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Goh JSK, Chandrasekaran R, Sirasanagandla SR, Acharyya S, Mogali SR. Efficacy of plastinated specimens in anatomy education: A systematic review and meta-analysis. Anat Sci Educ 2024. [PMID: 38591116 DOI: 10.1002/ase.2424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
Plastination, a permanent preservation method for human tissues and organs, is increasingly being used in anatomy education. However, there is a paucity of systematic reviews and meta-analyses summarizing the educational efficacy of plastinated specimens. This meta-analysis compared the assessment scores of students exposed to plastinated specimens against those exposed to other common instructional methods. A systematic search was conducted through four databases, from 2000 to July 2022. Titles and abstracts of the retrieved records were screened according to predetermined eligibility criteria. Of the 159 records screened, 18 were subjected to full-text review. Among the 18 studies, five articles reported post-intervention test scores for intervention (plastinated) and control (other modalities) groups. Studies were subjected to GRADE quality assessment, and four studies with moderate to high ratings were included for meta-analysis. Students' perceptions (n = 15 studies) were qualitatively analyzed using an inductive narrative analysis. No significant effect was detected between the intervention (n = 417) and control groups (n = 422) (standardized mean difference = 0.08; 95% CI [-0.36, 0.52]; p = 0.73). Four themes emerged from students' perceptions: ease of use, motivation to study, spatial understanding, and learning preference. Overall, student performance outcomes comparing the use of plastinated specimens versus other instructional modalities are very limited. This meta-analysis suggests that knowledge gained from plastinated specimens is comparable to learning achieved through other modalities; though this outcome should be interpreted with caution as there is currently insufficient evidence for definitive conclusions.
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Affiliation(s)
- Julian Shu Kai Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Ramya Chandrasekaran
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Srinivasa Rao Sirasanagandla
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Aravindhan A, Fenwick EK, Chan AWD, Man REK, Tan NC, Wong WT, Soo WF, Lim SW, Wee SYM, Sabanayagam C, Finkelstein E, Tan G, Hamzah H, Chakraborty B, Acharyya S, Shyong TE, Scanlon P, Wong TY, Lamoureux EL. Extending the diabetic retinopathy screening intervals in Singapore: methodology and preliminary findings of a cohort study. BMC Public Health 2024; 24:786. [PMID: 38481239 PMCID: PMC10935797 DOI: 10.1186/s12889-024-18287-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The Diabetic Retinopathy Extended Screening Study (DRESS) aims to develop and validate a new DR/diabetic macular edema (DME) risk stratification model in patients with Type 2 diabetes (DM) to identify low-risk groups who can be safely assigned to biennial or triennial screening intervals. We describe the study methodology, participants' baseline characteristics, and preliminary DR progression rates at the first annual follow-up. METHODS DRESS is a 3-year ongoing longitudinal study of patients with T2DM and no or mild non-proliferative DR (NPDR, non-referable) who underwent teleophthalmic screening under the Singapore integrated Diabetic Retinopathy Programme (SiDRP) at four SingHealth Polyclinics. Patients with referable DR/DME (> mild NPDR) or ungradable fundus images were excluded. Sociodemographic, lifestyle, medical and clinical information was obtained from medical records and interviewer-administered questionnaires at baseline. These data are extracted from medical records at 12, 24 and 36 months post-enrollment. Baseline descriptive characteristics stratified by DR severity at baseline and rates of progression to referable DR at 12-month follow-up were calculated. RESULTS Of 5,840 eligible patients, 78.3% (n = 4,570, median [interquartile range [IQR] age 61.0 [55-67] years; 54.7% male; 68.0% Chinese) completed the baseline assessment. At baseline, 97.4% and 2.6% had none and mild NPDR (worse eye), respectively. Most participants had hypertension (79.2%) and dyslipidemia (92.8%); and almost half were obese (43.4%, BMI ≥ 27.5 kg/m2). Participants without DR (vs mild DR) reported shorter DM duration, and had lower haemoglobin A1c, triglycerides and urine albumin/creatinine ratio (all p < 0.05). To date, we have extracted 41.8% (n = 1909) of the 12-month follow-up data. Of these, 99.7% (n = 1,904) did not progress to referable DR. Those who progressed to referable DR status (0.3%) had no DR at baseline. CONCLUSIONS In our prospective study of patients with T2DM and non-referable DR attending polyclinics, we found extremely low annual DR progression rates. These preliminary results suggest that extending screening intervals beyond 12 months may be viable and safe for most participants, although our 3-year follow up data are needed to substantiate this claim and develop the risk stratification model to identify low-risk patients with T2DM who can be assigned biennial or triennial screening intervals.
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Affiliation(s)
- Amudha Aravindhan
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Aurora Wing Dan Chan
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | | | | | | | | | - Charumathi Sabanayagam
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Gavin Tan
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Haslina Hamzah
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
| | | | | | - Tai E Shyong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Peter Scanlon
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - Ecosse L Lamoureux
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- The University of Melbourne, Melbourne, Australia.
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Tan CMP, Pillay KDOR, Ang ML, Chan ML, Acharyya S, Satkunanantham M. When is it safe to return to driving after distal radius fracture fixation? A prospective study. J Orthop Sci 2024; 29:537-541. [PMID: 37003851 DOI: 10.1016/j.jos.2023.02.018] [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: 12/13/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION After surgical fixation of distal radius fractures, many patients are keen to return to driving. There are however limited guidelines assisting surgeons. The aims of this study were to determine when patients could return to driving safely after distal radius fracture fixation and determine the clinical parameters (range of motion and grip strength) that patients needed to achieve before return to safe driving could be advised. MATERIALS AND METHODS A prospective grant-funded clinical study was conducted. Patients above the age of 21 years who underwent surgical fixation with a volar plate, possessed a class 3 standard motorcar license, and were regular drivers were recruited in a single institution from 2017 to 2019. A hand surgeon and an occupational therapist who sees routine hand therapy cases, assessed the patients at regular intervals from 2 to 12-weeks post-surgery. Clinical parameters of pain, wrist range of motion and grip strength were measured. Patients underwent off and on-road driving assessments. RESULTS A total of 26 patients were recruited, with 21 successfully completing the driving assessment. Median time post-surgery to passing the driving test was 6 and 8-weeks for off and on-road assessments respectively. Pain score was observed to decrease over time, with a significant decrease from week 2 to week 4. Range of motion improved over time, with maximal improvement between 2 to 4-weeks post-surgery. When compared with the unaffected wrist, the difference in pronation, supination and radial deviation in the affected hand was consistently no longer statistically significant 4 to 6-weeks post-surgery. CONCLUSION Patients with isolated surgically treated distal radius fractures can be recommended for a driving assessment as early as 4-6 weeks post-surgery if pain control is adequate, and clinical parameters for pronation and supination are met.
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Affiliation(s)
| | | | - Mu Liang Ang
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Mei Leng Chan
- Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore
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Chow JJL, Teo ZHT, Acharyya S, Natesan S, Cheong SK, Tony S, Ong YW, Li YJ, Wang B, Chai JY, Tam HZ, Low JK. Recovery of surgery in the elderly (ROSE) program: The efficacy of a multi-modal prehabilitation program implemented in frail and pre-frail elderly undergoing major abdominal surgery. World J Surg 2024; 48:48-58. [PMID: 38686802 DOI: 10.1002/wjs.12016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND Major abdominal surgery is associated with a high rate of post-operative complications with increased risk of adverse surgical outcomes due to the presence of frailty. This study aims to evaluate the effectiveness of the multimodal Recovery of Surgery in the Elderly (ROSE) prehabilitation program with supervised exercise in mitigating postoperative functional decline when compared to standard care. METHOD The ROSE program enrolled ambulant patients who were 65 years and above, had a Clinical Frailty Scale score of 4 or more and were planned for major abdominal surgery. Participation in supervised exercise sessions before surgery were compared with standard physiotherapy advice. The primary outcome was 6-min walk test (6MWT) distance assessed at baseline, after prehabilitation and 30 days follow-up after surgery. Secondary outcomes included physical performance, length of hospital stay and postoperative morbidity. RESULTS Data from 74 eligible patients, 37 in each group, were included. Median age was 78 years old. Forty-two patients (22 in Prehab group and 20 in control group) with complete 6MWT follow-up data at 30 days follow-up were analysed for outcomes. Most patients underwent laparoscopic surgery (63.5%) and almost all of the surgeries were for abdominal malignancies (97.3%). The Prehab group had an increase in 6MWT distance at the 30-day follow up, from a baseline mean (SD) of 277.4 (125) m to 287.6 (143.5) m (p = 0.415). The 6MWT distance in the control group decreased from a baseline mean (SD) of 281.7 (100.5) m to 260.1 (78.6) m at the 30-day follow up (p = 0.086). After adjusting for baseline 6MWT distance and frailty score, the Prehab group had significantly higher 6MWT distance at 30-day follow-up than control (difference in adjusted means 41.7 m, 95% confidence interval 8.7-74.8 m, p = 0.015). There were no significant between-group differences in the secondary outcomes. CONCLUSION A multimodal prehabilitation program with supervised exercise within a short time frame can improve preoperative functional capacity and maintain baseline functional capacity in frail older adults undergoing major abdominal surgery.
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Affiliation(s)
| | | | | | | | | | - Swapna Tony
- Tan Tock Seng Hospital Singapore, Singapore, Singapore
| | - Ya Wei Ong
- Tan Tock Seng Hospital Singapore, Singapore, Singapore
| | | | - Bei Wang
- Tan Tock Seng Hospital Singapore, Singapore, Singapore
| | - Jye Yi Chai
- Tan Tock Seng Hospital Singapore, Singapore, Singapore
| | - Hui Zhen Tam
- Tan Tock Seng Hospital Singapore, Singapore, Singapore
| | - Jee Keem Low
- Tan Tock Seng Hospital Singapore, Singapore, Singapore
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William Go TW, Mok HT, Acharyya S, Suelo DC, Ho EC. Communication Vulnerability within Singapore’s Healthcare Environment. Proceedings of Singapore Healthcare 2021. [DOI: 10.1177/20101058211068601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Communication difficulties can, and often do, create barriers between patients and healthcare workers (HCWs). We examined the perceptual differences between patients and caregivers; and HCWs with regards to their perceived communication vulnerabilities and identified communication needs in a tertiary hospital. A survey was conducted in selected outpatient settings among patients, their caregivers and HCWs, in a cross-sectional study. Respondents rated the reasons and frequency of encountering the communication difficulties during a hospital visit. Fifty-four percent of patients and caregivers cited poor hearing in the presence of noise, while HCWs cited patient’s poor vision (87%) as their primary communication barrier that requires improvement. Majority of HCWs (90%) had encountered patients who presented multiple communication barriers a quarter of the time. A third of HCWs felt that such encounters were especially challenging during communication, with very limited strategies available to deal with such communication vulnerable individuals. Patients, caregivers and HCWs universally experience communication challenges, even if their perceived barriers to communication happen to differ. Such perceptual difference between patients and HCWs may lead to inconsistent use of communication strategies by HCWs, potentially compromising patient’s healthcare needs. Nonetheless, the onus is on healthcare providers to bridge this communication gap to improve patient care.
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Affiliation(s)
- Teck W. William Go
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hoi T. Mok
- TTSH Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sanchalika Acharyya
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Darlin C. Suelo
- Centre for Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Eu C. Ho
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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Nakagawa K, Nagasaka M, Felip E, Pacheco J, Baik C, Goto Y, Saltos A, Li B, Udagawa H, Gadgeel S, Murakami H, Planchard D, Bazhenova L, Paz-Ares L, Perol M, Mazieres J, Barlesi F, Saxena K, Shiga R, Acharyya S, Cheng Y, Shahidi J, Jänne P, Smit E. OA04.05 Trastuzumab Deruxtecan in HER2-Overexpressing Metastatic Non-Small Cell Lung Cancer: Interim Results of DESTINY-Lung01. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.285] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Smit E, Nakagawa K, Nagasaka M, Felip E, Goto Y, Li B, Pacheco J, Murakami H, Barlesi F, Saltos A, Perol M, Udagawa H, Saxena K, Shiga R, Guevara F, Acharyya S, Shahidi J, Planchard D, Jänne P. MA11.03 Trastuzumab Deruxtecan in HER2-Mutated Metastatic Non-Small Cell Lung Cancer (NSCLC): Interim Results of DESTINY-Lung01. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION Children with solid organ tumours often present for curative surgery. Even with the best surgical technique, micrometastases can occur. Preclinical studies support the postulation that neuraxial anaesthesia maintains the body's immune and inflammatory milieu against metastasis. However, human retrospective adult studies showed varying results, and no study has been done in children. We aimed to find out if intraoperative epidural, perioperative opioid and volatile dose are associated with relapse-free survival (RFS) in children with solid organ tumours. METHODS This is a retrospective cohort study of 126 children from a tertiary paediatric unit who were diagnosed with solid organ tumours (neuroblastoma, hepatoblastoma or sarcoma) over a 16-year period. RFS, stratified by tumour subtypes, was estimated using the Kaplan-Meier method. Adjusted hazard ratios (aHRs) were obtained from multivariable Cox regression models after taking potential covariates into account. RESULTS Of 126 children with solid organ tumours (51.6% neuroblastoma, 34.9% sarcoma and 13.5% hepatoblastoma), 53.2% received combined general anaesthesia (GA)/epidural. A total of 21 (31.3%) and 20 (33.9%) patients relapsed during the study period in the combined GA/epidural group and the GA alone group, respectively. Patients with sarcoma receiving combined GA/epidural had a clinically meaningful lower risk of relapse compared to patients receiving GA alone (aHR 0.51, 95% confidence interval 0.14-1.79), although this was not statistically significant. CONCLUSION Our study demonstrated some clinically meaningful associations, especially in paediatric sarcoma patients. Overall, however, there was no statistically significant association between epidural use and an improved RFS.
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Affiliation(s)
- Shu Ying Lee
- Department of Paediatric Anaesthesia, KK Women’s and Children’s Hospital, Singapore
| | | | | | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women’s and Children’s Hospital, Singapore
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Woo CY, Koh MJ, Fung WK, Chan CS, Chua CB, Tay GT, Acharyya S, Chew GF, Lee NK, Lim KB. Effects of Cast Immobilisation on Skin Barrier Function. Ann Acad Med Singap 2020; 49:354-359. [PMID: 32712632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Cast immobilisation remains the mainstay of treatment for various fractures in paediatric patients, yet patients commonly complain of skin irritation and discomfort. This study aimed to perform a qualitative and quantitative evaluation of the effects of cast immobilisation on the skin of children and adolescents. MATERIALS AND METHODS Patients aged 6-17 years of age with a fracture treated in a fiberglass short-arm or short-leg cast were recruited. Transepidermal water loss (TEWL), stratum corneum (SC) hydration, hair density and presence of any skin signs were assessed before and after cast. Patients were required to complete a weekly questionnaire to rate itch, malodour, warmth, and dampness of the skin under the cast. RESULTS A total of 60 subjects completed the study. Thirty-six patients received a short-arm cast; 24 received a short-leg cast. Upon cast removal, TEWL was significantly increased on the volar surface of the arms and legs (P <0.05), and the dorsal surface of the arm (P <0.05). Likewise, SC hydration was significantly increased at most sites (P <0.05), except the volar surface of the leg (P = 0.513). There was no change in hair density. Throughout the duration of casting, there was an increase in itch and malodour scores. CONCLUSION Moderate but significant changes in TEWL, SC hydration and subjective symptoms were observed during the duration of cast immobilisation, demonstrating that cast immobilisation for up to 4 weeks exerts moderate adverse impact on patients' skin. Further studies to explore the use of better materials for cast immobilisation to improve skin barrier function and overall patient satisfaction are warranted.
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Affiliation(s)
- Chin Yee Woo
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
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Tan WJ, Acharyya S, Chew MH, Foo FJ, Chan WH, Wong WK, Ooi LL, Ng JCF, Ong HS. Randomized control trial comparing an Alvarado Score-based management algorithm and current best practice in the evaluation of suspected appendicitis. World J Emerg Surg 2020; 15:30. [PMID: 32357897 PMCID: PMC7193351 DOI: 10.1186/s13017-020-00309-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An objective algorithm for the management of suspected appendicitis guided by the Alvarado Score had previously been proposed. This algorithm was expected to reduce computed tomography (CT) utilization without compromising the negative appendectomy rate. This study attempts to validate the proposed algorithm in a randomized control trial. METHODS A randomized control trial comparing the management of suspected acute appendicitis using the proposed algorithm compared to current best practice, with the rate of CT utilization as the primary outcome of interest. Secondary outcomes included the percentage of missed diagnosis, negative appendectomies, length of stay in days, and overall cost of stay in dollars. RESULTS One hundred sixty patients were randomized. Characteristics such as age, ethnic group, American Society of Anesthesiologist score, white cell count, and symptom duration were similar between the two groups. The overall CT utilization rate of the intervention arm and the usual care arm were similar (93.7% vs 92.5%, p = 0.999). There were no differences in terms of negative appendectomy rate, length of stay, and cost of stay between the intervention arm as compared to the usual care arm (p = 0.926, p = 0.705, and p = 0.886, respectively). Among patients evaluated with CT, 75% (112 out of 149) revealed diagnoses for the presenting symptoms. CONCLUSION The proposed AS-based management algorithm did not reduce the CT utilization rate. Outcomes such as missed diagnoses, negative appendectomy rates, length of stay, and cost of stay were also largely similar. CT utilization was prevalent as 93% of the study cohort was evaluated by CT scan. TRIAL REGISTRATION The study has been registered at ClinicalTrials.gov (NCT03324165, Registered October 27 2017).
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Affiliation(s)
- Winson Jianhong Tan
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore. .,Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Sanchalika Acharyya
- Clinical Research & Innovation Office, Tan Tock Seng Hospital Singapore, Singapore, Singapore
| | - Min Hoe Chew
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.,Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Fung Joon Foo
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.,Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Weng Hoong Chan
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Wai Keong Wong
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.,Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - London Lucien Ooi
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Chung Fai Ng
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hock Soo Ong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
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Mubarak S, Acharyya S, Viardot-Foucault V, Tan HH, Phoon JWL. A Comparison of the Miscarriage and Live Birth Rate for Frozen Embryo Transfer According to Two Endometrial Preparations: Natural or Primed with Estrogens. FandR 2019. [DOI: 10.1142/s2661318219500038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The primary objective is to compare miscarriage rates in frozen-thawed embryo transfer (FET) cycles, according to the endometrial preparation used either artificial through the administration of exogenous estrogen and progesterone or natural without any treatment, during a spontaneous ovulatory cycle. The secondary objective is to compare the live birth rates between the two endometrial preparations. Study design This is a retrospective study done at KK Women’s and Children’s Hospital Singapore. We included women who underwent FET cycles either with hormone replacement treatment (HRT) or no treatment (natural) for the endometrial preparation, regardless of their cycle number, from 1 January 2011 till 31 December 2015. Results A total of 2,752 FET cycles were included in our analysis. The natural cycle followed by vaginal progesterone support was used in 1,221 cycles and the HRT cycle with estrogen and vaginal progesterone was used in 1,531 cycles. There is a significantly higher miscarriage rate in the HRT group (38.4%) compared with the natural group (22.3%). The live birth rate is significantly higher in the natural group (22.8%) compared with the HRT group (17.3%). The multivariate analysis further shows that the HRT therapy is independently associated with an increased risk of miscarriage (adjusted odds ratio 2.05; 95% confidence interval 1.45–2.90; [Formula: see text] <0.001) and hence lower odds of live birth (adjusted odds ratio 0.69; 95% confidence interval 0.56–0.84; [Formula: see text] <0.001) after adjusting for the patient’s age at which the embryo was cryopreserved, race, body mass index, main indications for in vitro fertilization, number of embryos transferred and type of embryo transferred. Conclusion We have shown in this study that the miscarriage rate is higher in the HRT FET group and that this increased miscarriage rate translates into a lower live birth rate in the HRT group. Thus, we conclude that patients with regular menstrual cycles should be offered a natural FET cycle to achieve better outcomes in terms of live birth rate and reducing the miscarriage rate.
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Affiliation(s)
- S. Mubarak
- Department of Obstetrics and Gynecology, Maternity Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur 50586, Malaysia
| | - S. Acharyya
- Senior Epidemiologist, Clinical Research and Innovation Office, Tan Tock Seng Hospital, 308433, Singapore
| | - V. Viardot-Foucault
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 229899, Singapore
| | - H. H. Tan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 229899, Singapore
| | - J. W. L. Phoon
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, 229899, Singapore
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Abstract
BACKGROUND The single looped suture modified Lim/Tsai technique is widely used for flexor tendon repairs. It has been shown to possess better biomechanical properties and require less repair time per tendon as compared to the double looped suture original Lim/Tsai technique. However, there is no clinical data on the modified technique. METHODS The retrospective study included zone 2 flexor tendon repairs made using the modified Lim/Tsai technique from January 2008 to December 2014. Clinical outcome was assessed using the revised Strickland and Glogovac criteria, which categorises repairs based on the total active motion of the repaired digit. RESULTS Sixty-two patients with 74 digits were included. The overall mean total active motion was 122°. The overall satisfactory outcome of the modified Lim/Tsai technique was 81.1%. The rupture rate of the modified Lim/Tsai technique was 2.7%. Using multivariate linear regression model, we found that outcomes were negatively influenced by subzone 2C and crush/saw injuries, but not by concomitant neurovascular injuries or post-operative follow-up duration. CONCLUSIONS Based on this retrospective study of patients with zone 2 flexor tendon injuries, the clinical outcomes of modified and original Lim/Tsai techniques are comparable. As such, there is no clinical evidence favouring one over the other.
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Affiliation(s)
- Min Kai Chang
- * Duke-NUS Medical School, Singapore General Hospital, Singapore
| | | | - Zeus Yiwei Lim
- † Biomechanics Laboratory, Singapore General Hospital, Singapore
| | - Shian Chao Tay
- * Duke-NUS Medical School, Singapore General Hospital, Singapore.,† Biomechanics Laboratory, Singapore General Hospital, Singapore.,‡ Department of Hand Surgery, Singapore General Hospital, Singapore
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Tan WJ, Hamzah JL, Acharyya S, Foo FJ, Lim KH, Tan IBH, Tang CL, Chew MH. Evaluation of Long-Term Outcomes of Microsatellite Instability Status in an Asian Cohort of Sporadic Colorectal Cancers. J Gastrointest Cancer 2018; 49:311-318. [PMID: 28550452 DOI: 10.1007/s12029-017-9953-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Microsatellite instability in colorectal cancer (CRC) and its long-term outcomes remains poorly studied in Asians. We investigate the prognostic significance of microsatellite instability in an Asian population and assess its clinical impact in patients who undergo adjuvant chemotherapy. METHODS Six hundred fifty-four consecutive CRC patients who underwent surgical resection between January 2010 and December 2012 were recruited. Survival was estimated using the Kaplan-Meier approach. Univariate Cox proportional hazard models were used to estimate the hazard ratios for variables associated with survival. A subgroup analyses was performed for stage III patients who underwent chemotherapy to evaluate the prognostic significance of microsatellite instability in this group. RESULTS Five hundred ninety-one (90.4%) patients were microsatellite stable (MSS) while 63 (9.6%) were microsatellite instable (MSI). Three years recurrence-free survival (RFS) and disease-specific survival (DSS) were 83.7 versus 73.7% (p = 0.295) and 87.1 versus 91.2% (p = 0.307) in MSS and MSI tumors, respectively. Among stage III patients who received adjuvant therapy, MSI status was found to be an adverse prognostic factor for RFS (HR 2.74 (95% CI 1.43-5.26), p = 0.002). This remained significant on multivariate analysis (HR 2.38 (95% CI 1.15-4.93), p = 0.018). Adjuvant chemotherapy was associated with survival benefit for patients with MSS tumors (HR 0.35, 95% CI 0.17-0.69, p = 0.002) but not MSI tumors (HR 0.67, 95% CI 0.08-8.15, p = 0.750). CONCLUSIONS MSI status is not a prognostic indicator in the general CRC population but appears to be an adverse prognostic indicator for RFS in stage III CRC patients who received adjuvant chemotherapy.
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Affiliation(s)
- Winson Jianhong Tan
- Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore.
| | - Julie Liana Hamzah
- Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Sanchalika Acharyya
- Centre for Qualitative Medicine, DUKE NUS Graduate Medical School, Singapore, Singapore
| | - Fung Joon Foo
- Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Kiat Hon Lim
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Iain Bee Huat Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Choong Leong Tang
- Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Min Hoe Chew
- Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
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Huang X, Ng SYE, Chia NSY, Acharyya S, Setiawan F, Lu Z, Tan YJ, Ng E, Wen MC, Ng AS, Tay KY, Au WL, Tan EK, Tan LCS. Higher serum triglyceride levels are associated with Parkinson's disease mild cognitive impairment. Mov Disord 2018; 33:1970-1971. [DOI: 10.1002/mds.27521] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/03/2018] [Accepted: 09/16/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Xinxin Huang
- Department of Neurology; National Neuroscience Institute; Singapore
- Duke-NUS Graduate Medical School; Singapore
| | - Samuel Yong-Ern Ng
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
| | - Nicole Shuang-Yu Chia
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
| | | | - Fiona Setiawan
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
| | - Zhonghao Lu
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
| | - Yi Jayne Tan
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
| | - Ebonne Ng
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
| | - Ming-Ching Wen
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
| | - Adeline S.L Ng
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
- Duke-NUS Graduate Medical School; Singapore
| | - Kay-Yaw Tay
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
- Duke-NUS Graduate Medical School; Singapore
| | - Wing-Lok Au
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
- Duke-NUS Graduate Medical School; Singapore
| | - Eng-King Tan
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
- Duke-NUS Graduate Medical School; Singapore
| | - Louis Chew-Seng Tan
- Department of Neurology; National Neuroscience Institute; Singapore
- Parkinson's Disease and Movement Disorders Centre; National Neuroscience Institute, Singapore, Parkinson Foundation International Centre of Excellence; Singapore
- Duke-NUS Graduate Medical School; Singapore
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15
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Huang X, Ng SYE, Chia NSY, Acharyya S, Setiawan F, Lu ZH, Ng E, Tay KY, Au WL, Tan EK, Tan LCS. Serum uric acid level and its association with motor subtypes and non-motor symptoms in early Parkinson's disease: PALS study. Parkinsonism Relat Disord 2018; 55:50-54. [PMID: 29779681 DOI: 10.1016/j.parkreldis.2018.05.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/11/2018] [Accepted: 05/12/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Uric acid has been found to be potentially neuroprotective in Parkinson's disease (PD). We investigated the relationship between serum uric acid levels and both motor and non-motor features in a prospective early PD cohort study. METHODS Fasting serum uric acid levels were measured from 125 early PD patients. Demographic, clinical characteristics, motor and non-motor assessments were performed. Patients were categorized into three motor subtypes: tremor-dominant (TD), postural instability/gait difficulty (PIGD), and mixed. Non-motor symptoms were classified as present or absent based on the appropriate cut-offs for each non-motor instrument. RESULTS Most patients had TD (n = 51, 40.8%) and mixed (n = 63, 50.4%) motor subtypes, while a minority had PIGD (n = 11, 8.8%) motor subtype. The mean serum uric acid levels were significantly different between the three motor subtypes (p = 0.0106), with the mixed subtype having the lowest serum uric acid levels. Using the TD subtype as reference, patients with higher serum uric acid levels were less likely to have the mixed (OR = 0.684; p = 0.0312) subtype as opposed to the TD subtype. Uric acid levels were not significantly different between the TD and PIGD subtypes. For non-motor symptoms, higher serum uric acid levels were significantly associated with less fatigue (OR = 0.693; p = 0.0408). CONCLUSION Higher serum uric acid levels were associated with TD motor subtype and less fatigue in early PD, which could be related to its anti-oxidative properties. Uric acid could be an important biomarker for specific motor features and symptoms of fatigue in PD.
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Affiliation(s)
| | - Samuel Yong-Ern Ng
- Department of Neurology, National Neuroscience Institute, Singapore; Parkinson's Disease and Movement Disorders Centre (NPF International Center of Excellence), National Neuroscience Institute, Singapore
| | - Nicole Shuang-Yu Chia
- Department of Neurology, National Neuroscience Institute, Singapore; Parkinson's Disease and Movement Disorders Centre (NPF International Center of Excellence), National Neuroscience Institute, Singapore
| | | | - Fiona Setiawan
- Department of Neurology, National Neuroscience Institute, Singapore; Parkinson's Disease and Movement Disorders Centre (NPF International Center of Excellence), National Neuroscience Institute, Singapore
| | - Z-H Lu
- Department of Neurology, National Neuroscience Institute, Singapore; Parkinson's Disease and Movement Disorders Centre (NPF International Center of Excellence), National Neuroscience Institute, Singapore
| | - Ebonne Ng
- Department of Neurology, National Neuroscience Institute, Singapore; Parkinson's Disease and Movement Disorders Centre (NPF International Center of Excellence), National Neuroscience Institute, Singapore
| | - Kay-Yaw Tay
- Department of Neurology, National Neuroscience Institute, Singapore; Parkinson's Disease and Movement Disorders Centre (NPF International Center of Excellence), National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Wing-Lok Au
- Department of Neurology, National Neuroscience Institute, Singapore; Parkinson's Disease and Movement Disorders Centre (NPF International Center of Excellence), National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore; Parkinson's Disease and Movement Disorders Centre (NPF International Center of Excellence), National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Louis Chew-Seng Tan
- Department of Neurology, National Neuroscience Institute, Singapore; Parkinson's Disease and Movement Disorders Centre (NPF International Center of Excellence), National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore.
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Li W, Abbas MM, Acharyya S, Ng HL, Tay KY, Au WL, Tan LCS. Suicide in Parkinson's Disease. Mov Disord Clin Pract 2018; 5:177-182. [PMID: 30363456 PMCID: PMC6174449 DOI: 10.1002/mdc3.12599] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 10/02/2017] [Revised: 12/19/2017] [Accepted: 01/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a potentially preventable event. Suicidal ideation is common in Parkinson's disease (PD), but literature on completed suicides is scarce. In this case-control study, we compared the clinical characteristics of PD subjects who completed suicide (case) with those who died from natural causes (control). METHODS PD patients from the National Neurosciences Institute's movement disorders database from 2002 till 2012 were identified. The database was linked to the Singapore National Registry of Disease Office for mortality information, and suicide deaths were confirmed with the coroner's office. The demographic and clinical variables were compared between the cases and controls and the significant factors were further analyzed using logistic regression analysis. RESULTS During the study period, 366 deaths were recorded and suicide accounted for 11 deaths. Ten subjects with suicide deaths with complete clinical information were compared with randomly selected 30 PD subjects who had died from natural causes. PD suicide patients were younger (65.9 vs. 74.48 years), had less comorbidities (CWI: 2.6 vs. 4.63), better cognition (MMSE: 25.75 vs. 21.36), lower 'ON' UPDRS motor scores (20.83 vs. 41.63), lower H &Y stage (2.16 vs. 3.86), and higher use of Entacapone than the PD non-suicide group. CONCLUSION Suicide is potentially preventable tragedy. PD patients with the identified clinical characteristics should be closely monitored for suicide ideations. Motor fluctuation is a treatable factor in such patients and should be aggressively managed.
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Affiliation(s)
- Wei Li
- Department of NeurologyNational Neuroscience InstituteSingapore
- Parkinson's Disease and Movement Disorders CenterNational Neuroscience InstituteSingapore
| | - Masoom M. Abbas
- Department of NeurologyNational Neuroscience InstituteSingapore
- Parkinson's Disease and Movement Disorders CenterNational Neuroscience InstituteSingapore
| | | | - Hwee Lan Ng
- Department of NeurologyNational Neuroscience InstituteSingapore
- Parkinson's Disease and Movement Disorders CenterNational Neuroscience InstituteSingapore
| | - Kay Yaw Tay
- Department of NeurologyNational Neuroscience InstituteSingapore
- Parkinson's Disease and Movement Disorders CenterNational Neuroscience InstituteSingapore
- Duke‐NUS Graduate Medical SchoolSingapore
| | - Wing Lok Au
- Department of NeurologyNational Neuroscience InstituteSingapore
- Parkinson's Disease and Movement Disorders CenterNational Neuroscience InstituteSingapore
- Duke‐NUS Graduate Medical SchoolSingapore
| | - Louis C. S. Tan
- Department of NeurologyNational Neuroscience InstituteSingapore
- Parkinson's Disease and Movement Disorders CenterNational Neuroscience InstituteSingapore
- Duke‐NUS Graduate Medical SchoolSingapore
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17
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Go YY, Sugimoto T, Bulluck H, Acharyya S, Allen JC, Chia SY, Jaufeerally FR, Sim D, Lim TK, Liew R, Lam CSP. Age and ejection fraction modify the impact of atrial fibrillation on acute heart failure outcomes. Eur J Heart Fail 2017; 20:821-822. [PMID: 29148227 DOI: 10.1002/ejhf.1075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yun Yun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.,Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman, Liège, Belgium.,Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Tadafumi Sugimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.,Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman, Liège, Belgium
| | | | | | | | - Shaw Yang Chia
- The Singapore Cardiac Databank, National Heart Centre Singapore, Singapore
| | - Fazlur Rehman Jaufeerally
- Duke-National University of Singapore Medical School, Singapore.,Department of Internal Medicine, Singapore General Hospital, Singapore
| | - David Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Tiong Keng Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Reginald Liew
- Duke-National University of Singapore Medical School, Singapore
| | - Carolyn S P Lam
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore.,Department of Cardiology, National Heart Centre Singapore, Singapore
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18
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Bin Abd Razak HR, Acharyya S, Tan SM, Pang HN, Tay KJD, Chia SL, Lo NN, Yeo SJ. Predictors of Midterm Outcomes after Medial Unicompartmental Knee Arthroplasty in Asians. Clin Orthop Surg 2017; 9:432-438. [PMID: 29201296 PMCID: PMC5705302 DOI: 10.4055/cios.2017.9.4.432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/20/2017] [Indexed: 11/06/2022] Open
Abstract
Background This study was designed to evaluate predictors of good outcomes following medial unicompartmental knee arthroplasty (UKA) in Asian patients. Methods Registry data of patients who underwent primary unilateral medial UKA from 2006 to 2011 were collected. Outcomes studied were the Oxford Knee Score (OKS) and the Physical Component Score (PCS) of the Short Form 36 (SF-36) questionnaire. These outcome scores were collected prospectively, pre- and postoperatively up to 5 years. Good outcome was defined as an overall improvement in score greater than or equal to the minimal clinically important difference (MCID). The MCID for the OKS was 5 while the MCID for the PCS was 10. Regression analysis was used to identify predictors of good outcomes following medial UKA. Results Primary medial UKA was performed in 1,075 patients. Higher (poorer) preoperative OKS (odds ratio [OR], 1.27; p < 0.001), lower (poorer) preoperative PCS (OR, 1.08; p < 0.001), lower (poorer) preoperative Knee Society Knee Score (KSKS; OR, 1.02; p < 0.001) and higher (better) preoperative SF-36 Mental Component Score (MCS; OR, 1.02; p < 0.001) were significant predictors of good outcomes. Conclusions Patients with poorer OKS, PCS and KSKS and better SF-36 MCS preoperatively tended to achieve good outcomes by the MCID criterion at 5 years following the index surgery.
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Affiliation(s)
| | | | - Shi-Ming Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Hee-Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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19
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Chong CY, Yung CF, Tan NWH, Acharyya S, Thoon KC. Risk factors of ICU or high dependency requirements amongst hospitalized pediatric pertussis cases: A 10 year retrospective series, Singapore. Vaccine 2017; 35:6422-6428. [PMID: 29032896 DOI: 10.1016/j.vaccine.2017.09.085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pertussis causes the highest complication rates and deaths in the infant group. Our study explored risk factors for ICU/high dependency (HD) admissions and intubation/non-invasive ventilation (NIV). METHODS A retrospective review of pertussis admissions over 10 years from 2007 to 2016 was done at KK Women's and Children's Hospital, Singapore. To understand risk factors for severe pertussis infection, we compared cases requiring ICU/HD care with controls admitted to the general ward. Risk factors for intubation/NIV were also studied. Vaccine efficacy for protection against ICU/HD admission or intubation/NIV was also calculated. RESULTS There were 200 pertussis patients with a median age of 2.75 months. Sixty-one % were ≤3 months and 14.5% were <6 weeks old. Majority of patients (77%) had no prior pertussis vaccination. After removing 3 patients with missing vaccination records, 20 cases were compared with 177 controls. On univariate analysis, risk factors for ICU/HD admission comprised: Age ≤3 months, contact history, underlying co-morbidity, prematurity, absent DTaP vaccination, lymphocytosis, hyperleukocytosis (wbc ≥50×109/L), thrombocytosis (platelet ≥500×109/L), and pneumonia. Multivariate analysis revealed that age ≤3 months (OR 40, 95% CI 4.57-1111.11, p=.007), co-morbidity (OR 8.46 (95% CI 1.47-56.89, p=.019), pneumonia (OR 18.08, 95% CI 3.22-132.15, p=.002), white cell count (OR 1.07, 95% CI 1.01-1.14, p=.023) and cyanosis (OR 5.09, 95% CI 1.31-24.71, p=.026) were risk factors for ICU/HD admission. Prior DTaP vaccination had a vaccine effectiveness of 86.5% in preventing ICU/HD admission and 82.1% in preventing intubation/NIV. CONCLUSIONS As the majority of pertussis patients were infants ≤3 months old who are at high risk for ICU/HD admission and intubation/NIV, prevention is key to reducing pertussis morbidity. Even though not statistically significant, DTaP vaccination had a role in preventing ICU/HD admission and intubation/NIV.
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Affiliation(s)
- Chia-Yin Chong
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Chee-Fu Yung
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Natalie Woon-Hui Tan
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Sanchalika Acharyya
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - Koh-Cheng Thoon
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
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20
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Shen J, Saini M, Acharyya S, Tu T, Gan E, Lee C, Ng O, Tan K. HIV infection in ischemic stroke: A case control study in a Singapore tertiary centre. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Tan PS, Bilger M, de Lima Lopes G, Acharyya S, Haaland B. Meta-analysis of first-line therapies with maintenance regimens for advanced non-small-cell lung cancer (NSCLC) in molecularly and clinically selected populations. Cancer Med 2017; 6:1847-1860. [PMID: 28675660 PMCID: PMC5548880 DOI: 10.1002/cam4.1101] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/14/2017] [Accepted: 04/23/2017] [Indexed: 12/28/2022] Open
Abstract
Evidence has suggested survival benefits of maintenance for advanced NSCLC patients not progressing after first‐line chemotherapy. Additionally, particular first‐line targeted therapies have shown survival improvements in selected populations. Optimal first‐line and maintenance therapies remain unclear. Here, currently available evidence was synthesized to elucidate optimal first‐line and maintenance therapy within patient groups. Literature was searched for randomized trials evaluating first‐line and maintenance regimens in advanced NSCLC patients. Bayesian network meta‐analysis was performed within molecularly and clinically selected groups. The primary outcome was combined clinically meaningful OS and PFS benefits. A total of 87 records on 56 trials evaluating first‐line treatments with maintenance were included. Results showed combined clinically meaningful OS and PFS benefits with particular first‐line with maintenance treatments, (1) first‐line intercalated chemotherapy+erlotinib, maintenance erlotinib in patients with EGFR mutations, (2) first‐line afatinib, maintenance afatinib in patients with EGFR deletion 19, (3) first‐line chemotherapy + bevacizumab, maintenance bevacizumab in EGFR wild‐type patients, (4) chemotherapy+conatumumab, maintenance conatumumab in patients with squamous histology, (5) chemotherapy+cetuximab, maintenance cetuximab or chemotherapy + necitumumab, maintenance necitumumab in EGFR FISH‐positive patients with squamous histology, and (6) first‐line chemotherapy+bevacizumab, maintenance bevacizumab or first‐line sequential chemotherapy+gefitinib, maintenance gefitinib in patients clinically enriched for EGFR mutations with nonsquamous histology. No treatment showed combined clinically meaningful OS and PFS benefits in patients with EGFR L858R or nonsquamous histology. Particular first‐line with maintenance treatments show meaningful OS and PFS benefits in patients selected by EGFR mutation or histology. Further research is needed to achieve effective therapy for patients with EGFR mutation L858R or nonsquamous histology.
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Affiliation(s)
- Pui San Tan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marcel Bilger
- Health Services & Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Gilberto de Lima Lopes
- Sylvester Comprehensive Cancer Center, University of Miami and the Miller School of Medicine, Miami, Florida
| | - Sanchalika Acharyya
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Benjamin Haaland
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
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22
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Tu TM, Phua SS, Acharyya S, Ng WM, Oh DC. Predicting Pneumonia in Acute Ischaemic Stroke: Comparison of Five Prediction Scoring Models. Ann Acad Med Singap 2017; 46:237-244. [PMID: 28733688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Although pneumonia is a major complication after acute ischaemic stroke (AIS), pneumonia prediction scores have not been extensively validated. This study aimed to compare the discrimination performance of 5 pneumonia prediction scores in AIS patients. MATERIALS AND METHODS We retrospectively reviewed all consecutive adult AIS patients whom presented to our emergency department within 4.5 hours of symptom-onset between January 2012 and February 2015. Diagnosis had to be made by a neurologist and infarcts confirmed by neuroimaging. We excluded patients with pneumonia on presentation. Pneumonia predictors were based on the 5 prediction scoring models: Kwon's score, Chumbler's score, Acute Ischaemic Stroke-Associated Pneumonia Score (AIS-APS), A2DS2 score and ISAN score. The definition of stroke-associated pneumonia was based on the criteria by the Pneumonia in Stroke Consensus Group. Analysis using area under receiver operating characteristics curve (AUROC) was performed. RESULTS Forty (5.5%) out of 731 patients analysed had stroke-associated pneumonia (SAP). A2DS2 score had the highest discrimination capacity (AUROC 0.88; 95% CI, 0.84 to 0.92), followed by AIS-APS (AUROC 0.87; 95% CI, 0.83 to 0.91), Kwon's score (AUROC 0.86; 95% CI, 0.82 to 0.92), Prestroke Independence, Sex, Age and National Institutes of Health Stroke Scale (ISAN) score (AUROC 0.85; 95% CI, 0.80 to 0.90) and Chumbler's score (AUROC 0.79; 95% CI, 0.74 to 0.84). However, there was no statistical difference of discrimination capacity among A2DS2 score, AIS-APS and Kwon's score. CONCLUSION A2DS2 , AIS-APS and Kwon's scores performed comparably in discriminating SAP in AIS patients.
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Affiliation(s)
- Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
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Garcia-Manero G, Sekeres MA, Egyed M, Breccia M, Graux C, Cavenagh JD, Salman H, Illes A, Fenaux P, DeAngelo DJ, Stauder R, Yee K, Zhu N, Lee JH, Valcarcel D, MacWhannell A, Borbenyi Z, Gazi L, Acharyya S, Ide S, Marker M, Ottmann OG. A phase 1b/2b multicenter study of oral panobinostat plus azacitidine in adults with MDS, CMML or AML with ⩽30% blasts. Leukemia 2017; 31:2799-2806. [PMID: 28546581 PMCID: PMC5729337 DOI: 10.1038/leu.2017.159] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 12/15/2022]
Abstract
Treatment with azacitidine (AZA), a demethylating agent, prolonged overall survival (OS) vs conventional care in patients with higher-risk myelodysplastic syndromes (MDS). As median survival with monotherapy is <2 years, novel agents are needed to improve outcomes. This phase 1b/2b trial (n=113) was designed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of panobinostat (PAN)+AZA (phase 1b) and evaluate the early efficacy and safety of PAN+AZA vs AZA monotherapy (phase 2b) in patients with higher-risk MDS, chronic myelomonocytic leukemia or oligoblastic acute myeloid leukemia with <30% blasts. The MTD was not reached; the RP2D was PAN 30 mg plus AZA 75 mg/m2. More patients receiving PAN+AZA achieved a composite complete response ([CR)+morphologic CR with incomplete blood count+bone marrow CR (27.5% (95% CI, 14.6–43.9%)) vs AZA (14.3% (5.4–28.5%)). However, no significant difference was observed in the 1-year OS rate (PAN+AZA, 60% (50–80%); AZA, 70% (50–80%)) or time to progression (PAN+AZA, 70% (40–90%); AZA, 70% (40–80%)). More grade 3/4 adverse events (97.4 vs 81.0%) and on-treatment deaths (13.2 vs 4.8%) occurred with PAN+AZA. Further dose or schedule optimization may improve the risk/benefit profile of this regimen.
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Affiliation(s)
- G Garcia-Manero
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M A Sekeres
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - M Egyed
- Kaposi Mor County Teaching Hospital, Kasposvár, Hungary
| | | | - C Graux
- Mont-Godinne University Hospital, Yvoir, Belgium
| | | | - H Salman
- Augusta University, Augusta, GA, USA
| | - A Illes
- University of Debrecen, Debrecen, Hungary
| | - P Fenaux
- Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | | | - R Stauder
- Innsbruck Medical University, Innsbruck, Austria
| | - K Yee
- Princess Margaret Cancer Centre, Toronto, Canada
| | - N Zhu
- University of Alberta Hospital, Edmonton, Canada
| | - J-H Lee
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | | | - A MacWhannell
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - L Gazi
- Novartis Pharma AG, Basel, Switzerland
| | - S Acharyya
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Ide
- Novartis Pharmaceuticals Corporation, Cambridge, MA, USA
| | - M Marker
- Novartis Pharma S.A.S., Rueil-Malmaison, France
| | - O G Ottmann
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
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Banerjee A, Dhar S, Acharyya S, Datta D, Nayak N. Numerical Simulation of Ballistic Impact of Armour Steel Plate by Typical Armour Piercing Projectile. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.proeng.2016.12.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chng CL, Lim AYY, Tan HC, Kovalik JP, Tham KW, Bee YM, Lim W, Acharyya S, Lai OF, Chong MFF, Yen PM. Physiological and Metabolic Changes During the Transition from Hyperthyroidism to Euthyroidism in Graves' Disease. Thyroid 2016; 26:1422-1430. [PMID: 27465032 DOI: 10.1089/thy.2015.0602] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The serum metabolomic profile and its relationship to physiological changes during hyperthyroidism and restoration to euthyroidism are not known. This study aimed to examine the physiological, adipokine, and metabolomic changes that occur when subjects with Graves' disease transition from hyperthyroidism to euthyroidism with medical treatment. METHODS Chinese women between 21 and 50 years of age and with newly diagnosed Graves' disease attending the endocrine outpatient clinics in a single institution were recruited between July 2012 and September 2014. All subjects were treated with thioamides to achieve euthyroidism. Clinical parameters (body weight, body composition via bioelectrical impedance analysis, resting energy expenditure and respiratory quotient via indirect calorimetry, and reported total energy intake via 24 h food diary), biochemical parameters (thyroid hormones, lipid profile, fasting insulin and glucose levels), serum leptin, adiponectin, and metabolomics profiles were measured during hyperthyroidism and repeated in early euthyroidism. RESULTS Twenty four Chinese women with an average age of 36.3 ± 8.6 years were included in the study. The average duration of treatment that was required to reach euthyroidism for these subjects was 38 ± 16.3 weeks. There was a significant increase in body weight (52.6 ± 9.0 kg to 55.3 ± 9.4 kg; p < 0.001) and fat mass (14.3 ± 6.9 kg to 16.8 ± 6.5 kg; p = 0.005). There was a reduction in resting energy expenditure corrected for weight (28.7 ± 4.0 kcal/kg to 21.5 ± 4.1 kcal/kg; p < 0.001) and an increase in respiratory quotient (0.76 to 0.81; p = 0.037). Resting energy expenditure increased significantly with increasing free triiodothyronine levels (p = 0.007). Significant increases in total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were noted. There was no significant change in leptin levels, but adiponectin levels increased significantly (p = 0.018). Significant reductions in fasting C2, medium-chain, long-chain, and total acylcarnitines were observed, but no changes in the fat-free mass, branched chain amino acid levels, or insulin sensitivity during recovery from hyperthyroidism were noted. CONCLUSIONS Serum metabolomics profile changes complemented the physiological changes observed during the transition from hyperthyroidism to euthyroidism. This study provides a comprehensive and integrated view of the changes in fuel metabolism and energy balance that occur following the treatment of hyperthyroidism.
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Affiliation(s)
- Chiaw-Ling Chng
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | | | - Hong Chang Tan
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Jean-Paul Kovalik
- 2 Cardiovascular and Metabolic Disorders Program, Duke-NUS Graduate Medical School , Singapore
| | - Kwang Wei Tham
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Yong Mong Bee
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Weiying Lim
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Sanchalika Acharyya
- 3 Centre for Quantitative Medicine, Duke-NUS Graduate Medical School , Singapore
| | - Oi Fah Lai
- 4 Department of Clinical Research, Singapore General Hospital , Singapore
| | - Mary Foong-Fong Chong
- 5 Singapore Institute for Clinical Sciences (SICS) , A*star, Brenner Centre for Molecular Medicine, Singapore
| | - Paul Michael Yen
- 2 Cardiovascular and Metabolic Disorders Program, Duke-NUS Graduate Medical School , Singapore
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Tan WJ, Chew MH, Dharmawan AR, Singh M, Acharyya S, Loi CTT, Tang CL. Critical appraisal of laparoscopic vs open rectal cancer surgery. World J Gastrointest Surg 2016; 8:452-460. [PMID: 27358678 PMCID: PMC4919713 DOI: 10.4240/wjgs.v8.i6.452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/05/2016] [Accepted: 03/25/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection (LRR) and the impact of conversion in patients with rectal cancer.
METHODS: An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection. Patients were compared in three groups: Open surgery (OP), laparoscopic surgery, and converted laparoscopic surgery. Short-term outcomes, long-term outcomes, and survival analysis were compared.
RESULTS: Among 633 patients studied, 200 patients had successful laparoscopic resections with a conversion rate of 11.1% (25 out of 225). Factors predictive of survival on univariate analysis include the laparoscopic approach (P = 0.016), together with factors such as age, ASA status, stage of disease, tumor grade, presence of perineural invasion and vascular emboli, circumferential resection margin < 2 mm, and postoperative adjuvant chemotherapy. The survival benefit of laparoscopic surgery was no longer significant on multivariate analysis (P = 0.148). Neither 5-year overall survival (70.5% vs 61.8%, P = 0.217) nor 5-year cancer free survival (64.3% vs 66.6%, P = 0.854) were significantly different between the laparoscopic group and the converted group.
CONCLUSION: LRR has equivalent long-term oncologic outcomes when compared to OP. Laparoscopic conversion does not confer a worse prognosis.
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Lopes G, Tan PS, Acharyya S, Bilger M, Haaland B. Network meta-analysis comparing first-line therapies and maintenance regimens in EGFR mutated advanced non-small-cell lung cancer (NSCLC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gilberto Lopes
- Centro Paulista de Oncologia e HCor Onco, members of the Oncoclínicas do Brasil Group, Sao Paulo, Brazil
| | - Pui San Tan
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore, Singapore
| | - Sanchalika Acharyya
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore, Singapore
| | - Marcel Bilger
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore, Singapore
| | - Benjamin Haaland
- Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA
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Tan WJ, Chew MH, Tan IBH, Law JH, Zhao R, Acharyya S, Mao YL, Fernandez LG, Loi CT, Tang CL. Palliative surgical intervention in metastatic colorectal carcinoma: a prospective analysis of quality of life. Colorectal Dis 2016; 18:357-63. [PMID: 26437936 DOI: 10.1111/codi.13142] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/10/2015] [Indexed: 02/08/2023]
Abstract
AIM Quality of life (QOL) was assessed after palliative surgery for incurable metastatic colorectal cancer (CRC). METHOD Newly diagnosed patients with incurable metastatic CRC who were offered elective palliative surgical intervention were included. The European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR29 questionnaire was used for the assessment of QOL at baseline and at 3 and 6 months after surgery. Generalized estimating equations were used to estimate the mean change in the QOL score from baseline. RESULTS Twenty-four patients formed the study group. Sixteen underwent resection of the primary tumour and eight had a proximal diversion or bypass. The Global Health (GH) score and Social Functioning (SF) score improved at 3 and 6 months after intervention respectively (GH +11, P = 0.021; SF +15, P = 0.005). Mean anxiety scores were markedly improved from the baseline of 51 to 71 (P = 0.004, 3 months) and 76 (P = 0.002, 6 months). Weight concerns also improved significantly when compared with baseline (3 months, +20, P < 0.001; 6 months, +14, P = 0.012). Symptoms of diarrhoea (3 months, --17, P = 0.007; 6 months,--16, P = 0.008) and nausea (--8, P = 0.032) improved. CONCLUSION In patients with incurable metastatic CRC, surgery improved QOL.
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Affiliation(s)
- W J Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - M H Chew
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - I B H Tan
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - J H Law
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - R Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S Acharyya
- Centre for Qualitative Medicine, DUKE NUS Graduate Medical School, Singapore, Singapore
| | - Y L Mao
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - L G Fernandez
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - C T Loi
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - C L Tang
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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Wee N, Kandiah N, Acharyya S, Chander RJ, Ng A, Au WL, Tan LCS. Baseline predictors of worsening apathy in Parkinson's disease: A prospective longitudinal study. Parkinsonism Relat Disord 2015; 23:95-8. [PMID: 26705846 DOI: 10.1016/j.parkreldis.2015.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 09/23/2015] [Revised: 11/11/2015] [Accepted: 12/03/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Apathy is one of the most common behavioural disorders in Parkinson's disease (PD) and contributes significantly to a reduced quality of life in PD patients. METHODS We conducted a prospective longitudinal study of 89 mild PD patients over 18 months, measuring apathy symptoms at 6-monthly intervals using the Starkstein Apathy Scale, as well as measures of motor and non-motor symptoms, cognitive function, and functional disability at baseline. Mixed-effects models were used to characterise the individual trajectories of apathy symptom severity, and linear regression with stepwise elimination procedure was used to select significant baseline predictors. RESULTS Clinically significant levels of apathy were present in 42.7% of our sample at baseline, with symptom severity remaining relatively stable on average over the course of 18 months. Male gender, lower educational attainment, higher depression symptom severity, more severe functional disability, and the presence of dyskinesias at study entry predicted increasing apathy over the subsequent 18 months. CONCLUSIONS Patients with these factors are at risk for progression of apathy, which may be prevented by treating depression and functional disability. Further studies are needed to address both the specific neurobiological pathways and psychosocial factors underpinning apathy in PD.
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Affiliation(s)
- Natalie Wee
- Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Sanchalika Acharyya
- Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Russell J Chander
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Aloysius Ng
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Wing Lok Au
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore.
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Wee N, Kandiah N, Acharyya S, Chander RJ, Ng A, Au WL, Tan LCS. Depression and anxiety are co-morbid but dissociable in mild Parkinson's disease: A prospective longitudinal study of patterns and predictors. Parkinsonism Relat Disord 2015; 23:50-6. [PMID: 26711668 DOI: 10.1016/j.parkreldis.2015.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 09/07/2015] [Revised: 10/26/2015] [Accepted: 12/01/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and anxiety are common in Parkinson's disease (PD) and contribute significantly to a reduced quality of life in PD patients. Though they often co-exist, it is unclear whether depression and anxiety result from a shared pathological process. We studied the longitudinal course and determinants of depression and anxiety in PD in order to understand which factors contribute to the development of these symptoms. METHODS We conducted a prospective longitudinal study of 89 mild PD patients over 18 months, measuring depressive and anxiety symptoms at 6 monthly intervals using the Geriatric Depression Scale and Hospital Anxiety and Depression Scale--'Anxiety' subscale. Univariate and multivariate Generalised Estimating Equations were used to investigate the course of depression and anxiety and their association with demographic factors, motor measures, non-motor symptoms, and pharmacological factors. RESULTS Depression and anxiety were co-morbid in 13.5% of the sample. Depressive symptoms remained relatively stable while anxiety symptoms improved over the course of 18 months. Severity of depressive symptoms was associated with female gender, motor fluctuations, apathy, and anxiety, while severity of anxiety was associated with older age, higher educational attainment, shorter disease duration, younger age of disease onset, and excessive daytime sleepiness. CONCLUSIONS Although depression and anxiety are frequently co-morbid in PD, they were dissociable from each other. They had distinct trajectories and different longitudinal relationships with demographic, motor, and non-motor factors that were unique to each disorder.
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Affiliation(s)
- Natalie Wee
- Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Sanchalika Acharyya
- Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Russell J Chander
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Aloysius Ng
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Wing Lok Au
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore.
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Fong P, Acharyya S, Lim D, Tan EH, Ng Q, Tan D, Ang M. 322P Association of clinical factors with survival outcomes in laryngeal squamous cell carcinoma (SCC) in Singapore. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv527.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tan PS, Lopes G, Acharyya S, Bilger M, Haaland B. Bayesian network meta-comparison of maintenance treatments for stage IIIb/IV non-small-cell lung cancer (NSCLC) patients with good performance status not progressing after first-line induction chemotherapy: results by performance status, EGFR mutation, histology and response to previous induction. Eur J Cancer 2015; 51:2330-44. [PMID: 26364517 DOI: 10.1016/j.ejca.2015.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/17/2015] [Accepted: 07/12/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent trials have suggested that maintenance treatments improve outcomes for patients not progressing after first-line therapy for advanced non-small-cell lung cancer (NSCLC). However, physicians have little guidance on selecting which patients benefit the most and what drug or regimen is optimal. Here, we report a systematic review and network meta-analysis of maintenance treatments in subgroups determined by performance status (PS), epidermal growth factor receptor (EGFR) mutation, histology and response to induction. METHODS PubMed and conference proceedings were reviewed and individual study relative efficacy measures were meta-analysed in a Bayesian hierarchical model. The primary outcome, overall survival (OS), was evaluated in terms of (i) posterior surface under cumulative ranking curve (SUCRA), (ii) probability of being best treatment, (iii) probability of outperforming no maintenance, and (iv) posterior median hazard ratio (95% credible interval). Secondary outcomes were progression-free survival (PFS) and adverse events. FINDINGS Twelve trials evaluating eight maintenance treatments in 3850 patients were meta-analysed. Selected maintenance treatments showed clinically meaningful benefits of ⩾20% reduction in hazards of death with ⩾90% probability of outperforming no maintenance in terms of OS: (i) switch to or continue pemetrexed (nonsquamous), continue gemcitabine, or switch to EGFR tyrosine kinase inhibitors (TKIs) for PS 0 patients, (ii) switch to pemetrexed (nonsquamous) for PS 1 patients, (iii) switch to EGFR TKI for EGFR mutation positive patients, (iv) switch to or continue pemetrexed or switch to EGFR TKI for nonsquamous patients, (v) continue gemcitabine for squamous patients, (vi) switch to docetaxel or continue gemcitabine for responders to induction, or (vii) switch to or continue pemetrexed (nonsquamous) or switch to EGFR TKI for patients with stable disease post-induction. INTERPRETATION Maintenance treatments show clinically meaningful survival benefits in good performance status patients with advanced NSCLC not progressing after first-line chemotherapy. Benefits are optimised by targeting specific maintenance to individual patients guided by PS, EGFR mutation status, histology and response to induction.
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Affiliation(s)
- Pui San Tan
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Gilberto Lopes
- Hospital do Coração Cancer Center (HCor Onco), and Research Institute, Brazil; Centro Paulista de Oncologia, Brazil; Oncoclinicas do Brasil, Brazil; Johns Hopkins University, Baltimore, MD, USA
| | - Sanchalika Acharyya
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| | - Marcel Bilger
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Benjamin Haaland
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore; H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, USA.
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Girard MJA, Tun TA, Husain R, Acharyya S, Haaland BA, Wei X, Mari JM, Perera SA, Baskaran M, Aung T, Strouthidis NG. Lamina cribrosa visibility using optical coherence tomography: comparison of devices and effects of image enhancement techniques. Invest Ophthalmol Vis Sci 2015; 56:865-74. [PMID: 25593025 DOI: 10.1167/iovs.14-14903] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare the visibility of the lamina cribrosa (LC) in optic disc images acquired from 60 glaucoma and 60 control subjects using three optical coherence tomography (OCT) devices, with and without enhanced depth imaging (EDI) and adaptive compensation (AC). METHODS A horizontal B-scan was acquired through the center of the disc using two spectral-domain (Spectralis and Cirrus; with and without EDI) and a swept-source (DRI) OCT. Adaptive compensation was applied post acquisition to improve image quality. To assess LC visibility, four masked observers graded the 1200 images in a randomized sequence. The anterior LC was graded from 0 to 4, the LC insertions from 0 to 2, and the posterior LC either 0 or 1. The effect of EDI, AC, glaucoma severity, and other clinical/demographic factors on LC visibility was assessed using generalized estimating equations. RESULTS The anterior LC was the most detectable feature, followed by the LC insertions. Adaptive compensation improved anterior LC visibility independent of EDI. Cirrus+EDI+AC generated the greatest anterior LC visibility grades (2.79/4). For LC insertions visibility, DRI+AC was the best method (1.10/2). Visibility of the posterior LC was consistently poor. Neither glaucoma severity nor clinical/demographic factors consistently affected LC visibility. CONCLUSIONS Adaptive compensation is superior to EDI in improving LC visibility. Visibility of the posterior LC remains poor suggesting impracticality in using LC thickness as a glaucoma biomarker.
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Affiliation(s)
- Michaël J A Girard
- In Vivo Biomechanics Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Tin A Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Sanchalika Acharyya
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Benjamin A Haaland
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Xin Wei
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Jean M Mari
- Department of Medical Physics and Bioengineering, UCL, London, United Kingdom
| | - Shamira A Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas G Strouthidis
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South Wales, Australia
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Ang SH, Haaland B, Acharyya S, Thu MMM, Krisna SS, Hwang SG, Tan PH, Ng QS, Tan DSW, Tai WM, Tan EH, Lim WT, Ang MK. Interactions between clinical factors, p16, and cyclin-D1 expression and survival outcomes in oropharyngeal and hypopharyngeal squamous cell carcinoma. Head Neck 2014; 37:1650-9. [PMID: 24953865 DOI: 10.1002/hed.23803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/21/2014] [Accepted: 06/18/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND P16 and cyclin-D1 are cell cycle proteins commonly dysregulated in head and neck carcinoma. We assessed their expression, clinicopathological variables, and overall survival (OS) in oropharyngeal and hypopharyngeal squamous cell carcinoma (SCC). METHODS Clinical characteristics and p16 and cyclin-D1 expression were evaluated in 101 patients with oropharyngeal SCC and 75 patients with hypopharyngeal SCC. Associations with OS were assessed using Cox regression and Kaplan-Meier analysis. RESULTS Compared to oropharyngeal SCC, patients with hypopharyngeal SCC were older, men, ever-smokers with higher mean Charlson Comorbidity Index (CCI), lower p16 expression, and poorer median OS (24.8 vs 62.3 months; p < .01). In oropharyngeal SCC, CCI (p < .001), cyclin-D1 (hazard ratio [HR] = 3.55; p = .007), current smoking (HR = 5.72; p = .004), and former smoking (HR = 4.12; p = .035) were independently associated with OS. In hypopharyngeal SCC, only nodal and Eastern Cooperative Oncology Group status were associated with OS. CONCLUSION In oropharyngeal SCC, cyclin-D1 expression is correlated with survival, whereas smoking status and CCI may allow further stratification of outcome.
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Affiliation(s)
| | - Benjamin Haaland
- Centre of Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Sanchalika Acharyya
- Centre of Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Minn M M Thu
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
- Department of Pathology, Singapore General Hospital, Singapore
| | - Sai-Sakktee Krisna
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
- Department of Pathology, Singapore General Hospital, Singapore
| | - Siok-Gek Hwang
- Department of Pathology, Singapore General Hospital, Singapore
| | - Puay-Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore
| | - Quan-Sing Ng
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Daniel S W Tan
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Wai-Meng Tai
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Eng-Huat Tan
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Wan-Teck Lim
- Duke-NUS Graduate Medical School, Singapore
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Mei-Kim Ang
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
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Haaland B, Chopra A, Acharyya S, Fay AP, Lopes GDL. Comparative effectiveness of approved first-line anti-angiogenic and molecularly targeted therapeutic agents in the treatment of good and intermediate risk metastatic clear cell renal cell carcinoma. BMC Cancer 2014; 14:592. [PMID: 25127891 PMCID: PMC4148555 DOI: 10.1186/1471-2407-14-592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 07/22/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Based on improved clinical outcomes in randomized controlled clinical trials (RCTs) the FDA and EMA have approved bevacizumab with interferon, sunitinib, and pazopanib in the first-line treatment of low to intermediate risk metastatic clear cell renal cell carcinoma (mRCC). However, there is little comparative data to help in choosing the most effective drug among these agents. METHODS We performed an indirect comparative effectiveness analysis of the pivotal RCTs of bevacizumab with interferon, sunitinib, or pazopanib compared to one another or interferon alone in first-line treatment of metastatic or advanced RCC. Endpoints of interest were overall survival (OS), progression free survival (PFS), and response rate (RR). Adverse events were also examined. RESULTS The meta-estimate of the hazard ratio (95% confidence interval) for OS for bevacizumab with interferon vs. interferon alone was 0.86 (0.76-0.97), for sunitinib vs. interferon alone was 0.82 (0.67-1.00), for pazopanib vs. interferon alone was 0.74 (0.57-0.97), for sunitinib vs. bevacizumab with interferon was 0.95 (0.75-1.20), for pazopanib vs. bevacizumab with interferon was 0.86 (0.64-1.16), and for pazopanib vs. sunitinib was 0.91 (0.76-1.08). Similarly, bevacizumab with interferon, sunitinib, or pazopanib had better PFS and RR than interferon alone. Sunitinib and pazopanib had better RR than bevacizumab with interferon and there was suggestive evidence pazopanib may outperform sunitinib in terms of RR. CONCLUSIONS Bevacizumab with interferon, sunitinib, and pazopanib are adequate first-line options in treatment of mRCC. Interferon alone should not be considered an optimal first-line treatment.
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Affiliation(s)
- Benjamin Haaland
- />Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
- />Department of Statistics and Applied Probability, National University of Singapore, Science Drive 2, Singapore, 117546 Singapore
| | - Akhil Chopra
- />Johns Hopkins Singapore International Medical Center, Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Sanchalika Acharyya
- />Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
| | - André P Fay
- />Post-Graduate Program - School of Medicine, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS 90619-900 Brazil
- />Dana-Farber Cancer Institute, Lank Center for Genitourinary Oncology, 450 Brookline Ave, Boston, MA 02215-5450 USA
| | - Gilberto de Lima Lopes
- />Oncoclinicas do Brasil, Avenida Barbacena 472-14° andar, Belo Horizonte, MG Brazil
- />Hospital do Coração Cancer Center (HCor Onco), São Paulo, Brazil
- />Johns Hopkins University, Baltimore, MD USA
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Fenaux P, DeAngelo D, Garcia-Manero G, Lubbert M, Jillella A, Sekeres M, Zahlten A, Squier M, Acharyya S, Winiger-Candolfi I, Ottmann O. 166 Safety of panobinostat plus 5-azacitidine in myelodysplastic syndrome, chronic myelomonocytic leukemia, or acute myeloid leukemia patients: a phase Ib study. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Acharyya S, Patra A, Bag PK. Evaluation of the Antimicrobial Activity of Some Medicinal Plants against Enteric Bacteria with Particular Reference to Multi-Drug Resistant Vibrio cholerae. TROP J PHARM RES 2009. [DOI: 10.4314/tjpr.v8i3.44538] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Roy A, Acharyya S, Das S, Ghosh R, Paul S, Srivastava RK, Ghosh SK. Distribution, epidemiology and molecular variability of the begomovirus complexes associated with yellow vein mosaic disease of mesta in India. Virus Res 2009; 141:237-46. [PMID: 19428737 DOI: 10.1016/j.virusres.2008.11.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2008] [Indexed: 10/21/2022]
Abstract
Yellow vein mosaic disease of mesta (Hibiscus spp.) poses a serious threat to the cultivation of this crop in India. The disease was found to be associated with two different whitefly-transmitted monopartite begomoviruses, Mesta yellow vein mosaic virus and Mesta yellow vein mosaic Bahraich virus, together with two betasatellite species, Cotton leaf curl Multan betasatellite and Ludwigia leaf distortion betasatellite. These begomovirus complexes were detected in different combinations throughout the mesta growing regions of India. All the eight cultivars tested were highly susceptible to the disease. The effect of the disease in terms of loss in fibre yield was greatest (around 70%) in plants that were inoculated at an early stage of growth. A regression approach was adopted to consider the relationship of whitefly vector populations with weather conditions and disease spread which explained that different conducive weather factors facilitated the build up of whitefly populations and contributed to the spread of the disease.
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Affiliation(s)
- Anirban Roy
- Plant Virus Laboratory and Biotechnology Unit, Division of Crop Protection, Central Research Institute for Jute and Allied Fibres, Barrackpore, Kolkata, West Bengal, India.
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Dutta K, Karmakar A, Sit S, Acharyya S. Material properties of dipolar liquid in non-polar solvent through relaxation phenomena under high frequency electric field. J Mol Liq 2006. [DOI: 10.1016/j.molliq.2006.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mitra U, Ghosh N, Ghosh P, Acharyya S. The physico-chemical aspects of some long straight chain alcohols from susceptibility measurement under a 24 GHz electric field at 25 °C. J Mol Liq 2006. [DOI: 10.1016/j.molliq.2005.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Acharyya S, Duttagupta A, Agarwal A, Bhattacharyya A. Characteristics of human sperm DNA and its relationship with male infertility. Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ghosh N, Sit S, Acharyya S. Double relaxation phenomena of monosubstituted anilines in benzene under high frequency electric field. J Mol Liq 2003. [DOI: 10.1016/s0167-7322(02)00052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Acharyya S, Acharyya K. Surfactant protein B deficiency: a rare but lethal condition in newborn. Indian Pediatr 2001; 38:1039-41. [PMID: 11568382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- S Acharyya
- Department of Pediatrics, Royal Gwent Hospital, Newport, UK.
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Sit S, Dutta K, Acharyya S, Majumder TP, Roy S. Double relaxation times, dipole moments, energy parameters and molecular structures of some aprotic polar molecules from relaxation phenomena. J Mol Liq 2000. [DOI: 10.1016/s0167-7322(00)90007-2] [Citation(s) in RCA: 11] [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: 11/28/2022]
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Dutta K, Basak RC, Sit S, Acharyya S. Dielectric relaxation phenomena and high frequency conductivity of rigid polar liquids in different solvents. J Mol Liq 2000. [DOI: 10.1016/s0167-7322(00)00142-2] [Citation(s) in RCA: 2] [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: 10/27/2022]
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Acharyya S. Promoting health of looked after children. Monitoring and documentation should be improved. BMJ 2000; 321:381. [PMID: 10991563 PMCID: PMC1118344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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