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Ng PY, Chan VWS, Ip A, Ling L, Chan KM, Leung AKH, Chan KKC, So D, Shum HP, Ngai CW, Chan WM, Sin WC. Ten-year territory-wide trends in the utilisation and clinical outcomes of extracorporeal membrane oxygenation in Hong Kong. Hong Kong Med J 2023; 29:514-523. [PMID: 37968897 DOI: 10.12809/hkmj2210025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION The utilisation of extracorporeal membrane oxygenation (ECMO) has been rapidly increasing in Hong Kong. This study examined 10-year trends in the utilisation and clinical outcomes of ECMO in Hong Kong. METHODS We retrospectively reviewed the records of all adult patients receiving ECMO who were admitted to the intensive care units (ICUs) of public hospitals in Hong Kong between 2010 and 2019. Temporal trends across years were assessed using the Mann-Kendall test. Observed hospital mortality was compared with the Acute Physiology and Chronic Health Evaluation (APACHE) IV-predicted mortality. RESULTS The annual number of patients receiving ECMO increased from 18 to 171 over 10 years. In total, 911 patients received ECMO during the study period: 297 (32.6%) received veno-arterial ECMO, 450 (49.4%) received veno-venous ECMO, and 164 (18.0%) received extracorporeal cardiopulmonary resuscitation. The annual number of patients aged ≥65 years increased from 0 to 47 (27.5%) [P for trend=0.001]. The median (interquartile range) Charlson Comorbidity Index increased from 1 (0-1) to 2 (1-3) [P for trend<0.001] while the median (interquartile range) APACHE IV score increased from 90 (57-112) to 105 (77-137) [P for trend=0.003]. The overall standardised mortality ratio comparing hospital mortality with APACHE IV-predicted mortality was 1.11 (95% confidence interval=1.01-1.22). Hospital and ICU length of stay both significantly decreased (P for trend=0.011 and <0.001, respectively). CONCLUSION As ECMO utilisation increased in Hong Kong, patients put on ECMO were older, more critically ill, and had more co-morbidities. It is important to combine service expansion with adequate resource allocation and training to maintain quality of care.
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Affiliation(s)
- P Y Ng
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
| | - V W S Chan
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A Ip
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - L Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K M Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A K H Leung
- Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K K C Chan
- Department of Intensive Care, Tuen Mun Hospital, Hong Kong SAR, China
| | - D So
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong SAR, China
| | - H P Shum
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - C W Ngai
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
| | - W M Chan
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
| | - W C Sin
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong SAR, China
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Ng SC, Chu AWH, Chan WM, Yip CCY, Leung KH, So CK, Leung JNS, To KKW, Lee CK. Re-examine the transfusion transmitted risk of SARS-CoV-2 virus during a major COVID-19 outbreak in 2022. Transfus Med 2023. [PMID: 37286528 DOI: 10.1111/tme.12981] [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: 11/22/2022] [Revised: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Although no case of COVID-19 transmission through transfusion has been reported, blood transfusion service (BTS) continues to implement pre-donation and post-donation measures to minimise the risk. In year 2022, when local healthcare system was badly impacted by a major outbreak, it opened an opportunity to re-examine the viraemia risk in these asymptomatic donors. MATERIALS AND METHODS Records were retrieved from blood donors who reported COVID-19 after donation and follow-up was also made for recipients who received their blood. Blood samples at donation were tested for SARS-CoV-2 viraemia by single-tube nested real-time RT-PCR assay designed to detect most SARS-CoV-2 variants including the prevailing delta and omicron variants. RESULTS From 1 January to 15 August 2022, the city with 7.4 M inhabitants recorded 1 187 844 COVID-19 positive cases and 125 936 successful blood donations were received. 781 donors reported to the BTS after donation with 701 being COVID-19 related (including close contact and symptoms respiratory tract infection). 525 COVID-19 were positive at the time of call back or follow-up. Of the 701 donations, they were processed into 1480 components with 1073 discarded upon donors' call back. For remaining 407 components, no recipient was found to have adverse event or COVID-19 positive. 510 samples from the above 525 COVID-19 positive donors were available and all tested negative for SARS-CoV-2 RNA. DISCUSSION With the negative SARS-CoV-2 RNA in blood donation samples and follow up data in transfusion recipients, the risk of transfusion transmitted COVID-19 appears negligible. However, current measures remains important in securing blood safety with ongoing surveillance of their effectiveness.
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Affiliation(s)
- S C Ng
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - A W H Chu
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - W M Chan
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C C Y Yip
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - K H Leung
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C K So
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - K K W To
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
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To HHM, Kwan AMC, Leung NYY, Chan WM, Ngai CW, Wong ASK, Tsai PNW, Ma TSK, Yam I, Ng PY, Yap DYH. A prospective study on serum citrate levels and clinical correlations in patients receiving regional citrate anticoagulation. Clin Kidney J 2022; 16:285-292. [PMID: 36755836 PMCID: PMC9900571 DOI: 10.1093/ckj/sfac223] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Current ways to diagnose citrate accumulation (CA) in patients receiving regional citrate anticoagulation (RCA) continuous renal replacement therapy (CRRT) are confounded by various clinical factors. Serum citrate measurement emerges as a more direct way to diagnose CA, but its clinical utility and optimal cut-off values remain undefined. This study examined serum citrate kinetics and its diagnostic performance for CA in patients receiving RCA CRRT. Methods A multicentre prospective study was carried out in two tertiary referral centre intensive care units in Hong Kong with serum citrate levels measured at baseline and 2, 6, 12, 24, 36, 48 and 72 h after initiation of RCA CRRT and their relationships with the development of CA. Results Among the 133 patients analysed, 18 patients (13.5%) developed CA. The serum citrate levels at baseline and 2, 6 and 12 h after initiation of RCA CRRT in patients who had CA were significantly higher than the non-CA group (P < .001 for all). The CA group also had higher serum citrate levels than the non-CA group {median 0.93 mmol/L [interquartile range (IQR) 0.81-1.16) versus 0.37 mmol/L (IQR 0.26-0.57), P < .001}. Using a cut-off of 0.85 mmol/L, the serum citrate level had a sensitivity of 0.77 and a specificity 0.96 for the diagnosis of CA [area under the receiver operating characteristics curve (AUROC) 0.90, P < .001]. The 2-h and 6-h serum citrate levels had good discriminatory abilities for predicting subsequent development of CA (AUROC 0.86 and 0.83 for 2-h and 6-h citrate levels using cut-off values of 0.34 and 0.63 mmol/L, respectively; P < .001). Conclusion Serum citrate levels were significantly higher in patients with CA compared with patients without CA. Serum citrate levels showed good performance in diagnosing and predicting the development of CA.
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Affiliation(s)
- Harmony H M To
- Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong
| | - Arthur M C Kwan
- Department of Anaesthesia and Intensive care, Tuen Mun Hospital, Hong Kong
| | | | - W M Chan
- Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong
| | - C W Ngai
- Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong
| | | | - Polly N W Tsai
- Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong
| | - Tammy S K Ma
- Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong
| | - Irene Yam
- Division of Nephrology, Department of Medicine, University of Hong Kong, Hong Kong
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Chan WM, Viskovska M, McArthur M, Yu XM, Liang W, Norman Z, Song X, Chang NT, Jiang H. Abstract 3300: Glycoimmune checkpoint and tumor stroma-targeted oncolytic vaccinia virus for the treatment of solid tumors. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Oncolytic virotherapy represents a promising therapeutic strategy for cancers that do not respond well to immune checkpoint inhibitors. Oncolytic viruses (OV) preferentially replicate in and lyse tumor cells, leading to systemic immune stimulation. Studies have shown that hypersialylation promotes tumor growth and metastasis, as well as the suppression of immune cells. Cancer-associated fibroblasts (CAFs) are known to facilitate tumor invasion and angiogenesis and maintain immunosuppressive microenvironment in solid tumors. We are developing vvDD-Sial-FAP/CD3, an oncolytic vaccinia virus expressing a membrane-bound sialidase, to remove sialic acids from the cell surface glycans, and fibroblast activation protein (FAP)-targeted T cell engager, to eliminate glycoimmune checkpoint and tumor stroma, respectively. vvDD-Sial-FAP/CD3 is an engineered vaccinia virus of Western Reserve (WR) strain with: (1) an insertional disruption of the viral thymidine kinase (TK) gene with the sialidase and FAP/CD3 transgenes. TK is an essential enzyme for the pyrimidine synthesis pathway; viral TK gene deletion thus results in selective replication of virus in rapidly dividing cancerous cells with high intracellular nucleotide pools, and (2) a deletion of the vaccinia growth factor (VGF) genes for greater dependence on the cell cycling status of the cancer cells. Our results showed that sialidase expressed from vvDD-Sial-FAP/CD3 efficiently cleaves the sialic acids from the cell surface and the Fc fused to the sialidase induced antibody-dependent cell-mediated cytotoxicity (ADCC) using an ADCC reporter assay. In vitro efficacy studies were conducted using HCT-116 human colon cancer cells mixed with FAP-expressing normal human dermal fibroblasts or FAP-positive HCC1143 human breast cancer cells in the presence of human peripheral blood mononuclear cells. In both tumor models, vvDD-Sial-FAP/CD3 induced activation of both CD4+ and CD8+ T cells, as measured by the upregulation of CD69 and CD25 markers and increased granzyme B release, which resulted in enhanced cell killing. Using A549 co-cultured with CAFs microtissues, we showed that vvDD-Sial-FAP/CD3 spread efficiently within the tumor spheroids. In addition, vvDD-Sial-FAP/CD3 increased tumor-infiltrated lymphocytes, leading to enhanced cell killing. Taken together, our results have demonstrated potent anti-tumor and -stroma effects induced by vvDD-Sial-FAP/CD3 in multiple cancer models. In vivo efficacy of vvDD-Sial-FAP/CD3, either alone or in combination with checkpoint inhibitor or NK cell therapy, is being evaluated.
Citation Format: Winnie M. Chan, Mariya Viskovska, Micaela McArthur, Xue Mary Yu, Wei Liang, Zane Norman, Xiaotong Song, Nancy T. Chang, Haiyan Jiang. Glycoimmune checkpoint and tumor stroma-targeted oncolytic vaccinia virus for the treatment of solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3300.
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Affiliation(s)
| | | | | | - Xue Mary Yu
- 2AnoVac (A Division of Ansun Biopharma), Houston, TX
| | - Wei Liang
- 1Ansun Biopharma, Inc., San Diego, CA
| | | | - Xiaotong Song
- 2AnoVac (A Division of Ansun Biopharma), Houston, TX
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Ching RCT, Mak SP, Wong MCS, Lam M, Chan WM, Wong MFY, Liang R, Lam TH. Response to the World Health Organization's working document for the development of a global action plan to reduce alcohol-related harm: Position Statement of the Hong Kong Alliance for Advocacy Against Alcohol. Hong Kong Med J 2021; 27:4-6. [PMID: 33518532 DOI: 10.12809/hkmj215109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- R C T Ching
- Hong Kong Alliance for Advocacy Against Alcohol
| | - S P Mak
- Hong Kong Alliance for Advocacy Against Alcohol
| | - M C S Wong
- Hong Kong Alliance for Advocacy Against Alcohol
| | - M Lam
- Hong Kong Alliance for Advocacy Against Alcohol
| | - W M Chan
- Hong Kong Alliance for Advocacy Against Alcohol
| | - M F Y Wong
- Hong Kong Alliance for Advocacy Against Alcohol
| | - R Liang
- Hong Kong Alliance for Advocacy Against Alcohol
| | - T H Lam
- Hong Kong Alliance for Advocacy Against Alcohol
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Springgay LK, Strauwald AM, Ewald B, Robbins JM, Chan WM. Abstract 6713: Oncolytic adenoviruses expressing immune modulators enhance tumor cell killing in human cancer 3D microtumor models. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-6713] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
A series of investigational oncolytic immunotherapies based on DNX-2401 (tasadenoturev) are under development for the treatment of advanced cancers. Viruses “armed” with cell surface or secreted immune modulatory molecules inserted in the DNX-2401 backbone were evaluated using human cell derived 3D microtumor/ T cell models to elucidate specific anti-tumor properties and determine differences in immune activation.
Background: DNX-2401 is a conditionally replicative adenovirus serotype 5 containing: 1) a 24 bp deletion from the E1A gene (Rb-binding domain) to confer cancer cell selectivity, and 2) insertion of an integrin-binding motif (RGD-4C) in the fiber to enhance infectivity across a broad range of cancers. DNX-2401 selectively replicates in cancer cells, causes tumor destruction, and triggers the recruitment of lymphocytes, leading to anti-tumor response. Phase 1 and 2 studies of DNX-2401 are ongoing in patients with glioblastoma and diffuse intrinsic pontine glioma. The first immune modified virus in the series, DNX-2440, engineered to express OX40L, is being evaluated in a Phase 1 study in patients with glioblastoma.
Results: Immune modulator coding sequences inserted in place of E3 in the DNX-2401 backbone expressed properly localized and biologically active transgenes. DNX-2440 infected tumor cells expressed OX40L localized to the cell surface capable of stimulating OX40-expressing T cells. Tumor cells infected with a second virus, which was engineered to express a cytokine, secreted high levels of active protein. Both armed viruses showed infection, replication, and oncolytic activity in a panel of cancer cell lines under standard culture conditions. 3D microtumors composed of melanoma or lung cancer cells and normal human dermal fibroblasts were utilized to assess immune activation following virus infection. Unstimlated or pre-stimulated human immune cells were co-cultured for 12 days with the 3D microtumors infected with DNX-2401 or each armed virus. Infection with DNX-2440 increased T cell-mediated killing of tumor cells that was dependent on OX40/OX40L engagement, as the effect was abrogated in the presence of an OX40L blocking antibody. The kinetics of oncolytic activity, immune cell activation, and tumor infiltration were dependent on the immune modulator expressed from the oncolytic virus, resulting in differences in tumor clearance. These results demonstrate how oncolytic viruses can be customized to have unique properties by inserting different immune modulators into the virus genome, thus providing a customized approach for treating different cancers.
Citation Format: Laura K. Springgay, Amy M. Strauwald, Brett Ewald, Joan M. Robbins, Winnie M. Chan. Oncolytic adenoviruses expressing immune modulators enhance tumor cell killing in human cancer 3D microtumor models [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6713.
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Yan BPY, Chan WM, Lai WHS, Cheng AOW, Chan CKY, Chi WK, Li S, To OTL, Tan GM. P3571Comparable limb salvage and amputation free survival in diabetic and non-diabetic patients with critical limb ischemia undergoing endovascular revascularization. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B P Y Yan
- The Chinese University of Hong Kong, Medicine & Therapeutics, Hong Kong, Hong Kong SAR People's Republic of China
| | - W M Chan
- The Chinese University of Hong Kong, Medicine & Therapeutics, Hong Kong, Hong Kong SAR People's Republic of China
| | - W H S Lai
- The Chinese University of Hong Kong, Medicine & Therapeutics, Hong Kong, Hong Kong SAR People's Republic of China
| | - A O W Cheng
- The Chinese University of Hong Kong, Medicine & Therapeutics, Hong Kong, Hong Kong SAR People's Republic of China
| | - C K Y Chan
- The Chinese University of Hong Kong, Medicine & Therapeutics, Hong Kong, Hong Kong SAR People's Republic of China
| | - W K Chi
- The Chinese University of Hong Kong, Medicine & Therapeutics, Hong Kong, Hong Kong SAR People's Republic of China
| | - S Li
- The Chinese University of Hong Kong, Medicine & Therapeutics, Hong Kong, Hong Kong SAR People's Republic of China
| | - O T L To
- The Chinese University of Hong Kong, Medicine & Therapeutics, Hong Kong, Hong Kong SAR People's Republic of China
| | - G M Tan
- The Chinese University of Hong Kong, Medicine & Therapeutics, Hong Kong, Hong Kong SAR People's Republic of China
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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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Villa NY, Bais S, Chan WM, Meacham AM, Wise E, Rahman MM, Moreb JS, Rosenau EH, Wingard JR, McFadden G, Cogle CR. Ex vivo virotherapy with myxoma virus does not impair hematopoietic stem and progenitor cells. Cytotherapy 2016; 18:465-80. [PMID: 26857235 DOI: 10.1016/j.jcyt.2015.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/18/2015] [Accepted: 12/29/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Relapsing disease is a major challenge after hematopoietic cell transplantation for hematological malignancies. Myxoma virus (MYXV) is an oncolytic virus that can target and eliminate contaminating cancer cells from auto-transplant grafts. The aims of this study were to examine the impact of MYXV on normal hematopoietic stem and progenitor cells and define the optimal treatment conditions for ex vivo virotherapy. METHODS Bone marrow (BM) and mobilized peripheral blood stem cells (mPBSCs) from patients with hematologic malignancies were treated with MYXV at various time, temperature and incubation media conditions. Treated BM cells from healthy normal donors were evaluated using flow cytometry for MYXV infection, long-term culture-initiating cell (LTC-IC) assay and colony-forming cell (CFC) assay. RESULTS MYXV initiated infection in up to 45% of antigen-presenting monocytes, B cells and natural killer cells; however, these infections were uniformly aborted in >95% of all cells. Fresh graft sources showed higher levels of MYXV infection initiation than cryopreserved specimens, but in all cases less than 10% of CD34(+) cells could be infected after ex vivo MYXV treatment. MYXV did not impair LTC-IC colony numbers compared with mock treatment. CFC colony types and numbers were also not impaired by MYXV treatment. MYXV incubation time, temperature or culture media did not significantly change the percentage of infected cells, LTC-IC colony formation or CFC colony formation. CONCLUSIONS Human hematopoietic cells are non-permissive for MYXV. Human hematopoietic stem and progenitor cells were not infected and thus unaffected by MYXV ex vivo treatment.
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Affiliation(s)
- Nancy Y Villa
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Swarna Bais
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Winnie M Chan
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Amy M Meacham
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Elizabeth Wise
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Masmudur M Rahman
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jan S Moreb
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Emma H Rosenau
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - John R Wingard
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Grant McFadden
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Christopher R Cogle
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.
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Vohra RS, Pasquali S, Kirkham AJ, Marriott P, Johnstone M, Spreadborough P, Alderson D, Griffiths EA, Fenwick S, Elmasry M, Nunes Q, Kennedy D, Basit Khan R, Khan MAS, Magee CJ, Jones SM, Mason D, Parappally CP, Mathur P, Saunders M, Jamel S, Ul Haque S, Zafar S, Shiwani MH, Samuel N, Dar F, Jackson A, Lovett B, Dindyal S, Winter H, Fletcher T, Rahman S, Wheatley K, Nieto T, Ayaani S, Youssef H, Nijjar RS, Watkin H, Naumann D, Emeshi S, Sarmah PB, Lee K, Joji N, Heath J, Teasdale RL, Weerasinghe C, Needham PJ, Welbourn H, Forster L, Finch D, Blazeby JM, Robb W, McNair AGK, Hrycaiczuk A, Charalabopoulos A, Kadirkamanathan S, Tang CB, Jayanthi NVG, Noor N, Dobbins B, Cockbain AJ, Nilsen-Nunn A, Siqueira J, Pellen M, Cowley JB, Ho WM, Miu V, White TJ, Hodgkins KA, Kinghorn A, Tutton MG, Al-Abed YA, Menzies D, Ahmad A, Reed J, Khan S, Monk D, Vitone LJ, Murtaza G, Joel A, Brennan S, Shier D, Zhang C, Yoganathan T, Robinson SJ, McCallum IJD, Jones MJ, Elsayed M, Tuck L, Wayman J, Carney K, Aroori S, Hosie KB, Kimble A, Bunting DM, Fawole AS, Basheer M, Dave RV, Sarveswaran J, Jones E, Kendal C, Tilston MP, Gough M, Wallace T, Singh S, Downing J, Mockford KA, Issa E, Shah N, Chauhan N, Wilson TR, Forouzanfar A, Wild JRL, Nofal E, Bunnell C, Madbak K, Rao STV, Devoto L, Siddiqi N, Khawaja Z, Hewes JC, Gould L, Chambers A, Urriza Rodriguez D, Sen G, Robinson S, Carney K, Bartlett F, Rae DM, Stevenson TEJ, Sarvananthan K, Dwerryhouse SJ, Higgs SM, Old OJ, Hardy TJ, Shah R, Hornby ST, Keogh K, Frank L, Al-Akash M, Upchurch EA, Frame RJ, Hughes M, Jelley C, Weaver S, Roy S, Sillo TO, Galanopoulos G, Cuming T, Cunha P, Tayeh S, Kaptanis S, Heshaishi M, Eisawi A, Abayomi M, Ngu WS, Fleming K, Singh Bajwa D, Chitre V, Aryal K, Ferris P, Silva M, Lammy S, Mohamed S, Khawaja A, Hussain A, Ghazanfar MA, Bellini MI, Ebdewi H, Elshaer M, Gravante G, Drake B, Ogedegbe A, Mukherjee D, Arhi C, Giwa Nusrat Iqbal L, Watson NF, Kumar Aggarwal S, Orchard P, Villatoro E, Willson PD, Wa K, Mok J, Woodman T, Deguara J, Garcea G, Babu BI, Dennison AR, Malde D, Lloyd D, Satheesan S, Al-Taan O, Boddy A, Slavin JP, Jones RP, Ballance L, Gerakopoulos S, Jambulingam P, Mansour S, Sakai N, Acharya V, Sadat MM, Karim L, Larkin D, Amin K, Khan A, Law J, Jamdar S, Smith SR, Sampat K, M O'shea K, Manu M, Asprou FM, Malik NS, Chang J, Johnstone M, Lewis M, Roberts GP, Karavadra B, Photi E, Hewes J, Gould L, Chambers A, Rodriguez D, O'Reilly DA, Rate AJ, Sekhar H, Henderson LT, Starmer BZ, Coe PO, Tolofari S, Barrie J, Bashir G, Sloane J, Madanipour S, Halkias C, Trevatt AEJ, Borowski DW, Hornsby J, Courtney MJ, Virupaksha S, Seymour K, Robinson S, Hawkins H, Bawa S, Gallagher PV, Reid A, Wood P, Finch JG, Parmar J, Stirland E, Gardner-Thorpe J, Al-Muhktar A, Peterson M, Majeed A, Bajwa FM, Martin J, Choy A, Tsang A, Pore N, Andrew DR, Al-Khyatt W, Taylor C, Bhandari S, Chambers A, Subramanium D, Toh SKC, Carter NC, Mercer SJ, Knight B, Tate S, Pearce B, Wainwright D, Vijay V, Alagaratnam 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Shahin Y, Ali A, Luther A, Nicholson JA, Rajendran I, Boal M, Ritchie J. Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103:1716-1726. [PMID: 27748962 DOI: 10.1002/bjs.10288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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Affiliation(s)
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - A J Kirkham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - P Marriott
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - M Johnstone
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - P Spreadborough
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - D Alderson
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Fenwick
- Aintree University Hospital NHS Foundation Trust
| | - M Elmasry
- Aintree University Hospital NHS Foundation Trust
| | - Q Nunes
- Aintree University Hospital NHS Foundation Trust
| | - D Kennedy
- Aintree University Hospital NHS Foundation Trust
| | | | | | | | | | - D Mason
- Wirral University Teaching Hospital
| | | | | | | | - S Jamel
- Barnet and Chase Farm Hospital
| | | | - S Zafar
- Barnet and Chase Farm Hospital
| | | | - N Samuel
- Barnsley District General Hospital
| | - F Dar
- Barnsley District General Hospital
| | | | | | | | | | | | | | - K Wheatley
- Sandwell and West Birmingham Hospitals NHS Trust
| | - T Nieto
- Sandwell and West Birmingham Hospitals NHS Trust
| | - S Ayaani
- Sandwell and West Birmingham Hospitals NHS Trust
| | - H Youssef
- Heart of England Foundation NHS Trust
| | | | - H Watkin
- Heart of England Foundation NHS Trust
| | - D Naumann
- Heart of England Foundation NHS Trust
| | - S Emeshi
- Heart of England Foundation NHS Trust
| | | | - K Lee
- Heart of England Foundation NHS Trust
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- Heart of England Foundation NHS Trust
| | - J Heath
- Blackpool Teaching Hospitals NHS Foundation Trust
| | - R L Teasdale
- Blackpool Teaching Hospitals NHS Foundation Trust
| | | | - P J Needham
- Bradford Teaching Hospitals NHS Foundation Trust
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- Bradford Teaching Hospitals NHS Foundation Trust
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- Bradford Teaching Hospitals NHS Foundation Trust
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- Bradford Teaching Hospitals NHS Foundation Trust
| | | | - W Robb
- University Hospitals Bristol NHS Trust
| | | | | | | | | | | | | | | | - B Dobbins
- Calderdale and Huddersfield NHS Trust
| | | | | | | | - M Pellen
- Hull and East Yorkshire NHS Trust
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- Hull and East Yorkshire NHS Trust
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- Hull and East Yorkshire NHS Trust
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- Chesterfield Royal Hospital NHS Foundation Trust
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- Chesterfield Royal Hospital NHS Foundation Trust
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- Chesterfield Royal Hospital NHS Foundation Trust
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- Colchester Hospital University NHS Foundation Trust
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- Colchester Hospital University NHS Foundation Trust
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- Colchester Hospital University NHS Foundation Trust
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- Colchester Hospital University NHS Foundation Trust
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- Colchester Hospital University NHS Foundation Trust
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- Colchester Hospital University NHS Foundation Trust
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- Countess of Chester NHS Foundation Trust
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- Countess of Chester NHS Foundation Trust
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- Countess of Chester NHS Foundation Trust
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- Countess of Chester NHS Foundation Trust
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- Croydon Health Services NHS Trust
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- Croydon Health Services NHS Trust
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- North Cumbria University Hospitals Trust
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- North Cumbria University Hospitals Trust
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- North Cumbria University Hospitals Trust
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- North Cumbria University Hospitals Trust
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- North Cumbria University Hospitals Trust
| | | | | | | | | | | | | | | | | | | | | | - M P Tilston
- Northern Lincolnshire and Goole NHS Foundation Trust
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- Northern Lincolnshire and Goole NHS Foundation Trust
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- Northern Lincolnshire and Goole NHS Foundation Trust
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- Northern Lincolnshire and Goole NHS Foundation Trust
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- Northern Lincolnshire and Goole NHS Foundation Trust
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- Northern Lincolnshire and Goole NHS Foundation Trust
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- Northern Lincolnshire and Goole NHS Foundation Trust
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- Northern Lincolnshire and Goole NHS Foundation Trust
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- Northern Lincolnshire and Goole NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Dorset County Hospital NHS Foundation Trust
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- Dorset County Hospital NHS Foundation Trust
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- Dorset County Hospital NHS Foundation Trust
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- Dorset County Hospital NHS Foundation Trust
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- Frimley Park Hospital NHS Trust
| | | | | | | | | | - O J Old
- Gloucestershire Hospitals NHS Trust
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- Gloucestershire Hospitals NHS Trust
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- Gloucestershire Hospitals NHS Trust
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- Gloucestershire Hospitals NHS Trust
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- Great Western Hospitals NHS Foundation Trust
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- Harrogate and District NHS Foundation Trust
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- Harrogate and District NHS Foundation Trust
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- Harrogate and District NHS Foundation Trust
| | | | | | | | | | - T Cuming
- Homerton University Hospital NHS Trust
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- Homerton University Hospital NHS Trust
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- Homerton University Hospital NHS Trust
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- Tees Hospitals NHS Foundation Trust
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- Tees Hospitals NHS Foundation Trust
| | | | | | - V Chitre
- Paget University Hospitals NHS Foundation Trust
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- Paget University Hospitals NHS Foundation Trust
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- Paget University Hospitals NHS Foundation Trust
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- Kettering General Hospital NHS Foundation Trust
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- Kettering General Hospital NHS Foundation Trust
| | - G Gravante
- Kettering General Hospital NHS Foundation Trust
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- Kettering General Hospital NHS Foundation Trust
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- Barking, Havering and Redbridge University Hospitals NHS Trust
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- Barking, Havering and Redbridge University Hospitals NHS Trust
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- Barking, Havering and Redbridge University Hospitals NHS Trust
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- Kingston Hospital NHS Foundation Trust
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- Kingston Hospital NHS Foundation Trust
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- Kingston Hospital NHS Foundation Trust
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- Kingston Hospital NHS Foundation Trust
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- University Hospitals of Leicester NHS Trust
| | - B I Babu
- University Hospitals of Leicester NHS Trust
| | | | - D Malde
- University Hospitals of Leicester NHS Trust
| | - D Lloyd
- University Hospitals of Leicester NHS Trust
| | | | - O Al-Taan
- University Hospitals of Leicester NHS Trust
| | - A Boddy
- University Hospitals of Leicester NHS Trust
| | - J P Slavin
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - R P Jones
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - L Ballance
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - S Gerakopoulos
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - P Jambulingam
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - S Mansour
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - N Sakai
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - V Acharya
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - M M Sadat
- Macclesfield District General Hospital
| | - L Karim
- Macclesfield District General Hospital
| | - D Larkin
- Macclesfield District General Hospital
| | - K Amin
- Macclesfield District General Hospital
| | - A Khan
- Central Manchester NHS Foundation Trust
| | - J Law
- Central Manchester NHS Foundation Trust
| | - S Jamdar
- Central Manchester NHS Foundation Trust
| | - S R Smith
- Central Manchester NHS Foundation Trust
| | - K Sampat
- Central Manchester NHS Foundation Trust
| | | | - M Manu
- Royal Wolverhampton Hospitals NHS Trust
| | | | - N S Malik
- Royal Wolverhampton Hospitals NHS Trust
| | - J Chang
- Royal Wolverhampton Hospitals NHS Trust
| | | | - M Lewis
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - G P Roberts
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - B Karavadra
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - E Photi
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Hornsby
- North Tees and Hartlepool NHS Foundation Trust
| | | | | | - K Seymour
- Northumbria Healthcare NHS Foundation Trust
| | - S Robinson
- Northumbria Healthcare NHS Foundation Trust
| | - H Hawkins
- Northumbria Healthcare NHS Foundation Trust
| | - S Bawa
- Northumbria Healthcare NHS Foundation Trust
| | | | - A Reid
- Northumbria Healthcare NHS Foundation Trust
| | - P Wood
- Northumbria Healthcare NHS Foundation Trust
| | - J G Finch
- Northampton General Hospital NHS Trust
| | - J Parmar
- Northampton General Hospital NHS Trust
| | | | | | - A Al-Muhktar
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - M Peterson
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - A Majeed
- Sheffield Teaching Hospitals NHS Foundation Trust
| | | | | | - A Choy
- Peterborough City Hospital
| | | | - N Pore
- United Lincolnshire Hospitals NHS Trust
| | | | | | - C Taylor
- United Lincolnshire Hospitals NHS Trust
| | | | | | | | | | | | | | | | - S Tate
- Portsmouth Hospitals NHS Trust
| | | | | | - V Vijay
- The Princess Alexandra Hospital NHS Trust
| | | | - S Sinha
- The Princess Alexandra Hospital NHS Trust
| | - S Khan
- The Princess Alexandra Hospital NHS Trust
| | | | - A A Hussain
- King's College Hospital NHS Foundation Trust
| | | | - N Kansal
- Gateshead Health NHS Foundation Trust
| | - T Fasih
- Gateshead Health NHS Foundation Trust
| | - C Jackson
- Gateshead Health NHS Foundation Trust
| | | | | | | | | | | | | | - K Gurung
- Queen Elizabeth Hospital NHS Trust
| | - G Tsavellas
- East Kent Hospitals University NHS Foundation Trust
| | - P Basynat
- East Kent Hospitals University NHS Foundation Trust
| | | | - S Basu
- East Kent Hospitals University NHS Foundation Trust
| | | | - M Rabie
- East Kent Hospitals University NHS Foundation Trust
| | - M Akhtar
- East Kent Hospitals University NHS Foundation Trust
| | - P Kumar
- Burton Hospitals NHS Foundation Trust
| | | | - N Hussain
- Burton Hospitals NHS Foundation Trust
| | - S Raza
- Burton Hospitals NHS Foundation Trust
| | - M Haque
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - I Alam
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - R Aseem
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - S Patel
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M Asad
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M I Booth
- Royal Berkshire NHS Foundation Trust
| | - W R Ball
- Royal Berkshire NHS Foundation Trust
| | | | | | | | | | - J Varghase
- Royal Bolton Hospital NHS Foundation Trust
| | - J Lodhia
- Royal Bolton Hospital NHS Foundation Trust
| | - D Bradley
- Royal Bolton Hospital NHS Foundation Trust
| | - C Rengifo
- Royal Bolton Hospital NHS Foundation Trust
| | - D Lindsay
- Royal Bolton Hospital NHS Foundation Trust
| | | | | | | | | | | | - A Awan
- Royal Derby NHS Foundation Trust
| | - J Ahmed
- Royal Derby NHS Foundation Trust
| | - P Leeder
- Royal Derby NHS Foundation Trust
| | | | | | | | | | - D Hou
- Hampshire Hospital NHS Foundation Trust
| | - F Noble
- Hampshire Hospital NHS Foundation Trust
| | | | | | - R Date
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - M R Hossack
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Y Li Goh
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - P Turner
- Lancashire Teaching Hospitals NHS Foundation Trust
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- Lancashire Teaching Hospitals NHS Foundation Trust
| | | | | | | | - S R Preston
- Royal Surrey County Hospital NHS Foundation Trust
| | - J R Hoban
- Royal Surrey County Hospital NHS Foundation Trust
| | - D J Puntis
- Royal Surrey County Hospital NHS Foundation Trust
| | - S V Williams
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| | | | | | - J Batt
- Royal United Hospital Bath NHS Trust
| | - M Doe
- Royal United Hospital Bath NHS Trust
| | | | | | | | - C Hall
- Salford Royal NHS Foundation Trust
| | - N Carty
- Salisbury Hospital Foundation Trust
| | - J Ahmed
- Salisbury Hospital Foundation Trust
| | | | | | | | - H Lennon
- Southport and Ormskirk Hospital NHS Trust
| | - C Hindley
- Southport and Ormskirk Hospital NHS Trust
| | - M Reddy
- St George's Healthcare NHS Trust
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- St George's Healthcare NHS Trust
| | | | | | | | - K Hancorn
- St Helens and Knowsley Teaching Hospitals NHS Trust
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- St Helens and Knowsley Teaching Hospitals NHS Trust
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- Imperial College Healthcare NHS Trust
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- Imperial College Healthcare NHS Trust
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- Imperial College Healthcare NHS Trust
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- Mid Staffordshire NHS Foundation Trust
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- City Hospitals Sunderland NHS Foundation Trust
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- Tunbridge Wells and Maidstone NHS Trust
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- University Hospital Coventry and Warwickshire NHS Trust
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- South Warwickshire NHS Foundation Trust
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- York Teaching Hospital NHS Foundation Trust
| | - T Hossain
- York Teaching Hospital NHS Foundation Trust
| | - A Pannu
- York Teaching Hospital NHS Foundation Trust
| | | | | | - G W Taylor
- York Teaching Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | - T Diamond
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - P Davey
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - C Jones
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - J M Clements
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - R Digney
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - W M Chan
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S McCain
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Gull
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Janeczko
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - E Dorrian
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Harris
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Dawson
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - D Johnston
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - B McAree
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
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- University Hospital Limerick
| | | | - A D K Hill
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Khogali
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - W Shabo
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Iskandar
- Louth County Hospital and Our Lady of Lourdes Hospital
| | | | | | | | | | | | | | | | | | - P Balfe
- St Luke's General Hospital Kilkenny
| | - M Lee
- St Luke's General Hospital Kilkenny
| | - D C Winter
- St Vincent's University and Private Hospitals, Dublin
| | - M E Kelly
- St Vincent's University and Private Hospitals, Dublin
| | - E Hoti
- St Vincent's University and Private Hospitals, Dublin
| | - D Maguire
- St Vincent's University and Private Hospitals, Dublin
| | - P Karunakaran
- St Vincent's University and Private Hospitals, Dublin
| | - J G Geoghegan
- St Vincent's University and Private Hospitals, Dublin
| | - S T Martin
- St Vincent's University and Private Hospitals, Dublin
| | - F McDermott
- St Vincent's University and Private Hospitals, Dublin
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- Crosshouse Hospital, Ayrshire and Arran
| | | | - D G Vass
- Crosshouse Hospital, Ayrshire and Arran
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - H C C Lim
- Glangwili General and Prince Philip Hospital
| | - D Duke
- Glangwili General and Prince Philip Hospital
| | - T Ahmed
- Glangwili General and Prince Philip Hospital
| | - W D Beasley
- Glangwili General and Prince Philip Hospital
| | | | - G Maharaj
- Glangwili General and Prince Philip Hospital
| | - C Malcolm
- Glangwili General and Prince Philip Hospital
| | | | | | | | - R Radwan
- Morriston and Singleton Hospitals
| | | | - S Wood
- Princess of Wales Hospital
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11
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Abstract
Community resources for stroke clients are underdeveloped in Hong Kong and stroke survivors often face difficulties in community reintegration. We have examined the feasibility of using videoconferencing for community-based stroke rehabilitation. The sample comprised 21 stroke patients living at home. All the subjects participated in an eight-week intervention programme at a community centre for seniors. The intervention, which comprised educational talks, exercise and psychosocial support, was conducted by a physiotherapist via a videoconference link. The Berg Balance Scale (BBS), State Self-Esteem Scale (SSES), Medical Outcomes Study 36-item Short Form (SF-36) and a stroke knowledge test were administered at the start and end of the programme. In addition, at the start of the study the Geriatric Depression Scale 15-item Short Form, the Elderly Mobility Scale and the Lawton Instrumental Activities of Daily Living Scale were used to assess subjects' baseline status, and a focus group was also held at the end of the programme to gather qualitative findings. Nineteen subjects completed the eight-week intervention. The baseline functional status was high, although 52% had symptoms of depression. After the intervention, there were significant improvements in BBS, SSES and knowledge test scores and scores on all subscales of the SF-36. All the subjects accepted the use of videoconferencing for delivery of the intervention. The pilot study demonstrated the feasibility, efficacy and high level of acceptance of telerehabilitation for community-dwelling stroke clients.
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Affiliation(s)
- Jerry C K Lai
- Division of Geriatrics, Department of Medicine and Therapeutics, Chinese University of Hong Kong, China
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12
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Tian LW, Wong WY, Ho SC, Ng S, Chan WM. Institutional risk factors for outbreaks of acute gastroenteritis in homes for the elderly: a retrospective cohort analysis. Hong Kong Med J 2015; 21 Suppl 4:20-21. [PMID: 26157098] [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)
- L W Tian
- School of Public Health and Primary Care, Chinese University of Hong Kong
| | - W Y Wong
- Centre for Health Protection, Hong Kong SAR
| | - S C Ho
- School of Public Health and Primary Care, Chinese University of Hong Kong
| | - S Ng
- Department of Health, Hong Kong SAR
| | - W M Chan
- Department of Health, Hong Kong SAR
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13
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Ng PY, Sin WC, Ng AK, Chan WM. Cardiac abnormalities in patients with septic shock detected by speckle tracking echocardiography. Crit Care 2015. [PMCID: PMC4471191 DOI: 10.1186/cc14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Schooling CM, Chan WM, Leung SL, Lam TH, Lee SY, Shen C, Leung JY, Leung GM. Cohort Profile: Hong Kong Department of Health Elderly Health Service Cohort. Int J Epidemiol 2014; 45:64-72. [PMID: 25480143 DOI: 10.1093/ije/dyu227] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 01/26/2023] Open
Abstract
The Department of Health Elderly Health Service Cohort in Hong Kong was set up to promote understanding of ageing in a global context, to exploit the role of Hong Kong as a sentinel for populations currently experiencing very rapid economic development, to provide a developed non-Western 'social laboratory' where empirically derived hypotheses can be tested and to leverage the different patterns of common chronic diseases between East and West to generate novel hypotheses about their determinants. The initial cohort enrolled from July 1998 to the end of December 2001 includes 66 820 people aged 65 years or older, forming about 9% of the population of this age. A comprehensive health assessment was made at enrollment and then repeated regularly on an ongoing basis. The health assessment included a comprehensive assessment of lifestyle, social circumstances, physical health and mental health, including an assessment of cognition and depressive symptoms. Health services use and deaths have been obtained by record linkage and confirmed, where necessary, by telephone interview. Currently, the data are not publicly available; we would welcome collaborations and research proposals.
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Affiliation(s)
- C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - W M Chan
- Department of Health, Government of Hong Kong SAR, China
| | - S L Leung
- Department of Health, Government of Hong Kong SAR, China
| | - T H Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - S Y Lee
- Department of Health, Government of Hong Kong SAR, China
| | - C Shen
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - J Y Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
| | - G M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China and
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15
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Wong CM, Chan WM, Yang L, Chan KP, Lai HK, Thach TQ, Ho LM, Lam TH, Peiris JSM. Effect of lifestyle factors on risk of mortality associated with influenza in elderly people. Hong Kong Med J 2014; 20 Suppl 6:16-19. [PMID: 25482965] [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)
- C M Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - W M Chan
- Department of Health, The Government of the Hong Kong Special Administrative Region
| | - L Yang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - K P Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - H K Lai
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - T Q Thach
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - L M Ho
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - T H Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - J S M Peiris
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong
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16
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Abstract
Current standard treatments of cancer can prolong survival of many cancer patients but usually do not effectively cure the disease. Oncolytic virotherapy is an emerging therapeutic for the treatment of cancer that exploits replication-competent viruses to selectively infect and destroy cancerous cells while sparing normal cells and tissues. Clinical and/or preclinical studies on oncolytic viruses have revealed that the candidate viruses being tested in trials are remarkably safe and offer potential for treating many classes of currently incurable cancers. Among these candidates are vaccinia and myxoma viruses, which belong to the family Poxviridae and possess promising oncolytic features. This article describes poxviruses that are being developed for oncolytic virotherapy and summarizes the outcomes of both clinical and preclinical studies. Additionally, studies demonstrating superior efficacy when poxvirus oncolytic virotherapy is combined with conventional therapies are described.
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Affiliation(s)
- Winnie M. Chan
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, Florida 32610
| | - Grant McFadden
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, Florida 32610
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17
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Lam LCW, Chan WM, Kwok TCY, Chiu HFK. Effectiveness of Tai Chi in maintenance of cognitive and functional abilities in mild cognitive impairment: a randomised controlled trial. Hong Kong Med J 2014; 20:20-23. [PMID: 25001031] [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: 06/03/2023] Open
Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - W M Chan
- Elderly Health Services, Department of Health, Hong Kong
| | - T C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - H F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong
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18
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Abstract
Many common neoplasms are still noncurative with current standards of cancer therapy. More therapeutic modalities need to be developed to significantly prolong the lives of patients and eventually cure a wider spectrum of cancers. Oncolytic virotherapy is one of the promising new additions to clinical cancer therapeutics. Successful oncolytic virotherapy in the clinic will be those strategies that best combine tumor cell oncolysis with enhanced immune responses against tumor antigens. The current candidate oncolytic viruses all share the common property that they are relatively nonpathogenic to humans, yet they have the ability to replicate selectively in human cancer cells and induce cancer regression by direct oncolysis and/or induction of improved anti-tumor immune responses. Many candidate oncolytic viruses are in various stages of clinical and preclinical development. One such preclinical candidate is myxoma virus (MYXV), a member of the Poxviridae family that, in its natural setting, exhibits a very restricted host range and is only pathogenic to European rabbits. Despite its narrow host range in nature, MYXV has been shown to productively infect various classes of human cancer cells. Several preclinical in vivo modeling studies have demonstrated that MYXV is an attractive and safe candidate oncolytic virus, and hence, MYXV is currently being developed as a potential therapeutic for several cancers, such as pancreatic cancer, glioblastoma, ovarian cancer, melanoma, and hematologic malignancies. This review highlights the preclinical cancer models that have shown the most promise for translation of MYXV into human clinical trials.
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Affiliation(s)
- Winnie M. Chan
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Masmudur M. Rahman
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Grant McFadden
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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19
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Wai MSM, Luan P, Jiang Y, Chan WM, Tsui TYM, Tang HC, Lam WP, Fan M, Yew DT. Long term ketamine and ketamine plus alcohol toxicity - what can we learn from animal models? Mini Rev Med Chem 2013; 13:273-9. [PMID: 22512581 DOI: 10.2174/1389557511313020009] [Citation(s) in RCA: 12] [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: 06/07/2011] [Revised: 02/27/2012] [Accepted: 03/01/2012] [Indexed: 11/22/2022]
Abstract
This review addressed the adverse effects of the frequently-used recreational drug, ketamine through using mice and monkey models. Our laboratory has documented initially that ketamine can induce the formation of hyperphosphorlated tau (hypertau), which is a hallmark of Alzheimer's disease (AD), in the cerebral cortex of both mice and monkeys as well as apoptosis in neurons in these species. Besides the cerebral cortex, other centers in the central nervous system (CNS) and peripheral nervous system (PNS) are also influenced by ketamine. Cerebellum was found to be down-regulated in both mice and humans after long-term of ketamine administration and it was caused by the apoptosis of Purkinje cells. Deleterious effects in other organs reported in long-term ketamine users include of kidney dysfunction leading to proteinuria, fibrosis of the urinary bladder and reduction in size of the urinary bladder leading to frequent urination, increase of liver fibrosis and cardiac problems such as premature ventricular beats. Moreover, ketamine is usually co-administrated with other chemicals such as caffeine or alcohol. It has been reported increased harmful effects when ketamine was used in combination with the above substances. Mechanisms of damages of ketamine might be due to 1) up-regulation of NMDA receptors leading to overestimation of glutamatergic system or 2) the metabolite of ketamine which was a hydroquinone exerted toxicity.
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Affiliation(s)
- M S M Wai
- Brain Research Centre, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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20
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Rahman MM, Liu J, Chan WM, Rothenburg S, McFadden G. Myxoma virus protein M029 is a dual function immunomodulator that inhibits PKR and also conscripts RHA/DHX9 to promote expanded host tropism and viral replication. PLoS Pathog 2013; 9:e1003465. [PMID: 23853588 PMCID: PMC3701710 DOI: 10.1371/journal.ppat.1003465] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 05/14/2013] [Indexed: 11/18/2022] Open
Abstract
Myxoma virus (MYXV)-encoded protein M029 is a member of the poxvirus E3 family of dsRNA-binding proteins that antagonize the cellular interferon signaling pathways. In order to investigate additional functions of M029, we have constructed a series of targeted M029-minus (vMyx-M029KO and vMyx-M029ID) and V5-tagged M029 MYXV. We found that M029 plays a pivotal role in determining the cellular tropism of MYXV in all mammalian cells tested. The M029-minus viruses were able to replicate only in engineered cell lines that stably express a complementing protein, such as vaccinia E3, but underwent abortive or abated infection in all other tested mammalian cell lines. The M029-minus viruses were dramatically attenuated in susceptible host European rabbits and caused no observable signs of myxomatosis. Using V5-tagged M029 virus, we observed that M029 expressed as an early viral protein is localized in both the nuclear and cytosolic compartments in virus-infected cells, and is also incorporated into virions. Using proteomic approaches, we have identified Protein Kinase R (PKR) and RNA helicase A (RHA)/DHX9 as two cellular binding partners of M029 protein. In virus-infected cells, M029 interacts with PKR in a dsRNA-dependent manner, while binding with DHX9 was not dependent on dsRNA. Significantly, PKR knockdown in human cells rescued the replication defect of the M029-knockout viruses. Unexpectedly, this rescue of M029-minus virus replication by PKR depletion could then be reversed by RHA/DHX9 knockdown in human monocytic THP1 cells. This indicates that M029 not only inhibits generic PKR anti-viral pathways, but also binds and conscripts RHA/DHX9 as a pro-viral effector to promote virus replication in THP1 cells. Thus, M029 is a critical host range and virulence factor for MYXV that is required for replication in all mammalian cells by antagonizing PKR-mediated anti-viral functions, and also conscripts pro-viral RHA/DHX9 to promote viral replication specifically in myeloid cells. Poxviruses exploit diverse strategies to modulate host anti-viral responses in order to achieve broad cellular tropism and replication. Here we report the findings that Myxoma virus (MYXV), a rabbit-specific poxvirus, expresses a viral protein M029 that possesses dual immunomodulatory functions. M029 binds and inhibits the anti-viral functions of protein kinase R (PKR) and also binds and conscripts the pro-viral activities of another cellular protein, RNA helicase A (RHA/DHX9), a member of the DEXD/H box family of proteins. Engineered M029-minus MYXVs did not cause lethal disease myxomatosis in the European rabbits. M029-minus MYXVs were also unable to replicate in diverse mammalian cell types, but can be rescued by knocking down the expression of PKR. However, this rescue of M029-minus virus replication could then be reversed by RHA/DHX9 knockdown in human myeloid cells. These findings reveal a novel strategy used by a single viral immunomodulatory protein that both inhibits a host anti-viral factor and additionally conscripting a host pro-viral factor to expand viral tropism in a wider range of target mammalian cells.
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Affiliation(s)
- Masmudur M. Rahman
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida, United States of America
| | - Jia Liu
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida, United States of America
| | - Winnie M. Chan
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida, United States of America
| | - Stefan Rothenburg
- Laboratory for Host-Specific Virology, Division of Biology, Kansas State University, Manhattan, Kansas, United States of America
| | - Grant McFadden
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
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21
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Cerin E, Macfarlane D, Sit CHP, Ho SY, Johnston JM, Chou KL, Chan WM, Cheung MC, Ho KS. Effects of built environment on walking among Hong Kong older adults. Hong Kong Med J 2013; 19 Suppl 4:39-41. [PMID: 23775186] [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: 06/02/2023] Open
Abstract
1. Reliable and valid interviewer-administered questionnaires were developed to investigate associations of perceived neighbourhood attributes of Hong Kong older adults with their walking for transportation and recreation. 2. Access to and availability of different types of services and destinations, provision of facilities for resting/sitting in the neighbourhood, and easy access to/from residential buildings may help maintain an active lifestyle by facilitating walking for transport in the neighbourhood. 3. Access to services, indoor places for walking, environmental aesthetics, low traffic, and absence of physical barriers may promote recreational walking..
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Affiliation(s)
- E Cerin
- Institute of Human Performance, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China.
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22
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Hung K, Lee CC, Chan WM, Choy SO, Kwok P. Development of a wearable system integrated with novel biomedical sensors for ubiquitous healthcare. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2012:5802-5. [PMID: 23367248 DOI: 10.1109/embc.2012.6347313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The world's ageing population has led to an urgent need for long-term and patient-centered healthcare solutions. Hence, there is a growing need for wearable systems for physiologic monitoring. While various biosignals are monitored with traditional approaches, it is worthwhile to investigate alternative sensing techniques in order to improve accessibility and understanding of patients' conditions. This paper presents our laboratory's development of such a wearable system, which makes use of unconventional techniques for physiologic monitoring. With its integrated textile electrocardiogram (ECG) electrodes, intelligent finger-ring photoplethysmogram (PPG) sensor, miniaturized optical fiber-based temperature sensor, eye dynamics monitor, global positioning system (GPS) module, and wireless capability, it demonstrates a feasible solution for ubiquitous healthcare.
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Affiliation(s)
- Kevin Hung
- School of Science & Technology, The Open University of Hong Kong (OUHK), Hong Kong.
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23
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Zhang L, Yu WHA, Wang YXJ, Wang C, Zhao F, Qi W, Chan WM, Huang Y, Wai MSM, Dong J, Yew DT. DL-3-n-Butylphthalide, an anti-oxidant agent, prevents neurological deficits and cerebral injury following stroke per functional analysis, magnetic resonance imaging and histological assessment. Curr Neurovasc Res 2013; 9:167-75. [PMID: 22621233 DOI: 10.2174/156720212801618956] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 05/16/2012] [Accepted: 05/18/2012] [Indexed: 11/22/2022]
Abstract
DL-3-n-Butylphthalide (NBP) is a synthetic compound based on L-3-n-Butylphthalide which was isolated from seeds of Apium graveolens. The present study aims at evaluating the outcome of NBP given prior to and after the onset of ischemic stroke in spontaneously hypertensive rats (SHR) and normotensive Wistar Kyoto rats (WKY). Stroke was induced by the middle cerebral artery occlusion (MCAO) in SHR and WKY. For pre-treatment, NBP was administered to SHR and WKY daily for two months prior to MCAO. For post-treatment, NBP was given daily for seven consecutive days after MCAO. Seven days post-surgery, rats were tested for the presence of neurological deficits. Magnetic resonance imaging (MRI) and 2,3,5-triphenyltetrazolium chloride (TTC) staining were employed to calculate the infarct volume. The cerebral cortex and corpus striatum in the ischemic penumbra area were examined microscopically for pathological changes. In SHR, NBP pre- and post-treatment significantly lowered neurological deficit scores, reduced infarct volume, and minimized pathological changes in the penumbra area when compared to oil-vehicle treated controls. In WKY, these beneficial effects were observed only in the post-treatment group. The beneficial effects of NBP post-treatment were greater in WKY than in SHR. Results indicated that NBP could exert both preventive and therapeutic effects on ischemic stroke in SHR, but only exerted therapeutic effect in WKY.
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Affiliation(s)
- Lihong Zhang
- Brain Research Centre, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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24
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Hung ASM, Tsui TYM, Lam JCY, Wai MSM, Chan WM, Yew DT. Serotonin and its receptors in the human CNS with new findings - a mini review. Curr Med Chem 2012; 18:5281-8. [PMID: 22087825 DOI: 10.2174/092986711798184253] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/06/2011] [Accepted: 09/09/2011] [Indexed: 11/22/2022]
Abstract
Serotonin (5-hydroxytryptamine, 5-HT) is well known to be closely associated with emotional disorders, such as depression and schizophrenia. The seven main members of 5-HT receptor family including the different subtypes are involved in the functional pathways in the brain and their balance in activity helps to maintain the normal mental stability. As any detrimental changes in the 5-HT system is believed to alter emotion in human, different drugs including serotonin reuptake inhibitors (SSRIs) are nowadays commonly used as anti- depressives. In this review, 5-HT(1A) and 5-HT(2A) receptors and serotonergic positive cells in the human were highlighted in particular. It is hoped that this review will give a map of these major 5-HT receptors and serotonergic neurons in the human CNS to facilitate further deciphering of their functions.
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Affiliation(s)
- A S M Hung
- School of Biomedical Sciences, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
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25
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Bartee E, Chan WM, Moreb JS, Cogle CR, McFadden G. Selective purging of human multiple myeloma cells from autologous stem cell transplantation grafts using oncolytic myxoma virus. Biol Blood Marrow Transplant 2012; 18:1540-51. [PMID: 22516053 DOI: 10.1016/j.bbmt.2012.04.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 04/04/2012] [Indexed: 12/22/2022]
Abstract
Autologous stem cell transplantation and novel therapies have improved overall survival of patients with multiple myeloma; however, most patients relapse and eventually succumb to their disease. Evidence indicates that residual cancer cells contaminate autologous grafts and may contribute to early relapses after autologous stem cell transplantation. Here, we demonstrate that ex vivo treatment with an oncolytic poxvirus called myxoma virus results in specific elimination of human myeloma cells by inducing rapid cellular apoptosis while fully sparing normal hematopoietic stem and progenitor cells. The specificity of this elimination is based on strong binding of the virus to myeloma cells coupled with an inability of the virus to bind or infect CD34(+) hematopoietic stem and progenitor cells. These 2 features allow myxoma to readily identify and distinguish even low levels of myeloma cells in complex mixtures. This ex vivo rabbit-specific oncolytic poxvirus called myxoma virus treatment also effectively inhibits systemic in vivo engraftment of human myeloma cells into immunodeficient mice and results in efficient elimination of primary CD138(+) myeloma cells contaminating patient hematopoietic cell products. We conclude that ex vivo myxoma treatment represents a safe and effective method to selectively eliminate myeloma cells from hematopoietic autografts before reinfusion.
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Affiliation(s)
- Eric Bartee
- Department of Molecular Genetics and Microbiology, University of Florida, College of Medicine, Gainesville, Florida, USA
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26
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Abstract
OBJECTIVE To examine the association between baseline HbA(1c) level and mortality attributable to all-cause, cardiovascular disease, coronary heart disease and stroke. METHODS A total of 2137 Chinese aged 65 years or above attending the Elderly Health Service, Department of Health, Hong Kong, with diagnosed diabetes had HbA(1c) measured during 1998 to 2000 and were followed up to 2009. Information on socio-economic position, lifestyle factors and disease history was collected. Hazard ratios and 95% confidence intervals with adjustment for potential confounders were calculated using Cox's proportional hazards models. RESULTS After an average of 7.9 years of follow-up, 540 participants had died. After adjusting for potential confounders, higher HbA(1c) (≥ 69 mmol/mol, 8.5%) increased the risk of cardiovascular disease (hazard ratio 2.11;95% CI 1.37-3.25) and stroke mortality (hazard ratio 2.43; 95% CI 1.06-5.55) compared with HbA(1c) of 58-68 mmol/mol (7.5-8.4%), and increased the risk of all-cause (hazard ratio 1.41; 95% CI 1.06-1.86) and coronary heart disease mortality (hazard ratio 2.44; 95% CI 1.11-5.37) compared with HbA(1c) of 48 mmol/mol (6.5%) or less. Analysis of HbA(1c) as a continuous variable showed that every XX mmol/mol (1%) increase in HbA(1c) decreased stroke mortality risk by 51% in those with HbA(1c) level less than 48 mmol/mol (6.5%) and increased stroke mortality risk by 30% in those with an HbA(1c) level of 48 mmol/mol (6.5%) or higher, suggesting a U-shaped association between HbA(1c) and stroke mortality. CONCLUSION High HbA(1c) predicted excess risk of all-cause, cardiovascular disease, coronary heart disease and stroke mortality. The question of whether low HbA(1c) increases mortality in older patients with diabetes needs further investigation.
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Affiliation(s)
- L Xu
- Department of Community Medicine and School of Public Health, University of Hong Kong, Hong Kong, China
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Wai MSM, Chan WM, Zhang AQ, Wu Y, Yew DT. Long-term ketamine and ketamine plus alcohol treatments produced damages in liver and kidney. Hum Exp Toxicol 2012; 31:877-86. [DOI: 10.1177/0960327112436404] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ketamine is one of the common recreational drugs used in rave parties and it is frequently taken with alcohol. In spite of this, the potential toxicity of ketamine in liver and kidney has not been fully documented. In this study, ICR mice were treated for periods of 6, 16 and 28 weeks with 30 mg/kg ketamine injected daily intraperitoneally, and together with alcohol (0.5 ml of 10% alcohol for each mouse) during the last 4 weeks of the treatment periods. Our experimental results showed significant damage in liver, including fatty degeneration of liver cells, fibrosis and increase in liver glutamic oxaloacetic transaminase, proliferative cell nuclear antigen and lactate dehydrogenase after 16 weeks of treatment with ketamine. Hydropic degenerations of the kidney tubules were observed as early as 6 weeks of treatment. Long-term ketamine administration (28 weeks) led to atresia of glomeruli in the kidney. Proteinuria was confirmed in the 67% of the ketamine-treated animals after 28 weeks of treatment. It was apparent that ketamine when taken chronically (16 weeks of treatment and thereafter) affected both liver and kidney definitively. The damages in both liver and kidney of these mice were more severe when the animals were treated with both ketamine and alcohol.
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Affiliation(s)
- MSM Wai
- Brain Research Centre, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - WM Chan
- Brain Research Centre, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - AQ Zhang
- Department of Anatomy, Capital Medical University, Beijing, China
| | - Y Wu
- Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, China
| | - DT Yew
- Brain Research Centre, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Schooling CM, McGhee SM, Cowling BJ, Thomas GN, Chan WM, Ho KS, Wong VCW, Leung GM. Influenza vaccination and hospitalisation in Elderly Health Centres. Hong Kong Med J 2012; 18 Suppl 2:4-7. [PMID: 22311352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
1. A cohort of Elderly Health Centres was examined to determine whether influenza vaccination decreased hospitalisation and mortality. 2. In the influenza season, influenza vaccination reduced all-cause mortality by half and cardiorespiratory hospitalisation by a quarter. The extent to which influenza vaccination protects older people from serious morbidity and mortality needs to be confirmed in appropriately designed studies, so that scarce health care resources can be used effectively
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Affiliation(s)
- C M Schooling
- Department of Community Medicine and School of Public Health, The University of Hong Kong
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Chau PH, Woo J, Lee CH, Cheung WL, Chen J, Chan WM, Hui L, McGhee SM. Older people with diabetes have higher risk of depression, cognitive and functional impairments: implications for diabetes services. J Nutr Health Aging 2011; 15:751-5. [PMID: 22089223 DOI: 10.1007/s12603-011-0071-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the relationship between diabetes and impairments in functional and cognitive status as well as depression in older people. DESIGN Cross-sectional study. SETTING Elderly Health Centres (EHC) in Hong Kong. PARTICIPANTS 66,813 older people receiving baseline assessment at EHC in 1998 to 2001. MEASUREMENTS Diabetes status was defined by self-report and blood glucose tests. Functional status was assessed by 5 items of instrumental activities of daily living (IADL) and 7 items of activities of daily living (ADL). Cognitive status was screened by the Abbreviated Mental Test-Hong Kong version (AMT). Depressive symptoms were screened by the Geriatric Depression Scale-Chinese version (GDS). RESULTS Among the subjects, 10.4% reported having regular treatment for diabetes, 3.4% had diabetes but were not receiving regular treatment, and 86.2% did not have diabetes. After controlling for age, sex and education level, those having regular treatment for diabetes were 1.7 times more likely (OR=1.65, 95% CI: 1.51-1.80) to have functional impairment, 1.3 times more likely (OR=1.28, 95% CI: 1.11-1.48) to have cognitive impairment and 1.3 times more likely (OR=1.35, 95% CI: 1.25-1.46) to have depression, than older people without diabetes. CONCLUSION Older people with diabetes may be less capable of managing the disease than the younger ones as a result of increased risk of both physical and cognitive impairment. This study provided further evidence for the need of an international consensus statement regarding care of diabetes in older people.
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Affiliation(s)
- P H Chau
- Faculty of Social Sciences, The University of Hong Kong, Hong Kong.
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Chan WM, Liang Y, Wai MSM, Hung ASM, Yew DT. Cardiotoxicity induced in mice by long term ketamine and ketamine plus alcohol treatment. Toxicol Lett 2011; 207:191-6. [PMID: 21945864 DOI: 10.1016/j.toxlet.2011.09.008] [Citation(s) in RCA: 14] [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: 06/21/2011] [Revised: 09/06/2011] [Accepted: 09/08/2011] [Indexed: 10/17/2022]
Abstract
Increased use of ketamine as a recreational drug in rave party has raised lots of social concerns. Although its toxicity on the central nervous system (CNS) and urinary system had been reported, its potential adverse effects on the heart is still not addressed. Using our long term ketamine addiction model in which, 1-month-old ICR mice were given ketamine intraperitoneally (i.p. 30 mg/kg) for different study periods (6 weeks, 16 weeks and 28 weeks). The electrocardiogram (ECG) and the level of troponin as well as the presence of lactate dehydrogenase were used together to determine the cardiac function of mice. ST elevations were observed in 30% of mice from 6 weeks onwards. Concomitant increase in troponin in serum and presence of lactate dehydrogenase positive cardiac cells were taken together to indicate cardiac damages. The potential interactive effects of alcohol (ethanol) and ketamine were also addressed and 0.5 ml of 10% ethanol was administrated additionally to the mice daily and orally for the last 4 weeks in the 28-week long-term ketamine treated animals. The cardiac functions of these mice deteriorated more severely as indicated by further rise in troponin levels. In addition, high number of lactate dehydrogenase positive cardiac cells and abnormal ECGs in both ketamine and ketamine plus alcohol treated models also gave coherent conclusions.
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Affiliation(s)
- W M Chan
- Brain Research Centre, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
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31
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Chan WM, Xu J, Fan M, Jiang Y, Tsui TYM, Wai MSM, Lam WP, Yew DT. Downregulation in the human and mice cerebella after ketamine versus ketamine plus ethanol treatment. Microsc Res Tech 2011; 75:258-64. [PMID: 21809417 DOI: 10.1002/jemt.21052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 06/08/2011] [Indexed: 12/17/2022]
Abstract
To study the deleterious effects of ketamine and the potential interaction effects between ethanol and ketamine on the cerebellum, functional magnetic resonance imaging (fMRI) tests were performed on the habitual ketamine users (n = 3) when they flexed and extended their upper limbs. Another fMRI test was performed on the same participants in which they consumed alcohol (12%, 200 mL) 1 h before the test. Downregulation on the activity of cerebellum was observed and the level of activation in the cerebellum decreased dramatically in habitual ketamine users with alcohol consumption before the test. Further studies were performed by using male ICR mice receiving treatment of ketamine only [30 mg kg(-1) intraperitoneally (i.p.)] or ethanol only everyday (0.5 mL 12% orally) and those with coadministration of the above dosages of ketamine and ethanol for 3 months. Fewer Purkinje cells were observed in the cerebellar sections of ketamine treated mice under silver staining. For TUNEL test, a significant increase in the apoptotic cells were observed in the cerebella of the ketamine treated mice (P = 0.016) and of those with co-administration of ketamine and ethanol (P < 0.001), when compared with the control. A statistical significance (P < 0.001) in two-way ANOVA test indicated that there might be an interactive mechanism between ethanol and ketamine acting on the cerebellum.
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Affiliation(s)
- W M Chan
- Brain Research Centre, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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32
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Lam LCW, Chau RCM, Wong BML, Fung AWT, Lui VWC, Tam CCW, Leung GTY, Kwok TCY, Chiu HFK, Ng S, Chan WM. Interim follow-up of a randomized controlled trial comparing Chinese style mind body (Tai Chi) and stretching exercises on cognitive function in subjects at risk of progressive cognitive decline. Int J Geriatr Psychiatry 2011; 26:733-40. [PMID: 21495078 DOI: 10.1002/gps.2602] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [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: 02/21/2010] [Accepted: 06/14/2010] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We reported the interim findings of a randomized controlled trial (RCT) to examine the effects of a mind body physical exercise (Tai Chi) on cognitive function in Chinese subjects at risk of cognitive decline. SUBJECTS 389 Chinese older persons with either a Clinical Dementia Rating (CDR 0.5) or amnestic-MCI participated in an exercise program. The exercise intervention lasted for 1 year; 171 subjects were trained with 24 forms simplified Tai Chi (Intervention, I) and 218 were trained with stretching and toning exercise (Control, C). The exercise comprised of advised exercise sessions of at least three times per week. RESULTS At 5th months (2 months after completion of training), both I and C subjects showed an improvement in global cognitive function, delayed recall and subjective cognitive complaints (paired t-tests, p < 0.05). Improvements in visual spans and CDR sum of boxes scores were observed in I group (paired t-tests, p < 0.001). Three (2.2%) and 21(10.8%) subjects from the I and C groups progressed to dementia (Pearson chi square = 8.71, OR = 5.34, 95% CI 1.56-18.29). Logistic regression analysis controlled for baseline group differences in education and cognitive function suggested I group was associated with stable CDR (OR = 0.14, 95%CI = 0.03-0.71, p = 0.02). CONCLUSIONS Our interim findings showed that Chinese style mind body (Tai Chi) exercise may offer specific benefits to cognition, potential clinical interests should be further explored with longer observation period.
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Affiliation(s)
- Linda C W Lam
- Department of Psychiatry, the Chinese University of Hong Kong, China.
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Ngai CW, Lam MF, Lo SH, Cheung CW, Chan WM. Use of Doppler ultrasound renal resistive index and neutrophil gelatinase-associated lipocalin in prediction of acute kidney injury in patients with septic shock. Crit Care 2011. [PMCID: PMC3061738 DOI: 10.1186/cc9528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chan WM, Mak J, Epstein RJ. Impact of income and education on drug purchasing decisions in Hong Kong Chinese cancer patients: a pilot study. Asian Pac J Cancer Prev 2011; 12:2093-2096. [PMID: 22292657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The affordability of diagnostic, preventive and therapeutic interventions is a global concern, particularly in the developing world. To clarify the educational and financial factors that influence purchasing decisions, we conducted a survey of Hong Kong cancer patients across a broad social spectrum. METHODS A questionnaire was designed to assess the effect of costs on purchasing decisions relating to six drug-related variables: efficacy, tolerability, convenience, safety, peer pressure, and uncertainty. Validation of the original 31-part survey resulted in a final set of 22 core questions that was administered to 51 consecutive oncology patients who were characterized in terms of varying household income and educational level. RESULTS Most respondents (87.6%) were Hong Kong-born or mainland Chinese. There was a strong correlation between household income and education. Demand for drug tolerability and safety was high and cost-inelastic across all educational and income groups. An unexpected finding was that patients from low-income/education households were keen to purchase costly medications (whether Western, or Chinese herbs) of reputed high efficacy, whereas patients from middle-income/-education backgrounds were more negatively influenced by considerations of cost. Only the most affluent and well-educated patients valued overall survival above disease-free survival when making drug purchasing decisions; this cohort was also the least influenced by peer pressure, and the most willing to pay extra for drugs offering more convenience alone. CONCLUSION Low-income/education Asian patients had paradoxically high expectations of costly drug interventions. Although larger studies addressing this issue are needed to confirm these conclusions, public education initiatives aimed at protecting low-income/education patients from exploitation or disappointment may be desirable.
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Affiliation(s)
- W M Chan
- Division of Haematology and Oncology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
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Chan WM, Kalkanoglu AE, Ward BM. The inability of vaccinia virus A33R protein to form intermolecular disulfide-bonded homodimers does not affect the production of infectious extracellular virus. Virology 2010; 408:109-18. [PMID: 20947114 DOI: 10.1016/j.virol.2010.09.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 09/10/2010] [Accepted: 09/19/2010] [Indexed: 10/19/2022]
Abstract
The orthopoxvirus protein A33 forms a disulfide-bonded high molecular weight species that could be either a homodimer or a heteromultimer. The protein is a major target for neutralizing antibodies and the majority of antibodies raised against A33 only recognize the disulfide-bonded form. Here, we report that A33 is present as a disulfide-bonded homodimer during infection. Additionally, we examined the function of intermolecular disulfide bonding in A33 homodimerization during infection. We show that the cysteine at amino acid 62 is required for intermolecular disulfide bonding, but not dimerization as this mutant was still able to form homodimers. To investigate the role of disulfide-bonded homodimers during viral morphogenesis, recombinant viruses that express an A33R with cysteine 62 mutated to serine were generated. The recombinant viruses had growth characteristics similar to their parental viruses, indicating that intermolecular disulfide-bonded homodimerization of A33 is not required for its function.
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Affiliation(s)
- Winnie M Chan
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA
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Cheng VCC, Tai JWM, Chan WM, Lau EHY, Chan JFW, To KKW, Li IWS, Ho PL, Yuen KY. Sequential introduction of single room isolation and hand hygiene campaign in the control of methicillin-resistant Staphylococcus aureus in intensive care unit. BMC Infect Dis 2010; 10:263. [PMID: 20822509 PMCID: PMC2944349 DOI: 10.1186/1471-2334-10-263] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 09/07/2010] [Indexed: 02/04/2023] Open
Abstract
Background After renovation of the adult intensive care unit (ICU) with installation of ten single rooms, an enhanced infection control program was conducted to control the spread of methicillin-resistant Staphylococcus aureus (MRSA) in our hospital. Methods Since the ICU renovation, all patients colonized or infected with MRSA were nursed in single rooms with contact precautions. The incidence of MRSA infection in the ICU was monitored during 3 different phases: the baseline period (phase 1); after ICU renovation (phase 2) and after implementation of a hand hygiene campaign with alcohol-based hand rub (phase 3). Patients infected with extended spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species were chosen as controls because they were managed in open cubicles with standard precautions. Results Without a major change in bed occupancy rate, nursing workforce, or the protocol of environmental cleansing throughout the study period, a stepwise reduction in ICU onset nonbacteraemic MRSA infection was observed: from 3.54 (phase 1) to 2.26 (phase 2, p = 0.042) and 1.02 (phase 3, p = 0.006) per 1000-patient-days. ICU onset bacteraemic MRSA infection was significantly reduced from 1.94 (phase 1) to 0.9 (phase 2, p = 0.005) and 0.28 (phase 3, p = 0.021) per 1000-patient-days. Infection due to ESBL-producing organisms did not show a corresponding reduction. The usage density of broad-spectrum antibiotics and fluoroquinolones increased from phase 1 to 3. However a significant trend improvement of ICU onset MRSA infection by segmented regression analysis can only be demonstrated when comparison was made before and after the severe acute respiratory syndrome (SARS) epidemic. This suggests that the deaths of fellow healthcare workers from an occupational acquired infection had an overwhelming effect on their compliance with infection control measures. Conclusion Provision of single room isolation facilities and promotion of hand hygiene practice are important. However compliance with infection control measures relies largely on a personal commitment, which may increase when personal safety is threatened.
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Affiliation(s)
- Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
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Kwok TCY, Yuen KSL, Ho FKY, Chan WM. Getting lost in the community: a phone survey on the community-dwelling demented people in Hong Kong. Int J Geriatr Psychiatry 2010; 25:427-32. [PMID: 19653244 DOI: 10.1002/gps.2361] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Research from Western countries reported that the incidence rate of dementia patients getting lost in the community ranged from 30 to 60%. It had imposed significant burden on the caregivers. In the current study, we investigated the situation on the incidents of getting lost in a densely populated as well as homogenous community environment. METHODS Two hundred and fifty one caregivers of older adults with demented people who had either used dementia day care service or participated in a community survey were interviewed on the telephone. Respondents were asked on older adult's experience of getting lost in the community and their mode of care. Correlating factors of such incidents were examined. RESULTS The overall prevalence of lost history in our subjects was 27.5%. The subjects recruited from day care center were much more likely than those recruited from the community survey to have lost history (39.2% vs. 7.5%, p < 0.0001, chi(2) test). Greater degrees of cognitive decline were associated with greater chance of having had lost episodes. Immobility was associated with lower risk. Both the older people and their caregivers had reported significant degrees of psychological disturbances after the incidents. CONCLUSION Demented people with greater degrees of cognitive decline and with mobility maintained are at greater risk of getting lost.
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Ting W, Cheung MC, Ng SP, Wan SY, Chan WM. Phy03 Effects of an Integrated Activity Programme for Demented Elders Living in Private Residential Care Homes. Hong Kong J Occup Ther 2009. [DOI: 10.1016/s1569-1861(10)70015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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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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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 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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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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Chan WM. Towards a better outcome of cardiopulmonary resuscitation. Hong Kong Med J 2007; 13:256-7. [PMID: 17664530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
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Abstract
AIMS More than 20 mutations associated with retinitis pigmentosa (RP) have been identified in the retinitis pigmentosa 1 (RP1) gene, all of them leading to the production of a truncated protein without 50-70% of the C-terminal of the RP1 protein. RP1 was recently found to be a microtubule-associated protein (MAP) and responsible for the organisation of the photoreceptor outer segment. The N-terminal doublecortin (DCX) domain of RP1 is essential for its function. But how the C-terminal of the protein affects its function is still not known. This study aims to get a better understanding of the RP1 gene by mutation screening on RP patients. METHODS Peripheral blood was taken from 72 RP patients. Together with 101 RP patients and 190 control subjects previously reported, mutation screening was performed by polymerase chain reaction (PCR) and direct sequencing. Statistical analysis was performed using SPSS. RESULTS Two novel missense sequence changes, D984G and C727W, and one novel variant, 6492T>G, at the 3' untranslated region were found. They were not found in 190 control subjects. D984G causes RP. It creates two possible N-myristoylation sites according to PROSITE. C727W does not segregate with RP in the family. It abolishes an N-myristoylation site. R872H, a previously reported polymorphism, was predominantly present in control subjects (P=0.001). CONCLUSIONS Our results suggest that disruption of the C-terminal of RP1 may be associated with the development of RP, and the possible involvement of the RP1 polypeptide downstream of its DCX domain in normal RP1 function.
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Affiliation(s)
- S W Y Chiang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Abd El-Aziz MM, El-Ashry MF, Chan WM, Chong KL, Barragan I, Antiñolo G, Pang CP, Bhattacharya SS. A novel genetic study of Chinese families with autosomal recessive retinitis pigmentosa. Ann Hum Genet 2006; 71:281-94. [PMID: 17156103 DOI: 10.1111/j.1469-1809.2006.00333.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 01/17/2023]
Abstract
Autosomal recessive retinitis pigmentosa (arRP) is the commonest form of RP worldwide. To date 22 loci have been implicated in the pathogenesis of this disease; however none of these loci independently account for a significant proportion of recessive RP. Linkage studies of arRP in consanguineous families have been mainly based on homozygosity mapping, but this strategy cannot be applied in the case of non-consanguineous families. Therefore, we implemented a systematic approach for identifying the disease locus in three non-consanguineous Chinese families with arRP. Initially, linkage analysis using SNPs/microsatellite markers or mutation screening of known arRP genes excluded all loci/genes except RP25 on chromosome 6. Subsequently a whole genome scan for the three families using the 10K GeneChip Mapping Array was performed, in order to identify the possible disease locus. To the best of our knowledge this is the first report on the utilisation of the 10K GeneChip to study linkage in non-consanguineous Chinese arRP. This analysis indicates that the studied families are probably linked to the RP25 locus, a well defined arRP locus in other populations. The identification of another ethnic group linked to RP25 is highly suggestive that this represents a major locus for arRP.
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Affiliation(s)
- M M Abd El-Aziz
- Department of Molecular Genetics, Institute of Ophthalmology, London EC1V 9EL, UK.
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Heung LCL, Li T, Mak SK, Chan WM. Prevalence of subclinical infection and transmission of severe acute respiratory syndrome (SARS) in a residential care home for the elderly. Hong Kong Med J 2006; 12:201-7. [PMID: 16760548] [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: 05/10/2023] Open
Abstract
OBJECTIVE To ascertain the prevalence of subclinical severe acute respiratory syndrome-coronavirus (SARS-CoV) infection and study the transmission of SARS-CoV in a local outbreak at a residential care home for the elderly. DESIGN Cross-sectional study. SETTING A residential care home for the elderly in Hong Kong with a local outbreak of SARS. PARTICIPANTS Residents and staff in the residential care home who had contact with three patients with SARS (residents A and B, and staff C). MAIN OUTCOME MEASURES Blood samples were tested for total antibodies to SARS-CoV by immunofluorescence antibody test. The transmission of SARS was elucidated based on information from standardised questionnaires, and records of investigation and surveillance by the Department of Health. RESULTS Among the 90 eligible residents, three died, one moved out, and 19 refused to participate. Of the 32 eligible staff, six refused to participate. None of the remaining 93 participants tested positive for antibody to SARS-CoV. Based on the chronological order, resident A might have transmitted infection to resident B and staff C. Sitting close to the bathroom doorway while resident A took a shower was the only contact of resident B with resident A. The only opportunity for staff C to have contact with body fluids/excreta of resident A was in the handling of rubbish from the resident's room. CONCLUSION Subclinical SARS-CoV infection was rare in a residential care home for the elderly with an outbreak of SARS. Nonetheless the close working and living conditions for staff and residents in such a home may facilitate transmission of SARS despite vigilant precautionary measures.
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Affiliation(s)
- L C L Heung
- Elderly Health Services, Department of Health, 35/F Hopewell Centre, 183 Queen's Road East, Wanchai, Hong Kong.
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Chong K, Chan WM, Lam DS. Effect of Smoking in Graves Ophthalmopathy: Are Pediatric Patients Exempted? Ophthalmic Plast Reconstr Surg 2006; 22:241-2. [PMID: 16714953 DOI: 10.1097/01.iop.0000217777.15305.f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cheng ACK, Yuen KSC, Chan WM. Assessing the accuracy of Orbscan II post-LASIK: apparent keratectasia is paradoxically associated with anterior chamber depth reduction in successful procedures - comment. Clin Exp Ophthalmol 2006; 34:94-5; author reply 95. [PMID: 16451273 DOI: 10.1111/j.1442-9071.2006.01159.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sivaprasad S, Membrey WL, Sivagnanavel V, Gonzalez JG, Liu DTL, Chan WM, Lam DSC, Jackson H, Chong NV. Second eye of patients with unilateral neovascular age-related macular degeneration: Caucasians vs Chinese. Eye (Lond) 2005; 20:923-6. [PMID: 16123783 DOI: 10.1038/sj.eye.6702056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/08/2022] Open
Abstract
PURPOSE To investigate the correlation between morphological features of choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD) in the first eye and the severity of age-related maculopathy (ARM) in the fellow eyes in two racial groups: Caucasians and Chinese. PARTICIPANTS A total of 135, fluorescein angiograms of patients with unilateral neovascular AMD and ARM in the fellow eyes were included in the study: 38 Caucasians from King's College Hospital, UK; 45 Caucasians from West Kent Eye Centre, UK; 52 Chinese from Hong Kong Eye Hospital, Hong Kong. MAIN OUTCOME MEASURES CNV subtype in the affected eye and ARM severity in the second eyes. RESULTS Although the proportion of CNV subtypes in the three groups were similar, the Chinese cohort showed significantly less ARM severity compared to the Caucasian cohorts (P < 0.05). CONCLUSION Although drusen and retinal pigmentary changes may be prognostic indicators of CNV, this study suggest that other factors contribute significantly to the pathogenesis of CNV in AMD.
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Affiliation(s)
- S Sivaprasad
- Retinal Research Unit, King's College Hospital, Denmark Hill, London, UK
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