research Institute, School of Nutrition and Translational Research in Metabolism, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - K K Cheng
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Richard T Bryan
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Gong W, Cheng KK. Challenges in screening and general health checks in China. The Lancet Public Health 2022; 7:e989-e990. [DOI: 10.1016/s2468-2667(22)00207-9] [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] [Received: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 12/05/2022] Open
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Maglakelidze M, Kurua I, Maglakelidze N, Maglakelidze T, Chkhaidze I, Gogvadze K, Chkhaidze N, Beadle H, Redden-Rowley K, Adab P, Adams R, Chi C, Cheng KK, Cooper B, Correia-de-Sousa J, Dickens AP, Enocson A, Farley A, Gale NK, Jowett S, Martins S, Rai K, Sitch AJ, Stavrikj K, Stelmach R, Turner AM, Williams S, Jordan RE, Jolly K. Feasibility of a pulmonary rehabilitation programme for patients with symptomatic chronic obstructive pulmonary disease in Georgia: a single-site, randomised controlled trial from the Breathe Well Group. BMJ Open 2022; 12:e056902. [PMID: 36153030 PMCID: PMC9511586 DOI: 10.1136/bmjopen-2021-056902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess the feasibility of delivering a culturally tailored pulmonary rehabilitation (PR) programme and conducting a definitive randomised controlled trial (RCT). DESIGN A two-arm, randomised feasibility trial with a mixed-methods process evaluation. SETTING Secondary care setting in Georgia, Europe. PARTICIPANTS People with symptomatic spirometry-confirmed chronic obstructive pulmonary disease recruited from primary and secondary care. INTERVENTIONS Participants were randomised in a 1:1 ratio to a control group or intervention comprising 16 twice-weekly group PR sessions tailored to the Georgian setting. PRIMARY AND SECONDARY OUTCOME MEASURES Feasibility of the intervention and RCT were assessed according to: study recruitment, consent and follow-up, intervention fidelity, adherence and acceptability, using questionnaires and measurements at baseline, programme end and 6 months, and through qualitative interviews. RESULTS The study recruited 60 participants (as planned): 54 (90%) were male, 10 (17%) had a forced expiratory volume in 1 second of ≤50% predicted. The mean MRC Dyspnoea Score was 3.3 (SD 0.5), and mean St George's Respiratory Questionnaire (SGRQ) 50.9 (SD 17.6). The rehabilitation specialists delivered the PR with fidelity. Thirteen (43.0%) participants attended at least 75% of the 16 planned sessions. Participants and rehabilitation specialists in the qualitative interviews reported that the programme was acceptable, but dropout rates were high in participants who lived outside Tbilisi and had to travel large distances. Outcome data were collected on 63.3% participants at 8 weeks and 88.0% participants at 6 months. Mean change in SGRQ total was -24.9 (95% CI -40.3 to -9.6) at programme end and -4.4 (95% CI -12.3 to 3.4) at 6 months follow-up for the intervention group and -0.5 (95% CI -8.1 to 7.0) and -8.1 (95% CI -16.5 to 0.3) for the usual care group at programme end and 6 months, respectively. CONCLUSIONS It was feasible to deliver the tailored PR intervention. Approaches to improve uptake and adherence warrant further research. TRIAL REGISTRATION NUMBER ISRCTN16184185.
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Affiliation(s)
- Mariam Maglakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Ia Kurua
- Georgian Respiratory Association, Tbilisi, Georgia
| | | | - Tamaz Maglakelidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University Faculty of Medicine, Tbilisi, Georgia
| | - Ivane Chkhaidze
- Georgian Respiratory Association, Tbilisi, Georgia
- Tbilisi State Medical University Faculty of Medicine, Tbilisi, Georgia
| | | | | | - Helen Beadle
- Department of Physiotherapy, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kelly Redden-Rowley
- iCares Directorate, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Rachel Adams
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Chunhua Chi
- Department of General Practice, Peking University First Hospital, Beijing, 100034, China
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Brendan Cooper
- Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
- International Primary Care Respiratory Group, Edinburgh, Scotland
| | - Andrew P Dickens
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Observational and Pragmatic Research Institute, Singapore
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Nicola K Gale
- Health Services Management Centre, University of Birmingham College of Arts and Law, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sonia Martins
- Family Medicine, ABC Medical School, São Paulo, Brazil
| | - Kiran Rai
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Alice J Sitch
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Katarina Stavrikj
- Centre for Family Medicine, Medical Faculty, Skopje, North Macedonia
| | - Rafael Stelmach
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sian Williams
- International Primary Care Respiratory Group, Edinburgh, Scotland
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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Adab P, Jordan RE, Fitzmaurice D, Ayres JG, Cheng KK, Cooper BG, Daley A, Dickens A, Enocson A, Greenfield S, Haroon S, Jolly K, Jowett S, Lambe T, Martin J, Miller MR, Rai K, Riley RD, Sadhra S, Sitch A, Siebert S, Stockley RA, Turner A. Case-finding and improving patient outcomes for chronic obstructive pulmonary disease in primary care: the BLISS research programme including cluster RCT. Programme Grants Appl Res 2021. [DOI: 10.3310/pgfar09130] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Chronic obstructive pulmonary disease is a major contributor to morbidity, mortality and health service costs but is vastly underdiagnosed. Evidence on screening and how best to approach this is not clear. There are also uncertainties around the natural history (prognosis) of chronic obstructive pulmonary disease and how it impacts on work performance.
Objectives
Work package 1: to evaluate alternative methods of screening for undiagnosed chronic obstructive pulmonary disease in primary care, with clinical effectiveness and cost-effectiveness analyses and an economic model of a routine screening programme. Work package 2: to recruit a primary care chronic obstructive pulmonary disease cohort, develop a prognostic model [Birmingham Lung Improvement StudieS (BLISS)] to predict risk of respiratory hospital admissions, validate an existing model to predict mortality risk, address some uncertainties about natural history and explore the potential for a home exercise intervention. Work package 3: to identify which factors are associated with employment, absenteeism, presenteeism (working while unwell) and evaluate the feasibility of offering formal occupational health assessment to improve work performance.
Design
Work package 1: a cluster randomised controlled trial with household-level randomised comparison of two alternative case-finding approaches in the intervention arm. Work package 2: cohort study – focus groups. Work package 3: subcohort – feasibility study.
Setting
Primary care settings in West Midlands, UK.
Participants
Work package 1: 74,818 people who have smoked aged 40–79 years without a previous chronic obstructive pulmonary disease diagnosis from 54 general practices. Work package 2: 741 patients with previously diagnosed chronic obstructive pulmonary disease from 71 practices and participants from the work package 1 randomised controlled trial. Twenty-six patients took part in focus groups. Work package 3: occupational subcohort with 248 patients in paid employment at baseline. Thirty-five patients took part in an occupational health intervention feasibility study.
Interventions
Work package 1: targeted case-finding – symptom screening questionnaire, administered opportunistically or additionally by post, followed by diagnostic post-bronchodilator spirometry. The comparator was routine care. Work package 2: twenty-three candidate variables selected from literature and expert reviews. Work package 3: sociodemographic, clinical and occupational characteristics; occupational health assessment and recommendations.
Main outcome measures
Work package 1: yield (screen-detected chronic obstructive pulmonary disease) and cost-effectiveness of case-finding; effectiveness of screening on respiratory hospitalisation and mortality after approximately 4 years. Work package 2: respiratory hospitalisation within 2 years, and barriers to and facilitators of physical activity. Work package 3: work performance – feasibility and acceptability of the occupational health intervention and study processes.
Results
Work package 1: targeted case-finding resulted in greater yield of previously undiagnosed chronic obstructive pulmonary disease than routine care at 1 year [n = 1278 (4%) vs. n = 337 (1%), respectively; adjusted odds ratio 7.45, 95% confidence interval 4.80 to 11.55], and a model-based estimate of a regular screening programme suggested an incremental cost-effectiveness ratio of £16,596 per additional quality-adjusted life-year gained. However, long-term follow-up of the trial showed that at ≈4 years there was no clear evidence that case-finding, compared with routine practice, was effective in reducing respiratory admissions (adjusted hazard ratio 1.04, 95% confidence interval 0.73 to1.47) or mortality (hazard ratio 1.15, 95% confidence interval 0.82 to 1.61). Work package 2: 2305 patients, comprising 1564 with previously diagnosed chronic obstructive pulmonary disease and 741 work package 1 participants (330 with and 411 without obstruction), were recruited. The BLISS prognostic model among cohort participants with confirmed airflow obstruction (n = 1894) included 6 of 23 candidate variables (i.e. age, Chronic Obstructive Pulmonary Disease Assessment Test score, 12-month respiratory admissions, body mass index, diabetes and forced expiratory volume in 1 second percentage predicted). After internal validation and adjustment (uniform shrinkage factor 0.87, 95% confidence interval 0.72 to 1.02), the model discriminated well in predicting 2-year respiratory hospital admissions (c-statistic 0.75, 95% confidence interval 0.72 to 0.79). In focus groups, physical activity engagement was related to self-efficacy and symptom severity. Work package 3: in the occupational subcohort, increasing dyspnoea and exposure to inhaled irritants were associated with lower work productivity at baseline. Longitudinally, increasing exacerbations and worsening symptoms, but not a decline in airflow obstruction, were associated with absenteeism and presenteeism. The acceptability of the occupational health intervention was low, leading to low uptake and low implementation of recommendations and making a full trial unfeasible.
Limitations
Work package 1: even with the most intensive approach, only 38% of patients responded to the case-finding invitation. Management of case-found patients with chronic obstructive pulmonary disease in primary care was generally poor, limiting interpretation of the long-term effectiveness of case-finding on clinical outcomes. Work package 2: the components of the BLISS model may not always be routinely available and calculation of the score requires a computerised system. Work package 3: relatively few cohort participants were in paid employment at baseline, limiting the interpretation of predictors of lower work productivity.
Conclusions
This programme has addressed some of the major uncertainties around screening for undiagnosed chronic obstructive pulmonary disease and has resulted in the development of a novel, accurate model for predicting respiratory hospitalisation in people with chronic obstructive pulmonary disease and the inception of a primary care chronic obstructive pulmonary disease cohort for longer-term follow-up. We have also identified factors that may affect work productivity in people with chronic obstructive pulmonary disease as potential targets for future intervention.
Future work
We plan to obtain data for longer-term follow-up of trial participants at 10 years. The BLISS model needs to be externally validated. Our primary care chronic obstructive pulmonary disease cohort is a unique resource for addressing further questions to better understand the prognosis of chronic obstructive pulmonary disease.
Trial registration
Current Controlled Trials ISRCTN14930255.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Fitzmaurice
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon G Ayres
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - KK Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Brendan G Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tosin Lambe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Martin R Miller
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kiran Rai
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Steve Sadhra
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Robert A Stockley
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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10
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Chiu RYT, Kojima N, Mosley GL, Cheng KK, Pereira DY, Brobeck M, Chan TL, Zee JST, Kittur H, Chung CYT, Tsang E, Maran K, Yung RWH, Leung ACP, Siu RHP, Ng JPL, Choi TH, Fung MW, Chan WS, Lam HY, Lee KH, Parkin S, Chao FC, Ho SKN, Marshak DR, Ma ESK, Klausner JD. Evaluation of the INDICAID COVID-19 Rapid Antigen Test in Symptomatic Populations and Asymptomatic Community Testing. Microbiol Spectr 2021; 9:e0034221. [PMID: 34346748 PMCID: PMC8552729 DOI: 10.1128/spectrum.00342-21] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/24/2021] [Indexed: 12/03/2022] Open
Abstract
As the COVID-19 pandemic progresses, there is an increasing need for rapid, accessible assays for SARS-CoV-2 detection. We present a clinical evaluation and real-world implementation of the INDICAID COVID-19 rapid antigen test (INDICAID rapid test). A multisite clinical evaluation of the INDICAID rapid test using prospectively collected nasal (bilateral anterior) swab samples from symptomatic subjects was performed. The INDICAID rapid test demonstrated a positive percent agreement (PPA) and negative percent agreement (NPA) of 85.3% (95% confidence interval [95% CI], 75.6% to 91.6%) and 94.9% (95% CI, 91.6% to 96.9%), respectively, compared to laboratory-based reverse transcriptase PCR (RT-PCR) using nasal specimens. The INDICAID rapid test was then implemented at COVID-19 outbreak screening centers in Hong Kong as part of a testing algorithm (termed "dual-track") to screen asymptomatic individuals for prioritization for confirmatory RT-PCR testing. In one approach, preliminary positive INDICAID rapid test results triggered expedited processing for laboratory-based RT-PCR, reducing the average time to confirmatory result from 10.85 h to 7.0 h. In a second approach, preliminary positive results triggered subsequent testing with an onsite rapid RT-PCR, reducing the average time to confirmatory result to 0.84 h. In 22,994 asymptomatic patients, the INDICAID rapid test demonstrated a PPA of 84.2% (95% CI, 69.6% to 92.6%) and an NPA of 99.9% (95% CI, 99.9% to 100%) compared to laboratory-based RT-PCR using combined nasal/oropharyngeal specimens. The INDICAID rapid test has excellent performance compared to laboratory-based RT-PCR testing and, when used in tandem with RT-PCR, reduces the time to confirmatory positive result. IMPORTANCE Laboratory-based RT-PCR, the current gold standard for COVID-19 testing, can require a turnaround time of 24 to 48 h from sample collection to result. The delayed time to result limits the effectiveness of centralized RT-PCR testing to reduce transmission and stem potential outbreaks. To address this, we conducted a thorough evaluation of the INDICAID COVID-19 rapid antigen test, a 20-minute rapid antigen test, in both symptomatic and asymptomatic populations. The INDICAID rapid test demonstrated high sensitivity and specificity with RT-PCR as the comparator method. A dual-track testing algorithm was also evaluated utilizing the INDICAID rapid test to screen for preliminary positive patients, whose samples were then prioritized for RT-PCR testing. The dual-track method demonstrated significant improvements in expediting the reporting of positive RT-PCR test results compared to standard RT-PCR testing without prioritization, offering an improved strategy for community testing and controlling SARS-CoV-2 outbreaks.
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Affiliation(s)
- Ricky Y. T. Chiu
- Phase Scientific International Ltd., Garden Grove, California, USA
- Phase Scientific International Ltd., Hong Kong, People’s Republic of China
| | - Noah Kojima
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Garrett L. Mosley
- Phase Scientific International Ltd., Hong Kong, People’s Republic of China
| | - Kwok Kin Cheng
- Phase Scientific International Ltd., Hong Kong, People’s Republic of China
| | - David Y. Pereira
- Phase Scientific International Ltd., Garden Grove, California, USA
| | - Matthew Brobeck
- Phase Scientific International Ltd., Garden Grove, California, USA
| | - Tsun Leung Chan
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong, People’s Republic of China
| | - Jonpaul Sze-Tsing Zee
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong, People’s Republic of China
| | - Harsha Kittur
- Phase Scientific International Ltd., Hong Kong, People’s Republic of China
| | | | - Eric Tsang
- Phase Scientific International Ltd., Garden Grove, California, USA
| | - Kajal Maran
- Phase Scientific International Ltd., Garden Grove, California, USA
| | - Raymond Wai-Hung Yung
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong, People’s Republic of China
| | - Alex Chin-Pang Leung
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong, People’s Republic of China
| | - Ryan Ho-Ping Siu
- Phase Scientific International Ltd., Hong Kong, People’s Republic of China
| | | | - Tsz Hei Choi
- Phase Scientific International Ltd., Hong Kong, People’s Republic of China
| | - Mei Wai Fung
- Phase Scientific International Ltd., Hong Kong, People’s Republic of China
| | - Wai Sing Chan
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong, People’s Republic of China
| | - Ho Yin Lam
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong, People’s Republic of China
| | - Koon Hung Lee
- Department of Hospital Administration, Hong Kong Sanatorium and Hospital, Hong Kong, People’s Republic of China
| | - Sean Parkin
- CityHealth Urgent Care, Alameda, California, USA
| | - Felix C. Chao
- Phase Scientific International Ltd., Garden Grove, California, USA
| | - Stephen Ka-Nung Ho
- Phase Scientific International Ltd., Hong Kong, People’s Republic of China
| | - Daniel R. Marshak
- Phase Scientific International Ltd., Garden Grove, California, USA
- Phase Scientific International Ltd., Hong Kong, People’s Republic of China
| | - Edmond Shiu-Kwan Ma
- Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong, People’s Republic of China
| | - Jeffrey D. Klausner
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
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11
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Dowell AC, Munford H, Goel A, Gordon NS, James ND, Cheng KK, Zeegers MP, Ward DG, Bryan RT. PD-L2 Is Constitutively Expressed in Normal and Malignant Urothelium. Front Oncol 2021; 11:626748. [PMID: 33718196 PMCID: PMC7951139 DOI: 10.3389/fonc.2021.626748] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/15/2021] [Indexed: 11/14/2022] Open
Abstract
The use of immune checkpoint blockade, in particular PD-1 and PD-L1 inhibitors, is now commonplace in many clinical settings including the treatment of muscle-invasive bladder cancer (MIBC). Notwithstanding, little information exists regarding the expression of the alternative PD-1 ligand, PD-L2 in urothelial bladder cancer (UBC). We therefore set out to characterise the expression of PD-L2 in comparison to PD-L1. Firstly, we assessed PD-L2 expression by immunohistochemistry and found widespread expression of PD-L2 in UBC, albeit with reduced expression in MIBC. We further investigated these findings using RNA-seq data from a cohort of 575 patients demonstrating that PDCD1LG2 (PD-L2) is widely expressed in UBC and correlated with CD274 (PD-L1). However, in contrast to our immunohistochemistry findings, expression was significantly increased in advanced disease. We have also provided detailed evidence of constitutive PD-L2 expression in normal urothelium and propose a mechanism by which PD-L2 is cleaved from the cell surface in MIBC. These data provide a comprehensive assessment of PD-L2 in UBC, showing PD-L2 is abundant in UBC and, importantly, constitutively present in normal urothelium. These data have implications for future development of immune checkpoint blockade, and also the understanding of the function of the immune system in the normal urinary bladder.
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Affiliation(s)
- Alexander C Dowell
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Haydn Munford
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Anshita Goel
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Naheema S Gordon
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nicholas D James
- Prostate and Bladder Cancer Research Team, The Institute of Cancer Research, London, United Kingdom
| | - K K Cheng
- School of Health and Population Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Maurice P Zeegers
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.,CAPHRI School for Public Health and Primary Care, University of Maastricht, Maastricht, Netherlands
| | - Douglas G Ward
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Richard T Bryan
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
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12
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Affiliation(s)
- K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
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13
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Pan J, Adab P, Cheng KK, Jiang CQ, Zhang WS, Zhu F, Jin YL, Thomas GN, Steyerberg EW, Lam TH. Development and validation of a prediction model for airflow obstruction in older Chinese: Guangzhou Biobank Cohort Study. Respir Med 2020; 173:106158. [PMID: 33011445 DOI: 10.1016/j.rmed.2020.106158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop and validate a prediction model for airflow obstruction (AO) in older Chinese. METHODS DESIGN Multivariable logistic regression analysis in large population cohort of Chinese aged ≥50 years. PARTICIPANTS Model development: 8762 Chinese aged ≥50 years were selected from the early phase recruits to the Guangzhou Biobank Cohort Study (GBCS) (recruited from September 2003 to May 2006). Internal validation: 100 bootstrap samples drawn with replacement from the development sample. External validation: 8395 Chinese aged ≥50 years from later phase GBCS (recruited from September 2006 to January 2008). OUTCOMES AO was defined by a forced expiratory volume in 1 s/forced vital capacity ratio < lower limits of normal. RESULTS 839 (9.6%) and 764 (9.1%) individuals had AO in the development and temporal validation samples respectively. The predictors in the prediction model included sex, age, body mass index groups, smoking status, presence of respiratory symptoms, and history of asthma. Model development and validation was stratified by sex. Model performance including calibration (calibration-in-the-large -0.017 vs. -0.157; and calibration slope 0.88 vs. 1.02), discrimination (C-statistic 0.72 vs. 0.63 with 95% confidence interval 0.69-0.75 vs. 0.62-0.73) and clinical usefulness (decision curve analysis) in the external temporal validation sample were more satisfactory in men than that in women. Prediction models with risk thresholds (13% in men and 7% in women) and easy-to-use nomograms were developed to assess the probability of AO. CONCLUSION The diagnostic models based on readily available epidemiologic and clinical information with satisfactory performance can assist physicians to identify older individuals at high risk of AO and may improve the efficiency of spirometry for active case finding. Further validation beyond the Chinese population is warranted.
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Affiliation(s)
- Jing Pan
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, Guangdong, China
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chao Qiang Jiang
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, Guangdong, China
| | - Wei Sen Zhang
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, Guangdong, China
| | - Feng Zhu
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, Guangdong, China
| | - Ya Li Jin
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, Guangdong, China
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Tai Hing Lam
- Molecular Epidemiology Research Center, Guangzhou Twelfth People's Hospital, Guangzhou, Guangdong, China; School of Public Health, The University of Hong Kong, Hong Kong, China
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14
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Tang HM, Xiao XP, Li C, Shi LH, Cheng KK, Wen L, Li WY, Wang K. Influences of different manure N input on soil ammonia-oxidizing archaea and bacterial activity and community structure in a double-cropping rice field. J Appl Microbiol 2020; 130:937-947. [PMID: 32852144 DOI: 10.1111/jam.14830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/24/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022]
Abstract
AIMS The short-term effects of different organic manure nitrogen (N) input on soil ammonia-oxidizing archaea (AOA) and bacterial (AOB) activity and community structure at maturity stages of early rice and late rice were investigated in the present paper, in a double-cropping rice system in southern China. METHODS AND RESULTS A field experiment was done by applying five different organic and inorganic N input treatments: (i) 100% N of chemical fertilizer (M0), (ii) 30% N of organic manure and 70% N of chemical fertilizer (M30), (iii) 50% N of organic manure and 50% N of chemical fertilizer (M50), (iv) 100% N of organic manure (M100) and (v) without N fertilizer input as control (CK). Microbial community changes were assessed using fatty acid methyl esters, and ammonia oxidizer (AO) changes were followed using quantitative PCR. The results showed that AOA were higher than that of AOB based upon amoA gene copy at maturity stages of early rice and late rice. Also, the abundance of AOB and AOA with M30, M50 and M100 treatments was significantly higher than that of CK treatment. Manure N input treatments had significant effect on AOB and AOA abundance, and a higher correlation between AOB and manure N input was observed. AOB correlated moderately with soil organic carbon content, and AOA correlated moderately with water-filled pore space. CONCLUSIONS This study found that abundance of AOB and AOA was increased under the given organic N conditions, and the soil AOB and AOA community and diversity were changed by different short-term organic manure N input treatments. SIGNIFICANCE AND IMPACT OF THE STUDY Soil microbial community and specific N-utilizing microbial groups were affected by organic manure N input practices.
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Affiliation(s)
- H M Tang
- Hunan Soil and Fertilizer Institute, Changsha, PR China
| | - X P Xiao
- Hunan Soil and Fertilizer Institute, Changsha, PR China
| | - C Li
- Hunan Soil and Fertilizer Institute, Changsha, PR China
| | - L H Shi
- Hunan Soil and Fertilizer Institute, Changsha, PR China
| | - K K Cheng
- Hunan Soil and Fertilizer Institute, Changsha, PR China
| | - L Wen
- Hunan Soil and Fertilizer Institute, Changsha, PR China
| | - W Y Li
- Hunan Soil and Fertilizer Institute, Changsha, PR China
| | - K Wang
- Hunan Soil and Fertilizer Institute, Changsha, PR China
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15
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Liu M, Cheng SZ, Xu KW, Yang Y, Zhu QT, Zhang H, Yang DY, Cheng SY, Xiao H, Wang JW, Yao HR, Cong YT, Zhou YQ, Peng S, Kuang M, Hou FF, Cheng KK, Xiao HP. Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: cross sectional study. BMJ 2020; 369:m2195. [PMID: 32522737 PMCID: PMC7284314 DOI: 10.1136/bmj.m2195] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the protective effects of appropriate personal protective equipment for frontline healthcare professionals who provided care for patients with coronavirus disease 2019 (covid-19). DESIGN Cross sectional study. SETTING Four hospitals in Wuhan, China. PARTICIPANTS 420 healthcare professionals (116 doctors and 304 nurses) who were deployed to Wuhan by two affiliated hospitals of Sun Yat-sen University and Nanfang Hospital of Southern Medical University for 6-8 weeks from 24 January to 7 April 2020. These study participants were provided with appropriate personal protective equipment to deliver healthcare to patients admitted to hospital with covid-19 and were involved in aerosol generating procedures. 77 healthcare professionals with no exposure history to covid-19 and 80 patients who had recovered from covid-19 were recruited to verify the accuracy of antibody testing. MAIN OUTCOME MEASURES Covid-19 related symptoms (fever, cough, and dyspnoea) and evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, defined as a positive test for virus specific nucleic acids in nasopharyngeal swabs, or a positive test for IgM or IgG antibodies in the serum samples. RESULTS The average age of study participants was 35.8 years and 68.1% (286/420) were women. These study participants worked 4-6 hour shifts for an average of 5.4 days a week; they worked an average of 16.2 hours each week in intensive care units. All 420 study participants had direct contact with patients with covid-19 and performed at least one aerosol generating procedure. During the deployment period in Wuhan, none of the study participants reported covid-19 related symptoms. When the participants returned home, they all tested negative for SARS-CoV-2 specific nucleic acids and IgM or IgG antibodies (95% confidence interval 0.0 to 0.7%). CONCLUSION Before a safe and effective vaccine becomes available, healthcare professionals remain susceptible to covid-19. Despite being at high risk of exposure, study participants were appropriately protected and did not contract infection or develop protective immunity against SARS-CoV-2. Healthcare systems must give priority to the procurement and distribution of personal protective equipment, and provide adequate training to healthcare professionals in its use.
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Affiliation(s)
- Min Liu
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Shou-Zhen Cheng
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Ke-Wei Xu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yang Yang
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing-Tang Zhu
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Hui Zhang
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Da-Ya Yang
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Shu-Yuan Cheng
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Han Xiao
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Ji-Wen Wang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - He-Rui Yao
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Tian Cong
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu-Qi Zhou
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sui Peng
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Ming Kuang
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Fan-Fan Hou
- Nan Fang Hospital, Southern Medical University, Guangzhou, China
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Hai-Peng Xiao
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
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16
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Goel A, Ward DG, Gordon NS, Abbotts B, Zeegers MP, Cheng KK, James ND, Bryan RT, Arnold R. Back-Splicing Transcript Isoforms (Circular RNAs) Affect Biologically Relevant Pathways and Offer an Additional Layer of Information to Stratify NMIBC Patients. Front Oncol 2020; 10:812. [PMID: 32670866 PMCID: PMC7326039 DOI: 10.3389/fonc.2020.00812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/24/2020] [Indexed: 12/24/2022] Open
Abstract
Circularized transcript isoforms due to back-splicing are increasingly being reported in different tissues types and pathological states including cancer. Since these circular RNAs (circRNAs) are more stable than linear messenger RNA their identification and profiling in tumor tissue could aid in stratifying patients and may serve as biomarkers. In this study, we have investigated the relationship between circRNA expression and tumor grade in a cohort of 58, mostly non-muscle-invasive bladder cancer patients. From 4571 circRNAs detected, we identified 157 that were significantly differentially expressed between tumor grades relative to the linear transcript. We demonstrated that such grade-related differences can be identified in an independent cohort, and that a large fraction of circRNAs can be, in principle, detected in urine. The differentially expressed circRNAs cluster into subgroups according to their co-expression, subgroups which are enriched for DNA repair, cell cycle and intracellular signaling genes. Since one proposed function of circRNAs is to interfere with gene-regulation by acting as microRNA “sponges,” candidates which were differentially expressed between tumor grades were investigated for potential miRNA target sites. By investigating the circRNAs from bladder cancer related pathways we demonstrated that the expression of these pathways, the circRNAs, and their parental genes are often decoupled and do not correlate, yet that some circRNAs do not follow this tendency. The present study provides the next step for the comprehensive evaluation of this novel class of RNAs in the context of non-muscle-invasive bladder cancer. Intriguingly, despite their possible function as microRNA sponges, they potentially affect host mRNA levels at the transcriptional stage, as compared to post-transcriptional control by miRNAs. Our analysis indicates differences of their activity between bladder cancer tumor stages, and their relative expression levels may provide an additional layer of information for patient stratification.
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Affiliation(s)
- Anshita Goel
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Douglas G Ward
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Naheema S Gordon
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ben Abbotts
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Maurice P Zeegers
- NUTRIM School for Nutrition and Translational Research in Metabolism & CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - K K Cheng
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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17
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Ng LFH, Tsang HHC, Wong FHY, Law MWC, Chong WH, Ho CHN, Fung JKJ, Chan CCY, Li LSK, Wong KT, Chan JCX, Lam SHY, Wong KH, Kwok PL, Xu L, Lai TKK, Cheng KK, Hon TYW, Hui JYH, Kwok SKY, Ma JKF. Radiological Findings in COVID-19 and Adaptive Approach in Radiology Departments: Literature Review and Experience sharing. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017218] [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)
- LFH Ng
- Department of Radiology, Princess Margaret Hospital, Laichikok, Hong Kong
| | - HHC Tsang
- Department of Radiology and Organ Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - FHY Wong
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - MWC Law
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong
| | - WH Chong
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CHN Ho
- Department of Radiology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - JKJ Fung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - CCY Chan
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - LSK Li
- Department of Radiology, Princess Margaret Hospital, Laichikok, Hong Kong
| | - KT Wong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong
| | - JCX Chan
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - SHY Lam
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - KH Wong
- Department of Radiology, North District Hospital, Sheung Shui, Hong Kong
| | - PL Kwok
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - L Xu
- Department of Radiology and Organ Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - TKK Lai
- Department of Radiology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - KK Cheng
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - TYW Hon
- Department of Radiology, United Christian Hospital, Kwun Tong, Hong Kong
| | - JYH Hui
- Department of Radiology, United Christian Hospital, Kwun Tong, Hong Kong
| | - SKY Kwok
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - JKF Ma
- Department of Radiology, Princess Margaret Hospital, Laichikok, Hong Kong
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18
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Affiliation(s)
- C C Leung
- The Advisory Committee on Communicable Diseases, Hong Kong Medical Association, Hong Kong, China
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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19
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Fung KKF, Chiu JHF, Cheng KK. Inverted Meckel’s Diverticulum — A Rare Complication of a Common Congenital Anomaly: A Case Report. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017009] [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)
- KKF Fung
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - JHF Chiu
- Department of Surgery, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - KK Cheng
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
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20
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Affiliation(s)
- Allyson M Pollock
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Peter Roderick
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - K K Cheng
- Institute of Applied Health Research College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Bharat Pankhania
- College of Medicine and Health, University of Exeter, Exeter, UK
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21
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Affiliation(s)
- Rachel E Jordan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Peymane Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - K K Cheng
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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22
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Fung KKF, Cheng KK, Lee BKH, Cho DHY. Anomalous Direct Drainage of Left Adrenal Vein into Left-sided Inferior Vena Cava Encountered during Adrenal Venous Sampling: a Case Report. Hong Kong Journal of Radiology 2019. [DOI: 10.12809/hkjr1916982] [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)
- KKF Fung
- Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - KK Cheng
- Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - BKH Lee
- Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - DHY Cho
- Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
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23
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Yu EY, Nekeman D, Billingham LJ, James ND, Cheng KK, Bryan RT, Wesselius A, Zeegers MP. Health-related quality of life around the time of diagnosis in patients with bladder cancer. BJU Int 2019; 124:984-991. [PMID: 31077532 PMCID: PMC6907410 DOI: 10.1111/bju.14804] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To quantify the health-related quality of life (HRQoL) of patients with bladder cancer around the time of diagnosis and to test the hypotheses of a two-factor model for the HRQoL questionnaire QLQ-C30. METHODS From participants in the Bladder Cancer Prognoses Programme, a multicentre cohort study, sociodemographic data were collected using semi-structured face-to-face interviews. Answers to the QLQ-C30 were transformed into a scale from 0 to 100. HRQoL data were analysed in multivariate analyses. The hypothesized two-factor (Physical and Mental Health) domain structure of the QLQ-C30 was also tested with confirmatory factor analyses (CFA). RESULTS A total of 1160 participants (78%) completed the questionnaire after initial visual diagnosis and before pathological confirmation. Despite non-muscle-invasive bladder cancer (NMIBC) being associated with a higher HRQoL than carcinoma invading bladder muscle, only the domain Role Functioning was clinically significantly better in patients with NMIBC. Age, gender, bladder cancer stage and comorbidity all had a significant influence on QLQ-C30 scores. The CFA showed an overall good fit of the hypothesized two-factor model. CONCLUSION This study identified a baseline reference value for HRQoL for patients with bladder cancer, which allows better evaluation of any changes in HRQoL as disease progresses or after treatment. In addition, a two-factor (Physical and Mental Health) model was developed for the QLQ-C30.
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Affiliation(s)
- Evan Yi‐Wen Yu
- NUTRIM School for Nutrition and Translational Research in MetabolismUniversity of MaastrichtMaastrichtthe Netherlands
- CAPHRI School for Public Health and Primary CareUniversity of MaastrichtMaastrichtthe Netherlands
| | - Duncan Nekeman
- Department of Public Health, Epidemiology and BiostatisticsSchool of Health and Population SciencesUniversity of BirminghamBirminghamUK
| | - Lucinda J. Billingham
- MRC Midland Hub for Trials Methodology Research and Cancer Research UK Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | | | - KK Cheng
- Department of Public Health, Epidemiology and BiostatisticsSchool of Health and Population SciencesUniversity of BirminghamBirminghamUK
| | | | - Anke Wesselius
- NUTRIM School for Nutrition and Translational Research in MetabolismUniversity of MaastrichtMaastrichtthe Netherlands
| | - Maurice P. Zeegers
- CAPHRI School for Public Health and Primary CareUniversity of MaastrichtMaastrichtthe Netherlands
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24
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van Osch FHM, Nekeman D, Aaronson NK, Billingham LJ, James ND, Cheng KK, Bryan RT, Zeegers MP. Patients choose certainty over burden in bladder cancer surveillance. World J Urol 2019; 37:2747-2753. [PMID: 30903352 PMCID: PMC6867982 DOI: 10.1007/s00345-019-02728-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/11/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Due to the high risk of recurrence of non-muscle invasive bladder cancer, all patients undergo regular cystoscopic surveillance for early detection. As cystoscopy is invasive, costly and increases the burden of the disease considerably, there is significant ongoing research and development into non-invasive urinary biomarker substitutes. This study aims to assess the level of sensitivity required before patients accept a new urinary biomarker. METHODS We studied the preferences for a hypothetical diagnostic urinary biomarker and compared this to usual care (cystoscopy) at different levels of sensitivity among 437 patients with bladder cancer (354 men and 83 women) from the UK Bladder Cancer Prognosis Programme. A standard gamble approach was used to estimate the minimally acceptable sensitivity (MAS) of the new biomarker. Additionally, non-parametric statistical analyses were performed to investigate the association between surveillance preference and various patient characteristics. RESULTS Almost half of patients (183, 43%) would not replace cystoscopy with a urinary biomarker unless it was 100% sensitive. The median MAS was 99.9999%, and nearly 85% of patients demanded a sensitivity of at least 99% before preferring a urinary biomarker test over cystoscopy. These results were consistent across all patient characteristics and demographic categories. CONCLUSIONS Our results indicate that patients demand urinary biomarkers as sensitive as cystoscopy before they would be willing to forego cystoscopy for bladder cancer surveillance.
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Affiliation(s)
- Frits H M van Osch
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
- Department of Complex Genetics, Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Duncan Nekeman
- Department of Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lucinda J Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - K K Cheng
- Department of Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Maurice P Zeegers
- Department of Complex Genetics, Nutrition and Metabolism in Translational Research (NUTRIM), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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25
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Lambe T, Adab P, Jordan RE, Sitch A, Enocson A, Jolly K, Marsh J, Riley R, Miller M, Cooper BG, Turner AM, Ayres JG, Stockley R, Greenfield S, Siebert S, Daley A, Cheng KK, Fitzmaurice D, Jowett S. Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care. Thorax 2019; 74:730-739. [PMID: 31285359 PMCID: PMC6703126 DOI: 10.1136/thoraxjnl-2018-212148] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 03/15/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Abstract
Introduction ‘One-off’ systematic case-finding for COPD using a respiratory screening questionnaire is more effective and cost-effective than routine care at identifying new cases. However, it is not known whether early diagnosis and treatment is beneficial in the longer term. We estimated the long-term cost-effectiveness of a regular case-finding programme in primary care. Methods A Markov decision analytic model was developed to compare the cost-effectiveness of a 3-yearly systematic case-finding programme targeted to ever smokers aged ≥50 years with the current routine diagnostic process in UK primary care. Patient-level data on case-finding pathways was obtained from a large randomised controlled trial. Information on the natural history of COPD and treatment effects was obtained from a linked COPD cohort, UK primary care database and published literature. The discounted lifetime cost per quality-adjusted life-year (QALY) gained was calculated from a health service perspective. Results The incremental cost-effectiveness ratio of systematic case-finding versus current care was £16 596 per additional QALY gained, with a 78% probability of cost-effectiveness at a £20 000 per QALY willingness-to-pay threshold. The base case result was robust to multiple one-way sensitivity analyses. The main drivers were response rate to the initial screening questionnaire and attendance rate for the confirmatory spirometry test. Discussion Regular systematic case-finding for COPD using a screening questionnaire in primary care is likely to be cost-effective in the long-term despite uncertainties in treatment effectiveness. Further knowledge of the natural history of case-found patients and the effectiveness of their management will improve confidence to implement such an approach.
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Affiliation(s)
- Tosin Lambe
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Alice Sitch
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Alex Enocson
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Jen Marsh
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Richard Riley
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Martin Miller
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, West Midlands, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Brendan G Cooper
- Lung Investigation Unit, University Hospital Birmingham, Birmingham, UK
| | - Alice Margaret Turner
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, Birmingham, UK
| | - Jon G Ayres
- Institute of Occupational and Environmental Med, University of Birmingham, Birmingham, UK
| | | | - Sheila Greenfield
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Stanley Siebert
- Birmingham Business School, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - K K Cheng
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - David Fitzmaurice
- Institute of Applied Health Research, The University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Health Economics Unit, University of Birmingham, Birmingham, UK
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26
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Wang J, Moore D, Subramanian A, Cheng KK, Toulis KA, Qiu X, Saravanan P, Price MJ, Nirantharakumar K. Gestational dyslipidaemia and adverse birthweight outcomes: a systematic review and meta-analysis. Obes Rev 2018; 19:1256-1268. [PMID: 29786159 DOI: 10.1111/obr.12693] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/30/2018] [Accepted: 02/26/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Low and high birthweight is known to increase the risk of acute and longer-term adverse outcomes, such as stillbirth, infant mortality, obesity, type 2 diabetes and cardiovascular diseases. Gestational dyslipidaemia is associated with a numbers of adverse birth outcomes, but evidence regarding birthweight is still inconsistent to reliably inform clinical practice and treatment recommendations. OBJECTIVE The aim of this study was to explore the relationship between maternal gestational dyslipidaemia and neonatal health outcomes, namely, birthweight, metabolic factors and inflammatory parameters. METHODS We searched systematically Embase, MEDLINE, PubMed, CINAHL Plus and Cochrane Library up to 1 August 2016 (with an updated search in MEDLINE at the end of July 2017) for longitudinal studies that assessed the association of maternal lipid levels during pregnancy with neonatal birthweight, or metabolic and inflammatory parameters up to 3 years old. RESULTS Data from 46 publications including 31,402 pregnancies suggest that maternal high triglycerides and low high-density-lipoprotein cholesterol levels throughout pregnancy are associated with increased birthweight, higher risk of large for gestational age and macrosomia and lower risk of small-for-gestational age. The findings were consistent across the studied populations, but stronger associations were observed in women who were overweight or obese prior to pregnancy. CONCLUSIONS This meta-analysis suggested that the potential under-recognized adverse effects of intrauterine exposure to maternal dyslipidaemia may warrant further investigation into the relationship between maternal dyslipidaemia and birthweight in large prospective cohorts or in randomized trials.
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Affiliation(s)
- J Wang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - D Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K A Toulis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - X Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - P Saravanan
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - M J Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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27
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Adab P, Fitzmaurice DA, Dickens AP, Ayres JG, Buni H, Cooper BG, Daley AJ, Enocson A, Greenfield S, Jolly K, Jowett S, Kalirai K, Marsh JL, Miller MR, Riley RD, Siebert WS, Stockley RA, Turner AM, Cheng KK, Jordan RE. Cohort Profile: The Birmingham Chronic Obstructive Pulmonary Disease (COPD) Cohort Study. Int J Epidemiol 2018; 46:23. [PMID: 27378796 DOI: 10.1093/ije/dyv350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - D A Fitzmaurice
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J G Ayres
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - H Buni
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - B G Cooper
- Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A J Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - S Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K Kalirai
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J L Marsh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M R Miller
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R D Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - W S Siebert
- Business School, University of Birmingham, Birmingham, UK
| | - R A Stockley
- Queen Elizabeth Hospital Research Laboratories, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A M Turner
- School of Inflammation & Aging, University of Birmingham, UK
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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28
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Jochems SHJ, van Osch FHM, Reulen RC, van Hensbergen M, Nekeman D, Pirrie SJ, Wesselius A, van Schooten FJ, James ND, Wallace DMA, Bryan RT, Cheng KK, Zeegers MP. Total Fluid Intake and the Risk of Recurrence in Patients With Non-Muscle Invasive Bladder Cancer: A Prospective Cohort Study. Bladder Cancer 2018; 4:303-310. [PMID: 30112441 PMCID: PMC6087451 DOI: 10.3233/blc-180172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives: To investigate the role of fluid intake from beverages before and after a diagnosis of bladder cancer in relation to the risk of developing bladder cancer recurrence. Study Design: Prospective cohort study. Methods: 716 patients with non-muscle invasive bladder cancer (NMIBC), who received transurethral resection of a primary bladder tumour (TURBT) and completed self-administrated questionnaires on usual fluid intake from beverages at time of diagnosis (over the year before diagnosis) and during follow-up (over the year after diagnosis), were included. Multivariable Cox regression was used to calculate hazard ratios and 95% confidence intervals of developing recurrent bladder cancer in relation to the intake of total fluid, total alcohol, and individual beverages. Results: During 2,025 person-years of follow-up, 238 (33%) of the included 716 NMIBC patients developed one or more recurrences of bladder cancer. Total fluid intake before diagnosis was not associated with a first recurrence of bladder cancer when comparing the highest and lowest intake group (HR = 0.98, 95% C.I. 0.70–1.38, p = 0.91). Comparable results were obtained for total fluid intake pre-diagnosis and the risk of developing multiple recurrences of bladder cancer (HR = 1.01, 95% C.I. 0.87–1.19, p = 0.85). A total of 379 of the 716 patients reported on usual fluid intake within 1 year of diagnosis. No significant associations between total fluid intake 1 year after diagnosis and a first recurrence of bladder cancer were found when comparing the highest and lowest intake group (HR = 0.91; 95% C.I. 0.60–1.37, p = 0.65) or with multiple recurrences of bladder cancer (HR = 1.06; 95% C.I. 0.89–1.26, p = 0.54). In addition, total alcohol intake and individual beverages were not associated with bladder cancer recurrence. Conclusions: The results indicate that an individual’s fluid intake from beverages is unlikely to have an important role in bladder cancer recurrence.
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Affiliation(s)
- Sylvia H J Jochems
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,School for Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands
| | - Frits H M van Osch
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,School for Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands
| | - Raoul C Reulen
- Department of Public Health, Epidemiology and Biostatistics, institute of Applied Health Research, University of Birmingham, UK
| | - Mitch van Hensbergen
- School for Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands
| | - Duncan Nekeman
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sarah J Pirrie
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Anke Wesselius
- School for Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands
| | - Frederik J van Schooten
- School for Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
| | - D Michael A Wallace
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - K K Cheng
- Department of Public Health, Epidemiology and Biostatistics, institute of Applied Health Research, University of Birmingham, UK
| | - Maurice P Zeegers
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,School for Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands
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29
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van Osch FHM, Jochems SHJ, Reulen RC, Pirrie SJ, Nekeman D, Wesselius A, James ND, Wallace DMA, Cheng KK, van Schooten FJ, Bryan RT, Zeegers MP. The association between smoking cessation before and after diagnosis and non-muscle-invasive bladder cancer recurrence: a prospective cohort study. Cancer Causes Control 2018; 29:675-683. [PMID: 29846846 PMCID: PMC5999150 DOI: 10.1007/s10552-018-1046-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/28/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Smoking is a major risk factor for bladder cancer, but the relationship between smoking cessation after initial treatment and bladder cancer recurrence has been investigated less frequently and not prospectively yet. METHODS 722 non-muscle-invasive bladder cancer (NMIBC) patients (pTa, pT1, and CIS) from the prospective Bladder Cancer Prognosis Programme (BCPP) cohort, selected in the UK between 2005 and 2011, provided complete data on smoking behavior before and up to 5 years after diagnosis. The impact of smoking behavior on NMIBC recurrence was explored by multivariable Cox regression models investigating time-to-first NMIBC recurrence. RESULTS Over a median follow-up period of 4.21 years, 403 pathologically confirmed NMIBC recurrences occurred in 210 patients. Only 25 current smokers at diagnosis quit smoking (14%) during follow-up and smoking cessation after diagnosis did not decrease risk of recurrence compared to continuing smokers (p = 0.352). CONCLUSIONS Although quitting smoking after diagnosis might reduce the risk of recurrence based on retrospective evidence, this is not confirmed in this prospective study because the number of NMIBC patients quitting smoking before their first recurrence was too low. Nevertheless, this indicates an important role for urologists and other health care professionals in promoting smoking cessation in NMIBC.
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Affiliation(s)
- Frits H M van Osch
- Unit of Nutritional and Cancer Epidemiology, Chairgroup of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Sylvia H J Jochems
- Unit of Nutritional and Cancer Epidemiology, Chairgroup of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Raoul C Reulen
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | - Sarah J Pirrie
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Duncan Nekeman
- Unit of Nutritional and Cancer Epidemiology, Chairgroup of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Anke Wesselius
- Unit of Nutritional and Cancer Epidemiology, Chairgroup of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
| | - D Michael A Wallace
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
| | - K K Cheng
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | - Frederik J van Schooten
- Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Maurice P Zeegers
- Unit of Nutritional and Cancer Epidemiology, Chairgroup of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Chairgroup of Complex Genetics and Epidemiology, Care and Public Health Research Institute (CAPRHI), Maastricht University, Maastricht, The Netherlands
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Snell KIE, Ward DG, Gordon NS, Goldsmith JC, Sutton AJ, Patel P, James ND, Zeegers MP, Cheng KK, Bryan RT. Exploring the roles of urinary HAI-1, EpCAM & EGFR in bladder cancer prognosis & risk stratification. Oncotarget 2018; 9:25244-25253. [PMID: 29861867 PMCID: PMC5982738 DOI: 10.18632/oncotarget.25397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/28/2018] [Indexed: 11/25/2022] Open
Abstract
Objectives To investigate whether elevated urinary HAI-1, EpCAM and EGFR are independent prognostic biomarkers within non-muscle-invasive bladder cancer (NMIBC) patients, and have utility for risk stratification to facilitate treatment decisions. Results After accounting for EAU risk group in NMIBC patients, the risk of BC-specific death was 2.14 times higher (95% CI: 1.08 to 4.24) if HAI-1 was elevated and 2.04 times higher (95% CI: 1.02 to 4.07) if EpCAM was elevated. The majority of events occurred in the high-risk NMIBC group and this is where the biggest difference is seen in the survival curves when plotted for EAU risk groups separately. In MIBC patients, being elevated for any of the three biomarkers was significantly associated with BC-specific mortality after accounting for other risk factors, HR = 4.30 (95% CI: 1.85 to 10.03). Patients and Methods Urinary levels of HAI-1, EpCAM and EGFR were measured by ELISA in 683 and 175 patients with newly-diagnosed NMIBC and MIBC, respectively, recruited to the Bladder Cancer Prognosis Programme. Associations between biomarkers and progression, BC-specific mortality and all-cause mortality were evaluated using univariable and multivariable Cox regression models, adjusted for European Association of Urology (EAU) NMIBC risk groups. The upper 25% of values for each biomarker within NMIBC patients were considered as elevated. Exploratory analyses in urine from MIBC patients were also undertaken. Conclusion Urinary HAI-1 and EpCAM are prognostic biomarkers for NMIBC patients. These biomarkers have potential to guide treatment decisions for high-risk NMIBC patients. Further analyses are required to define the roles of HAI-1, EpCAM and EGFR in MIBC patients.
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Affiliation(s)
- Kym I E Snell
- Centre for Prognosis Research, Research Institute for Primary Care and Health Science, Keele University, Newcastle-under-Lyme, ST5 5BG, UK
| | - Douglas G Ward
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Naheema S Gordon
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - James C Goldsmith
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Andrew J Sutton
- Leeds Institute of Health Sciences, University of Leeds and The Diagnostic Evidence Cooperative, Leeds LS2 9JT, UK
| | - Prashant Patel
- Institute of Cancer and Genomic Sciences, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Maurice P Zeegers
- NUTRIM School for Nutrition and Translational Research in Metabolism and CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht 6200 MD, The Netherlands
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Jochems SHJ, van Osch FHM, Reulen RC, van Hensbergen M, Nekeman D, Pirrie S, Wesselius A, van Schooten FJ, James ND, Wallace DMA, Bryan RT, Cheng KK, Zeegers MP. Fruit and vegetable intake and the risk of recurrence in patients with non-muscle invasive bladder cancer: a prospective cohort study. Cancer Causes Control 2018; 29:573-579. [PMID: 29667104 PMCID: PMC5938309 DOI: 10.1007/s10552-018-1029-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/05/2018] [Indexed: 11/29/2022]
Abstract
Introduction There is some evidence that greater consumption of fruit and vegetables decreases the risk of bladder cancer. The role of fruit and vegetables in bladder cancer recurrence is still unknown. Objective The role of total fruit and vegetable intake in relation to the risk of developing bladder cancer recurrence in a prospective cohort study. Methods 728 patients with non-muscle invasive bladder cancer (NMIBC), who completed self-administrated questionnaires on fruit and vegetable intake at time of diagnosis (over the year before diagnosis) and 1 year after diagnosis, were included. Hazard ratios and 95% confidence intervals were calculated by multivariable Cox regression for developing recurrent bladder cancer in relation to fruit and vegetable intake. Results During 2,051 person-years of follow-up [mean (SD) follow-up 3.7 (1.5) years], 241 (33.1%) of the included 728 NMIBC patients developed a recurrence of bladder cancer. The sum of total fruit and vegetables before diagnosis was not related to a first bladder cancer recurrence (HR 1.07; 95% CI 0.78–1.47, p = 0.66). No association was found between greater consumption of fruit and vegetables over the year before diagnosis and the risk of developing multiple recurrences of bladder cancer (HR 1.02; 95% CI 0.90–1.15, p = 0.78). Among the remaining 389 NMIBC patients who reported on fruit and vegetable intake 1 year after diagnosis, no association was found between greater consumption of fruit and vegetables and a first recurrence of bladder cancer (HR 0.65; 95% CI 0.42–1.01, p = 0.06) nor with multiple recurrences of bladder cancer (HR 1.00, 95% CI 0.85–1.18, p = 1.00). Similar results were obtained when investigating the association between total intakes of fruit and vegetables separately and bladder cancer recurrence. Conclusion Results from this study did not indicate a protective role for total fruit and vegetables in the development of a recurrence of NMIBC. Electronic supplementary material The online version of this article (10.1007/s10552-018-1029-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sylvia H J Jochems
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK. .,Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Frits H M van Osch
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Raoul C Reulen
- Department of Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mitch van Hensbergen
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Duncan Nekeman
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sarah Pirrie
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Anke Wesselius
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Frederik-Jan van Schooten
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
| | - D Michael A Wallace
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - K K Cheng
- Department of Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Maurice P Zeegers
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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Adab P, Pallan MJ, Lancashire ER, Hemming K, Frew E, Barrett T, Bhopal R, Cade JE, Canaway A, Clarke JL, Daley A, Deeks JJ, Duda JL, Ekelund U, Gill P, Griffin T, McGee E, Hurley K, Martin J, Parry J, Passmore S, Cheng KK. Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study). BMJ 2018; 360:k211. [PMID: 29437667 PMCID: PMC5792961 DOI: 10.1136/bmj.k211] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity. DESIGN Cluster randomised controlled trial. SETTING UK primary schools from the West Midlands. PARTICIPANTS 200 schools were randomly selected from all state run primary schools within 35 miles of the study centre (n=980), oversampling those with high minority ethnic populations. These schools were randomly ordered and sequentially invited to participate. 144 eligible schools were approached to achieve the target recruitment of 54 schools. After baseline measurements 1467 year 1 pupils aged 5 and 6 years (control: 28 schools, 778 pupils) were randomised, using a blocked balancing algorithm. 53 schools remained in the trial and data on 1287 (87.7%) and 1169 (79.7%) pupils were available at first follow-up (15 month) and second follow-up (30 month), respectively. INTERVENTIONS The 12 month intervention encouraged healthy eating and physical activity, including a daily additional 30 minute school time physical activity opportunity, a six week interactive skill based programme in conjunction with Aston Villa football club, signposting of local family physical activity opportunities through mail-outs every six months, and termly school led family workshops on healthy cooking skills. MAIN OUTCOME MEASURES The protocol defined primary outcomes, assessed blind to allocation, were between arm difference in body mass index (BMI) z score at 15 and 30 months. Secondary outcomes were further anthropometric, dietary, physical activity, and psychological measurements, and difference in BMI z score at 39 months in a subset. RESULTS Data for primary outcome analyses were: baseline, 54 schools: 1392 pupils (732 controls); first follow-up (15 months post-baseline), 53 schools: 1249 pupils (675 controls); second follow-up (30 months post-baseline), 53 schools: 1145 pupils (621 controls). The mean BMI z score was non-significantly lower in the intervention arm compared with the control arm at 15 months (mean difference -0.075 (95% confidence interval -0.183 to 0.033, P=0.18) in the baseline adjusted models. At 30 months the mean difference was -0.027 (-0.137 to 0.083, P=0.63). There was no statistically significant difference between groups for other anthropometric, dietary, physical activity, or psychological measurements (including assessment of harm). CONCLUSIONS The primary analyses suggest that this experiential focused intervention had no statistically significant effect on BMI z score or on preventing childhood obesity. Schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments. TRIAL REGISTRATION Current Controlled Trials ISRCTN97000586.
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Affiliation(s)
- Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Miranda J Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma R Lancashire
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tim Barrett
- School of Clinical and Experimental Medicine, University of Birmingham; Birmingham, UK
| | - Raj Bhopal
- Edinburgh Migration, Ethnicity and Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | - Joanne L Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ulf Ekelund
- Cambridge MRC Epidemiology Unit, Cambridge, UK
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Paramjit Gill
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tania Griffin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eleanor McGee
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Kiya Hurley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Kitchen MO, Bryan RT, Emes RD, Luscombe CJ, Cheng KK, Zeegers MP, James ND, Gommersall LM, Fryer AA. HumanMethylation450K Array-Identified Biomarkers Predict Tumour Recurrence/Progression at Initial Diagnosis of High-risk Non-muscle Invasive Bladder Cancer. Biomark Cancer 2018; 10:1179299X17751920. [PMID: 29343995 PMCID: PMC5764140 DOI: 10.1177/1179299x17751920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 11/15/2017] [Indexed: 01/03/2023]
Abstract
Background: High-risk non-muscle invasive bladder cancer (HR-NMIBC) is a clinically unpredictable disease. Despite clinical risk estimation tools, many patients are undertreated with intra-vesical therapies alone, whereas others may be over-treated with early radical surgery. Molecular biomarkers, particularly DNA methylation, have been reported as predictive of tumour/patient outcomes in numerous solid organ and haematologic malignancies; however, there are few reports in HR-NMIBC and none using genome-wide array assessment. We therefore sought to identify novel DNA methylation markers of HR-NMIBC clinical outcomes that might predict tumour behaviour at initial diagnosis and help guide patient management. Patients and methods: A total of 21 primary initial diagnosis HR-NMIBC tumours were analysed by Illumina HumanMethylation450 BeadChip arrays and subsequently bisulphite Pyrosequencing. In all, 7 had not recurred at 1 year after resection and 14 had recurred and/or progressed despite intra-vesical BCG. A further independent cohort of 32 HR-NMIBC tumours (17 no recurrence and 15 recurrence and/or progression despite BCG) were also assessed by bisulphite Pyrosequencing. Results: Array analyses identified 206 CpG loci that segregated non-recurrent HR-NMIBC tumours from clinically more aggressive recurrence/progression tumours. Hypermethylation of CpG cg11850659 and hypomethylation of CpG cg01149192 in combination predicted HR-NMIBC recurrence and/or progression within 1 year of diagnosis with 83% sensitivity, 79% specificity, and 83% positive and 79% negative predictive values. Conclusions: This is the first genome-wide DNA methylation analysis of a unique HR-NMIBC tumour cohort encompassing known 1-year clinical outcomes. Our analyses identified potential novel epigenetic markers that could help guide individual patient management in this clinically unpredictable disease.
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Affiliation(s)
- Mark O Kitchen
- Institute for Science and Technology in Medicine, Keele University, London, UK.,Urology Department, University Hospitals of North Midlands NHS Trust, Stafford, UK
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Richard D Emes
- Advanced Data Analysis Centre, University of Nottingham, Nottingham, UK
| | | | - K K Cheng
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Maurice P Zeegers
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,Department of Complex Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Lyndon M Gommersall
- Urology Department, University Hospitals of North Midlands NHS Trust, Stafford, UK
| | - Anthony A Fryer
- Institute for Science and Technology in Medicine, Keele University, London, UK
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Li X, Lu J, Hu S, Cheng KK, De Maeseneer J, Meng Q, Mossialos E, Xu DR, Yip W, Zhang H, Krumholz HM, Jiang L, Hu S. The primary health-care system in China. Lancet 2017; 390:2584-2594. [PMID: 29231837 DOI: 10.1016/s0140-6736(17)33109-4] [Citation(s) in RCA: 513] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/23/2017] [Accepted: 10/26/2017] [Indexed: 01/10/2023]
Abstract
China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world's population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidies and incentives that do not encourage cost savings and good performance, insurance policies that hamper the efficiency of care delivery, an insufficient quality measurement and improvement system, and poor performance in the control of risk factors (such as hypertension and diabetes). As China deepens its health-care reform, it has the opportunity to build an integrated, cooperative primary health-care system, generating knowledge from practice that can support improvements, and bolstered by evidence-based performance indicators and incentives.
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Affiliation(s)
- Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiapeng Lu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Hu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; General Practice Development and Research Center, Peking University Health Science Center, Beijing, China
| | - Jan De Maeseneer
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Qingyue Meng
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Dong Roman Xu
- Sun Yat-sen Global Health Institute, Sun Yat-sen University School of Public Health, Guangzhou, Guangdong, China
| | - Winnie Yip
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Hongzhao Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Xu L, Lam TH, Jiang CQ, Zhang WS, Jin YL, Zhu T, Zhu F, Thomas GN, Cheng KK. Adiposity and incident diabetes within 4 years of follow-up: the Guangzhou Biobank Cohort Study. Diabet Med 2017; 34:1400-1406. [PMID: 28477424 DOI: 10.1111/dme.13378] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] [Accepted: 05/03/2017] [Indexed: 01/19/2023]
Abstract
AIM Whether different adiposity measures predict incident diabetes differentially in general Chinese populations is unclear. We investigated this in Chinese people aged 50+ years in the Guangzhou Biobank Cohort Study. METHODS Waist circumference and BMI were measured at baseline, and fasting glucose was measured at both baseline and follow-up examinations. Incident diabetes was defined as fasting glucose ≥ 7.0 mmol/l, glucose after 2-h oral glucose tolerance test ≥ 11.1 mmol/l, and/or self-reported physician-diagnosed diabetes during the follow-up period. RESULTS Of 15 752 people without diabetes at baseline from 2003 to 2008, 1779 (11.3%) developed incident diabetes during the follow-up from 2008 to 2012 (mean = 3.6 years, sd = 1.0). After mutually adjusting each other and adjusting for other potential confounders, waist circumference showed a higher predictive value than BMI. The odds ratio (OR) (95% confidence interval (CI) was 1.50 (95% CI 1.37-1.64) for a 1 sd increment in waist circumference and 1.21 (95% CI 1.11-1.33), for a 1 sd increment in BMI. Similarly, after mutual adjustment, abdominal obesity was associated with an almost twofold odds of incident diabetes (OR 1.93, 95% CI 1.71-2.17), which was higher than that for general obesity (OR 1.76, 95% CI 1.50-2.06). The area under receiver operating characteristic curve (AUC) for waist circumference was higher than that for BMI [AUC = 0.676 (95% CI 0.660-0.686) vs. 0.665 (95% CI 0.651-0.678), P = 0.02]. CONCLUSION Abdominal obesity predicted incident diabetes in older people better than general obesity. Our findings may be an early warning signal for local government or public health practitioners to develop and investigate more effective intervention programmes for diabetes, and should also be disseminated to the public to pay more attention to this important public health issue.
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Affiliation(s)
- L Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong
- School of Public Health, the University of Hong Kong, Hong Kong
| | - T H Lam
- School of Public Health, the University of Hong Kong, Hong Kong
- Guangzhou 12th Hospital, Guangzhou, China
| | - C Q Jiang
- School of Public Health, the University of Hong Kong, Hong Kong
| | - W S Zhang
- Guangzhou 12th Hospital, Guangzhou, China
| | - Y L Jin
- Guangzhou 12th Hospital, Guangzhou, China
| | - T Zhu
- Guangzhou 12th Hospital, Guangzhou, China
| | - F Zhu
- Guangzhou 12th Hospital, Guangzhou, China
| | - G N Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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36
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Daley A, Pallan M, Clifford S, Jolly K, Bryant M, Adab P, Cheng KK, Roalfe A. Are babies conceived during Ramadan born smaller and sooner than babies conceived at other times of the year? A Born in Bradford Cohort Study. J Epidemiol Community Health 2017; 71:722-728. [DOI: 10.1136/jech-2016-208800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/28/2017] [Accepted: 03/07/2017] [Indexed: 01/20/2023]
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Liu W, Lin R, Liu W, Guo Z, Xiong L, Li B, Cheng KK, Adab P, Pallan M. Relationship between weight status and health-related quality of life in Chinese primary school children in Guangzhou: a cross-sectional study. Health Qual Life Outcomes 2016; 14:166. [PMID: 27912761 PMCID: PMC5135837 DOI: 10.1186/s12955-016-0567-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/25/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To investigate the association between weight status and health-related quality of life (HRQOL) among pupils in Guangzhou, China. METHODS The study comprised 5781 children aged 8-12 years from 29 schools. Height and weight were objectively measured using standardized methods, and BMI z-score derived using the age and sex specific WHO reference 2007 for 5-19 years. Weight status was classified as underweight (<-2SD), healthy weight (between -2SD and 1SD), overweight/obesity (>1SD). HRQOL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0. RESULTS After controlling for gender, age, school type, parental education, and family income, HRQOL scores were significantly lower in overweight/obese compared with healthy weight children only in the social functioning domain (β = -1.93, p = 0.001). Compared with healthy weight children, underweight children had significantly lower total (β = -1.47, p = 0.05) and physical summary scores (β = -2.18, p = 0.02). Subgroup analysis for gender indicated that compared to healthy weight, total (β = -1.96, p = 0.02), psychosocial (β = -2.40, p = 0.01), social functioning (β = -3.36, p = 0.001), and school functioning (β = -2.19, p = 0.03) scores were lower in overweight/obese girls, but not boys. On the other hand, being underweight was associated with lower physical functioning (β = -2.27, p = 0.047) in girls, and lower social functioning (β = -3.63, p = 0.01) in boys. The associations were mainly observed in children aged 10 and over, but were not significant in younger children. Children from private schools had generally lower HRQOL compared to those in public schools, but the associations with weight status were similar in both groups. CONCLUSIONS The relationship between overweight/obesity and HRQOL in children in China is not as prominent as that seen in children in western or high-income countries. However, there appears to be gender and age differences, with more of an impact of overweight on HRQOL in girls and older children compared with boys and younger children. Underweight is also associated with lower HRQOL. Future intervention to prevent both obesity and undernutrition may have a positive impact on the HRQOL in children in China.
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Affiliation(s)
- Wei Liu
- Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Rong Lin
- Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Weijia Liu
- Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Zhongshan Guo
- Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Lihua Xiong
- Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Bai Li
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - K K Cheng
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Peymane Adab
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Miranda Pallan
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Togneri FS, Ward DG, Foster JM, Devall AJ, Wojtowicz P, Alyas S, Vasques FR, Oumie A, James ND, Cheng KK, Zeegers MP, Deshmukh N, O'Sullivan B, Taniere P, Spink KG, McMullan DJ, Griffiths M, Bryan RT. Genomic complexity of urothelial bladder cancer revealed in urinary cfDNA. Eur J Hum Genet 2016; 24:1167-74. [PMID: 26757983 PMCID: PMC4970693 DOI: 10.1038/ejhg.2015.281] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/26/2015] [Accepted: 12/08/2015] [Indexed: 11/27/2022] Open
Abstract
Urothelial bladder cancers (UBCs) have heterogeneous clinical characteristics that are mirrored in their diverse genomic profiles. Genomic profiling of UBCs has the potential to benefit routine clinical practice by providing prognostic utility above and beyond conventional clinicopathological factors, and allowing for prediction and surveillance of treatment responses. Urinary DNAs representative of the tumour genome provide a promising resource as a liquid biopsy for non-invasive genomic profiling of UBCs. We compared the genomic profiles of urinary cellular DNA and cell-free DNA (cfDNA) from the urine with matched diagnostic formalin-fixed paraffin-embedded tumour DNAs for 23 well-characterised UBC patients. Our data show urinary DNAs to be highly representative of patient tumours, allowing for detection of recurrent clinically actionable genomic aberrations. Furthermore, a greater aberrant load (indicative of tumour genome) was observed in cfDNA over cellular DNA (P<0.001), resulting in a higher analytical sensitivity for detection of clinically actionable genomic aberrations (P<0.04) when using cfDNA. Thus, cfDNA extracted from the urine of UBC patients has a higher tumour genome burden and allows greater detection of key genomic biomarkers (90%) than cellular DNA from urine (61%) and provides a promising resource for robust whole-genome tumour profiling of UBC with potential to influence clinical decisions without invasive patient interventions.
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Affiliation(s)
- Fiona S Togneri
- West Midland Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Douglas G Ward
- Institute of Cancer & Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Adam J Devall
- Institute of Cancer & Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paula Wojtowicz
- West Midland Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Sofia Alyas
- West Midland Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Fabiana Ramos Vasques
- West Midland Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | | | | | - K K Cheng
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Maurice P Zeegers
- Department of Complex Genetics, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands
| | - Nayneeta Deshmukh
- Institute of Cancer & Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Brendan O'Sullivan
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Philippe Taniere
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Dominic J McMullan
- West Midland Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Mike Griffiths
- West Midland Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Richard T Bryan
- Institute of Cancer & Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Jiang CQ, Chan YH, Xu L, Jin YL, Zhu T, Zhang WS, Cheng KK, Lam TH. Smoking and serum vitamin D in older Chinese people: cross-sectional analysis based on the Guangzhou Biobank Cohort Study. BMJ Open 2016; 6:e010946. [PMID: 27338881 PMCID: PMC4932269 DOI: 10.1136/bmjopen-2015-010946] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Studies on serum vitamin D in smokers showed conflicting results. We examined the association of smoking status with serum vitamin D in older Chinese men, taking advantage of a community-based sample with natural exposure to vitamin D. DESIGN Cross-sectional study based on the Guangzhou Biobank Cohort Study (GBCS). SETTING Community-based sample from the Guangzhou Biobank Cohort Study. PARTICIPANTS 612 male participants aged 50+years recruited from 2009 to 2011. RESULTS The mean (SD) of vitamin D concentration was 58.3 (17.2), 57.0 (15.0) and 54.7 (15.4) nmol/L for never, former and current smokers, respectively. Adjusted for multiple confounders, vitamin D decreased from never to former, then to current smokers (P for trend 0.02). Compared to never smokers, current smokers had lower serum concentrations of vitamin D, and the concentrations decreased with the increasing number of cigarettes per day (-3.11 (95% CI -9.05 to 2.82), -3.29 (-8.3 to 1.72) and -4.61 (-8.89 to -0.33) for 1-9, 10-19 and 20+cigarettes per day, respectively; p for trend 0.01), duration of smoking (-1.39 (-6.09 to 3.30) and -5.39 (-9.42 to -1.35) for 1-39 and 40+years, respectively; p for trend 0.008) as well as pack-years (-2.89 (-6.78 to 1.01) and -5.58 (-10.48 to -0.67) for 1-39 and 40+pack-years, respectively; p for trend 0.009). Longer duration of quitting smoking was associated with higher vitamin D than was current smoking (P for trend 0.04). CONCLUSIONS Current smokers had lower vitamin D than never smokers, and the association showed a dose-response pattern.
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Affiliation(s)
- C Q Jiang
- Guangzhou No 12 Hospital, Guangzhou, China
| | - Y H Chan
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - L Xu
- School of Public Health, the University of Hong Kong, Hong Kong, China
| | - Y L Jin
- Guangzhou No 12 Hospital, Guangzhou, China
| | - T Zhu
- Guangzhou No 12 Hospital, Guangzhou, China
| | - W S Zhang
- Guangzhou No 12 Hospital, Guangzhou, China
| | - K K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - T H Lam
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
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Liu W, Liu W, Lin R, Li B, Pallan M, Cheng KK, Adab P. Socioeconomic determinants of childhood obesity among primary school children in Guangzhou, China. BMC Public Health 2016; 16:482. [PMID: 27277601 PMCID: PMC4898378 DOI: 10.1186/s12889-016-3171-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 05/19/2016] [Indexed: 12/26/2022] Open
Abstract
Background Socioeconomic inequalities in childhood obesity prevalence differ according to a country’s stage of nutrition transition. The aim of this study was to determine which socioeconomic factors influence inequalities in obesity prevalence in Chinese primary school children living in an urban setting. Methods We assessed obesity prevalence among 9917 children aged 5–12 years from a stratified random sample of 29 state-funded (residents) and private (migrants) schools in Guangzhou, China. Height and weight were objectively measured using standardised methods and overweight (+1 SD < BMI-for-age z-score ≤ +2 SD) and obesity (BMI-for-age z-score > +2 SD) were defined using the World Health Organisation reference 2007. Socioeconomic characteristics were ascertained through parental questionnaires. Generalised Linear Mixed Models with schools as a random effect were used to compare likelihood of overweight/obesity among children in private, with public schools, adjusting for child age and sex, maternal and paternal BMI and education level, and household per-capita income. Results The prevalence of overweight/obesity was 20.0 % (95 % CI 19.1 %–20.9 %) in resident compared with 14.3 % (95 % CI 13.0 %–15.4 %) in migrant children. In the adjusted model, the odds of overweight/obesity remained higher among resident children (OR 1.36; 1.16–1.59), was higher in boys compared with girls (OR 2.56; 2.24–2.93), and increased with increasing age (OR 2.78; 1.95–3.97 in 11–12 vs 5–6 year olds), per-capita household income (OR 1.27; 1.01–1.59 in highest vs lowest quartile) and maternal education (OR 1.51; 1.16–1.97 in highest vs lowest). Socioeconomic differences were most marked in older boys, and were only statistically significant in resident children. Conclusions The socioeconomic gradient for childhood obesity in China is the reverse of the patterns seen in countries at more advanced stages of the obesity epidemic. This presents an opportunity to intervene and prevent the onset of social inequalities that are likely to ensue with further economic development. The marked gender inequality in obesity needs further exploration.
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Affiliation(s)
- Weijia Liu
- Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Wei Liu
- Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Rong Lin
- Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China
| | - Bai Li
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Miranda Pallan
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - K K Cheng
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Chan CH, Cheng KK, Pan NY, Wong KC, Lai HY, Chan HF, Chow HL. Mueller-Weiss Syndrome: an Important but Under-recognised Cause of Foot Pain and Deformity. Hong Kong J Radiol 2016. [DOI: 10.12809/hkjr1615337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kitchen MO, Bryan RT, Emes RD, Glossop JR, Luscombe C, Cheng KK, Zeegers MP, James ND, Devall AJ, Mein CA, Gommersall L, Fryer AA, Farrell WE. Quantitative genome-wide methylation analysis of high-grade non-muscle invasive bladder cancer. Epigenetics 2016; 11:237-46. [PMID: 26929985 DOI: 10.1080/15592294.2016.1154246] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
High-grade non-muscle invasive bladder cancer (HG-NMIBC) is a clinically unpredictable disease with greater risks of recurrence and progression relative to their low-intermediate-grade counterparts. The molecular events, including those affecting the epigenome, that characterize this disease entity in the context of tumor development, recurrence, and progression, are incompletely understood. We therefore interrogated genome-wide DNA methylation using HumanMethylation450 BeadChip arrays in 21 primary HG-NMIBC tumors relative to normal bladder controls. Using strict inclusion-exclusion criteria we identified 1,057 hypermethylated CpGs within gene promoter-associated CpG islands, representing 256 genes. We validated the array data by bisulphite pyrosequencing and examined 25 array-identified candidate genes in an independent cohort of 30 HG-NMIBC and 18 low-intermediate-grade NMIBC. These analyses revealed significantly higher methylation frequencies in high-grade tumors relative to low-intermediate-grade tumors for the ATP5G2, IRX1 and VAX2 genes (P<0.05), and similarly significant increases in mean levels of methylation in high-grade tumors for the ATP5G2, VAX2, INSRR, PRDM14, VSX1, TFAP2b, PRRX1, and HIST1H4F genes (P<0.05). Although inappropriate promoter methylation was not invariantly associated with reduced transcript expression, a significant association was apparent for the ARHGEF4, PON3, STAT5a, and VAX2 gene transcripts (P<0.05). Herein, we present the first genome-wide DNA methylation analysis in a unique HG-NMIBC cohort, showing extensive and discrete methylation changes relative to normal bladder and low-intermediate-grade tumors. The genes we identified hold significant potential as targets for novel therapeutic intervention either alone, or in combination, with more conventional therapeutic options in the treatment of this clinically unpredictable disease.
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Affiliation(s)
- Mark O Kitchen
- a Institute for Science and Technology in Medicine, Keele University , UK.,b Urology Department , University Hospitals of North Midlands NHS Trust , UK
| | - Richard T Bryan
- c Institute of Cancer and Genomic Sciences, University of Birmingham , UK
| | - Richard D Emes
- d Advanced Data Analysis Center, University of Nottingham , UK
| | - John R Glossop
- a Institute for Science and Technology in Medicine, Keele University , UK
| | | | - K K Cheng
- c Institute of Cancer and Genomic Sciences, University of Birmingham , UK
| | - Maurice P Zeegers
- c Institute of Cancer and Genomic Sciences, University of Birmingham , UK.,e Department of Complex Genetics , Maastricht University Medical Center , The Netherlands.,f NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center , The Netherlands.,g CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center , The Netherlands
| | | | - Adam J Devall
- c Institute of Cancer and Genomic Sciences, University of Birmingham , UK
| | - Charles A Mein
- i The Genome Center, Barts and the London School of Medicine and Dentistry , London , UK
| | - Lyndon Gommersall
- b Urology Department , University Hospitals of North Midlands NHS Trust , UK
| | - Anthony A Fryer
- a Institute for Science and Technology in Medicine, Keele University , UK
| | - William E Farrell
- a Institute for Science and Technology in Medicine, Keele University , UK
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Ward DG, Baxter L, Gordon NS, Ott S, Savage RS, Beggs AD, James JD, Lickiss J, Green S, Wallis Y, Wei W, James ND, Zeegers MP, Cheng KK, Mathews GM, Patel P, Griffiths M, Bryan RT. Multiplex PCR and Next Generation Sequencing for the Non-Invasive Detection of Bladder Cancer. PLoS One 2016; 11:e0149756. [PMID: 26901314 PMCID: PMC4762704 DOI: 10.1371/journal.pone.0149756] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/04/2016] [Indexed: 11/19/2022] Open
Abstract
Background Highly sensitive and specific urine-based tests to detect either primary or recurrent bladder cancer have proved elusive to date. Our ever increasing knowledge of the genomic aberrations in bladder cancer should enable the development of such tests based on urinary DNA. Methods DNA was extracted from urine cell pellets and PCR used to amplify the regions of the TERT promoter and coding regions of FGFR3, PIK3CA, TP53, HRAS, KDM6A and RXRA which are frequently mutated in bladder cancer. The PCR products were barcoded, pooled and paired-end 2 x 250 bp sequencing performed on an Illumina MiSeq. Urinary DNA was analysed from 20 non-cancer controls, 120 primary bladder cancer patients (41 pTa, 40 pT1, 39 pT2+) and 91 bladder cancer patients post-TURBT (89 cancer-free). Results Despite the small quantities of DNA extracted from some urine cell pellets, 96% of the samples yielded mean read depths >500. Analysing only previously reported point mutations, TERT mutations were found in 55% of patients with bladder cancer (independent of stage), FGFR3 mutations in 30% of patients with bladder cancer, PIK3CA in 14% and TP53 mutations in 12% of patients with bladder cancer. Overall, these previously reported bladder cancer mutations were detected in 86 out of 122 bladder cancer patients (70% sensitivity) and in only 3 out of 109 patients with no detectable bladder cancer (97% specificity). Conclusion This simple, cost-effective approach could be used for the non-invasive surveillance of patients with non-muscle-invasive bladder cancers harbouring these mutations. The method has a low DNA input requirement and can detect low levels of mutant DNA in a large excess of normal DNA. These genes represent a minimal biomarker panel to which extra markers could be added to develop a highly sensitive diagnostic test for bladder cancer.
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Affiliation(s)
- Douglas G. Ward
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Laura Baxter
- Warwick Systems Biology Centre, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Naheema S. Gordon
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Sascha Ott
- Warwick Systems Biology Centre, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Richard S. Savage
- Warwick Systems Biology Centre, University of Warwick, Coventry, CV4 7AL, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Andrew D. Beggs
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Jonathan D. James
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Jennifer Lickiss
- West Midlands Regional Genetics Laboratory, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham, B15 2TG, United Kingdom
| | - Shaun Green
- West Midlands Regional Genetics Laboratory, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham, B15 2TG, United Kingdom
| | - Yvonne Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham, B15 2TG, United Kingdom
| | - Wenbin Wei
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Nicholas D. James
- Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Maurice P. Zeegers
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
- Department of Complex Genetics, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - KK Cheng
- School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Glenn M. Mathews
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Prashant Patel
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - Michael Griffiths
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
- West Midlands Regional Genetics Laboratory, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham, B15 2TG, United Kingdom
| | - Richard T. Bryan
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom
- * E-mail:
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Wu L, He Y, Jiang B, Zuo F, Liu Q, Zhang L, Zhou C, Liu M, Chen H, Cheng KK, Chan SSC, Lam TH. Effectiveness of additional follow-up telephone counseling in a smoking cessation clinic in Beijing and predictors of quitting among Chinese male smokers. BMC Public Health 2016; 16:63. [PMID: 26801402 PMCID: PMC4722719 DOI: 10.1186/s12889-016-2718-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 01/08/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND No previous studies have investigated whether additional telephone follow-up counseling sessions after face-to-face counseling can increase quitting in China, and whether this strategy is feasible and effective for promoting smoking cessation is still unclear. METHODS A non-randomized controlled study was conducted in Beijing. We compared the quit rates of one group which received face-to-face counseling (FC) alone (one session of 40 min) to another group which received the same face-to-face counseling plus four follow-up sessions of brief telephone counseling (15-20 min each) at 1 week, 1, 3 and 6 month follow-up (FCF). No smoking cessation medication was provided. From October 2008 to August 2013, Chinese male smokers who sought treatment in a part-time regular smoking cessation clinic of a large general hospital in Beijing were invited to participate in the present study. Eligible male smokers (n = 547) were divided into two groups: FC (n = 149) and FCF (n = 398). Main outcomes were self-reported 7-day point prevalence and 6 month continuous quit rates at 12 month follow-up. RESULTS By intention to treat, at 12 month follow-up, the 7-day point prevalence and 6 month continuous quit rates of FC and FCF were 14.8 % and 26.4 %, and 10.7 % and 19.6 % respectively. The adjusted odds ratios (95 % confidence intervals) of quitting in FCF compared to FC was 2.34 (1.34-4.10) (P = 0.003) and 2.41 (1.28-4.52) (P = 0.006), respectively. Stepwise logistic regression showed that FCF, being married, unemployed and a lower Fagerström score were significant independent predictors of 6 month continuous quitting at 12 month follow-up. CONCLUSIONS Using systematically collected data from real-world practice, our smoking cessation clinic has shown that the additional telephone follow-up counseling sessions doubled the quit rate.
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Affiliation(s)
- Lei Wu
- Department of Epidemiology, Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
- Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Institute of Geriatrics, 28 Fuxing Road, Beijing, 100853 China
| | - Yao He
- Department of Epidemiology, Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
- Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Institute of Geriatrics, 28 Fuxing Road, Beijing, 100853 China
- State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
| | - Bin Jiang
- Nanlou Faculty of Clinical Medicine, Department of Acupuncture, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
| | - Fang Zuo
- Nanlou Faculty of Clinical Medicine, Department of Acupuncture, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
| | - Qinghui Liu
- Nanlou Faculty of Clinical Medicine, Department of Respiration, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
| | - Li Zhang
- Nanlou Faculty of Clinical Medicine, Department of Rehabilitation, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Changxi Zhou
- Nanlou Faculty of Clinical Medicine, Department of Respiration, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
| | - Miao Liu
- Department of Epidemiology, Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
- Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Institute of Geriatrics, 28 Fuxing Road, Beijing, 100853 China
| | - Hongyan Chen
- Department of Epidemiology, Institute of Geriatrics, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 China
- Beijing Key Laboratory of Aging and Geriatrics, Chinese PLA General Hospital, Institute of Geriatrics, 28 Fuxing Road, Beijing, 100853 China
| | - KK Cheng
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | | | - Tai Hing Lam
- Department of Community Medicine and School of Public Health, The University of Hong Kong, Hong Kong, China
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Jiang B, He Y, Zuo F, Wu L, Liu QH, Zhang L, Zhou CX, Cheng KK, Chan SSC, Lam TH. Effectiveness of varenicline and counselling for smoking cessation in an observational cohort study in China. BMJ Open 2016; 6:e009381. [PMID: 26739730 PMCID: PMC4716213 DOI: 10.1136/bmjopen-2015-009381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of varenicline for smoking cessation in Chinese smokers in a real world cessation clinic practice. DESIGN A prospective observational study. SETTING Beijing, China. PARTICIPANTS A total of 924 smokers (883 men and 41 women) who attended a smoking cessation clinic of a large general hospital were assessed with data from structured questionnaires at baseline and follow-up at 1, 3 and 6 months. Trained physician counsellors provided free individual counselling for all subjects and follow-up interviews with brief counselling. 332 subjects additionally prescribed varenicline according to their own choice were compared with those without varenicline. MAIN OUTCOME MEASURES Primary outcomes were self-reported 7-day point prevalence abstinence rate and 3-month continuous abstinence rate at 6-month follow-up. Secondary outcomes were 7-day point prevalence abstinence rates at 1 and 3-month follow-up, and 1-month continuous abstinence rate at 3-month follow-up. RESULTS By intention-to-treat, the 7-day point prevalence abstinence rate with varenicline and counselling at 6 months was significantly higher than counselling only (37.0% vs 23.1%; OR, 1.75; 95% CI 1.46 to 2.62; p=0.001). The 3-month continuous abstinence rate at 6 months was higher with varenicline (33.1% vs 18.4%; OR, 2.04; 95% CI 1.61 to 2.99; p<0.001). Varenicline also showed better secondary outcomes. CONCLUSIONS Varenicline prescription in the smoking cessation clinic appeared to be effective with doubling of quit rates in Chinese smokers in a real world cessation clinic practice. CLINICAL TRIAL REGISTRATION NCT01935505; Results.
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Affiliation(s)
- Bin Jiang
- Nanlou Faculty of Clinical Medicine, Department of Traditional Chinese Medicine and Acupuncture, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yao He
- Department of Epidemiology, Institute of Geriatrics, Beijing key laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fang Zuo
- Nanlou Faculty of Clinical Medicine, Department of Traditional Chinese Medicine and Acupuncture, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lei Wu
- Department of Epidemiology, Institute of Geriatrics, Beijing key laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qing-Hui Liu
- Nanlou Faculty of Clinical Medicine, Department of Respiration, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Li Zhang
- Nanlou Faculty of Clinical Medicine, Department of Rehabilitation, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chang-Xi Zhou
- Nanlou Faculty of Clinical Medicine, Department of Respiration, Chinese People's Liberation Army General Hospital, Beijing, China
| | - K K Cheng
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Sophia S C Chan
- School of Nursing, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- Department of Community Medicine, School of Public Health and The University of Hong Kong, Hong Kong, China
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Ostovaneh MR, Poustchi H, Hemming K, Marjani H, Pourshams A, Nateghi A, Majed M, Navabakhsh B, Khoshnia M, Jaafari E, Mohammadifard N, Malekzadeh F, Merat S, Sadeghi M, Naemi M, Etemadi A, Thomas GN, Sarrafzadegan N, Cheng KK, Marshall T, Malekzadeh R. Polypill for the prevention of cardiovascular disease (PolyIran): study design and rationale for a pragmatic cluster randomized controlled trial. Eur J Prev Cardiol 2015; 22:1609-17. [PMID: 25230980 PMCID: PMC5836725 DOI: 10.1177/2047487314550803] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 03/29/2014] [Accepted: 08/20/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND The complexity of treatment regimens, costs and pill burden decrease the medication adherence and contribute to shortfall in cardiovascular preventive drug coverage. The polypill, a fixed dose combination pill of established drugs, is expected to increase adherence and reduce the costs whilst preventing major cardiovascular events (MCVE). DESIGN AND METHODS The PolyIran trial is a pragmatic cluster randomized trial nested within the Golestan Cohort Study (GCS). Subjects were randomized to either non-pharmacological preventive interventions alone (minimal care arm) or together with a polypill (polypill arm) comprising hydrochlorothiazide, aspirin, atorvastatin and either enalapril or valsartan. This study benefits from the infrastructure of the primary health care system in Iran and the interventions are delivered by the local auxiliary health workers (Behvarz) to the participants. The primary outcome of the study is the occurrence of first MCVE within five years defined as non-fatal and fatal myocardial infarction, unstable angina, sudden death, heart failure, coronary artery revascularization procedures, and non-fatal and fatal stroke. TRIAL STATUS From February 2011 to April 2013, 8410 individuals (236 clusters) attended the eligibility assessment. Of those, 3421 in the polypill arm and 3417 in the minimal care arm were eligible. The study is ongoing. CONCLUSION The infrastructure of GCS and the primary health care system in Iran enabled the conduct of this pragmatic large-scale trial. If the polypill strategy proves effective, it may be implemented to prevent cardiovascular disease in developing countries.
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Affiliation(s)
- Mohammad Reza Ostovaneh
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Hossein Poustchi
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Karla Hemming
- School of Health and Population Sciences, University of Birmingham, UK
| | - Hajiamin Marjani
- Golestan Research Center of Gastroenterology and Herpetology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Akram Pourshams
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Nateghi
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Majed
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrouz Navabakhsh
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khoshnia
- Golestan Research Center of Gastroenterology and Herpetology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Elham Jaafari
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Malekzadeh
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Merat
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Naemi
- Golestan Research Center of Gastroenterology and Herpetology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Arash Etemadi
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - G Neil Thomas
- School of Health and Population Sciences, University of Birmingham, UK
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - K K Cheng
- School of Health and Population Sciences, University of Birmingham, UK
| | - Tom Marshall
- School of Health and Population Sciences, University of Birmingham, UK
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Zhu XQ, Xu YH, Liao CX, Liu WG, Cheng KK, Chen JX. Differentiating the extent of cartilage repair in rabbit ears using nonlinear optical microscopy. J Microsc 2015; 260:219-26. [PMID: 26366638 DOI: 10.1111/jmi.12288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/09/2015] [Indexed: 11/26/2022]
Abstract
Nonlinear optical microscopy (NLOM) was used as a noninvasive and label-free tool to detect and quantify the extent of the cartilage recovery. Two cartilage injury models were established in the outer ears of rabbits that created a different extent of cartilage recovery based on the presence or absence of the perichondrium. High-resolution NLOM images were used to measure cartilage repair, specifically through spectral analysis and image texture. In contrast to a wound lacking a perichondrium, wounds with intact perichondria demonstrated significantly larger TPEF signals from cells and matrix, coarser texture indicating the more deposition of type I collagen. Spectral analysis of cells and matrix can reveal the matrix properties and cell growth. In addition, texture analysis of NLOM images showed significant differences in the distribution of cells and matrix of repaired tissues with or without perichondrium. Specifically, the decay length of autocorrelation coefficient based on TPEF images is 11.2 ± 1.1 in Wound 2 (with perichondrium) and 7.5 ± 2.0 in Wound 1 (without perichondrium), indicating coarser image texture and faster growth of cells in repaired tissues with perichondrium (p < 0.05). Moreover, the decay length of autocorrelation coefficient based on collagen SHG images also showed significant difference between Wound 2 and 1 (16.2 ± 1.2 vs. 12.2 ± 2.1, p < 0.05), indicating coarser image texture and faster deposition of collagen in repaired tissues with perichondrium (Wound 2). These findings suggest that NLOM is an ideal tool for studying cartilage repair, with potential applications in clinical medicine. NLOM can capture macromolecular details and distinguish between different extents of cartilage repair without the need for labelling agents.
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Affiliation(s)
- X Q Zhu
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, P. R. China
| | - Y H Xu
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, P. R. China
| | - C X Liao
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, P. R. China
| | - W G Liu
- Department of Orthopedics, Affiliated Union Hospital of Fujian Medical University, Fuzhou, P. R. China
| | - K K Cheng
- Institute of Bioproduct Development & Department of Bioprocess Engineering, Universiti Teknologi Malaysia, Johor, Malaysia
| | - J X Chen
- Institute of Laser and Optoelectronics Technology, Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, P. R. China
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48
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Cheng KK, Lau S. Spontaneous Oesophageal Intramural Haematoma: an Uncommon Condition in Two Patients. Hong Kong J Radiol 2015. [DOI: 10.12809/hkjr1514257] [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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49
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Cheng KK, Lam SCH, Cho DHY, Lau S. N-Butyl Cyanoacrylate Embolisation for Acute Arterial Haemorrhage and Pseudoaneurysms in Extracranial Locations. Hong Kong J Radiol 2015. [DOI: 10.12809/hkjr1514290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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50
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Kitchen MO, Bryan RT, Haworth KE, Emes RD, Luscombe C, Gommersall L, Cheng KK, Zeegers MP, James ND, Devall AJ, Fryer AA, Farrell WE. Methylation of HOXA9 and ISL1 Predicts Patient Outcome in High-Grade Non-Invasive Bladder Cancer. PLoS One 2015; 10:e0137003. [PMID: 26332997 PMCID: PMC4558003 DOI: 10.1371/journal.pone.0137003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/11/2015] [Indexed: 12/28/2022] Open
Abstract
Introduction Inappropriate DNA methylation is frequently associated with human tumour development, and in specific cases, is associated with clinical outcomes. Previous reports of DNA methylation in low/intermediate grade non-muscle invasive bladder cancer (NMIBC) have suggested that specific patterns of DNA methylation may have a role as diagnostic or prognostic biomarkers. In view of the aggressive and clinically unpredictable nature of high-grade (HG) NMIBC, and the current shortage of the preferred treatment option (Bacillus:Calmette-Guerin), novel methylation analyses may similarly reveal biomarkers of disease outcome that could risk-stratify patients and guide clinical management at initial diagnosis. Methods Promoter-associated CpG island methylation was determined in primary tumour tissue of 36 initial presentation high-grade NMIBCs, 12 low/intermediate-grade NMIBCs and 3 normal bladder controls. The genes HOXA9, ISL1, NKX6-2, SPAG6, ZIC1 and ZNF154 were selected for investigation on the basis of previous reports and/or prognostic utility in low/intermediate-grade NMIBC. Methylation was determined by Pyrosequencing of sodium-bisulphite converted DNA, and then correlated with gene expression using RT-qPCR. Methylation was additionally correlated with tumour behaviour, including tumour recurrence and progression to muscle invasive bladder cancer or metastases. Results The ISL1 genes’ promoter-associated island was more frequently methylated in recurrent and progressive high-grade tumours than their non-recurrent counterparts (60.0% vs. 18.2%, p = 0.008). ISL1 and HOXA9 showed significantly higher mean methylation in recurrent and progressive tumours compared to non-recurrent tumours (43.3% vs. 20.9%, p = 0.016 and 34.5% vs 17.6%, p = 0.017, respectively). Concurrent ISL1/HOXA9 methylation in HG-NMIBC reliably predicted tumour recurrence and progression within one year (Positive Predictive Value 91.7%), and was associated with disease-specific mortality (DSM). Conclusions In this study we report methylation differences and similarities between clinical sub-types of high-grade NMIBC. We report the potential ability of methylation biomarkers, at initial diagnosis, to predict tumour recurrence and progression within one year of diagnosis. We found that specific biomarkers reliably predict disease outcome and therefore may help guide patient treatment despite the unpredictable clinical course and heterogeneity of high-grade NMIBC. Further investigation is required, including validation in a larger patient cohort, to confirm the clinical utility of methylation biomarkers in high-grade NMIBC.
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Affiliation(s)
- Mark O Kitchen
- Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom; Urology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Richard T Bryan
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Kim E Haworth
- Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom
| | - Richard D Emes
- Advanced Data Analysis Centre, University of Nottingham, Nottingham, United Kingdom
| | - Christopher Luscombe
- Urology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Lyndon Gommersall
- Urology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - K K Cheng
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Maurice P Zeegers
- Department of Complex Genetics, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Nicholas D James
- Cancer Research Unit, University of Warwick, Coventry, United Kingdom
| | - Adam J Devall
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Anthony A Fryer
- Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom
| | - William E Farrell
- Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom
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