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Ngan JST, Chan WC, Wong ST, Wong CSM, Cheng CPW. Reward System in Late-Life Depression: a Cross-Sectional Case-Control Study. East Asian Arch Psychiatry 2023; 33:71-76. [PMID: 37400229 DOI: 10.12809/eaap2309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Anhedonia, commonly defined as a reduced ability to feel pleasure, is a core clinical symptom of late-life depression (LLD). Deficits in reward processing are hypothesised to be associated with anhedonia. We examined differences in reward sensitivity between patients with LLD and healthy controls and explored the associations between LLD-related symptomatology, global cognition, and the reward system. METHODS The reward responsiveness of 63 patients with LLD and 58 healthy controls aged ≥60 years was assessed using the probabilistic reward learning task with an asymmetric reward schedule. RESULTS Compared with healthy controls, patients with LLD displayed lower response bias and reward learning. Global cognition of all participants was positively correlated with response bias. In patients with LLD, anhedonia severity explained impaired reward learning. CONCLUSION A deficit in reward processing is implicated in patients with LLD. Our findings suggest that executive dysfunction and anhedonia contribute to lower sensitivity to reward learning in patients with LLD.
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Affiliation(s)
- J S T Ngan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - W C Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong SAR, China
| | - S T Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C S M Wong
- Division of Community Medicine and Public Health Practice, School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - C P W Cheng
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
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Koka H, Bodelon C, Horvath S, Lee PMY, Wang D, Song L, Zhang T, Hurson AN, Guida JL, Zhu B, Bailey-Whyte M, Wang F, Wu C, Tsang KH, Tsoi YK, Chan WC, Law SH, Hung RKW, Tse GM, Yuen KKW, Karlins E, Jones K, Vogt A, Zhu B, Hutchinson A, Hicks B, Garcia-Closas M, Chanock S, Barnholtz-Sloan J, Tse LA, Yang XR. DNA methylation age in paired tumor and adjacent normal breast tissue in Chinese women with breast cancer. Clin Epigenetics 2023; 15:55. [PMID: 36991516 PMCID: PMC10062015 DOI: 10.1186/s13148-023-01465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Few studies have examined epigenetic age acceleration (AA), the difference between DNA methylation (DNAm) predicted age and chronological age, in relation to somatic genomic features in paired cancer and normal tissue, with less work done in non-European populations. In this study, we aimed to examine DNAm age and its associations with breast cancer risk factors, subtypes, somatic genomic profiles including mutation and copy number alterations and other aging markers in breast tissue of Chinese breast cancer (BC) patients from Hong Kong. METHODS We performed genome-wide DNA methylation profiling of 196 tumor and 188 paired adjacent normal tissue collected from Chinese BC patients in Hong Kong (HKBC) using Illumina MethylationEPIC array. The DNAm age was calculated using Horvath's pan-tissue clock model. Somatic genomic features were based on data from RNA sequencing (RNASeq), whole-exome sequencing (WES), and whole-genome sequencing (WGS). Pearson's correlation (r), Kruskal-Wallis test, and regression models were used to estimate associations of DNAm AA with somatic features and breast cancer risk factors. RESULTS DNAm age showed a stronger correlation with chronological age in normal (Pearson r = 0.78, P < 2.2e-16) than in tumor tissue (Pearson r = 0.31, P = 7.8e-06). Although overall DNAm age or AA did not vary significantly by tissue within the same individual, luminal A tumors exhibited increased DNAm AA (P = 0.004) while HER2-enriched/basal-like tumors exhibited markedly lower DNAm AA (P = < .0001) compared with paired normal tissue. Consistent with the subtype association, tumor DNAm AA was positively correlated with ESR1 (Pearson r = 0.39, P = 6.3e-06) and PGR (Pearson r = 0.36, P = 2.4e-05) gene expression. In line with this, we found that increasing DNAm AA was associated with higher body mass index (P = 0.039) and earlier age at menarche (P = 0.035), factors that are related to cumulative exposure to estrogen. In contrast, variables indicating extensive genomic instability, such as TP53 somatic mutations, high tumor mutation/copy number alteration burden, and homologous repair deficiency were associated with lower DNAm AA. CONCLUSIONS Our findings provide additional insights into the complexity of breast tissue aging that is associated with the interaction of hormonal, genomic, and epigenetic mechanisms in an East Asian population.
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Affiliation(s)
- Hela Koka
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- San Diego Institute of Science, Alto Labs, San Diego, CA, USA
| | - Priscilla Ming Yi Lee
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong., Prince of Wales Hospital, Sha Tin, N.T., Hong Kong SAR, China
| | - Difei Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Lei Song
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Tongwu Zhang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Amber N Hurson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Jennifer Lyn Guida
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Bin Zhu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Maeve Bailey-Whyte
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Feng Wang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong., Prince of Wales Hospital, Sha Tin, N.T., Hong Kong SAR, China
| | - Cherry Wu
- Department of Pathology, North District Hospital, Hong Kong, China
| | - Koon Ho Tsang
- Department of Pathology, Yan Chai Hospital, Hong Kong, China
| | - Yee-Kei Tsoi
- Department of Surgery, North District Hospital, Hong Kong, China
| | - W C Chan
- Department of Surgery, North District Hospital, Hong Kong, China
| | - Sze Hong Law
- Department of Surgery, North District Hospital, Hong Kong, China
| | - Ray Ka Wai Hung
- Department of Surgery, North District Hospital, Hong Kong, China
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Eric Karlins
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Kristine Jones
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Aurelie Vogt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Bin Zhu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Amy Hutchinson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Belynda Hicks
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Stephen Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Jill Barnholtz-Sloan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Lap Ah Tse
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong., Prince of Wales Hospital, Sha Tin, N.T., Hong Kong SAR, China.
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
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Chan SHW, Ng SM, Yu CH, Chan CM, Wang SM, Chan WC. The effects of an integrated mindfulness-based tai chi chuan programme on sleep disturbance among community-dwelling elderly people: protocol for a randomized controlled trial. Trials 2022; 23:808. [PMID: 36153623 PMCID: PMC9509614 DOI: 10.1186/s13063-022-06737-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Many elderly individuals who experience sleep disturbances would consider complementary and alternative medicine as an alternative therapeutic option in light of the limitations of traditional treatments. Mindfulness-based interventions (MBIs) and Tai Chi Chuan (TCC) are two alternative forms of complementary and alternative medicine. They both share the common feature of a focus on breathing but represent distinct approaches with different mechanisms and philosophical orientations. The trial described in this protocol aims to evaluate the effects of an integrated form of mindfulness-based Tai Chi Chuan (MBTCC) programme and the underlying mechanisms of the beneficial effects over a 12-month follow-up.
Methods
The planned study is a four-armed randomized controlled trial with repeated measures. A total of 256 community-dwelling older adults with sleep problems will be recruited and randomized into four groups: (1) an MBTCC group, (2) an MBI group, (3) a TCC group, and (4) a sleep hygiene education (SHE) control group. The outcome measures in terms of insomnia severity, interoception, sleep-wake pattern, health status, rumination, and hyperarousal level will be collected at four time points: at baseline (T1), after the 8-week intervention (T2), 6 months after the intervention (T3), and 1 year after the intervention (T4). In addition, qualitative evaluation through focus group interviews will be conducted at the end of the 12-month assessment period (T4).
Discussion
This trial will illuminate the synergetic effect of combining both MBIs and TCC on optimizing improvements in sleep disturbance. The findings from this study can provide empirical support for this integrated treatment, which provides an alternative for healthcare professionals in elderly service to select appropriate practices to treat elderly people with sleep disturbance. It can further help to lessen the growing public health burden of sleep disturbances among the elderly living in the community.
Trial registration
ClinicalTrials.gov. NCT05396092. Published on 24 May 2022
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Lam LCW, Chan WC, Kwok TCY, Lee JSW, Yu BML, Lee S, Lee ATC, Ma SL, Cheng ST. Combined physical exercise-working memory training on slowing down cognitive decline in elders with mild clinical Alzheimer disease: a randomised controlled study (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 3:28-30. [PMID: 35701227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - T C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - J S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - B M L Yu
- Social Welfare Department, Hong Kong SAR Government
| | - S Lee
- Department of Psychiatry, The Chinese University of Hong Kong
| | - A T C Lee
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S L Ma
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S T Cheng
- Department of Health and Physical Education, The Education University of Hong Kong
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Lee PMY, Kwok CH, Tsoi YK, Wu C, Law SH, Tsang KH, Yeung YC, Chan WC, Tse GM, Yuen KKW, Hung RKW, Wang F, Tse LA. Associations between Preserved foods and Breast Cancer Risk in Hong Kong Chinese Women. Cancer Prev Res (Phila) 2022; 15:497-507. [PMID: 35504011 DOI: 10.1158/1940-6207.capr-21-0509] [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] [Received: 10/17/2021] [Revised: 02/21/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
Abstract
Preserved food such as cured foods may contain nitrate and nitrite that may contribute to the breast cancer development. Evidence on the associations between these preserved food intakes and risk of breast cancer is sparse. This study aimed to examine the associations between preserved foods (i.e. cured meat, pickled vegetables, canned meat, canned fruit/vegetables) and breast cancer risk in Hong Kong Chinese women. A total of 1307 breast cancer cases and 1050 age-matched controls were recruited from three hospitals during 11/2011-01/2018. We used a standardized questionnaire to collect information on dietary factors including preserved foods. Unconditional multiple logistic regression was performed to calculate the adjusted odds ratio(AOR) of breast cancer in relation to preserved food with adjustment of potential confounders. We further performed stratified analysis according to the breast cancer biology subtypes. We found that cured meat consumption was significantly associated with the risk of breast cancer [AOR=1.32, 95% confidence interval 95%CI)=1.06-1.64]. Compared to no cured meat consumption, cured meat intake {greater than or equal to} once per week was associated with an AOR of 2.66 (95%CI=1.38-5.35). Women with canned fruit/vegetable {greater than or equal to} consumption once per week had a higher risk of breast cancer (OR=1.19, 95%CI=1.00-1.41), particularly for the HER2-positive subtypes, but it became borderline after adjustment of confounders. Our study reveals a positive association between consumption of cured meat and breast cancer risk in Chinese population. Cured meat intake might be a potential novel risk factor for breast cancer but this would have to be confirmed by large prospective cohort studies.
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Affiliation(s)
| | - Chi-Hei Kwok
- Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Yee-Kei Tsoi
- North District Hospital, Hong Kong, Hong Kong, China
| | | | | | | | | | - W C Chan
- Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Gary M Tse
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | | | | | - Feng Wang
- Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Lap Ah Tse
- Chinese University of Hong Kong, Hong Kong, Hong Kong
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Chan KW, Liu CY, Wong HY, Chan WC, Wong KY, Chen S. Specific Amino Acid Substitutions in OXA-51-Type β-Lactamase Enhance Catalytic Activity to a Level Comparable to Carbapenemase OXA-23 and OXA-24/40. Int J Mol Sci 2022; 23:ijms23094496. [PMID: 35562886 PMCID: PMC9105447 DOI: 10.3390/ijms23094496] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
The chromosomal blaOXA-51-type gene encodes carbapenem-hydrolyzing class D β-lactamases (CHDLs), specific variants shown to mediate carbapenem resistance in the Gram-negative bacterial pathogen Acinetobacter baumannii. This study aims to characterize the effect of key amino acid substitutions in OXA-51 variants of carbapenem-hydrolyzing class D β-lactamases (CHDLs) on substrate catalysis. Mutational and structural analyses indicated that each of the L167V, W222G, or I129L substitutions contributed to an increase in catalytic activity. The I129L mutation exhibited the most substantial effect. The combination of W222G and I129L substitutions exhibited an extremely strong catalytic enhancement effect in OXA-66, resulting in higher activity than OXA-23 and OXA-24/40 against carbapenems. These findings suggested that specific arrangement of residues in these three important positions in the intrinsic OXA-51 type of enzyme can generate variants that are even more active than known CHDLs. Likewise, mutation leading to the W222M change also causes a significant increase in the catalytic activity of OXA-51. blaOXA-51 gene in A. baumannii may likely continue to evolve, generating mutant genes that encode carbapenemase with extremely strong catalytic activity.
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Affiliation(s)
- Kwan-Wai Chan
- State Key Laboratory of Chemical Biology and Drug Discovery, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; (K.-W.C.); (H.-Y.W.); (W.-C.C.); (K.-Y.W.)
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Kowloon, Hong Kong;
| | - Chen-Yu Liu
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Kowloon, Hong Kong;
| | - Ho-Yin Wong
- State Key Laboratory of Chemical Biology and Drug Discovery, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; (K.-W.C.); (H.-Y.W.); (W.-C.C.); (K.-Y.W.)
| | - Wai-Chi Chan
- State Key Laboratory of Chemical Biology and Drug Discovery, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; (K.-W.C.); (H.-Y.W.); (W.-C.C.); (K.-Y.W.)
| | - Kwok-Yin Wong
- State Key Laboratory of Chemical Biology and Drug Discovery, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; (K.-W.C.); (H.-Y.W.); (W.-C.C.); (K.-Y.W.)
| | - Sheng Chen
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Kowloon, Hong Kong;
- Correspondence: ; Tel.: +852-3442-5782
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Fong TKH, Cheung T, Chan WC, Cheng CPW. Depression, Anxiety and Stress on Caregivers of Persons with Dementia (CGPWD) in Hong Kong amid COVID-19 Pandemic. Int J Environ Res Public Health 2021; 19:ijerph19010184. [PMID: 35010451 PMCID: PMC8751129 DOI: 10.3390/ijerph19010184] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 01/03/2023]
Abstract
Background: Coronavirus disease 2019 (COVID-19) contributed to increasing prevalence of depressive symptoms and other psychological repercussions, particularly in the disease population in Hong Kong. Nonetheless, the caregiver burden of caregivers of persons with dementia (CGPWD), has been under-investigated. Aims: This study examined the psychological impact and its correlates on the CGPWD in Hong Kong amid the COVID-19 outbreak. Methods: CGPWD referred from rehabilitation clinics and online seminar were used to recruit participants to complete an online questionnaire by the end of the second-wave of the COVID-19 outbreak (June 2021). To be eligible, either full-time or part-time CGPWD, aged 18 or above, can understand Cantonese, currently reside in Hong Kong and offering care to PWD for at least one year, were recruited. Those CGPWD diagnosed with any type of psychiatric disorder were excluded from this study. The Chinese Center for Epidemiologic Studies Depression Scale (CES-D), Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder (GAD-7), Zarit Burden Interview (ZBI-22), and Nonattachment Scale (NAS-7) were used to measure participants’ depression, perceived stress, anxiety symptoms, caregiver burden and wisdom in subjective feelings of internal stress. The modified Medical Outcomes Study Social Support Survey (mMOS-SS) and the SARS Appraisal Inventory (SAI) were also administered to measure participants’ perceived support and coping efficacy. Follow-up responses were gathered by the end of third-wave outbreak (October 2021). Results: A total of 51 CGPWD participated, of which, 33 (64.7%) suffered from probable depression (CES-D score ≥ 16). Participants also showed a significant increase in depression symptom scores at the three-month follow-up period (t = 2.25, p = 0.03). CGPWD with probable depression had less non-attachment awareness and higher scores in anxiety, stress, caregiving burden, and coronavirus impact (all p < 0.05) than those without. Conclusions: High prevalence of depressive symptoms was noted among our CGPWD sample and these symptoms seemed to worsen substantially. Contingent online mental health support should be prioritized to those CGPWD to reduce psychiatric morbidity and the global disease burden.
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Affiliation(s)
- Tommy Kwan-Hin Fong
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; (T.K.-H.F.); (W.-C.C.)
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China;
| | - Wai-Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; (T.K.-H.F.); (W.-C.C.)
| | - Calvin Pak-Wing Cheng
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; (T.K.-H.F.); (W.-C.C.)
- Correspondence:
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Li GHY, Cheung CL, Cheung EYN, Chan WC, Tan KCB. Genetically Determined TSH Level Within Reference Range Is Inversely Associated With Alzheimer Disease. J Clin Endocrinol Metab 2021; 106:e5064-e5074. [PMID: 34272859 DOI: 10.1210/clinem/dgab527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Contradictory findings were reported in observational studies on the association of thyroid function (thyrotropin [TSH] and free thyroxine [FT4] levels) with Alzheimer disease (AD). OBJECTIVE This work aims to determine whether genetically determined TSH/FT4 levels within reference range are causally associated with AD. METHODS A bidirectional, 2-sample mendelian randomization (MR) study was conducted. With summary statistics from the largest genome-wide association studies (GWAS)/GWAS meta-analysis of TSH level(n ≥ 54 288), FT4 level(n = 49 269), and AD (71 880 cases; 383 378 controls), we used an MR approach to evaluate the bidirectional causal relationship between TSH/FT4 levels and AD. The inverse-variance weighted method was adopted as the main analysis. RESULTS One SD increase in genetically determined TSH level within reference range was causally associated with a reduced risk of AD (odds ratio: 0.988; 95% CI, 0.977-0.998). A similar inverse association was observed in sex-specific analysis. The causal association was attenuated after adjustment for atrial fibrillation and blood pressure, suggesting they may mediate the causal pathway. A positive causal effect of AD on TSH level was detected only in male participants. This male-specific feedback loop may explain why the largest cohort study to date (Rotterdam Study) demonstrated a null observational association in men. Null association was observed between FT4 level and AD in both directions. CONCLUSION Genetic predisposition to increased TSH level, even within reference range, may lower the risk of AD, with atrial fibrillation, systolic, and diastolic blood pressure as possible mediators. Given the higher magnitude of risk reduction observed in the Rotterdam Study, whether the causal estimates derived from this MR study are underestimated warrants further investigation.
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Affiliation(s)
- Gloria Hoi-Yee Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong
| | - Elaine Yun-Ning Cheung
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wai-Chi Chan
- Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong
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9
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Wong YL, Cheng CPW, Wong CSM, Wong SN, Wong HL, Tse S, Wong GHY, Chan WC. Cognitive Stimulation for Persons with Dementia: a Systematic Review and Meta-Analysis. East Asian Arch Psychiatry 2021; 31:55-66. [PMID: 34588315 DOI: 10.12809/eaap2102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We aim to provide an up-to-date systematic review and meta-analysis of the effects of cognitive stimulation (CS) on cognition, depressive symptoms, and quality of life in persons with dementia. Factors affecting the treatment effect were examined. METHODS A literature search was performed on databases of MEDLINE, EMBASE, PsycINFO, CINAHL Plus, and Cochrane Library up to 7 March 2019. Only randomised controlled trials investigating the effects of CS in persons with dementia were included. The outcome measures were cognitive function, depressive symptoms, and quality of life. RESULTS 20 randomised controlled trials with a total of 1251 participants (intervention group: 674; control group: 577) were included for meta-analysis. Most participants had mild to moderate dementia. CS had a significant positive small-to-moderate effect on cognition (Hedges's g = 0.313, p < 0.001). Heterogeneity of CS was low to moderate (Q=30.5854, df=19, p < 0.05, I2 = 37.877%). Inconclusive results were found for depressive symptoms and quality of life. CONCLUSION CS has a significant positive effect on cognitive function, but its effect on depressive symptoms and quality of life was inconclusive. Future studies with more robust methodology establishing evidence of its efficacy are required.
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Affiliation(s)
- Y L Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - C P W Cheng
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - C S M Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - S N Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - H L Wong
- Department of Psychology, The University of Hong Kong, Hong Kong
| | - S Tse
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - G H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - W C Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
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10
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Shih VWY, Chan WC, Tai OK, Wong HL, Cheng CPW, Wong CSM. Mindfulness-Based Cognitive Therapy for Late-Life Depression: a Randomised Controlled Trial. East Asian Arch Psychiatry 2021; 31:27-35. [PMID: 34987115 DOI: 10.12809/eaap2075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Rumination and overgeneral autobiographical memory are dysfunctional cognitions commonly found in older adults with depression. The theoretical underpinnings of mindfulness-based cognitive therapy (MBCT) address the ruminative tendencies and the non-specific retrieval of autobiographical memories. This study aims to examine the efficacy and cognitive mechanisms of MBCT in older adults with active depressive symptoms. METHODS 57 older adults (mean age, 70 years) with normal cognition and mild to moderate depressive symptoms were randomly allocated to either the MBCT group or the active control group for 8 weeks. The MBCT group consisted of eight 2-hour weekly sessions and a 7-hour full-day retreat, with different themes for each class, guided mindfulness exercises, feedback and discussion, homework review, and psychoeducation. The active control group comprised a 1-hour physical exercise and a standardised health education of the specific theme with group discussion (eg fall prevention, chronic pain). Participants were assessed before and after the 8-week intervention for four outcome measures: the Hamilton Depression Rating Scale (HAMD), the Ruminative Response Scale (RRS), the Autobiographical Memory Test (AMT), and the Mindful Attention Awareness Scale (MAAS). RESULTS There was a significant reduction in severity of depressive symptoms (HAMD score) in both the MBCT group (F(1, 27) = 35.9, p < 0.001, η2 = 0.57) and the active control group (F(1, 28) = 9.29, p < 0.01, η2 = 0.24), but only the MBCT group showed substantial improvements in autobiographical memory specificity (AMT score), rumination (RRS score), and mindfulness (MAAS score). CONCLUSION Although both MBCT and active control programme decrease the severity of depressive symptoms in older adults, only MBCT improves AMS, rumination, and mindfulness. Our findings provide empirical support for the theoretical underpinnings of MBCT. Older adults with more severe depression and more severe dysfunctional cognition may benefit more from the specific therapeutic effects of MBCT.
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Affiliation(s)
- V W Y Shih
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - W C Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - O K Tai
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - H L Wong
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - C P W Cheng
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - C S M Wong
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
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Abstract
OBJECTIVES To compare older adults with late-life depression (LLD) and healthy controls in terms of suicidal ideation during the COVID-19 pandemic, and to determine predictors of suicidal ideation. METHODS Between March and April 2020, old adults diagnosed with major depressive disorder (single or recurrent episode) as defined by the DSM-5 were recruited from psychiatric clinics or inpatient wards, whereas 31 healthy older adults without a history of depression or other psychiatric illnesses were recruited from voluntary organisations or elderly community centres. Their depressive symptoms, perceived severity of the pandemic, perceived time spent on receiving related information, perceived health, levels of loneliness, perceived coping efficacy, suicidal ideation, and the level of symptomatic responses to a specific traumatic stressor in the past week were assessed. RESULTS In total, 21 men and 43 women aged 61 to 89 years were interviewed through telephone by trained research assistants. Of them, 33 were older adults with LLD (cases) and 31 were healthy older adults (controls). Older people with LLD had a higher level of suicidal ideation than healthy controls, after controlling for the level of depression and medical comorbidity (F (1, 59) = 5.72, p = 0.020). Regression analyses showed that coping efficacy and loneliness accounted for a significant portion of the variance in suicidal ideation, and loneliness significantly predicted the level of stress. Mediation analyses reveal an indirect effect between group and suicidal ideation through coping efficacy (Z = 2.43, p = 0.015). CONCLUSIONS Older people with LLD are at increased suicidal risk and require timely mental health support. Coping efficacy and loneliness are important predictors for suicidal ideation and stress.
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Affiliation(s)
- L L C Louie
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - C P W Cheng
- Department of Psychiatry, The University of Hong Kong, Hong Kong
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12
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Chan WC, Lam LCW, Lautenschlager N, Dow B, Ma SL. Home-based exercise intervention for caregivers of persons with dementia: a randomised controlled trial: abridged secondary publication. Hong Kong Med J 2020; 26 Suppl 7:13-16. [PMID: 33229611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - N Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- NorthWestern Aged Mental Health, Royal Park Campus, Parkville, Australia
- School of Clinical Neurosciences and the Western Australia Centre and Health and Ageing, University of Western Australia, Perth, Australia
| | - B Dow
- National Ageing Research Institute, The University of Melbourne, Melbourne, Australia
| | - S L Ma
- Department of Psychiatry, The Chinese University of Hong Kong
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Luo H, Lau KK, Wong GHY, Chan WC, Mak HKF, Zhang Q, Knapp M, Wong ICK. Predicting dementia diagnosis from cognitive footprints in electronic health records: a case-control study protocol. BMJ Open 2020; 10:e043487. [PMID: 33444218 PMCID: PMC7678375 DOI: 10.1136/bmjopen-2020-043487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Dementia is a group of disabling disorders that can be devastating for persons living with it and for their families. Data-informed decision-making strategies to identify individuals at high risk of dementia are essential to facilitate large-scale prevention and early intervention. This population-based case-control study aims to develop and validate a clinical algorithm for predicting dementia diagnosis, based on the cognitive footprint in personal and medical history. METHODS AND ANALYSIS We will use territory-wide electronic health records from the Clinical Data Analysis and Reporting System (CDARS) in Hong Kong between 1 January 2001 and 31 December 2018. All individuals who were at least 65 years old by the end of 2018 will be identified from CDARS. A random sample of control individuals who did not receive any diagnosis of dementia will be matched with those who did receive such a diagnosis by age, gender and index date with 1:1 ratio. Exposure to potential protective/risk factors will be included in both conventional logistic regression and machine-learning models. Established risk factors of interest will include diabetes mellitus, midlife hypertension, midlife obesity, depression, head injuries and low education. Exploratory risk factors will include vascular disease, infectious disease and medication. The prediction accuracy of several state-of-the-art machine-learning algorithms will be compared. ETHICS AND DISSEMINATION This study was approved by Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 18-225). Patients' records are anonymised to protect privacy. Study results will be disseminated through peer-reviewed publications. Codes of the resulted dementia risk prediction algorithm will be made publicly available at the website of the Tools to Inform Policy: Chinese Communities' Action in Response to Dementia project (https://www.tip-card.hku.hk/).
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Affiliation(s)
- Hao Luo
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
- Department of Computer Science, University of Hong Kong, Hong Kong, China
| | - Kui Kai Lau
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Wai-Chi Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Henry K F Mak
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Martin Knapp
- Care Policy and Evaluation Centre (CPEC), The London School of Economics and Political Science, London, UK
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, China
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
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14
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Cheng Y, Tung CK, Chung AKK, Liu WW, Huang D, Chan PH, Lam M, Chan WC, Siu CW, Hai JJ. Screening Of Pulmonary Hypertension in Methamphetamine Abusers (SOPHMA): rationale and design of a multicentre, cross-sectional study. BMJ Open 2019; 9:e027193. [PMID: 31375608 PMCID: PMC6688696 DOI: 10.1136/bmjopen-2018-027193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Methamphetamine misuse is classified as a 'likely' risk factor for pulmonary arterial hypertension (PAH). Nevertheless, the actual prevalence of and a screening strategy for PAH in methamphetamine users have not been established. We plan to study the prevalence of PAH and identify its independent risk factors among methamphetamine users. METHODS AND ANALYSIS The Screening Of Pulmonary Hypertension in Methamphetamine Abusers (SOPHMA) study will be a multicentre, cross-sectional screening study that will involve substance abuse clinics, hospitals and rehabilitation facilities in Hong Kong that cater to more than 20 methamphetamine users. A total of 400 patients who (1) are ≥18 years at enrolment; (2) report methamphetamine use in the last 2 years; (3) are diagnosed with methamphetamine use disorder; and (4) voluntarily agree to participate by providing written informed consent will be included. Patients will undergo standard echocardiography-based PAH screening procedures recommended for those with systemic sclerosis. Right heart catheterisation will be offered to participants with intermediate or high echocardiographic probability of PAH. For participants with a low echocardiographic probability of PAH, rescreening will be performed within 1 year. The primary measure will be the prevalence of PAH in methamphetamine users. The secondary measures will be the risk factors and a prediction model for PAH in methamphetamine users. ETHICS AND DISSEMINATION The SOPHMA study has been approved by the institutional review board. The findings of this study will provide the necessary evidence to establish universal guidelines for screening of PAH in methamphetamine users. Our results will be disseminated through immediate feedback to study participants, press release to the general public, as well as presentation in medical conferences and publications in peer-reviewed journals to healthcare providers and academia worldwide.
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Affiliation(s)
- Yangyang Cheng
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - Chi-Kwong Tung
- Institute of Mental Health, Castle Peak Hospital, Hong Kong
| | | | - Wan-Wan Liu
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Duo Huang
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - Pak Hei Chan
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - Ming Lam
- Institute of Mental Health, Castle Peak Hospital, Hong Kong
| | - Wai-Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Chung-Wah Siu
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - Jo Jo Hai
- Department of Medicine, The University of Hong Kong, Hong Kong
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15
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Yeung WF, Chung KF, Zhang ZJ, Zhang SP, Chan WC, Ng RMK, Chan CLW, Ho LM, Yu BYM, Chau JCS, Lau NCL, Lao LX. Electroacupuncture for tapering off long-term benzodiazepine use: A randomized controlled trial. J Psychiatr Res 2019; 109:59-67. [PMID: 30504097 DOI: 10.1016/j.jpsychires.2018.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy of using electroacupuncture as an adjunct treatment in enhancing the benzodiazepine cessation rate in long-term benzodiazepine users. METHODS This was a randomized, assessor- and subject-blinded, controlled trial. One hundred and forty-four long-term benzodiazepine users were randomly assigned to receive either electroacupuncture or placebo acupuncture (a sham itervention using non-invasive placebo needles) combined with a gradual benzodiazepine tapering schedule for 4 weeks. The primary outcome was the cessation rate of benzodiazepine use. Subjects were assessed on their benzodiazepine usage, benzodiazepine withdrawal symptoms, insomnia severity, and anxiety and depressive symptoms at baseline, week 6 and week 16. RESULTS The cessation rates of the electroacupuncture and placebo acupuncture groups at 12 weeks post-treatment were 9.17% and 10.83%, respectively. Both groups showed a reduction in benzodiazepine usage by a self-completed drug record at week 16 (compared to baseline: electroacupuncture group -40.23% versus placebo acupuncture group -48.76%). However, no significant between-group differences were found in the benzodiazepine cessation rate, reduction in benzodiazepine usage, and other secondary measures across all the study time points. CONCLUSIONS Electroacupuncture showed a similar cessation rate in benzodiazepine use to that of non-invasive placebo acupuncture in long-term users during a 4-week gradual tapering schedule. The evidence did not support advantages of electroacupuncture over non-invasive placebo acupuncture on reducing insomnia, anxiety, depression, or other withdrawal symptoms during the gradual tapering schedule. Despite a 40% decrease in the benzodiazepine usage in both groups, the effects may be attributed to the non-specific effects of acupuncture. TRIAL REGISTRATION ClinicalTrials.gov # NCT02475538.
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Affiliation(s)
- Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region.
| | - Ka-Fai Chung
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Zhang-Jin Zhang
- School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Shi-Ping Zhang
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region
| | - Wai-Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Roger Man-Kin Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong Special Administrative Region
| | - Connie Lai-Wah Chan
- Department of Psychiatry, United Christian Hospital, Hong Kong Special Administrative Region
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Branda Yee-Man Yu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Janet Ching-Sum Chau
- School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Novella Chi-Ling Lau
- School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Li-Xing Lao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
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Cheng CPW, Cheng ST, Tam CWC, Chan WC, Chu WCW, Lam LCW. Relationship between Cortical Thickness and Neuropsychological Performance in Normal Older Adults and Those with Mild Cognitive Impairment. Aging Dis 2018; 9:1020-1030. [PMID: 30574415 PMCID: PMC6284757 DOI: 10.14336/ad.2018.0125] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 11/24/2017] [Accepted: 01/25/2018] [Indexed: 01/24/2023] Open
Abstract
Mild cognitive impairment (MCI) has been extensively investigated in recent decades to identify groups with a high risk of dementia and to establish effective prevention methods during this period. Neuropsychological performance and cortical thickness are two important biomarkers used to predict progression from MCI to dementia. This study compares the cortical thickness and neuropsychological performance in people with MCI and cognitively healthy older adults. We further focus on the relationship between cortical thickness and neuropsychological performance in these two groups. Forty-nine participants with MCI and 40 cognitively healthy older adults were recruited. Cortical thickness was analysed with semiautomatic software, Freesurfer. The analysis reveals that the cortical thickness in the left caudal anterior cingulate (p=0.041), lateral occipital (p=0.009) and right superior temporal (p=0.047) areas were significantly thinner in the MCI group after adjustment for age and education. Almost all neuropsychological test results (with the exception of forward digit span) were significantly correlated to cortical thickness in the MCI group after adjustment for age, gender and education. In contrast, only the score on the Category Verbal Fluency Test and the forward digit span were found to have significant inverse correlations to cortical thickness in the control group of cognitively healthy older adults. The study results suggest that cortical thinning in the temporal region reflects the global change in cognition in subjects with MCI and may be useful to predict progression of MCI to Alzheimer’s disease. The different pattern in the correlation of cortical thickness to the neuropsychological performance of patients with MCI from the healthy control subjects may be explained by the hypothesis of MCI as a disconnection syndrome.
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Affiliation(s)
- Calvin Pak-Wing Cheng
- 1Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Sheung-Tak Cheng
- 2Department of Health and Physical Education, The Education University of Hong Kong and Norwich Medical School, University of East Anglia, UK
| | | | - Wai-Chi Chan
- 4Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Winnie Chiu-Wing Chu
- 5Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
| | - Linda Chiu-Wa Lam
- 6Department of Psychiatry, Tai Po Hospital, The Chinese University of Hong Kong, Hong Kong
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17
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Mikhail MA, Mangioris G, Best RM, McGimpsey S, Chan WC. Management of giant retinal tears with vitrectomy and perfluorocarbon liquid postoperatively as a short-term tamponade. Eye (Lond) 2017; 31:1290-1295. [PMID: 28799563 PMCID: PMC5601443 DOI: 10.1038/eye.2017.157] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/05/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeThe purpose of this study was to study outcomes after using perfluorocarbon liquid (PFCL) as a short-term postoperative vitreous substitute in eyes with retinal detachment from giant retinal tears (GRTs).Patients and methodsA retrospective consecutive case series of patients with retinal detachment from GRT, who underwent vitrectomy using PFCL as short-term postoperative retinal tamponade. PFCL was left in the eye for a mean of 6.7 days (range 7-8 days) and then replaced with gas or silicone oil (SO). The anatomical and functional outcomes and postoperative complications are reported.ResultsA total of 30 eyes of 29 patients with a follow-up of 26.8 months (range 9-55 months) were included. GRTs had a mean size of 150° (range 90°-270°) with 46.6% of eyes with a tear of >180°. Intraoperative retinal re-attachment was achieved in all cases. No cases of retinal slippage were recorded. Four eyes (13.3%) had re-detachment and further surgery required. At final review, 27 eyes (90.9%) had attached retinas, while the remaining 9.1% had SO in situ. The visual acuity improved in 70% of eyes with 41% improving at least 2 Snellen lines and 35% with visual acuity of 6/12 or better. Mild anterior uveitis developed in six eyes (20%), which resolved on topical steroids. Glaucoma developed in one eye and was controlled medically.ConclusionOur study supports the safety and efficacy of PFCL as a short-term postoperative tamponade in cases of GRTs. As it reduces retinal slippage, the use of SO as a primary tamponade decreased in significant proportion of cases.
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Affiliation(s)
- M A Mikhail
- Vitreoretinal Service, Ophthalmology Department, Royal Victoria Hospital, Belfast, UK
| | - G Mangioris
- Vitreoretinal Service, Ophthalmology Department, Royal Victoria Hospital, Belfast, UK
| | - R M Best
- Vitreoretinal Service, Ophthalmology Department, Royal Victoria Hospital, Belfast, UK
| | - S McGimpsey
- Vitreoretinal Service, Ophthalmology Department, Royal Victoria Hospital, Belfast, UK
| | - W C Chan
- Vitreoretinal Service, Ophthalmology Department, Royal Victoria Hospital, Belfast, UK
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18
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Gnana Jothi V, McGimpsey S, Sharkey JA, Chan WC. Retinal detachment repair and cataract surgery in patients with atopic dermatitis. Eye (Lond) 2017; 31:1296-1301. [PMID: 28799561 DOI: 10.1038/eye.2017.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 06/22/2017] [Indexed: 12/28/2022] Open
Abstract
PurposeThe aim of this study is to report a case series of ocular complications including retinal detachment (RD) and cataract in atopic dermatitis (AD) and surgical management involving a majority of Caucasian patients.Patients and methodsThis study is an observational case series, originally designed as an audit. It involves detailed discussion of history, clinical features, and surgical management of patients presenting with retinal detachment and cataracts secondary to severe AD. Six consecutive patients with diagnosis of severe AD requiring posterior segment and cataract surgery were included in the study.ResultsEight eyes of six patients had retinal detachment. Most of them involved the temporal retina. The retinal breaks were located anteriorly close to the ora serrata in six eyes and Giant tear retinal (GRT) detachment was found in two eyes. Five eyes had proliferative vitreo-retinopathy (PVR) at presentation. All six patients had bilateral cataracts and cataract surgery was performed in eleven eyes. Bilateral simultaneous surgery was essential in two patients. Three eyes had secondary intra-ocular lens (IOL) implantation with pars plana vitrectomy for subluxed lens implant.ConclusionsAnterior retinal breaks and temporal RD are common in retinal detachment secondary to AD. PVR is often present, which makes surgical management difficult. Cataract formation is quite often and late subluxation of IOL may occur.
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Affiliation(s)
- V Gnana Jothi
- Department of Ophthalmolgy, Royal Victoria Hospital, Belfast, UK
| | - S McGimpsey
- Department of Ophthalmolgy, Royal Victoria Hospital, Belfast, UK
| | - J A Sharkey
- Department of Ophthalmolgy, Royal Victoria Hospital, Belfast, UK
| | - W C Chan
- Department of Ophthalmolgy, Royal Victoria Hospital, Belfast, UK
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19
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Yeung WF, Chung KF, Zhang ZJ, Chan WC, Zhang SP, Ng RMK, Chan CLW, Ho LM, Yu YM, Lao LX. Electroacupuncture for tapering off long-term benzodiazepine use: study protocol of randomized controlled trial. BMC Complement Altern Med 2017; 17:183. [PMID: 28359309 PMCID: PMC5374579 DOI: 10.1186/s12906-017-1692-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/16/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Conventional approaches for benzodiazepine tapering have their limitations. Anecdotal studies have shown that acupuncture is a potential treatment for facilitating successful benzodiazepine tapering. As of today, there was no randomized controlled trial examining its efficacy and safety. The purpose of the study is to evaluate the efficacy of using electroacupuncture as an adjunct treatment to gradual tapering of benzodiazepine doses in complete benzodiazepine cessation in long-term benzodiazepine users. METHODS/DESIGN The study protocol of a randomized, assessor- and subject-blinded, controlled trial is presented. One hundred and forty-four patients with histories of using benzodiazepines in ≥50% of days for more than 3 months will be randomly assigned in a 1:1 ratio to receive either electroacupuncture or placebo electroacupuncture combined with gradual benzodiazepine tapering schedule. Both experimental and placebo treatments will be delivered twice per week for 4 weeks. Major assessments will be conducted at baseline, week 6 and week 16 post-randomization. Primary outcome is the cessation rate of benzodiazepine use. Secondary outcomes include the percentage change in the doses of benzodiazepine usage and the severity of withdrawal symptoms experienced based on the Benzodiazepine Withdrawal Symptom Questionnaire, insomnia as measured by the Insomnia Severity Index, and anxiety and depressive symptoms as evaluated by the Hospital Anxiety and Depression Scale. Adverse events will also be measured at each study visit. DISCUSSION Results of this study will provide high quality evidence of the efficacy and safety of electroacupuncture as an adjunct treatment for benzodiazepine tapering in long-term users. TRIAL REGISTRATION ClinicalTrials.gov NCT02475538 .
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Affiliation(s)
- Wing-Fai Yeung
- The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong SAR China
| | - Ka-Fai Chung
- Department of Psychiatry, University of Hong Kong, Pokfulam, Hong Kong SAR China
| | - Zhang-Jin Zhang
- School of Chinese Medicine, University of Hong Kong, Pokfulam, Hong Kong SAR China
| | - Wai-Chi Chan
- Department of Psychiatry, University of Hong Kong, Pokfulam, Hong Kong SAR China
| | - Shi-Ping Zhang
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong SAR China
| | - Roger Man-Kin Ng
- Department of Psychiatry, Kowloon Hospital, 147A Argyle Street, Kowloon, Hong Kong SAR China
| | - Connie Lai-Wah Chan
- Department of Psychiatry, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong SAR China
| | - Lai-Ming Ho
- School of Public Health, University of Hong Kong, Pokfulam, Hong Kong SAR China
| | - Yee-Man Yu
- The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong SAR China
| | - Li-Xing Lao
- School of Chinese Medicine, University of Hong Kong, Pokfulam, Hong Kong SAR China
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20
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Chan WC, Wong CS, Chen EY, Ng RM, Hung SF, Cheung EF, Sham PC, Chiu HF, Lam M, Chang WC, Lee EH, Chiang TP, Lau JT, van Os J, Lewis G, Bebbington P, Lam LC. Validation of the Chinese Version of the Revised Clinical Interview Schedule: Findings from Hong Kong Mental Morbidity Survey. East Asian Arch Psychiatry 2017; 27:3-10. [PMID: 28387207] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study aimed to assess the psychometric properties of the Chinese version of the Revised Clinical Interview Schedule (C-CIS-R), and explore its applicability as a diagnostic instrument for common mental disorders (CMDs) in Hong Kong. Its psychometric properties were evaluated among 140 patients and 161 healthy controls. In comparison to the diagnoses made by the Structured Clinical Interview for the DSM-IV, the C-CIS-R showed good criterion validity in diagnosing CMDs. The correlation of the total score of C-CIS-R with the 12-item General Health Questionnaire and Hospital Anxiety and Depression Scale was satisfactory, indicating favourable convergent validity as well. The inter-rater and test-retest reliability were also satisfactory. Receiver operating characteristic analyses suggested an optimal cut-off point of 11/12 for detecting diagnosable CMDs (sensitivity: 0.69; specificity: 0.93) and 17/18 for identifying a need for treatment (sensitivity: 0.70; specificity: 0.95). In conclusion, C-CIS-R is a valid diagnostic instrument for CMDs in a Chinese community. Its cut-off points for clinically significant symptoms and treatment needs among Chinese are identical to those adopted in the original English version.
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Affiliation(s)
- W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C Sm Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Yh Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - R Mk Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR, China
| | - S F Hung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong SAR, China
| | - E Fc Cheung
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - P C Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - H Fk Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M Lam
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Hm Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - T P Chiang
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - J Tf Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - P Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - L Cw Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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Sitt JCM, Ni SY, Tsoi VYK, Chan WC, Chau HHL. Giant Fibroadenoma Presenting as an Axillary Mass in a Young Renal Transplant Recipient on Long-term Cyclosporine A Therapy. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1615367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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22
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Lee AT, Chan WC, Chiu HF, Richards M, Hui LY, Ng SP, Chan WM, Lam LC. Physical health and lifestyle predictors for significant cognitive impairment in community-dwelling Chinese older adults in Hong Kong. Hong Kong Med J 2016; 22 Suppl 6:37-39. [PMID: 27807316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- A Tc Lee
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - H Fk Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - M Richards
- MRC Unit for Lifelong Health and Ageing, UK
| | - L Yf Hui
- Elderly Health Service, Department of Health, Hong Kong
| | - S Ps Ng
- Elderly Health Service, Department of Health, Hong Kong
| | - W M Chan
- Elderly Health Service, Department of Health, Hong Kong
| | - L Cw Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
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23
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Yang YH, Meguro K, Kim SY, Shim YS, Yu X, Chen CLH, Wang H, Lam L, Senanarong V, Dominguez J, Lu PY, Lin YT, Hu CJ, Chiu PY, Fuh JL, Wang WF, Yu BC, Li T, Wang MW, Situmeang RFV, Jang JW, Zhang J, Chan WC, Zhou YY, Lou HL, Zhang L, Ye M, Chen X. Impact of Alzheimer's Disease in Nine Asian Countries. Gerontology 2016; 62:425-33. [PMID: 26829322 DOI: 10.1159/000443525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/21/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Asia will soon have the majority of demented patients in the world. OBJECTIVE To assess dementia using a uniform data system to update the current status of dementia in Asia. METHODS A uniformed data set was administered in Taiwan, China, Hong Kong, Korea, Japan, Philippines, Thailand, Singapore, and Indonesia to gather data with regard to Alzheimer's disease (AD) and its related issues for these countries. RESULTS In total, 2,370 AD patients and their caregivers were recruited from 2011 to 2014. The demographic characteristics of these patients and the relationships between patients and caregivers were different among individuals in these countries (p < 0.001). Of note, the family history for having dementia was 8.2% for females in contrast to 3.2% for males. CONCLUSION Our study highlighted the differences in dementia assessment and care in developing versus developed countries. Greater effort with regard to studying dementia, especially in developing countries, is necessary.
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Affiliation(s)
- Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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24
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Rohr J, Guo S, Huo J, Bouska A, Lachel C, Li Y, Simone PD, Zhang W, Gong Q, Wang C, Cannon A, Heavican T, Mottok A, Hung S, Rosenwald A, Gascoyne R, Fu K, Greiner TC, Weisenburger DD, Vose JM, Staudt LM, Xiao W, Borgstahl GEO, Davis S, Steidl C, McKeithan T, Iqbal J, Chan WC. Recurrent activating mutations of CD28 in peripheral T-cell lymphomas. Leukemia 2015; 30:1062-70. [PMID: 26719098 DOI: 10.1038/leu.2015.357] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/30/2015] [Accepted: 12/15/2015] [Indexed: 11/09/2022]
Abstract
Peripheral T-cell lymphomas (PTCLs) comprise a heterogeneous group of mature T-cell neoplasms with a poor prognosis. Recently, mutations in TET2 and other epigenetic modifiers as well as RHOA have been identified in these diseases, particularly in angioimmunoblastic T-cell lymphoma (AITL). CD28 is the major co-stimulatory receptor in T cells which, upon binding ligand, induces sustained T-cell proliferation and cytokine production when combined with T-cell receptor stimulation. We have identified recurrent mutations in CD28 in PTCLs. Two residues-D124 and T195-were recurrently mutated in 11.3% of cases of AITL and in one case of PTCL, not otherwise specified (PTCL-NOS). Surface plasmon resonance analysis of mutations at these residues with predicted differential partner interactions showed increased affinity for ligand CD86 (residue D124) and increased affinity for intracellular adaptor proteins GRB2 and GADS/GRAP2 (residue T195). Molecular modeling studies on each of these mutations suggested how these mutants result in increased affinities. We found increased transcription of the CD28-responsive genes CD226 and TNFA in cells expressing the T195P mutant in response to CD3 and CD86 co-stimulation and increased downstream activation of NF-κB by both D124V and T195P mutants, suggesting a potential therapeutic target in CD28-mutated PTCLs.
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Affiliation(s)
- J Rohr
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - S Guo
- Department of Pathology, Xi Jing Hospital, Fourth Military Medical University, Xi'an, Shaan Xi Province, China
| | - J Huo
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - A Bouska
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - C Lachel
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Y Li
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - P D Simone
- Internal Medicine Residency Program, Florida Atlantic University College of Medicine, Boca Raton, FL, USA
| | - W Zhang
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Q Gong
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - C Wang
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA.,School of Medicine, Shandong University, Jinan, China
| | - A Cannon
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - T Heavican
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - A Mottok
- Department for Lymphoid Cancer Research, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - S Hung
- Department for Lymphoid Cancer Research, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Rosenwald
- Institute of Pathology and Comprehensive Cancer Center Mainfranken (CCC MF), University of Wuerzburg, Wuerzburg, Germany
| | - R Gascoyne
- Department for Lymphoid Cancer Research, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - K Fu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - T C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - D D Weisenburger
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - J M Vose
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - L M Staudt
- National Institutes of Health, Bethesda, MD, USA
| | - W Xiao
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, Food and Drug Administration, Washington, DC, USA
| | - G E O Borgstahl
- Eppley Institute for Cancer Research and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Davis
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - C Steidl
- Department for Lymphoid Cancer Research, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - T McKeithan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - J Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - W C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
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25
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Yang YH, Wang H, Lam L, Chan WC, Yu X, Li T, Wang WF, Chiu PY, Lin YT, Hu CJ, Fuh JL, Morris JC. Characteristics of Alzheimer's disease among patients in Taiwan, Hong Kong, and Beijing. J Alzheimers Dis 2015; 42:193-200. [PMID: 24840566 DOI: 10.3233/jad-140174] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In order to obtain data from patients with Alzheimer's disease dementia and their informants in a uniform manner and to foster further research among the Chinese and other races, we have conducted an international study to recruit patients diagnosed with Alzheimer's disease (AD) from Taiwan, Hong Kong, and Beijing. The Uniform Data Set was translated into Chinese and administrated to AD patients and their informants. A total of 1,107 AD dementia patients were recruited, including 691 from Taiwan, 244 from Beijing, and 172 from Hong Kong. There were differences in the AD patients: gender (p = 0.099), education (p < 0.001), age (p < 0.001), and handedness (p = 0.007). For informants, age (p = 0.679), gender (p = 0.117), education (p < 0.001), and living together or not (p < 0.001) differed in the three samples. Although three areas across the Taiwan Strait are ethnic Chinese, the clinical picture for patients and informants are very different. Further study is needed to clarify the significance of clinical characteristics in Chinese societies.
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Affiliation(s)
- Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Department of and Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Mentality Protection Center, Fo Guang Shan Compassion Foundation, Taiwan
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health, Beijing, China
| | - Linda Lam
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Wai-Chi Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - Xin Yu
- Dementia Care and Research Center, Peking University Institute of Mental Health, Beijing, China
| | - Tao Li
- Dementia Care and Research Center, Peking University Institute of Mental Health, Beijing, China
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital,Changhua, Taiwan Center for General Education, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Lin Shin Hospital, Taichung, Taiwan
| | - Yu-Te Lin
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, Shung Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - John C Morris
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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26
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Chan WC, Chow PPL, Lam LCW, Hung SF, Cheung EFC, Dunn ELW, Ng RMK, Fu JCK. Pathway of psychiatric care in Hong Kong. Hong Kong Med J 2015; 21 Suppl 2:41-44. [PMID: 25852102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - P P L Chow
- Department of Old Age Psychiatry, Castle Peak Hospital
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S F Hung
- Department of Psychiatry, Kwai Chung Hospital
| | - E F C Cheung
- Department of General Adult Psychiatry, Castle Peak Hospital
| | - E L W Dunn
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital
| | - R M K Ng
- Department of Psychiatry, Kowloon Hospital
| | - J C K Fu
- Department of General Adult Psychiatry, Castle Peak Hospital
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Au A, Gallagher-Thompson D, Wong MK, Leung J, Chan WC, Chan CC, Lu HJ, Lai MK, Chan K. Behavioral activation for dementia caregivers: scheduling pleasant events and enhancing communications. Clin Interv Aging 2015; 10:611-9. [PMID: 25848237 PMCID: PMC4381894 DOI: 10.2147/cia.s72348] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Dementia caregiving is often associated with increase in depressive symptoms and strained relationships. This study tested whether telephone-delivered psychoeducation combined with an enhanced behavioral activation (BA) module had a better effect on the well-being of Alzheimer’s caregivers than psychoeducation alone. The focus is on enhancing the competent use of coping skills via BA. The program is delivered by telephone to increase accessibility and sustainability for caregivers. Senior citizens are trained as paraprofessionals to deliver the BA module to increase the potential for sustainability of the program. Methods and subjects The study compared two telephone interventions using a 4-month longitudinal randomized controlled trial. For the first 4 weeks, all participants received the same psychoeducation program via telephone. Then for the following 4 months, eight biweekly telephone follow-up calls were carried out. For these eight follow-up calls, participants were randomized into either one of the two following groups with different conditions. For the psychoeducation with BA (PsyED-BA) group, participants received eight biweekly sessions of BA practice focused on pleasant event scheduling and improving communications. For the psychoeducation only (PsyED only) group, participants received eight biweekly sessions of general discussion of psychoeducation and related information. A total of 62 family caregivers of persons living with dementia were recruited and 59 (29 in the PsyED-BA group and 30 in the PsyED only group) completed the whole study. Results As compared to the group with psychoeducation and discussion, the group with enhanced BA had decreased levels of depressive symptoms. The study had a low attrition rate. Conclusion Results suggested that competence-based training could be effectively administered through the telephone with the help of senior citizens trained and engaged as paraprofessionals. Results contribute to the present literature by offering some framework for developing effective, accessible, sustainable, and less costly interventions.
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Affiliation(s)
- Alma Au
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China ; Institute of Active Aging, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Dolores Gallagher-Thompson
- Department of Psychiatry and Behavioral Sciences and Geriatric Education Centre, School of Medicine, Stanford University, Stanford, CA, USA
| | - Meng-Kong Wong
- Department of Psychiatry, United Christian Hospital, Hong Kong, People's Republic of China
| | - Jess Leung
- Department of Psychiatry, United Christian Hospital, Hong Kong, People's Republic of China
| | - Wai-Chi Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong, People's Republic of China
| | - Chun Chung Chan
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, People's Republic of China
| | - Hui-Jing Lu
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Man Kin Lai
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Kevin Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
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28
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Abstract
We report a cluster of acute hepatitis in five air-conditioning maintenance workers following accidental exposure to 2,2-dichloro-1,1,1-trifluoroethane (HCFC-123). They presented to us with complaints of feverishness, generalised malaise, and epigastric discomfort. Their blood biochemistry tests were compatible with acute hepatitis. Viral hepatitis serology, tests for autoimmune hepatitis, and analyses for drugs and alcohol consumption were all negative. No focal hepatic lesion was detected by ultrasound imaging. Percutaneous liver biopsy samples were taken from two of them. The patients were managed with supportive treatment. All had spontaneous, but slow, recovery. Their liver function tests returned to normal after 4 months and their outcomes were favourable. Physicians should be aware of this occupational disease entity.
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Affiliation(s)
- Y M Kan
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - C F Lau
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - W C Chan
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - W S Chan
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - Y M Tung
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - C K Loo
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Yaumatei, Hong Kong
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29
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Lam LCW, Chan WC, Wong CSM, Chen EYH, Ng RMK, Lee EHM, Chang WC, Hung SF, Cheung EFC, Sham PC, Chiu HFK, Lam M, Chiang TP, van Os J, Lau JTF, Lewis G, Bebbington P. The Hong Kong mental morbidity survey: background and study design. East Asian Arch Psychiatry 2014; 24:30-36. [PMID: 24676485] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Mental disorders are highly prevalent conditions with immense disease burden. To inform health and social services policy formulation, local psychiatric epidemiological data are required. The Hong Kong Mental Morbidity Survey is a 3-year population-based study in which 5700 community-dwelling Chinese adults aged between 16 and 75 years were interviewed with the aim of evaluating the prevalence, co-morbidity, functional impairment, physical morbidity, and social determinants of significant mental disorders in the population. This paper describes the background and design of the survey, and is the first territory-wide psychiatric epidemiological study in Hong Kong.
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Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C S M Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - R M K Ng
- Kowloon Hospital, Hong Kong SAR, China
| | - E H M Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - S F Hung
- Kwai Chung Hospital, Hong Kong SAR, China
| | | | - P C Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - H F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M Lam
- Castle Peak Hospital, Hong Kong SAR, China
| | - T P Chiang
- Castle Peak Hospital, Hong Kong SAR, China
| | - J van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J T F Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - G Lewis
- Academic Unit of Psychiatry, University of Bristol, Bristol, England
| | - P Bebbington
- Department of Mental Health Sciences, University College London, London, England
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30
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Wang F, Yeung KL, Chan WC, Kwok CCH, Leung SL, Wu C, Chan EYY, Yu ITS, Yang XR, Tse LA. A meta-analysis on dose-response relationship between night shift work and the risk of breast cancer. Ann Oncol 2013; 24:2724-32. [PMID: 23975662 DOI: 10.1093/annonc/mdt283] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [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: 12/21/2022] Open
Abstract
This study aimed to conduct a systematic review to sum up evidence of the associations between different aspects of night shift work and female breast cancer using a dose-response meta-analysis approach. We systematicly searched all cohort and case-control studies published in English on MEDLINE, Embase, PSYCInfo, APC Journal Club and Global Health, from January 1971 to May 2013. We extracted effect measures (relative risk, RR; odd ratio, OR; or hazard ratio, HR) from individual studies to generate pooled results using meta-analysis approaches. A log-linear dose-response regression model was used to evaluate the relationship between various indicators of exposure to night shift work and breast cancer risk. Downs and Black scale was applied to assess the methodological quality of included studies. Ten studies were included in the meta-analysis. A pooled adjusted relative risk for the association between 'ever exposed to night shift work' and breast cancer was 1.19 [95% confidence interval (CI) 1.05-1.35]. Further meta-analyses on dose-response relationship showed that every 5-year increase of exposure to night shift work would correspondingly enhance the risk of breast cancer of the female by 3% (pooled RR = 1.03, 95% CI 1.01-1.05; Pheterogeneity < 0.001). Our meta-analysis also suggested that an increase in 500-night shifts would result in a 13% (RR = 1.13, 95% CI 1.07-1.21; Pheterogeneity = 0.06) increase in breast cancer risk. This systematic review updated the evidence that a positive dose-response relationship is likely to present for breast cancer with increasing years of employment and cumulative shifts involved in the work.
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Affiliation(s)
- F Wang
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR
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31
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To KW, Chan WC, Chan TO, Ngai J, Tung A, Ng S, Choo KL, Hui DS. Comparison of empirical continuous positive airway pressure (CPAP) treatment versus initial portable sleep monitoring followed by CPAP treatment for patients with suspected obstructive sleep apnoea. Intern Med J 2012; 42:e107-14. [PMID: 21118409 DOI: 10.1111/j.1445-5994.2010.02402.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Polysomnography is labour-intensive for diagnosing obstructive sleep apnoea (OSA). We compared two algorithms for initiating continuous positive airway pressure (CPAP) treatment for patients with suspected OSA. METHODS Symptomatic OSA patients were randomised into either algorithm I or II. Algorithm I consisted of an empirical CPAP trial whereas algorithm II utilised an Apnea Risk Evaluation System, a wireless device applied on the forehead, for establishing a diagnosis before a CPAP trial for 3 weeks. Primary outcome was success of CPAP trial, defined as CPAP usage > 4 h/night and willingness to continue CPAP. Subjective usefulness of CPAP, accuracy of Apnea Risk Evaluation System versus polysomnography and CPAP adherence at 6 months were secondary end-points. RESULTS Altogether 138 patients in algorithm I and 110 patients in algorithm II completed the CPAP trial. There were no significant differences between these algorithms with respect to the primary end-point. The sensitivity and specificity of algorithm I versus II as a diagnostic test for OSA were 0.3, 0.8 versus 0.31, 1.00 respectively. In predicting CPAP adherence at 6 months, the likelihood ratio positive for algorithms I and II was 2.7 and 5.27 respectively. The mean (SE) time taken from the first consultation to the end of CPAP trial in algorithm I and algorithm II was 60 (2) and 98 (5) days, respectively, P < 0.01. CONCLUSION An ambulatory approach with portable sleep monitoring for diagnosing OSA before a CPAP trial can identify more patients who would adhere to CPAP at 6 months than empirical CPAP treatment alone.
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Affiliation(s)
- K W To
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Mao HJ, Li HJ, Chiu H, Chan WC, Chen SL. Effectiveness of antenatal emotional self-management training program in prevention of postnatal depression in Chinese women. Perspect Psychiatr Care 2012; 48:218-24. [PMID: 23005589 DOI: 10.1111/j.1744-6163.2012.00331.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to study the effectiveness of an emotional self-management training program to antenatal women in the prevention of postnatal depression. DESIGN AND METHODS The sample comprised 240 women who were at 32 weeks antenatal. They were randomly assigned into the intervention group and the control group. FINDINGS On completion of the program, the intervention group reported significantly lower mean Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale scores than the control group. Fewer participants from the intervention group were diagnosed as having postnatal depression using the Structured Clinical Interview for DSM-IV. PRACTICE IMPLICATIONS An antenatal emotional self-management training that may lower the risk of developing postnatal depression among Chinese women is recommended.
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Affiliation(s)
- Hong-Jing Mao
- Department of Psychiatry, The Seventh Hospital of HangZhou, HangZhou, ZheJiang, China
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33
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Mian M, Scandurra M, Chigrinova E, Shen Y, Inghirami G, Greiner TC, Chan WC, Vose JM, Testoni M, Chiappella A, Baldini L, Ponzoni M, Ferreri AJM, Franceschetti S, Gaidano G, Montes-Moreno S, Piris MA, Facchetti F, Tucci A, Nomdedeu JF, Lazure T, Uccella S, Tibiletti MG, Zucca E, Kwee I, Bertoni F. Clinical and molecular characterization of diffuse large B-cell lymphomas with 13q14.3 deletion. Ann Oncol 2012; 23:729-735. [PMID: 21693768 DOI: 10.1093/annonc/mdr289] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deletions at 13q14.3 are common in chronic lymphocytic leukemia and are also present in diffuse large B-cell lymphomas (DLBCL) but never in immunodeficiency-related DLBCL. To characterize DLBCL with 13q14.3 deletions, we combined genome-wide DNA profiling, gene expression and clinical data in a large DLBCL series treated with rituximab, cyclophosphamide, doxorubicine, vincristine and prednisone repeated every 21 days (R-CHOP21). PATIENTS AND METHODS Affymetrix GeneChip Human Mapping 250K NspI and U133 plus 2.0 gene were used. MicroRNA (miRNA) expression was studied were by real-time PCR. Median follow-up of patients was 4.9 years. RESULTS Deletions at 13q14.3, comprising DLEU2/MIR15A/MIR16, occurred in 22/166 (13%) cases. The deletion was wider, including also RB1, in 19/22 cases. Samples with del(13q14.3) had concomitant specific aberrations. No reduced MIR15A/MIR16 expression was observed, but 172 transcripts were significantly differential expressed. Among the deregulated genes, there were RB1 and FAS, both commonly deleted at genomic level. No differences in outcome were observed in patients treated with R-CHOP21. CONCLUSIONS Cases with 13q14.3 deletions appear as group of DLBCL characterized by common genetic and biologic features. Deletions at 13q14.3 might contribute to DLBCL pathogenesis by two mechanisms: deregulating the cell cycle control mainly due RB1 loss and contributing to immune escape, due to FAS down-regulation.
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Affiliation(s)
- M Mian
- Laboratory of Experimental Oncology and Lymphoma Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Hematology, Azienda Ospedaliera S. Maurizio, Bolzano/Bozen, Italy
| | - M Scandurra
- Laboratory of Experimental Oncology and Lymphoma Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - E Chigrinova
- Laboratory of Experimental Oncology and Lymphoma Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Y Shen
- Department of Pathology and Microbiology, University of Nebraska, Omaha, USA
| | - G Inghirami
- Department of Pathology and Center for Experimental Research and Medical Studies, University of Turin, Turin
| | - T C Greiner
- Department of Pathology and Microbiology, University of Nebraska, Omaha, USA
| | - W C Chan
- Department of Pathology and Microbiology, University of Nebraska, Omaha, USA
| | - J M Vose
- Department of Pathology and Microbiology, University of Nebraska, Omaha, USA
| | - M Testoni
- Laboratory of Experimental Oncology and Lymphoma Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - A Chiappella
- Department of Pathology and Center for Experimental Research and Medical Studies, University of Turin, Turin
| | - L Baldini
- Hematology/Bone Marrow Transplantation Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan
| | - M Ponzoni
- Pathology Unit and Unit of Lymphoid Malignancies, San Raffaele Scientific Institute, Milan
| | - A J M Ferreri
- Pathology Unit and Unit of Lymphoid Malignancies, San Raffaele Scientific Institute, Milan
| | - S Franceschetti
- Division of Hematology, Department of Clinical and Experimental Medicine & Centro di Biotecnologie per la Ricerca Medica Applicata, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - G Gaidano
- Division of Hematology, Department of Clinical and Experimental Medicine & Centro di Biotecnologie per la Ricerca Medica Applicata, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - S Montes-Moreno
- Molecular Pathology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - M A Piris
- Molecular Pathology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - F Facchetti
- Department of Pathology, University of Brescia, I Servizio di Anatomia Patologica, Spedali Civili di Brescia, Brescia; Division of Hematology, Spedali Civili di Brescia, Brescia, Italy
| | - A Tucci
- Department of Pathology, University of Brescia, I Servizio di Anatomia Patologica, Spedali Civili di Brescia, Brescia; Division of Hematology, Spedali Civili di Brescia, Brescia, Italy
| | - J Fr Nomdedeu
- Department of Hematology and Laboratori d'Hematologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Lazure
- Departments of Internal Medicine and Pathology, University Hospital of Bicêtre, AP/HP, Le Kremlin Bicêtre, France
| | - S Uccella
- Anatomic Pathology Unit, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - M G Tibiletti
- Anatomic Pathology Unit, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - E Zucca
- Laboratory of Experimental Oncology and Lymphoma Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - I Kwee
- Laboratory of Experimental Oncology and Lymphoma Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dalle Molle Institute for Artificial Intelligence (IDSIA), Manno, Switzerland
| | - F Bertoni
- Laboratory of Experimental Oncology and Lymphoma Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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Siu BWM, Chow KKW, Lam LCW, Chan WC, Tang VWK, Chui WWH. A questionnaire survey on attitudes and understanding towards mental disorders. East Asian Arch Psychiatry 2012; 22:18-24. [PMID: 22447801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES. To obtain information about basic knowledge towards mental disorders and to evaluate public attitudes towards mental disorders in the Hong Kong Chinese population. METHODS. Questionnaires which collected basic demographic information, opinions about potential stigmas and myths, and knowledge on case vignettes depicting fictional characters with symptoms of mental illness were delivered to subjects in a secondary school, 2 homes for the elderly, a private housing estate, and a public housing estate in Hong Kong. RESULTS. Completed questionnaires were collected from 1035 subjects. In general, the participants' acceptance of mental illness was good. Regular contacts with such patients were associated with better knowledge (t = -2.71, p < 0.01) and better acceptance (t = 2.77, p < 0.01) of mental illness. Younger participants aged 15 to 19 years had a lower level of knowledge about mental health problems compared with other age-groups (p < 0.001). CONCLUSIONS. Personal contact with people with mental illness may help to improve knowledge and acceptance. Younger people in secondary school should be the target and prioritised group for mental health education. Apart from the delivery of mental health knowledge, strategies to increase social contact of the public with people having mental illness could be considered in the design and implementation of anti-stigma programmes.
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Affiliation(s)
- B W M Siu
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.
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Rao E, Jiang C, Ji M, Huang X, Iqbal J, Lenz G, Wright G, Staudt LM, Zhao Y, McKeithan TW, Chan WC, Fu K. The miRNA-17∼92 cluster mediates chemoresistance and enhances tumor growth in mantle cell lymphoma via PI3K/AKT pathway activation. Leukemia 2011; 26:1064-72. [PMID: 22116552 DOI: 10.1038/leu.2011.305] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The median survival of patients with mantle cell lymphoma (MCL) ranges from 3 to 5 years with current chemotherapeutic regimens. A common secondary genomic alteration detected in MCL is chromosome 13q31-q32 gain/amplification, which targets a microRNA (miRNA) cluster, miR-17∼92. On the basis of gene expression profiling, we found that high level expression of C13orf25, the primary transcript from which these miRNAs are processed, was associated with poorer survival in patients with MCL (P=0.021). We demonstrated that the protein phosphatase PHLPP2, an important negative regulator of the PI3K/AKT pathway, was a direct target of miR-17∼92 miRNAs, in addition to PTEN and BIM. These proteins were down-modulated in MCL cells with overexpression of the miR-17∼92 cluster. Overexpression of miR-17∼92 activated the PI3K/AKT pathway and inhibited chemotherapy-induced apoptosis in MCL cell lines. Conversely, inhibition of miR-17∼92 expression suppressed the PI3K/AKT pathway and inhibited tumor growth in a xenograft MCL mouse model. Targeting the miR-17∼92 cluster may therefore provide a novel therapeutic approach for patients with MCL.
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Affiliation(s)
- E Rao
- Department of Pathology, University of Nebraska Medical Center, Omaha, NE 68198-3135, USA
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Affiliation(s)
- P H Teesdale-Spittle
- Department of Pharmaceutical Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - W C Chan
- Department of Pharmaceutical Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - B W Bycroft
- Department of Pharmaceutical Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK
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Chan WC, Ng C, Mok CCM, Wong FLF, Pang SL, Chiu HFK. Lived experience of caregivers of persons with dementia in Hong Kong: a qualitative study. East Asian Arch Psychiatry 2010; 20:163-168. [PMID: 22348924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To report the lived experience of caregivers of persons with dementia in Hong Kong, and to explore their service needs. METHODS This was a qualitative study of caregivers of persons with dementia. Four focus group interviews, each group comprising 6 to 7 informal caregivers, were conducted. A total of 27 participants were recruited. With the participants' consent, interviews were audiotaped and transcribed verbatim. Colaizzi's methods for phenomenological analysis were used. RESULTS Caregiving in dementia in Hong Kong is as demanding and challenging as reported in other developed communities. 'Confusion regarding diagnosis', 'Emotional impact', 'Difficulty in coping with the care recipient behaviours', 'Provision of care recipient's daily care needs is demanding', and 'Conflicts among social roles' were themes pervasive across every focus group. In addition, the needs of carers changed as the disease of their care recipients progressed. CONCLUSIONS As the local population continues to age, family caregivers are faced with increasing demands. Understanding their experience is pivotal in the design of effective carer support services. Our findings highlight the sources of strain and unmet needs of Hong Kong Chinese caregivers, which may serve as a guide for future service development.
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Affiliation(s)
- W C Chan
- Department of Old Age Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.
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Lai V, Hau KC, Lau HY, Chan WC. Myocardial rupture associated with bolus injection of contrast medium during computed tomographic study in a patient with acute myocardial infarction: a rare but lethal complication. Hong Kong Med J 2009; 15:285-287. [PMID: 19652236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Well-documented potential cardiovascular complications associated with the use of contrast media include bradycardia, hypotension, arrhythmia, and conduction disturbances. Rupture of the myocardium after acute myocardial infarction is a known cause of death, but has yet to be recognised as a potential complication of the use of a bolus injection of contrast medium. On the contrary, contrast-enhanced computed tomographic studies have been performed widely for the diagnosis and evaluation of myocardial infarction. We report a case of complicated myocardial rupture after a single bolus injection of contrast medium during a computed tomographic study in an elderly woman with acute myocardial infarction, which led to cardiac tamponade and rapid death. Although rare, this should alert us to the need for cautious use of contrast medium in patients with acute myocardial infarction.
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Affiliation(s)
- Vincent Lai
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong.
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Lam LCW, Tam CWC, Lui VWC, Chan WC, Chan SSM, Chiu HFK, Wong A, Tham MK, Ho KS, Chan WM. Modality of physical exercise and cognitive function in Hong Kong older Chinese community. Int J Geriatr Psychiatry 2009; 24:48-53. [PMID: 18615844 DOI: 10.1002/gps.2072] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We reported the association between modality of Physical Exercise and cognitive function in 782 older Chinese adults assessed in the second phase of a population survey for dementia in Hong Kong. METHODS Profiles of physical exercise was measured by a questionnaire (no exercise, stretching, aerobic and mind-body exercise). Cognitive Assessments included the CMMSE, ADAS-Cog, and Category Verbal Fluency Test (CVFT). RESULTS The aerobic and mind body exercise groups with longer exercise habits (>5 years) had higher scores in most cognitive tests (Kruskal Wallis tests, p < 0.01). Beneficial effects were more significant in the young old group from 65- 75 years. CONCLUSIONS Possible age related specific effects of aerobic and mind body exercise on cognitive reserve are worthy of further exploration.
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Affiliation(s)
- Linda C W Lam
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR.
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Lenz G, Wright G, Dave SS, Xiao W, Powell J, Zhao H, Xu W, Tan B, Goldschmidt N, Iqbal J, Vose J, Bast M, Fu K, Weisenburger DD, Greiner TC, Armitage JO, Kyle A, May L, Gascoyne RD, Connors JM, Troen G, Holte H, Kvaloy S, Dierickx D, Verhoef G, Delabie J, Smeland EB, Jares P, Martinez A, Lopez-Guillermo A, Montserrat E, Campo E, Braziel RM, Miller TP, Rimsza LM, Cook JR, Pohlman B, Sweetenham J, Tubbs RR, Fisher RI, Hartmann E, Rosenwald A, Ott G, Muller-Hermelink HK, Wrench D, Lister TA, Jaffe ES, Wilson WH, Chan WC, Staudt LM. Stromal gene signatures in large-B-cell lymphomas. N Engl J Med 2008; 359:2313-23. [PMID: 19038878 PMCID: PMC9103713 DOI: 10.1056/nejmoa0802885] [Citation(s) in RCA: 1316] [Impact Index Per Article: 82.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The addition of rituximab to combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), or R-CHOP, has significantly improved the survival of patients with diffuse large-B-cell lymphoma. Whether gene-expression signatures correlate with survival after treatment of diffuse large-B-cell lymphoma is unclear. METHODS We profiled gene expression in pretreatment biopsy specimens from 181 patients with diffuse large-B-cell lymphoma who received CHOP and 233 patients with this disease who received R-CHOP. A multivariate gene-expression-based survival-predictor model derived from a training group was tested in a validation group. RESULTS A multivariate model created from three gene-expression signatures--termed "germinal-center B-cell," "stromal-1," and "stromal-2"--predicted survival both in patients who received CHOP and patients who received R-CHOP. The prognostically favorable stromal-1 signature reflected extracellular-matrix deposition and histiocytic infiltration. By contrast, the prognostically unfavorable stromal-2 signature reflected tumor blood-vessel density. CONCLUSIONS Survival after treatment of diffuse large-B-cell lymphoma is influenced by differences in immune cells, fibrosis, and angiogenesis in the tumor microenvironment.
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MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols
- Cyclophosphamide
- Disease Progression
- Doxorubicin
- Extracellular Matrix/genetics
- Gene Expression
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Genes, MHC Class II
- Germinal Center
- Humans
- Immunologic Factors/administration & dosage
- Kaplan-Meier Estimate
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Multivariate Analysis
- Neovascularization, Pathologic/genetics
- Prednisone
- Prognosis
- Rituximab
- Stromal Cells/metabolism
- Stromal Cells/pathology
- Vincristine
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Affiliation(s)
- G Lenz
- Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Tam CWC, Lam LCW, Lui VWC, Chan WC, Chan SSM, Chiu HFK, Chan WM. Clinical correlates of Parkinsonian signs in community- dwelling Chinese older persons: a population based study. Int J Geriatr Psychiatry 2008; 23:719-25. [PMID: 18213739 DOI: 10.1002/gps.1966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE This study examined the clinical correlates of parkinsonian signs including neuropsychiatric symptoms, cognitive impairment and medical illness burden in the community-dwelling non-demented Chinese elderly. METHODS A random sample of 765 Chinese elderly subjects from a thematic household survey was recruited. There were 389 normal elderly controls (Clinical Dementia Rating [CDR] 0) (NC) and 376 subjects with questionable dementia (CDR 0.5). The subjects with questionable dementia (CDR 0.5) were categorized into two groups: a MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Parkinsonian signs were measured by Unified Parkinson Disease Rating Scale- motor scale (UPDRS). The clinical correlates were investigated in each group. RESULTS UPDRS motor score was associated with age, cumulative medical illness burden and cerebrovascular accidents in the normal control and MCI groups. It correlated negatively with MMSE scores in the NC group. It was associated with presence of soft signs in the NC and MCI groups; and apathy in the VMD group. CONCLUSION Neuropsychiatric symptoms, cognitive impairment and vascular risk factors had different patterns of associations with parkinsonian signs in the older persons with different degree of cognitive impairment.
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Affiliation(s)
- Cindy W C Tam
- Department of Psychiatry, Tai Po Hospital, Hong Kong SAR
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Chan WC, Wright C, Tobias M, Mann S, Jackson R. Explaining trends in coronary heart disease hospitalisations in New Zealand: trend for admissions and incidence can be in opposite directions. Heart 2008; 94:1589-93. [PMID: 18519549 DOI: 10.1136/hrt.2008.142588] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A recent increase in the absolute number of hospitalisations for acute myocardial infarction (AMI) in New Zealand may signal a new epidemic of coronary heart disease (CHD). OBJECTIVE To quantify the impact of factors other than incidence of disease on these national hospitalisation trends. METHODS A total of 324,663 electronic records of New Zealand public CHD hospitalisations from 1993 to 2005 were examined. Repeat admissions were identified by record linkage using a unique national health identifier for each patient. RESULTS Hospitalisations for AMI increased by about 8% a year throughout the 13-year study period. Interhospital transfers increased by 117% over the study period, while readmissions increased by 42%. By 2005 over 60% of all admissions for CHD were readmissions. After accounting for readmissions, hospital transfers and population changes, the age-standardised first AMI hospitalisation rate peaked in 1995 and has since declined by 15%. Reciprocal trends in AMI and angina hospitalisations were seen, indicating changing diagnostic criteria. Overall hospitalisation rates for first CHD events remained relatively steady at about 216.4 events per 100,000 between 1993 and 2000 and subsequently declined by 25% to 162.2 events per 100,000 in 2005. CONCLUSION Recent trends in hospitalisation rates for AMI are significantly influenced by factors other than underlying changes in CHD incidence. Increasing absolute numbers of admissions coded as AMI in New Zealand between 1993 and 2005 can be accounted for by increases in readmissions, increases in interhospital transfers, changes in diagnostic criteria for AMI and in demography.
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Affiliation(s)
- W C Chan
- Faculty of Medical and Health Sciences, Section of Epidemiology and Biostatistics, School of Population Health, Tamaki Campus, University of Auckland, Glen Innes, Private Bag, Auckland, New Zealand.
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Chan SSM, Lam LCW, Tam CWC, Lui VWC, Chan WC, Wong S, Wong A, Tham MK, Ho KS, Chan WM, Chiu HFK. Prevalence of clinically significant depressive symptoms in an epidemiologic sample of community-dwelling elders with milder forms of cognitive impairment in Hong Kong SAR. Int J Geriatr Psychiatry 2008; 23:611-7. [PMID: 18041794 DOI: 10.1002/gps.1948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depression and cognitive impairment in later-life have great bearings on public health. The two conditions often co-occur and have mutual implications on short-term risk and long-term prognosis. METHOD A two-phase epidemiologic survey on the prevalence of dementia in elders aged 60 and over was conducted in Hong Kong in 2005-2006. In the first phase, 6,100 randomly selected community dwelling elders were assessed with Cantonese version of Mini-Mental State Examination (C-MMSE) and Abbreviated Memory Inventory for Chinese (AMIC). Two thousand and seventy-three subjects were screened positive and invited for second phase cognitive and psychiatric assessment. 35.5% of screen-positive subjects participated in Phase 2 assessment conducted by psychiatrists for diagnosis of dementia. Severity of dementia was determined using Clinical Dementia Rating Scale (CDR). Cornell Scale for Depression in Dementia (CSDD) and a structured bedside cognitive battery were also administered to each subject. RESULTS 1.7% of subjects with CDR 0.5 and 5.9% of subjects with CDR 1 had clinically significant depressive symptoms (>or= 8 on CSDD). Score on CSDD correlated positively with duration of cognitive symptoms, scores on CIRS and CMMSE in linear regression model. In a logistic regression model, male gender, duration of cognitive symptoms, CIRS and CMMSE was associated with increased risk for clinically significant depressive symptoms. CONCLUSIONS In our sample, milder forms of cognitive impairment were associated with increased risk for depression in the presence of other risk factors such as male gender, higher physical illness burden and longer duration of cognitive symptoms.
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Affiliation(s)
- Sandra S M Chan
- Department of Psychiatry, the Chinese University of Hong Kong, New Territories, Hong Kong SAR.
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Rountree SD, Waring SC, Chan WC, Lupo PJ, Darby EJ, Doody RS. Importance of subtle amnestic and nonamnestic deficits in mild cognitive impairment: prognosis and conversion to dementia. Dement Geriatr Cogn Disord 2008; 24:476-82. [PMID: 17992015 DOI: 10.1159/000110800] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To evaluate baseline characteristics and conversion to dementia in mild cognitive impairment (MCI) subtypes. METHODS We prospectively evaluated conversion to dementia in 106 patients with amnestic MCI (A-MCI) as defined by Petersen's operationalized criteria on a paragraph recall task, amnestic-subthreshold MCI (AS-MCI) as defined by impairment on the ADAS-cog delayed word list recall with normal paragraph recall, nonamnestic MCI (NA-MCI) defined by a nonmemory domain, and in 27 patients with subjective memory loss who had no deficit on formal neuropsychological testing. RESULTS For all MCI subtypes, the 4-year conversion to dementia was 56% (14% annually) and to AD was 46% (11% annually). Conversion to AD in the A-MCI (56%) was similar to the rate in AS-MCI (50%). Conversion to AD in the A-MCI and AS-MCI combined was 56% (14% annually). Conversion to dementia in the NA-MCI was 52% (13% annually) and the majority converted to AD (62%). CONCLUSIONS All MCI subtypes are at risk of converting to AD if the groups are carefully defined by an abnormal psychometric domain. All subtypes except subjective memory loss converted to AD at higher than expected rates. Both the A-MCI and AS-MCI subtypes had a similarly high rate of conversion to AD. The deficit on a word list recall task may develop before an abnormality on delayed paragraph recall is evident, at least in some subjects.
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Affiliation(s)
- S D Rountree
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
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Lam LCW, Tam CWC, Lui VWC, Chan WC, Chan SSM, Wong S, Wong A, Tham MK, Ho KS, Chan WM, Chiu HFK. Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong. Int Psychogeriatr 2008; 20:135-48. [PMID: 17892609 DOI: 10.1017/s1041610207006199] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In this report, the results of a household survey were used to examine the prevalence of very mild and mild dementia in Chinese older persons in Hong Kong. METHODS The study adopted a two-phase design. At Phase 1, 6100 subjects were screened using the Cantonese version of the Mini-mental State Examination (MMSE) and a short memory inventory. At Phase 2, 2073 subjects were screened positive and 737 were evaluated by psychiatrists. Clinical Dementia Rating (CDR) and cognitive assessment were used for diagnosis of dementia. Very mild dementia (VMD) was defined as a global CDR of 0.5, with memory and non-memory subscale scores of 0.5 or more. Mild dementia was classified for subjects with a CDR of 1. RESULTS The overall prevalence of VMD and mild dementia for persons aged 70 years or above was 8.5% (95%CI: 7.4-9.6) and 8.9% (95%CI: 7.8-10.0) respectively. Among subjects with clinical dementia, 84.6% had mild (CDR1) dementia. Logistic regression analyses revealed that older age, lower educational level and significant cerebrovascular risk factors were risk factors for dementia, while regular physical exercise was a protective factor for dementia. CONCLUSIONS A sizable proportion of community-living subjects suffered from milder forms of dementia. They represent a high risk for early intervention to reduce potential physical and psychiatric morbidity.
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Affiliation(s)
- Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, The People's Republic of China.
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Lam LCW, Tam CWC, Lui VWC, Chan WC, Chan SSM, Chiu HFK, Leung T, Tham MK, Ho KS, Chan WM. Screening of mild cognitive impairment in Chinese older adults--a multistage validation of the Chinese abbreviated mild cognitive impairment test. Neuroepidemiology 2008; 30:6-12. [PMID: 18204291 DOI: 10.1159/000113300] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Accepted: 08/08/2007] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To develop a short cognitive test for screening mild cognitive impairment (MCI) in Hong Kong Chinese older adults. METHODS The Chinese Abbreviated MCI (CAMCI) test was developed with a multistage process. In phase 1, a short version of the cognitive test comprising a 1-min animal fluency test and a 10-min delayed word list recall was developed and tested in 578 volunteers (community-dwelling active elderly persons). In phase 2, the CAMCI test was validated in an independent and randomly recruited sample of 459 participants in a community survey. Additionally, the predictive significance of the CAMCI test was evaluated in a group of 196 subjects assessed in phase 1 for conversion to clinical dementia at 20 months' follow-up. The discriminating power of the CAMCI test in differentiating MCI from normal control (NC) and mildly demented subjects was compared with Mini Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscales. RESULTS The CAMCI test was found to have high discriminating power in differentiating NC from MCI and mildly demented subjects in the phase 1 volunteer sample. The receiver operating characteristics (ROC) revealed an area under the curve (AUC) of 0.91. The ROC were further validated in the phase 2 sample. The AUC of the CAMCI test was compared with MMSE and ADAS-Cog subscales. The short MCI test was comparable to the ADAS-Cog subscale in discriminating NC from MCI and demented subjects (chi(2) test, p = n.s.). Logistic regression analysis was carried out to determine significant baseline predictors for conversion to dementia at phase 3 follow-up. Both ADAS-Cog total [Exp(B) = 1.115, p = 0.028] and CAMCI [Exp(B) = 0.88, p = 0.045] scores were significant predictors for dementia status at follow-up. CONCLUSION The CAMCI test is able to discriminate NC from MCI and mild dementia in Hong Kong Chinese older adults. Its potential for large-scale community screening for early detection of cognitive impairment in late life should be emphasized and explored.
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Affiliation(s)
- Linda C W Lam
- Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
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Tobias M, Chan WC, Wright C, Jackson RT, Mann S, Yeh LC. THE ESTIMATED INCIDENCE AND PREVALENCE OF CORONARY HEART DISEASE IN NEW ZEALAND FOR 2001–2003 BASED ON ROUTINELY COLLECTED DATA. Heart Lung Circ 2008. [DOI: 10.1016/j.hlc.2008.03.048] [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: 12/01/2022]
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Jaye DL, Iqbal J, Fujita N, Geigerman CM, Li S, Karanam S, Fu K, Weisenburger DD, Chan WC, Moreno CS, Wade PA. The BCL6-associated transcriptional co-repressor, MTA3, is selectively expressed by germinal centre B cells and lymphomas of putative germinal centre derivation. J Pathol 2007; 213:106-15. [PMID: 17573669 DOI: 10.1002/path.2199] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Metastasis-associated protein 3 (MTA3) is a recently described cell-type specific component of the Mi-2-NURD transcriptional co-repressor complex that is expressed in breast epithelia and germinal centre B cells. In model B cell lines, MTA3 physically interacts with BCL6 and appears to be instrumental in maintenance of the germinal centre B cell transcriptional programme that precludes premature plasmacytic differentiation. Here, we report selective, in situ cell-type specific expression of MTA3 among lymphoid cells largely confined to the germinal centre B cell compartment. Centroblasts display greater expression than smaller, less proliferative centrocytes, with undetectable expression in quiescent plasma cells. Among B cell neoplasms, germinal centre B cell-like lymphomas likewise exhibit selective expression that generally escalates with increasing proliferative capacity. MTA3 protein expression was, in accord, highly predictive of the germinal centre B cell-like gene expression profile for diffuse large B cell lymphomas. Lastly, relative repression of a subset of known BCL6 targets, including BLIMP1 and p27kip1, was highest in diffuse large B cell lymphomas that co-expressed both MTA3 and BCL6 protein. Together, these novel data suggest a role for MTA3 in BCL6-mediated lymphomagenesis in germinal centre B cell-like neoplasms.
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Affiliation(s)
- D L Jaye
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Pavletic SZ, Zhou G, Sobocinski K, Marti G, Doney K, DiPersio J, Feremans W, Foroni L, Goodman S, Prentice G, LeMaistre C, Bandini G, Ferrant A, Jacobsen N, Khouri I, Gale RP, Wiestner A, Giralt S, Montserrat E, Chan WC, Bredeson C. Genetically identical twin transplantation for chronic lymphocytic leukemia. Leukemia 2007; 21:2452-5. [PMID: 17728782 DOI: 10.1038/sj.leu.2404928] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We identified 19 persons with B-cell chronic lymphocytic leukemia (CLL) who received genetically identical twin blood cell or bone marrow transplants after high-dose conditioning. Ten are alive (eight disease-free) with a median follow-up of 89 months (range, 31-171 months); 5-year relapse rate was 50% (95% confidence interval (CI), 26-73%). Estimated 5-year survival and disease-free survival were 61% (95% CI, 37-82%) and 45% (95% CI, 23-68%). In two of four patients tested at 12 and 21 months by polymerase chain reaction no evidence of residual CLL was detected post-transplant. In one recipient who relapsed at 6 years, molecular studies showed a different CLL clone from that detected pretransplant. This clone was subsequently identified in the donor suggesting transfer of occult leukemia at the time of transplant. Genetically identical twin transplants can result in long-term disease-free survival and molecular remissions, these data suggest the potential for CLL control in the absence of allogeneic graft-versus-leukemia effect. The case of leukemia transfer indicates the need for careful evaluation of donors prior to graft collection.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Bone Marrow Transplantation/adverse effects
- Bone Marrow Transplantation/statistics & numerical data
- Combined Modality Therapy
- Disease-Free Survival
- Diseases in Twins/genetics
- Female
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/surgery
- Male
- Middle Aged
- Neoplastic Stem Cells/transplantation
- Peripheral Blood Stem Cell Transplantation/adverse effects
- Peripheral Blood Stem Cell Transplantation/statistics & numerical data
- Postoperative Complications/mortality
- Recurrence
- Remission Induction
- Retrospective Studies
- Survival Rate
- Transplantation Conditioning
- Transplantation, Homologous/adverse effects
- Transplantation, Homologous/statistics & numerical data
- Twins, Monozygotic/genetics
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Affiliation(s)
- S Z Pavletic
- National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD 20892-1203, USA.
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50
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Iqbal J, Greiner TC, Patel K, Dave BJ, Smith L, Ji J, Wright G, Sanger WG, Pickering DL, Jain S, Horsman DE, Shen Y, Fu K, Weisenburger DD, Hans CP, Campo E, Gascoyne RD, Rosenwald A, Jaffe ES, Delabie J, Rimsza L, Ott G, Müller-Hermelink HK, Connors JM, Vose JM, McKeithan T, Staudt LM, Chan WC. Distinctive patterns of BCL6 molecular alterations and their functional consequences in different subgroups of diffuse large B-cell lymphoma. Leukemia 2007; 21:2332-43. [PMID: 17625604 PMCID: PMC2366166 DOI: 10.1038/sj.leu.2404856] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gene expression profiling of diffuse large B-cell lymphoma (DLBCL) has revealed biologically and prognostically distinct subgroups: germinal center B-cell-like (GCB), activated B-cell-like (ABC) and primary mediastinal (PM) DLBCL. The BCL6 gene is often translocated and/or mutated in DLBCL. Therefore, we examined the BCL6 molecular alterations in these DLBCL subgroups, and their impact on BCL6 expression and BCL6 target gene repression. BCL6 translocations at the major breakpoint region (MBR) were detected in 25 (18.8%) of 133 DLBCL cases, with a higher frequency in the PM (33%) and ABC (24%) subgroups than in the GCB (10%) subgroup. Translocations at the alternative breakpoint region (ABR) were detected in five (6.4%) of 78 DLBCL cases, with three cases in ABC and one case each in the GCB and the unclassifiable subgroups. The translocated cases involved IgH and non-IgH partners in about equal frequency and were not associated with different levels of BCL6 mRNA and protein expression. BCL6 mutations were detected in 61% of DLBCL cases, with a significantly higher frequency in the GCB and PM subgroups (>70%) than in the ABC subgroup (44%). Exon-1 mutations were mostly observed in the GCB subgroup. The repression of known BCL6 target genes correlated with the level of BCL6 mRNA and protein expression in GCB and ABC subgroups but not with BCL6 translocation and intronic mutations. No clear inverse correlation between BCL6 expression and p53 expression was observed. Patients with higher BCL6 mRNA or protein expression had a significantly better overall survival. The biological role of BCL6 in translocated cases where repression of known target genes is not demonstrated is intriguing and warrants further investigation.
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Affiliation(s)
- J Iqbal
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - TC Greiner
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - K Patel
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - BJ Dave
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - L Smith
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - J Ji
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - G Wright
- Metabolism Branch and Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - WG Sanger
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - DL Pickering
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Jain
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - DE Horsman
- Departments of Pathology and British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Y Shen
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - K Fu
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - DD Weisenburger
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - CP Hans
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - E Campo
- Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - RD Gascoyne
- Departments of Pathology and British Columbia Cancer Agency, Vancouver, BC, Canada
| | - A Rosenwald
- Department of Pathology, University of Würzburg, Würzburg, Germany
| | - ES Jaffe
- Metabolism Branch and Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Delabie
- Norwegian Radium Hospital, Oslo, Norway
| | - L Rimsza
- Department of Pathology, University of Arizona, Tucson, Arizona, USA
| | - G Ott
- Department of Pathology, University of Würzburg, Würzburg, Germany
| | | | - JM Connors
- Departments of Pathology and British Columbia Cancer Agency, Vancouver, BC, Canada
| | - JM Vose
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - T McKeithan
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - LM Staudt
- Metabolism Branch and Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - WC Chan
- Departments of Pathology and Microbiology, Pediatrics, Internal Medicine, and Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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