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Lam TJR, Liu Z, Tan BYQ, Ng YY, Tan CK, Wong XY, Venketasubramanian N, Yeo LLL, Ho AFW, Ong MEH. Prehospital stroke care in Singapore. Singapore Med J 2024:00077293-990000000-00102. [PMID: 38449072 DOI: 10.4103/singaporemedj.smj-2023-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/03/2023] [Indexed: 03/08/2024]
Abstract
ABSTRACT Due to the narrow window of opportunity for stroke therapeutics to be employed, effectiveness of stroke care systems is predicated on the efficiency of prehospital stroke systems. A robust prehospital stroke system of care that provides a rapid and well-coordinated response maximises favourable poststroke outcomes, but achieving this presents a unique set of challenges dependent on demographic and geographical circumstances. Set in the context of a highly urbanised first-world nation with a rising burden of stroke, Singapore's prehospital stroke system has evolved to reflect the environment in which it operates. This review aims to characterise the current state of prehospital stroke care in Singapore, covering prehospital aspects of the stroke survival chain from symptom onset till arrival at the emergency department. We identify areas for improvement and innovation, as well as provide insights into the possible future of prehospital stroke care in Singapore.
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Affiliation(s)
| | - Zhenghong Liu
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Yih Ying Ng
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore
- Ministry of Home Affairs, Singapore Civil Defence Force, Singapore
| | - Colin Kaihui Tan
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Xiang Yi Wong
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | | | | | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Pre-Hospital and Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Pre-Hospital and Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore
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Chua GWY, Ho BS, Ng YY, Master ZR, Sultana R, Cheah P, Kusumawidjaja G. Intensity-Modulated Proton Therapy (IMPT) Offered Advantageous Dosimetry Compared to Volumetric Arc Therapy (VMAT) or Helical Tomotherapy (HT) in Patients with Synchronous Bilateral Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e169-e170. [PMID: 37784773 DOI: 10.1016/j.ijrobp.2023.06.1010] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiotherapy of synchronous bilateral breast cancer poses some technical challenges with regards to dose coverage and sparing of organs at risk (OAR). In this study, we aimed to evaluate dosimetric characteristics of 3 different techniques, IMPT vs photon (VMAT and HT). We hypothesized that IMPT would result in lower doses to organs at risk, as compared to the other 2 techniques. MATERIALS/METHODS A total of 10 patients with synchronous bilateral breast cancer who were treated with VMAT at our institution were retrospectively analyzed. Clinical target volume (CTV) included chest wall and regional nodes (supraclavicular fossa and internal mammary chain) and prescription dose was 40.05 Gy in 15 daily fractions. HT and IMPT plans were generated for each patient. Dose-volume statistics, including planning target volume (PTV) coverage and dose to OAR: lungs, heart, thyroid, spinal cord, brachial plexus and esophagus, were compared between modalities using a paired T-test. RESULTS Mean age of patients was 61 years (43-84). Majority of the patients (80%) were ER+ PR+ and HER2-. 40% of patients underwent breast reconstruction following surgery. All 3 techniques provided adequate target volume distribution and OAR sparing. Compared to VMAT and HT plans, IMPT had better heart and lung sparing effects, resulting in lower mean and V25 Gy heart dose; mean, V20 Gy and V5 Gy lung dose (p<0.0001). There was no significant difference in VMAT and HT plans for mean heart and lung dose. VMAT plans showed significantly lower V25 Gy heart dose on average (p = 0.04). V5 Gy lung dose was slightly lower in HT compared to VMAT plans, approaching statistical significance (p = 0.08). PTV coverage was adequate for all 3 techniques. All techniques fulfilled cord, esophagus, thyroid and brachial plexus constraints. CONCLUSION IMPT plans showed significantly better OAR sparing compared to photon techniques. All 3 techniques met OAR constraints, and resulted in adequate target volume coverage. As IMPT is significantly more costly than VMAT or HT techniques, appropriate patient selection is important to deliver treatment in the most resource-effective manner for patients who would derive the most benefit, for example those with young age or existing heart or lung comorbidities.
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Affiliation(s)
- G W Y Chua
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - B S Ho
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Y Y Ng
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Z R Master
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - R Sultana
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - P Cheah
- Transmedic Healthcare Sdn Bhd, Kuala Lumpur, Kuala Lump, Malaysia
| | - G Kusumawidjaja
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore
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Tam EMYY, Kwan YK, Ng YY, Yam PW. Clinical course and mortality in older patients with COVID-19: a cluster-based study in Hong Kong. Hong Kong Med J 2022; 28:215-222. [PMID: 35686472 DOI: 10.12809/hkmj219367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Compared with previous waves of the coronavirus disease 2019 (COVID-19) pandemic in Hong Kong, the third wave involved a greater number of frail older patients. Because local healthcare policy required hospitalisation for all older adults with COVID-19, we aimed to investigate the clinical course and outcomes in such patients. METHODS This retrospective observational study included all patients aged ≥65 years who were admitted to Tuen Mun Hospital for management of COVID-19 between 1 July 2020 and 31 August 2020. We reviewed baseline characteristics, clinical presentation, laboratory results, complications, and outcomes. We also investigated the associations of age and Clinical Frailty Scale (CFS) score with in-patient mortality. RESULTS In total, 101 patients were included (median age, 73 years); 52.5% were men and 85% had at least co-morbid chronic disease. The most common symptoms were fever (80.2%) and cough (63.4%). Fifty-two patients (51.5%) developed hypoxia, generally on day 8 (interquartile range, 5-11) after symptom onset. Of the 16 patients who required intensive care unit support, 13 required mechanical ventilation. The overall mortality rate was 16.8%. Patients aged 65-69, 70-79, 80-89, and ≥90 years had mortality rates of 9.1%, 10%, 30%, and 25%, respectively. Patients with CFS scores of 1-2, 3-4, 5-6, and ≥7 had mortality rates of 5.7%, 14.7%, 23.5%, and 40%, respectively. A linear relationship was confirmed between the two mortality trends. CONCLUSION Clinical deterioration was common in older patients with COVID-19; their overall mortality rate was 16.8%. Mortality increased linearly with both age and CFS score.
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Affiliation(s)
| | - YK Kwan
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong
| | - YY Ng
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong
| | - PW Yam
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong
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Sin SY, Chua MLK, Wong SMM, Sommat K, Lin XY, Ng YY, Soong YL. An evaluation of concordance between head and neck advanced practice radiation therapist and radiation oncologists in toxicity assessment for nasopharyngeal carcinoma patients. Tech Innov Patient Support Radiat Oncol 2021; 19:52-56. [PMID: 34527820 PMCID: PMC8430423 DOI: 10.1016/j.tipsro.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/24/2021] [Accepted: 08/05/2021] [Indexed: 12/01/2022] Open
Abstract
Show concordance in toxicity assessment between Head and Neck Advanced Practice Radiation Therapist (APRT) and Radiation Oncologist (RO) for Nasopharyngeal Carcinoma (NPC) patients. Describe the importance of timely treatment for NPC patients. Underline the important role development of APRT in complementing the RO. Different ways of data analysis to support the concordance study.
Background Weekly toxicity assessments for patients undergoing head and neck (HN) radiotherapy are essential to ensure that acute side effects are appropriately managed in order for patients to complete their treatment in a safe and timely manner. The incorporation of Advanced Practice Radiation Therapist (APRT) led treatment reviews has been reported for various subsites, but there is currently a lack of published literature regarding this role for patients with HN cancer. The purpose of this study is to assess the concordance of toxicity assessments performed during weekly radiotherapy treatment reviews for patients undergoing HN radiotherapy between the HN APRT and Radiation Oncologist (RO). Methods Twenty-three patients with nasopharyngeal cancer (NPC) under the care of 3 ROs were recruited from June to December 2018; weekly assessments were independently performed by HN APRT and ROs. The HN toxicity assessment was graded according to the Common Terminology Criteria for Advanced Events v4.0. Both assessors were blinded to each other’s assessments. The percentage agreement of concordance and agreement level were interpreted by Cohen’s Kappa statistic (κ), with the ROs’ assessments deemed as the ‘gold standard’. Results The overall concordance for all graded toxicity assessments between HN APRT and ROs was 78.4%. Xerostomia, dysgeusia, pharyngeal pain and dermatitis assessment were evaluated as ‘Good’ with agreement ranging from κ = 0.608–0.640 between the HN APRT and ROs while dysphagia scored an ‘Almost Perfect’ agreement of κ = 0.834. ‘Moderate’ agreement between the HN APRT and ROs was observed for oral pain and mucositis assessment. A scoring discrepancy of 1 and 2 grades was observed in 21.2% and 0.4% for these two toxicities. Conclusion There was high concordance in scoring of acute toxicity between the HN APRT and ROs. The results support the continuing involvement of HN APRT in weekly assessments for NPC patients.
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Affiliation(s)
- S Y Sin
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Duke-National University of Singapore, Graduate Medical School, Singapore
| | - Sharon M M Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,College of Allied Health-SingHealth Academy, Singapore.,Singapore Institute of Technology, Singapore
| | - K Sommat
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Duke-National University of Singapore, Graduate Medical School, Singapore
| | - X Y Lin
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Y Y Ng
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Y L Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.,Duke-National University of Singapore, Graduate Medical School, Singapore
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Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, Ng YY, Chu MY, Chung TWH, Tam AR, Yip CCY, Leung KH, Fung AYF, Zhang RR, Lin Y, Cheng HM, Zhang AJX, To KKW, Chan KH, Yuen KY, Leung WK. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. Gastroenterology 2020; 159:81-95. [PMID: 32251668 PMCID: PMC7194936 DOI: 10.1053/j.gastro.2020.03.065] [Citation(s) in RCA: 1046] [Impact Index Per Article: 261.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been characterized by fever, respiratory, and gastrointestinal symptoms as well as shedding of virus RNA into feces. We performed a systematic review and meta-analysis of published gastrointestinal symptoms and detection of virus in stool and also summarized data from a cohort of patients with COVID-19 in Hong Kong. METHODS We collected data from the cohort of patients with COVID-19 in Hong Kong (N = 59; diagnosis from February 2 through February 29, 2020),and searched PubMed, Embase, Cochrane, and 3 Chinese databases through March 11, 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We analyzed pooled data on the prevalence of overall and individual gastrointestinal symptoms (loss of appetite, nausea, vomiting, diarrhea, and abdominal pain or discomfort) using a random effects model. RESULTS Among the 59 patients with COVID-19 in Hong Kong, 15 patients (25.4%) had gastrointestinal symptoms, and 9 patients (15.3%) had stool that tested positive for virus RNA. Stool viral RNA was detected in 38.5% and 8.7% among those with and without diarrhea, respectively (P = .02). The median fecal viral load was 5.1 log10 copies per milliliter in patients with diarrhea vs 3.9 log10 copies per milliliter in patients without diarrhea (P = .06). In a meta-analysis of 60 studies comprising 4243 patients, the pooled prevalence of all gastrointestinal symptoms was 17.6% (95% confidence interval [CI], 12.3-24.5); 11.8% of patients with nonsevere COVID-19 had gastrointestinal symptoms (95% CI, 4.1-29.1), and 17.1% of patients with severe COVID-19 had gastrointestinal symptoms (95% CI, 6.9-36.7). In the meta-analysis, the pooled prevalence of stool samples that were positive for virus RNA was 48.1% (95% CI, 38.3-57.9); of these samples, 70.3% of those collected after loss of virus from respiratory specimens tested positive for the virus (95% CI, 49.6-85.1). CONCLUSIONS In an analysis of data from the Hong Kong cohort of patients with COVID-19 and a meta-analysis of findings from publications, we found that 17.6% of patients with COVID-19 had gastrointestinal symptoms. Virus RNA was detected in stool samples from 48.1% patients, even in stool collected after respiratory samples had negative test results. Health care workers should therefore exercise caution in collecting fecal samples or performing endoscopic procedures in patients with COVID-19, even during patient recovery.
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Affiliation(s)
- Ka Shing Cheung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ivan F N Hung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
| | - Pierre P Y Chan
- Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospital, Hong Kong
| | - K C Lung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Eugene Tso
- Department of Medicine, United Christian Hospital, Hong Kong
| | - Raymond Liu
- Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospital, Hong Kong
| | - Y Y Ng
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Man Y Chu
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Tom W H Chung
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Anthony Raymond Tam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Cyril C Y Yip
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kit-Hang Leung
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Agnes Yim-Fong Fung
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
| | - Ricky R Zhang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
| | - Yansheng Lin
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ho Ming Cheng
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Anna J X Zhang
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
| | - Kelvin K W To
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong; Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kwok-H Chan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong; Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kwok-Y Yuen
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
| | - Wai K Leung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
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Lim BL, Cheah SO, Goh HK, Lee FCY, Ng YY, Asinas-Tan M, Ong MEH. Long-term effect of hyperoxemia during chronic obstructive pulmonary disease exacerbation managed by emergency medical service and emergency department: a prospective, exploratory study. Eur J Emerg Med 2020; 27:461-467. [PMID: 32516160 DOI: 10.1097/mej.0000000000000727] [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: 11/25/2022]
Abstract
OBJECTIVE Long-term effects of hyperoxemia during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remained unknown. We aimed to explore these effects of hyperoxemia during AECOPD. METHODS This was an exploratory follow-up study of a cohort with AECOPD managed by Emergency Medical Service and two emergency departments (EDs). Patients were classified as hyperoxemic (PaO2 > 65 mmHg) or nonhyperoxemic (PaO2 ≤ 65 mmHg). Patients discharged from ED/inpatient care were followed up prospectively for 1 year. The primary outcome was 1-year all-cause mortality in hyperoxemic vs. nonhyperoxemic groups. Secondary outcomes were 3-month all-cause mortality and median number of repeat AECOPD hospitalizations within 1 year. We generated Kaplan-Meier curves and compared them using log-rank test. The primary outcome was also analyzed using Cox proportional-hazards model. We reported crude and adjusted hazard ratios, their 95% confidence intervals (CIs) and P values. We adjusted for two a priori predictors of delayed mortality; age ≥ 70 years and repeat AECOPD hospitalizations. RESULTS A total of 231 patients were analyzed. One-year mortality rates in hyperoxemic vs. nonhyperoxemic groups were 26/137 (19.0%) and 12/94 (12.8%), respectively (P = 0.693). Although Kaplan-Meier curves showed divergent courses favoring nonhyperoxemic group, log-rank test was not statistically significant (P = 0.203). The crude and adjusted hazard ratios (reference: nonhyperoxemic group) were 1.55 (95% CIs, 0.78-3.08; P = 0.207) and 1.57 (95% CIs, 0.79-3.13; P = 0.196), respectively. Secondary outcomes did not differ. CONCLUSIONS Our study reported no effect on 1-year all-cause mortality associated with hyperoxemia during AECOPD. Further studies are needed to prove/disprove our findings.
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Affiliation(s)
| | - Si Oon Cheah
- Emergency Department, Ng Teng Fong General Hospital
| | - Hsin Kai Goh
- Emergency Department, Khoo Teck Phuat General Hospital
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Patiroglu T, Akar HH, Gunduz Z, Sisko S, Ng YY. X-linked agammaglobulinemia in two siblings with a novel mutation in theBTKgene who presented with polyarticular juvenile idiopathic arthritis. Scand J Rheumatol 2015; 44:168-70. [DOI: 10.3109/03009742.2014.995699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ong MEH, Wah W, Hsu LY, Ng YY, Leong BSH, Goh ES, Gan HN, Tham LP, Charles RA, Foo DCG, Earnest A. Geographic factors are associated with increased risk for out-of hospital cardiac arrests and provision of bystander cardio-pulmonary resuscitation in Singapore. Resuscitation 2014; 85:1153-60. [DOI: 10.1016/j.resuscitation.2014.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/07/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
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Ko SH, Chiang KL, Kao HW, Chen LC, Ng CJ, Chen PY, Chen JY, Yang WC, Ng YY. Crystallization in transfer set before continuous ambulatory peritoneal dialysis initiation-three case reports. Perit Dial Int 2014; 34:244-5. [PMID: 24676746 DOI: 10.3747/pdi.2012.00344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S H Ko
- Division of Nephrology1 Department of Medicine2 Department of Teaching3 Taipei Veterans General Hospital National Yang-Ming University School of Medicine Taipei, Taiwan
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Abstract
Radiation injuries are closer to home than expected as radioactive sources are common in daily life. Our case study illustrates a case of radiation burns to the hand which presented about two weeks later to the emergency department after accidental exposure to an industrial radiation source. A 45-year old Chinese man presented 17 days later after being exposed accidentally to iridium-192 source at 43 curies. He subsequently suffered burns that required multiple operations to treat. The diagnosis of patients who present early after exposure with no clinical signs will likely pose a challenge for the emergency medicine clinician as radiation burns take time to manifest and may present days to weeks after radiation exposure.
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Affiliation(s)
| | - Jean Mui Hua Lee
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Yih Ying Ng
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - R Ponampalam
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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Chang YC, Lee KH, Chen TH, Tsai PJ, Chen PY, Guo MC, Lin SA, Chen JY, Yang WC, Ng YY. A case of intraperitoneal fracture of a double-cuff Tenckhoff catheter. Perit Dial Int 2014; 34:132-4. [PMID: 24525604 DOI: 10.3747/pdi.2012.00239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Y C Chang
- Division of Nephrology1 Department of Medicine2 Department of Surgery3 Taipei Veterans General Hospital National Yang-Ming University School of Medicine Taipei, Taiwan
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Wei Lam SS, Zhang ZC, Oh HC, Ng YY, Wah W, Hock Ong ME. Reducing Ambulance Response Times Using Discrete Event Simulation. PREHOSP EMERG CARE 2013; 18:207-16. [DOI: 10.3109/10903127.2013.836266] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ou SM, Lee SY, Chen JY, Cheng HW, Wei TH, Yu KW, Lin WM, King KL, Yang WC, Ng YY. First identification of Gordonia sputi in a continuous ambulatory peritoneal dialysis patient with Peritonitis. Perit Dial Int 2013; 33:107-8. [PMID: 23349205 DOI: 10.3747/pdi.2012.00030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wu YL, Chen LC, Sheu MH, Chen TH, Wu SC, Wu CL, Li SY, Yang WC, Ng YY. Peritoneal-uterine communication: a complication of prolonged embedding of a peritoneal catheter. ARCH ESP UROL 2012; 32:481-3. [PMID: 22859846 DOI: 10.3747/pdi.2011.00016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ng YY, Baert MRM, Pike-Overzet K, Rodijk M, Brugman MH, Schambach A, Baum C, Hendriks RW, van Dongen JJM, Staal FJT. Correction of B-cell development in Btk-deficient mice using lentiviral vectors with codon-optimized human BTK. Leukemia 2010; 24:1617-30. [PMID: 20574453 DOI: 10.1038/leu.2010.140] [Citation(s) in RCA: 32] [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] [Indexed: 11/09/2022]
Abstract
X-linked agammaglobulinemia (XLA) is the most common primary immunodeficiency (PID) in man and caused by mutations in the Bruton's tyrosine kinase (BTK) gene. XLA is characterized by a B-cell differentiation arrest in bone marrow, absence of mature B cells and immunoglobulins (Igs), and recurrent bacterial infections. We used self-inactivating lentiviral vectors expressing codon-optimized human BTK under the control of three different ubiquitous or B cell-specific promoters. Btk-/- mice engrafted with transduced cells showed correction of both precursor B-cell and peripheral B-cell development. Lentiviral vectors containing the wildtype BTK sequence did not correct the phenotype. All treated mice with codon-optimized BTK exhibited the recovery of B1 cells in the peritoneal cavity, and of serum IgM and IgG3 levels. Calcium mobilization responses upon B-cell receptor stimulation as well as in vivo responses to T cell-independent antigens were restored. Viral promoters overexpressing BTK >100-fold above normal resulted in erythro-myeloid proliferations independent of insertional mutagenesis. However, transplantation into secondary Btk-/- recipients using cellular promoters resulted in functional restoration of peripheral B cells and IgM levels, without any adverse effects. In conclusion, transduction of human BTK corrects B-cell development and antigen-specific antibody responses in Btk-/- mice, thus indicating the feasibility of lentiviral gene therapy for XLA, provided that BTK expression does not vastly exceed normal levels.
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Affiliation(s)
- Y Y Ng
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
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Weerkamp F, Dekking E, Ng YY, van der Velden VHJ, Wai H, Böttcher S, Brüggemann M, van der Sluijs AJ, Koning A, Boeckx N, Van Poecke N, Lucio P, Mendonça A, Sedek L, Szczepański T, Kalina T, Kovac M, Hoogeveen PG, Flores-Montero J, Orfao A, Macintyre E, Lhermitte L, Chen R, Brouwer-De Cock KAJ, van der Linden A, Noordijk AL, Comans-Bitter WM, Staal FJT, van Dongen JJM. Flow cytometric immunobead assay for the detection of BCR-ABL fusion proteins in leukemia patients. Leukemia 2009; 23:1106-17. [PMID: 19387467 DOI: 10.1038/leu.2009.93] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BCR-ABL fusion proteins show increased signaling through their ABL tyrosine kinase domain, which can be blocked by specific inhibitors, thereby providing effective treatment. This makes detection of BCR-ABL aberrations of utmost importance for diagnosis, classification and treatment of leukemia patients. BCR-ABL aberrations are currently detected by karyotyping, fluorescence in situ hybridization (FISH) or PCR techniques, which are time consuming and require specialized facilities. We developed a simple flow cytometric immunobead assay for detection of BCR-ABL fusion proteins in cell lysates, using a bead-bound anti-BCR catching antibody and a fluorochrome-conjugated anti-ABL detection antibody. We noticed protein stability problems in lysates caused by proteases from mature myeloid cells. This problem could largely be solved by adding protease inhibitors in several steps of the immunobead assay. Testing of 145 patient samples showed fully concordant results between the BCR-ABL immunobead assay and reverse transcriptase PCR of fusion gene transcripts. Dilution experiments with BCR-ABL positive cell lines revealed sensitivities of at least 1%. We conclude that the BCR-ABL immunobead assay detects all types of BCR-ABL proteins in leukemic cells with high specificity and sensitivity. The assay does not need specialized laboratory facilities other than a flow cytometer, provides results within approximately 4 h, and can be run in parallel to routine immunophenotyping.
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Affiliation(s)
- F Weerkamp
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
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Lee VJ, Low E, Ng YY, Teo C. Disaster relief and initial response to the earthquake and tsunami in Meulaboh, Indonesia. Ann Acad Med Singap 2005; 34:586-90. [PMID: 16284685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The Singapore Humanitarian Assistance Support Group deployed a team of 32 medical relief workers to Meulaboh, Indonesia to provide medical assistance for victims of the 26 December earthquake and tsunami disaster. The team was deployed at a primary healthcare clinic at an internally displaced persons' (IDP) camp and at the sole hospital's emergency and surgical departments. The team saw a total of 1841 patients, 1371 at the clinic and 446 at the hospital's emergency department, and performed surgery on 24 patients. Tsunami-related trauma cases accounted for 31.8% (142) of cases at the emergency department, 1.6% (22) of cases at the clinic, and 91.7% (22) of surgeries. This paper details the difficulties and lessons learnt by the team, including the lack of important resources for healthcare delivery. Water, sanitation, hygiene, and vector control were some of the problems faced, with the goal to provide the most effective public health for the greatest number of people given the limited resources available.
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Affiliation(s)
- V J Lee
- Headquarters Medical Crops, Singapore Armed Forces, Singapore.
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18
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Ang BCH, Chen MIC, Goh TLH, Ng YY, Fan SW. An assessment of electronically captured data in the patient care enhancement system (PACES) for syndromic surveillance. Ann Acad Med Singap 2005; 34:539-4. [PMID: 16284674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION A common approach to the surveillance of emerging infectious diseases and agents of bioterrorism is to analyse electronically captured data for disease syndromes. The Patient Care Enhancement System (PACES) is a form of electronic medical records presently in service in the Singapore Armed Forces (SAF). We assess the feasibility of PACES data for surveillance, describe time-trends, and identify methods of sub-analysis which could improve performance. MATERIALS AND METHODS Medical consults from July 2000 to June 2003 were extracted. Diagnosis codes were mapped to 7 infectious disease syndromes according to the categorisation in the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE): gastrointestinal (GI), fever (FEVER), respiratory, (RESP), coma (COMA), neurological (NEURO), dermatologic-haemorrhagic (DERMHEM) and dermatologic- infectious (DERM-INF). RESULTS A total of 732,233 episodes of care were analysed. Weekly periodicity was observed, with decreased weekend consults; there were no obvious seasonal trends in any of the syndromes. RESP, FEVER and GI syndromes were common events. Sub-analyses, either by restricting to cases with a repeated consultation, or grouping the data by medical centres, could dramatically lower thresholds used to flag outbreaks. CONCLUSION In spite of the level of background noise inherent in a system consisting mainly of primary care consults, sub-analysis by medical centre, or restriction to cases with repeated consults were able to yield sensitive thresholds for outbreak detection.
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Affiliation(s)
- B C H Ang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Chiang YC, Huei SS, Ng YY, Yang WC. Unusual presentation of peritonitis in a CAPD patient with lupus vasculitis. Perit Dial Int 2005; 25:199-200. [PMID: 15796151] [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: 05/02/2023] Open
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20
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Abstract
Appendicitis is an important differential diagnosis in patients with right iliac fossa pain. The diagnosis in patients with equivocal signs can be difficult. Many patients with suspected appendicitis are admitted for observation. We studied the Alvarado scores of 175 patients who presented to the emergency department with right iliac fossa pain and found that patients with scores of 4 or less did not have appendicitis. We also present an algorithm incorporating the Alvarado score for patients with suspected appendicitis.
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Affiliation(s)
- M Y P Chan
- Department of Surgery, Alexandra Hospital, Singapore
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21
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Tong MKH, Siu YP, Ng YY, Kwan TH, Au TC. Misplacement of a right internal jugular vein haemodialysis catheter into the mediastinum. Hong Kong Med J 2004; 10:135-8. [PMID: 15075435] [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: 04/29/2023] Open
Abstract
A 69-year-old woman with end-stage renal failure discontinued continuous ambulatory peritoneal dialysis and commenced temporary haemodialysis because of resistant peritonitis. Right internal jugular vein haemodialysis catheter placement was performed. The cuffed, tunnelled haemodialysis catheter was inserted using the modified Seldinger technique. When haemodialysis was initiated the following day, blood could not be aspirated from the catheter and the patient complained of central chest pain during the aspiration. Subsequent venography and computed tomography scan of the thorax showed that the catheter was placed extraluminally into the posterior mediastinum. The importance of a chest radiograph after placement of a central venous catheter is highlighted by this case report. Subtle deviations in catheter position from normal should alert the physician to the possibility of catheter misplacement and lead to further investigation.
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Affiliation(s)
- M K H Tong
- Division of Nephrology, Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong.
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22
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Nilsson L, Ng YY, Christiansen JN, Jørgensen BL, Grótinum D, Gram L. The contribution of bacteriocin to inhibition of Listeria monocytogenes by Carnobacterium piscicola strains in cold-smoked salmon systems. J Appl Microbiol 2004; 96:133-43. [PMID: 14678166 DOI: 10.1046/j.1365-2672.2003.02129.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [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: 11/20/2022]
Abstract
AIMS To study the importance of bacteriocin production for the antilisterial effect of a bacteriocinogenic Carnobacterium piscicola strain A9b on growth of Listeria monocytogenes in broth and cold-smoked salmon systems. METHODS AND RESULTS Acriflavin treatment of strain A9b resulted in loss of bacteriocin production and of immunity to carnobacteriocin B2. Two plasmids present in the wild-type were lost in the variant that was also more sensitive to bavaricin and leucocin A than the wild-type indicating cross-resistance to class IIa bacteriocins. The growth rate of the bac- mutant was higher than that of the wild-type at 5 and 37 degrees C but not at 25 or 30 degrees C. In salmon juice the maximum cell density of L. monocytogenes was suppressed 3 and 6 log by co-culture with C. piscicola A9b bac- and bac+, respectively, as compared with the control. Sterile filtered cultures of C. piscicola A9b bac- caused a limited suppression of the maximum cell density of L. monocytogenes similar to that observed when sterile buffer was added in equal amounts. Semi-purified carnobacteriocin B2 caused a 3.5 log decline in viable cell count after 6 day of incubation in cold-smoked salmon juice at 5 degrees C. High resistance level to carnobacteriocin B2 was observed for L. monocytogenes cells exposed to semi-purified and in situ produced carnobacteriocin B2. CONCLUSIONS The presence of bacteriocin production in C. piscicola enhances its inhibition of L. monocytogenes. SIGNIFICANCE AND IMPACT OF THE STUDY Due to the emergence of resistance, a bacteriocin negative lactic acid bacteria may be more suited for practical use as a bioprotective agent against L. monocytogenes in ready-to-eat foods.
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Affiliation(s)
- L Nilsson
- Department of Seafood Research, Danish Institute for Fisheries Research, Lyngby, Denmark
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23
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Abstract
Jiawey siwu (JS) is a modified formula of siwu with the addition of Ginseng Radix and Eucommiae Cortex. We studied the CNS effect of JS on pentobarbital-induced hypnosis in ICR mice after acute oral administration. We also investigated the motor activity and exercise performance effects of JS in SD rats after subchronic (12 days) and chronic (8 weeks) oral administration with an activity cage and rotarod, respectively. The duration of pentobarbital-induced hypnosis was significantly decreased in mice after acute oral administration of 0.21, 1.05 or 4.2 g/kg JS. The time of ambulatory activity and time on the rotarod significantly increased in rats after subchronic and chronic oral administration of 1.05 g/kg JS, respectively. These results indicate that JS potentially increased the excitability of the CNS in mice, as well as increasing motor activity and physical endurance in rats.
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Affiliation(s)
- Z H Jian
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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24
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Hu J, Sheu MH, Yang WC, Li JC, Ng YY. Peritonitis and pancreatic abscess in a CAPD patient. Perit Dial Int 2002; 22:430-1. [PMID: 12227410] [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: 02/26/2023] Open
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25
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Ng YY, Lin CC, Wu SC, Hwang SJ, Ho CH, Yang WC, Lee SD. Leukopenia and thrombocytopenia in hemodialysis patients with hepatitis B or C virus infection and non-hemodialysis patients with hepatitis cirrhosis. Clin Nephrol 2002; 57:289-95. [PMID: 12005245 DOI: 10.5414/cnp57289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/18/2022] Open
Abstract
AIMS To investigate the relation of leukopenia and thrombocytopenia in hemodialysis (HD) patients with hepatitis C virus (HCV) infection. MATERIALS AND METHODS The study included 86 HD patients with hepatitis B surface antigen-negative and hepatitis C antibody-negative, 28 HD patients with hepatitis C antibody-positive, 22 HD patients with hepatitis B surface antigen-positive, 78 non-HD patients with hepatitis B-induced liver cirrhosis and 38 non-hemodialysis patients with hepatitis C-induced liver cirrhosis. The following parameters were checked: anti-HCV, hepatitis B surface antigen, hemoglobin, hematocrit, white blood cells, platelets, calcium, phosphate, iron, ferritin, albumin, globulin, aspartate transaminase (AST), alanine transaminase (ALT) and C-reactive protein. The history of blood transfusions, medications, erythropoietin doses and adequate dialysis (KTNV) for 6 consecutive months was also recorded from charts. RESULTS The HD patients with positive serum anti-HCV and non-HD patients with hepatitis B- or C-induced liver cirrhosis had higher prevalences of leukopenia (39.3%, 43.6% and 50% vs. 15.1%; p < 0.001) and thrombocytopenia (67.9%, 89.7% and 81.6% vs. 34.9%: p < 0.001) than HD patients with serum anti-HCV(-)HbsAg(-). The WBC (4,432 +/- 1,394, 4,792 +/- 2,263 and 4,624 2,446 vs. 5,590 +/- 1,500/mm3; p < 0.001) and platelet counts (140 +/- 45, 80 +/- 50 and 89 +/- 65 vs. 186 +/- 62 x 10(3)/mm3; p < 0.001) of HD patients with positive serum anti-HCV and non-HD patients with hepatitis B- or C-induced cirrhosis were also lower than HD patients without anti-HCV antibody. The liver cirrhosis patients had more thrombocytopenia than the HD patients with anti-HCV(+). The WBC and platelet counts did not vary between HD patients with HbsAg(+) and HD patients with anti-HCV(-)HBsAg(-). The durations of HD, hepatitis and liver cirrhosis were not related to the leukopenia or thrombocytopenia (p > 0.05). CONCLUSIONS HCV infection associated with leukopenia and/or thrombocytopenia in HD patients is as common as in non-HD patients with liver cirrhosis. This may be due to the direct effect of hemopoiesis rather than the hyperspleenism of liver cirrhosis patients. There is a need for further prospective investigation to ascertain the clinical significance of leukopenia and thrombocytopenia in HD patients with anti-HCV(+). The prevalence of leukopenia and thrombocytopenia was higher in HD patients with hepatitis C than in HD patients with hepatitis B and HD patient without hepatitis.
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Affiliation(s)
- Y Y Ng
- Department of Medicine, Taipei Veterans General Hospital, Taiwan, Republic of China.
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26
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Fan JM, Huang XR, Ng YY, Nikolic-Paterson DJ, Mu W, Atkins RC, Lan HY. Interleukin-1 induces tubular epithelial-myofibroblast transdifferentiation through a transforming growth factor-beta1-dependent mechanism in vitro. Am J Kidney Dis 2001; 37:820-31. [PMID: 11273883 DOI: 10.1016/s0272-6386(01)80132-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.2] [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: 12/25/2022]
Abstract
Interleukin-1 (IL-1) has been shown to exert profibrotic activity in a number of disease models, including crescentic glomerulonephritis and pulmonary fibrosis, but the mechanisms by which this operates are poorly understood. Recent studies have identified a novel mechanism promoting renal fibrosis: tubular epithelial-myofibroblast transdifferentiation (TEMT). The present study examined whether IL-1 can stimulate TEMT in vitro. Cells of the normal rat kidney tubular epithelial cell line (NRK52E) were grown to confluence on collagen-coated plates and cultured for 5 days in the presence 1 to 20 ng/mL of IL-1alpha. Doses of 10 to 20 ng/mL of IL-1 caused transdifferentiation of NRK52E cells into myofibroblast-like cells. Scanning electron microscopy identified IL-1-induced morphological changes as a loss of apical-basal polarity and microvilli, cell hypertrophy, and the development of an elongated and invasive appearance. Phenotypically, IL-1-induced TEMT was characterized by de novo messenger RNA and protein expression of the mesenchymal marker alpha-smooth muscle actin, shown by Northern blotting, immunohistochemistry, and Western blotting. This was accompanied by loss of the epithelial marker E-cadherin. The addition of an excess of IL-1-receptor antagonist completely inhibited IL-1-induced TEMT. IL-1 was shown to stimulate the secretion of active transforming growth factor-beta1 (TGF-beta1) by NRK52E cells. Furthermore, the addition of a neutralizing anti-TGF-beta1 antibody inhibited IL-1-induced TEMT. In conclusion, IL-1 is a profibrogenic cytokine capable of inducing TEMT through a TGF-beta1-dependent mechanism. This may represent a novel mechanism by which IL-1 induces renal fibrosis in vivo.
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Affiliation(s)
- J M Fan
- Department of Nephrology, Western China University Hospital, Chengdu, China
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Lin YP, Wu MH, Ng YY, Lee RC, Liou JK, Yang WC, Wang JH, Teng MM, Huang TP. Spiral computed tomographic angiography--a new technique for evaluation of vascular access in hemodialysis patients. Am J Nephrol 2000; 18:117-22. [PMID: 9569953 DOI: 10.1159/000013319] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 11/19/2022]
Abstract
Spiral computed tomographic angiography (CTA), a new noninvasive imaging technique, was used to study 10 arteriovenous fistulas (AVF) in 9 hemodialysis patients. Digital subtraction angiography (DSA) was also performed as a gold standard for comparison. AVF stenosis was graded by a four-point scale: grade 0, well patency of supplying artery, anastomosis and drainage vein; grade 1, < 50% stenosis; grade 2, 50-70% stenosis; grade 3, 70-99% stenosis, and grade 4, total occlusion. We found CTA correlated closely to DSA in detecting both stenosis and dilatation of AVF and it spared all the shortcomings of DSA. CTA has the potential to be alternative for imaging of dialysis fistulas. Further studies will be performed to specify the role of CTA images in the assessment of the hemodialysis vascular access.
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Affiliation(s)
- Y P Lin
- Department of Medicine, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan, ROC
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Yang AH, Ng YY, Tarng DC, Chen JY, Shiao MS, Kao JT. Association of apolipoprotein E polymorphism with lipoprotein glomerulopathy. Report of 2 cases with a new genotype and comparison of the relative frequencies of apolipoprotein E isoforms in lipoprotein glomerulopathy and in the general population. Nephron Clin Pract 2000; 78:266-70. [PMID: 9546684 DOI: 10.1159/000044933] [Citation(s) in RCA: 11] [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: 11/19/2022] Open
Abstract
Two cases of lipoprotein glomerulopathy with a new apolipoprotein E (Apo E) genotype, epsilon3/epsilon4, were diagnosed recently. These 2 cases, together with other cases documented in English literature made a total of 6 common isoforms of Apo E encountered in lipoprotein glomerulopathy. Although the calculated allele frequency of epsilon2 is relatively high in cases with lipoprotein glomerulopathy as compared with that in the general population (39.3 vs. 6.4-11.4%), the gradual emergence of Apo E isoforms other than E2/E3 in lipoprotein glomerulopathy implicates that the genetic susceptibility of certain Apo E isoforms may not be a crucial factor. An alteration in the local environment of glomerular capillaries may be more important in the pathogenesis of lipoprotein glomerulopathy.
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Affiliation(s)
- A H Yang
- Department of Pathology, Veterans General Hospital-Taipei, School of Medicine, National Yang-Ming University, Taiwan.
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29
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Vu C, Ng YY. Prevalence of Helicobacter pylori in peptic ulcer disease in a Singapore hospital. Singapore Med J 2000; 41:478-81. [PMID: 11281437] [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: 02/19/2023]
Abstract
INTRODUCTION High Helicobacter pylori (H. pylori) prevalence is well documented among peptic ulcer patients. However, there have been recent reports of declining H. pylori infection rates in developed countries. Based on previous local data in a different hospital, H. pylori prevalence was 66% in gastric ulcer, 86% in duodenal ulcer and 75% in combined gastric and duodenal ulcers. Our present study aims to review the recent H. pylori prevalence in peptic ulcer patients in a Singapore hospital. H. pylori infection rate in relation to sex, age, non-steroidal anti-inflammatory drug (NSAID) use and race were also examined. METHODS Over a 6-month period, patients diagnosed with peptic ulcer by oesophagogastroduodenoscopy were selected. Relevant information was obtained from case notes retrieved from the Medical Records Office. H. pylori status was assessed by rapid urease test (CLOtest) and/or histology. Exclusion criteria were(1) history of peptic ulcer(2), active bleeding(3), cancer or(4) recent use of antibiotics or proton pump inhibitors. RESULTS 107 peptic ulcer patients were selected; 53 gastric ulcer, 47 duodenal ulcer and 7 with combined gastric and duodenal ulcers. Overall H. pylori prevalence was 67.9%(36/53), 85.1%(40/47) and 85.7%(6/7) respectively. Except for the gender variable in gastric ulcer group, age, race and NSAID use was not found to influence H. pylori prevalence. CONCLUSIONS The prevalence of H. pylori among our peptic ulcer patients is slightly lower compared to overseas studies but the local trend,when compared indirectly to another previous local study did not appear to have changed much. Reasons for the lower H. pylori infection rate in comparison to overseas studies are discussed. The lower H. pylori prevalence among female gastric ulcer patients may be due to the higher prevalence of NSAID use.
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Affiliation(s)
- C Vu
- Department of General Medicine, Tan Tock Seng Hospital Pte Ltd, Singapore.
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Hung SC, Wen YK, Ng YY, Yang WC. Inappropriate antidiuresis associated with pituitary adenoma--mechanisms not involving inappropriate secretion of vasopressin. Clin Nephrol 2000; 54:157-60. [PMID: 10968694] [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: 02/17/2023] Open
Abstract
We report an unusual case of inappropriate antidiuresis with undetectable vasopressin in an elderly man presenting with confusion due to severe hyponatremia. Further investigations led to the diagnosis of non-functional pituitary macroadenoma. The patient had normal thyroid and adrenal function. The abnormal water balance resolved promptly after transsphenoidal removal of the tumor, confirmed by a repeat water loading test. We conclude that inappropriate antidiuresis in the absence of excess vasopressin secretion may implicate mass effect from an underlying pituitary tumor.
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Affiliation(s)
- S C Hung
- Department of Medicine, Veterans General Hospital-Taipei and School of Medicine, National Yang-Ming University, Taiwan
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Abstract
BACKGROUND All-trans-retinoic acid (ATRA, vitamin A acid or tretinoin) is effective in the treatment of acute promyelocytic leukaemia (APL). Unfortunately, the oral absorption of ATRA is highly variable. Its poor aqueous solubility also makes it difficult to be formulated into parenteral formulation. To date, there is no parenteral formulation of ATRA available commercially. OBJECTIVE To undertake the preformulation work necessary for developing such a product. METHOD We investigated the solubility and stability profile of ATRA in various formulations. RESULTS The aqueous solubility of ATRA could be greatly increased by the inclusion of ATRA in 2-hydroxypropyl-beta-cyclodextrin (HP-beta-CD). Adjusting the pH value further improved the water solubility of ATRA. The photostability of HP-beta-CD-based formulation of ATRA was evaluated and it was found that inclusion ATRA into HP-beta-CD did improve the photostability of ATRA. CONCLUSION These results showed that it is possible to develop a parenteral formulation and/or an aqueous oral formulation of all-trans-retinoic acid by using 2-hydroxypropyl-beta-cyclodextrin. However, the biopharmaceutical properties of such a formulation would be necessary before its use.
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Affiliation(s)
- H S Lin
- Department of Pharmacy, National University of Singapore, 10 Kent Ridge Crescent, Singapore 119260
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Lee CC, Ng YY, Chou YH, Tiu CM, Wang Z, Yang HM, Chen TW, Yang WC. Mycotic aneurysm of the abdominal aorta in a patient undergoing hemodialysis: an unusual complication of Staphylococcus aureus bacteremia. Clin Infect Dis 2000; 30:823-4. [PMID: 10816154 DOI: 10.1086/313769] [Citation(s) in RCA: 15] [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: 11/03/2022] Open
Abstract
When Staphylococcus aureus is repeatedly positive in blood cultures even under effective antibiotics therapy (vancomycin, teicoplanin, or rifampin), computed tomography scan and sonography should be performed early to exclude mycotic aneurysm of the deeply seated arteries, especially in patients with abdominal aortic calcification. Before 1990, the most common causative organism of suprarenal aortic mycotic aneurysm was Salmonella; since 1990, it has been gram-positive cocci (i.e., Streptococcus and Staphylococcus) rather than gram-negative bacilli (i.e., Salmonella), possibly because of the more invasive procedures performed in clinical settings, but this hypothesis needs further investigation.
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Affiliation(s)
- C C Lee
- Department of Internal Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China
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Abstract
A major goal in retroviral-based gene therapy is to establish methods that allow for the selection and tracking of transduced cell populations. Ex vivo gene marking of normal and malignant hemopoietic cells allows the cells to be followed subsequently in vivo. For in vivo applications, a neutral marker gene that is nonimmunogenic is desirable. To track two distinctively treated cell populations in a single individual, we designed and constructed two retroviral vectors; both of these vectors encode a truncated form of the human low-affinity nerve growth factor receptor, a neutral gene that does not transduce signals and is expected to be nonimmunogenic in humans. The two vectors, named Frape-1 and Frape-3, are identical at the protein level but differ at the DNA level, containing restriction sites that allow easy detection by polymerase chain reaction analysis. We show that cell lines and primary CD34+ cells can be readily transduced with these vectors and that transduced cells can be distinguished by polymerase chain reaction- and vector-specific restriction sites. These vectors will be useful for toxicity studies on in vivo gene therapy and for determining the source of relapse in hematological malignancies.
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Affiliation(s)
- Y Y Ng
- Departments of Immunology and Hematology, Utrecht University Hospital, The Netherlands
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Ng YY, Fan JM, Mu W, Nikolic-Paterson DJ, Yang WC, Huang TP, Atkins RC, Lan HY. Glomerular epithelial-myofibroblast transdifferentiation in the evolution of glomerular crescent formation. Nephrol Dial Transplant 1999; 14:2860-72. [PMID: 10570089 DOI: 10.1093/ndt/14.12.2860] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [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: 11/13/2022] Open
Abstract
BACKGROUND Glomerular cellular crescents consist of epithelial cells and macrophages, which can undergo an irreversible process of fibrous organization. However, the origin of the fibroblast-type cells that mediate this fibrous organization is unclear. METHODS This study examined glomerular epithelial- myofibroblast transdifferentiation (GEMT) in the formation and evolution of glomerular crescents in two distinct rat models of glomerulonephritis: 5/6 nephrectomy and antiglomerular basement membrane (GBM) disease. RESULTS Early in the course of both disease models, and prior to crescent formation, immunohistochemistry staining and in-situ hybridization demonstrated de novo expression of alpha-smooth-muscle actin (alpha-SMA), a marker of smooth muscle cells and myofibroblasts, by glomerular parietal epithelial cells (GPEC). The expression of alpha-SMA by GPEC was accompanied by a loss of E-cadherin staining, a marker of epithelial cells. At this early stage of GEMT, ultrastructural studies identified the presence of characteristic actin microfilaments and dense bodies within GPEC which retained a normal epithelial morphology with apical-basal polarity and microvilli. A late stage of transdifferentiation was seen in fibrocellular crescents. In this case, GPEC attached to intact segments of the capsular basement membrane contained large bundles of actin microfilaments throughout the cell, and this was accompanied by a loss of polarity, microvilli, and tight junctions. There was a significant correlation between the presence of alpha-SMA(+) GPEC and glomerular crescent formation. Cellular crescents contained small numbers of alpha-SMA(+) myofibroblasts. These cells become the dominant population in fibrocellular crescents, which was associated with marked local proliferation. Relatively few alpha-SMA(+) myofibroblasts remained in fibrotic/organizing crescents. Most cells within cellular and fibrocellular crescents expressed transforming growth factor-beta (TGF-beta) and basic fibroblast growth factor (FGF-2), suggesting that these growth factors may regulate this GEMT process during the evolution of glomerular crescents. CONCLUSIONS This study provides the first phenotypic and morphological evidence that glomerular epithelial-myofibroblast transdifferentiation participates in the formation and evolution of glomerular crescents.
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Affiliation(s)
- Y Y Ng
- Department of Nephrology, Veterans General Hospital-Taipei, National Yang-Ming University, Taipei, Taiwan
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Fan JM, Ng YY, Hill PA, Nikolic-Paterson DJ, Mu W, Atkins RC, Lan HY. Transforming growth factor-beta regulates tubular epithelial-myofibroblast transdifferentiation in vitro. Kidney Int 1999; 56:1455-67. [PMID: 10504497 DOI: 10.1046/j.1523-1755.1999.00656.x] [Citation(s) in RCA: 396] [Impact Index Per Article: 15.8] [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: 12/13/2022]
Abstract
BACKGROUND We recently found evidence of tubular epithelial-myofibroblast transdifferentiation (TEMT) during the development of tubulointerstitial fibrosis in the rat remnant kidney. This study investigated the mechanisms that induce TEMT in vitro. METHODS The normal rat kidney tubular epithelial cell line (NRK52E) was cultured for six days on plastic or collagen type I-coated plates in the presence or absence of recombinant transforming growth factor-beta1 (TGF-beta1). Transdifferentiation of tubular cells into myofibroblasts was assessed by electron microscopy and by expression of alpha-smooth muscle actin (alpha-SMA) and E-cadherin. RESULTS NRK52E cells cultured on plastic or collagen-coated plates showed a classic cobblestone morphology. Culture in 1 ng/ml TGF-beta caused only very minor changes in morphology, but culture in 10 or 50 ng/ml TGF-beta1 caused profound changes. This involved hypertrophy, a loss of apical-basal polarity and microvilli, with cells becoming elongated and invasive, the formation of a new front-end back-end polarity, and the appearance of actin microfilaments and dense bodies. These morphological changes were accompanied by phenotypic changes. Double immunohistochemistry staining showed that the addition of TGF-beta1 to confluent cell cultures caused a loss of the epithelial marker E-cadherin and de novo expression of alpha-SMA. An intermediate stage in transdifferentiation could be seen with hypertrophic cells expressing both E-cadherin and alpha-SMA. De novo alpha-SMA expression was confirmed by Northern blotting, Western blotting, and flow cytometry. In particular, cells with a transformed morphology showed strong alpha-SMA immunostaining of characteristic microfilament structures along the cell axis. There was a dose-dependent increase in the percentage of cells expressing alpha-SMA with increasing concentrations of TGF-beta1, which was completely inhibited by the addition of a neutralizing anti-TGF-beta1 antibody. Compared with growth on plastic, cell culture on collagen-coated plates showed a threefold increase in the percentage of cells expressing alpha-SMA in response to TGF-beta1. CONCLUSION TGF-beta1 is a key mediator that regulates, in a dose-dependent fashion, transdifferentiation of tubular epithelial cells into alpha-SMA+ myofibroblasts. This transdifferentiation is markedly enhanced by growth on collagen type I. These findings have identified a novel pathway that may contribute to renal fibrosis associated with overexpression of TGF-beta1 within the diseased kidney.
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MESH Headings
- Actins/genetics
- Animals
- Blotting, Northern
- Cadherins/genetics
- Cell Differentiation/drug effects
- Cell Line
- Collagen/pharmacology
- Epithelial Cells/cytology
- Epithelial Cells/drug effects
- Epithelial Cells/ultrastructure
- Fibroblasts/cytology
- Fibroblasts/drug effects
- Fibroblasts/ultrastructure
- Gene Expression/drug effects
- In Vitro Techniques
- Kidney Tubules/cytology
- Microscopy, Electron
- Microscopy, Electron, Scanning
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/ultrastructure
- Phenotype
- RNA, Messenger/analysis
- Rats
- Transforming Growth Factor beta/pharmacology
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Affiliation(s)
- J M Fan
- Department of Nephrology, The First Hospital, Western China University of Medical Sciences, Chengdu
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36
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Ng YY, Chang IT, Chen TW, Liou HN, Yang AH, Yang WC. Concomitant lupus nephritis and bullous eruption in systemic lupus erythematosus. Nephrol Dial Transplant 1999; 14:1739-43. [PMID: 10435885 DOI: 10.1093/ndt/14.7.1739] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y Y Ng
- Department of Medicine, Veterans General Hospital-Taipei, National Yang Ming University, Taiwan, Republic of China
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Hou CC, Wu SC, Wu SC, Chen TW, Yang WC, Ng YY. Is serum transferrin receptor a sensitive marker of iron repletion in patients with iron-deficiency anemia and hemodialysis patients? Zhonghua Yi Xue Za Zhi (Taipei) 1999; 62:189-94. [PMID: 10367478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Serum transferrin receptor (sTfR) concentration has been recognized as a reliable laboratory indicator of iron deficiency in recent years. But its response to iron supplementation has not been investigated. METHODS We evaluated the sTfR concentrations in 15 patients diagnosed with iron-deficiency anemia, in 30 patients receiving maintenance hemodialysis (HD) with iron repletion and in 31 healthy controls. The serial changes of sTfR concentration and their correlation with serum ferritin in patients with iron deficiency under iron repletion were also examined in three patients. RESULTS In patients with iron-deficiency anemia, the sTfR concentration was 5.6 +/- 2.4 mg/ml, significantly higher than that in the control group (1.8 +/- 0.4 mg/ml) and patients receiving maintenance HD with iron repletion (1.7 +/- 0.5 mg/ml). The three patients with iron-deficiency anemia who received eight to 16 weeks of iron supplementation showed steady and significant decreases in sTfR concentration and significant increases in serum ferritin and transferrin saturation. However, the decreases in sTfR concentration did not occur immediately, as did the increases in serum ferritin and transferrin saturation, following iron repletion. There was a four-week delayed response in the decrease of sTfR concentrations as measured against serum ferritin and transferrin saturation. CONCLUSIONS sTfR concentration may not be as effective as an early index of iron repletion compared with serum ferritin and transferrin saturation.
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Affiliation(s)
- C C Hou
- Department of Medicine, Veterans General Hospital-Taipei, Taiwan, ROC
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Hussain HK, Ng YY, Wells CA, Courts M, Nockler IB, Curling OM, Carpenter R, Perry NM. The significance of new densities and microcalcification in the second round of breast screening. Clin Radiol 1999; 54:243-7. [PMID: 10210344 DOI: 10.1016/s0009-9260(99)91159-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 11/22/2022]
Abstract
AIM To assess the nature of new densities and microcalcifications in the second round of breast screening. MATERIALS AND METHODS A total of 34 634 women were screened at our unit in the second round of the United Kingdom National Health Service Breast Screening Programme. Of those attending for the second time, 302 were recalled for further work-up of 311 new lesions. The lesions were divided into masses, microcalcifications, asymmetric densities and architectural distortions. Masses were classified according to margin and density, and microcalcifications according to morphology and distribution. RESULTS Among women attending for the second time, the cancer detection rate was 0.45% (89 cancers). One hundred and eighty-eight new masses were identified: 53 well-defined (two malignant), 67 partially defined (six malignant), 54 ill-defined (18 malignant), and 14 spiculate (14 malignant). Well-defined masses were usually cysts, especially in women on hormone replacement therapy. Of 97 new microcalcifications, 71 were pleomorphic (28 malignant), 12 linear (one malignant), and 14 punctate (none malignant). Twenty-five new asymmetric densities were identified (five malignant). One of two architectural distortions was malignant. Malignancy was found in 21% of new masses, 30% of new microcalcification and 20% of asymmetric densities. CONCLUSION Carcinoma was found in 24% of all new mammographic abnormalities appearing in a 3-year screening period. Spiculate and ill-defined masses, clustered pleomorphic microcalcification, and new asymmetric densities should be regarded with particular suspicion. The use of fine needle aspiration cytology in combination with imaging assessment may help to reduce the number of benign excisional biopsies for new mammographic lesions.
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Affiliation(s)
- H K Hussain
- Department of Diagnostic Radiology, St Bartholomew's Hospital, London, UK
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Lee CC, Chou YH, Chen TW, Wu TH, Charng YP, Chiou HJ, Tiu CM, Yang WC, Ng YY. Engorgement of brachiocephalic vein after creation of an AV fistula--a result of sternoclavicular joint osteophyte. Nephrol Dial Transplant 1999; 14:757-9. [PMID: 10193835 DOI: 10.1093/ndt/14.3.757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C C Lee
- Department of Internal Medicine, Veterans General Hospital-Taipei, National Yang Ming University, School of Medicine, Taiwan, Republic of China
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Chang YP, Chen TW, Chen CP, Ng YY, Yang WC. Inguinal abscess in a CAPD patient secondary to inguinal hernia and repeated episodes of peritonitis: a case report. Perit Dial Int 1999; 19:177-8. [PMID: 10357193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Affiliation(s)
- Y P Chang
- Department of Internal Medicine, Veterans General Hospital-Taipe,i National Yang Ming University, Taiwan, Republic of China
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Lin CC, Chen TW, Ng YY, Chou YH, Yang WC. Thyroid dysfunction and nodular goiter in hemodialysis and peritoneal dialysis patients. ARCH ESP UROL 1998; 18:516-21. [PMID: 9848631] [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: 02/09/2023]
Abstract
OBJECTIVE To investigate the prevalence of nodular goiter and thyroid dysfunction in uremic patients undergoing hemodialysis (HD) and peritoneal dialysis. DESIGN Cross-sectional study. SETTING Single dialysis unit and outpatient clinic. PATIENTS The study included 221 patients [143 HD and 78 continuous ambulatory peritoneal dialysis (CAPD) patients] along with 135 consecutively selected outpatients as controls. MAIN OUTCOME MEASURES Ultrasonography was used to detect patients' thyroid function and nodular goiter. RESULTS Nodular goiter was detected in 54.8% of the uremic patients and in 21.5% of the controls. Uremic patients had higher prevalence of thyroid dysfunction, which included reduced serum concentration of total T3, total T4, and free T4, and increased serum level of TSH. Hypothyroidism was also observed more frequently in uremic patients than in the control group (5.4% vs 0.7%, p < 0.05). Nodular goiter was more frequently found in females than in males (63.5% vs 48%, p < 0.05). Moreover, the prevalence of nodular goiter increased with age (p < 0.02) in uremic patients. Hemodialysis patients had a higher frequency of reduced total T3 level (46.9% vs 29.5%, p < 0.02). However, CAPD patients had lower T4 levels (6.23+/-1.82 microg/dL vs 7.15+/-1.99 microg/dL, p < 0.05). CONCLUSION Because of the high incidence of hypothyroidism and nodular goiter in uremic patients, screening of thyroid function and goiter detection with ultrasound should be considered in evaluation of end-stage renal disease patients.
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Affiliation(s)
- C C Lin
- Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China
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42
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Ng YY, Huang TP, Yang WC, Chen ZP, Yang AH, Mu W, Nikolic-Paterson DJ, Atkins RC, Lan HY. Tubular epithelial-myofibroblast transdifferentiation in progressive tubulointerstitial fibrosis in 5/6 nephrectomized rats. Kidney Int 1998; 54:864-76. [PMID: 9734611 DOI: 10.1046/j.1523-1755.1998.00076.x] [Citation(s) in RCA: 307] [Impact Index Per Article: 11.8] [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: 11/20/2022]
Abstract
BACKGROUND Tubulointerstitial fibrosis is the final common pathway to end-stage renal failure. The present study investigated the potential role of tubular epithelial cells (TEC) in progressive fibrosis in the rat remnant kidney model. METHODS Rats underwent 5/6 nephrectomy or a sham operation (control), and groups of six animals were killed at weeks 1, 3, 5, 9, 13, 17 and 21. RESULTS Immunohistochemistry staining and in situ hybridization at week 3 after nephrectomy demonstrated de novo expression of alpha-smooth muscle actin (alpha-SMA)--a marker of smooth muscle cells and myofibroblasts--by TEC that was invariably associated with disruption of the tubular basement membrane (TBM). This phenotypic evidence of tubular epithelial-myofibroblast transdifferentiation was supported by ultrastructural studies identifying the presence of characteristic actin microfilaments and dense bodies within TEC with a transformed morphology. In the late stage of this apparent tubular epithelial-myofibroblast transdifferentiation, TEC lost apical-basal polarity and tight junctions, became elongated, detached from the TBM, separated from neighboring cells and appeared to migrate into the peritubular interstitium through the damaged basement membrane. Indeed, focal peritubular accumulation of alpha-SMA+ myofibroblasts and local tubulointerstitial fibrosis was closely associated with alpha-SMA+ tubules, suggesting a tubular epithelial origin for some of these cells. Quantitative analysis found a significant correlation between the number of alpha-SMA+ TEC and the accumulation of interstitial alpha-SMA+ myofibroblasts and the severity of tubulointerstitial fibrosis (both P < 0.001). CONCLUSIONS This study provides phenotypic and morphological evidence to support the hypothesis that TEC are pro-fibrogenitor cells capable of tubular epithelial-myofibroblast transdifferentiation in progressive renal fibrosis. In addition, we postulate that disruption of the TBM, which facilitates epithelial cell contact with the interstitial matrix, promotes this process of transdifferentiation.
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Affiliation(s)
- Y Y Ng
- Department of Nephrology, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan
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Ng YY, Yu S, Chen TW, Wu SC, Yang AH, Yang WC. Interstitial renal fibrosis in a young woman: association with a Chinese preparation given for irregular menses. Nephrol Dial Transplant 1998; 13:2115-7. [PMID: 9719178 DOI: 10.1093/ndt/13.8.2115] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y Y Ng
- Department of Medicine and Pathology, Veterans General Hospital-Taipei, National Yang-Ming University, School of Medicine, Taiwan, Republic of China
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Hou CC, Wu SC, Wu SC, Yang WC, Huang TP, Ng YY. Serum transferrin receptor concentration is not indicative of erythropoietic activity in chronic hemodialysis patients with poor response to recombinant human erythropoietin. Zhonghua Yi Xue Za Zhi (Taipei) 1998; 61:456-62. [PMID: 9745161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Serum transferrin receptor (sTfR) is a transmembrane glycoprotein derived from erythroid precursors in the bone marrow. Its concentration provides a quantitative measure of total erythropoietic activity and an indication of functional iron deficiency. This study was conducted to investigate whether sTfR is a useful index of erythropoietic activity in chronic hemodialysis patients with poor response to maintenance recombinant human erythropoietin (rHuEPO) therapy. METHODS Using an enzyme-linked immunosorbent assay, sTfR concentration was measured in 67 uremic patients who had been on hemodialysis for a mean of 42 months (3-242 months). rHuEPO was administered three times a week to keep the hematocrit above 30%. Hemoglobin, red blood cell indices, serum ferritin, serum total iron binding capacity and unsaturated iron binding capacity were determined. Of the 67 patients, 35 who responded favorably to rHuEPO with hematocrits above 30% were categorized as Group I and 32 who did not attain the target hematocrit were categorized as Group II. As a control group, 31 healthy subjects were also investigated. RESULTS The serum iron, ferritin, transferrin iron saturation, dialysis efficiency and nutritional state were not different between groups of hemodialysis patients. The mean sTfR concentration was 2.1 +/- 0.6 micrograms/ml (range, 1.15-3.53 micrograms/ml) in Group I patients, compared with 1.9 +/- 0.9 micrograms/ml (range, 1.03-2.65 micrograms/ml) in Group II. The difference was not significant. In addition, the mean sTfR concentration of 1.8 +/- 0.4 micrograms/ml (range, 0.86-2.76 micrograms/ml) in the healthy controls was not significantly different from Groups I and II. CONCLUSIONS sTfR concentration cannot be used to distinguish good from poor rHuEPO responders among chronic hemodialysis patients who have elevated serum ferritin (> 300 micrograms/l) and transferrin iron saturation (> 25%) during the course of maintenance rHuEPO therapy.
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Affiliation(s)
- C C Hou
- Department of Medicine, Veterans General Hospital-Taipei, Taiwan, ROC
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Yang N, Wu LL, Nikolic-Paterson DJ, Ng YY, Yang WC, Mu W, Gilbert RE, Cooper ME, Atkins RC, Lan HY. Local macrophage and myofibroblast proliferation in progressive renal injury in the rat remnant kidney. Nephrol Dial Transplant 1998; 13:1967-74. [PMID: 9719149 DOI: 10.1093/ndt/13.8.1967] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [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: 11/13/2022] Open
Abstract
BACKGROUND We have recently shown that blockade of angiotensin II activity inhibits local macrophage and myofibroblast proliferation in progressive non-immune renal injury in the rat remnant kidney. However, it is not known whether this local proliferation contributes to macrophage and myofibroblast accumulation and the development of renal injury. Therefore, we examined this issue in a detailed time-course study of the rat remnant kidney. METHODS Groups of five rats were killed 4, 8,12 or 16 weeks after 5/6 subtotal nephrectomy (STNx) or a sham operation. Macrophage and myofibroblast proliferation was assessed by two-colour immunostaining for ED1+ macrophages or alpha-smooth muscle actin (alpha-SMA)-positive myofibroblasts with the proliferating cell nuclear antigen (PCNA) or bromodeoxyuridine. RESULTS All parameters of renal function and histology remained normal in the sham-operated controls, and no macrophage or myofibroblast accumulation was evident. In contrast, prominent macrophage accumulation developed in both the glomerulus and tubulointerstitium in STNx animals, peaking at week 12. Many ED1+ macrophages showed PCNA expression, accounting for 19-34% of the total macrophage population. There was a highly significant correlation between proliferating macrophages and total macrophage accumulation in the glomerulus (r = 0.82, P < 0.0001) and tubulointerstitium (r = 0.70, P < 0.001). Macrophage proliferation was largely restricted to focal areas of renal damage, such as glomerular segmental lesions and severe tubulointerstitial damage. Also, the subpopulation of proliferating macrophages gave a highly significant correlation with loss of renal function, proteinuria, and glomerular and tubulointerstitial lesions. In addition, many alpha-SMA myofibroblasts were evident within expanded mesangial areas and the tubulointerstitium following STNx. Interestingly, active lesions contained many large alpha-SMA+ cells double-stained for PCNA, accounting for 24-29% of total myofibroblasts. There was a highly significant correlation between the number of proliferating myofibroblasts and total myofibroblast accumulation during the evolution of this disease, and both populations correlated with progressive renal injury. CONCLUSIONS This study has shown that local proliferation is an important mechanism in both macrophage and myofibroblast accumulation during the development of renal injury in the rat remnant kidney. In addition, local macrophage proliferation is postulated as a mechanism for amplifying kidney damage in nonimmune renal injury.
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Affiliation(s)
- N Yang
- Department of Nephrology, First Affiliated Hospital of Sun Yat-Sen University of Medical Sciences, Guangzhou, PR China
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Abstract
PURPOSE To evaluate the clinical, imaging, and histopathologic features of breast carcinoma in the retroareolar tissues and to determine whether there are any characteristics common to this location. MATERIALS AND METHODS Thirty-five patients (age range, 38-77 years) with 37 retroareolar carcinomas were identified retrospectively. Retroareolar carcinoma was defined as that within 2 cm of the nipple-areolar complex. Mammographically occult tumors were identified by using histopathologic records (n = 4) or clinical examination findings (n = 6). RESULTS Twenty-nine (78%) tumors had clinical findings, including palpable mass (n = 29), associated nipple inversion or retraction (n = 4), and associated nipple discharge (n = 2). Twenty-seven (73%) tumors had mammographic findings of mass (n = 16), mass with calcifications (n = 5), and microcalcifications (n = 6; four of these microcalcifications were associated with a mammographically occult palpable mass). Ultrasound was performed in 17 tumors, all of which were hypoechoic. The stage of 31 carcinomas was known: one was stage 0, 17 were stage I, and 13 were stage II. Histopathologic analysis revealed 35 ductal carcinomas and two invasive lobular carcinomas. CONCLUSION Retroareolar carcinoma usually manifests as a palpable mass. Mammography is less sensitive in this area than in other areas of the breast. Ultrasound can be a valuable adjunct in the assessment of retroareolar malignancy.
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Affiliation(s)
- C S Giess
- Department of Radiology, New York Hospital-Cornell Medical Center, Strang-Cornell Breast Center, NY 10021, USA
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Yang N, Nikolic-Paterson DJ, Ng YY, Mu W, Metz C, Bacher M, Meinhardt A, Bucala R, Atkins RC, Lan HY. Reversal of established rat crescentic glomerulonephritis by blockade of macrophage migration inhibitory factor (MIF): potential role of MIF in regulating glucocorticoid production. Mol Med 1998; 4:413-24. [PMID: 10780884 PMCID: PMC2230272] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Macrophage migration inhibitory factor (MIF) is a potent pro-inflammatory cytokine that also counter-regulates glucocorticoid action. We investigated whether immunoneutralization of MIF could reverse established experimental crescentic glomerulonephritis and if this treatment could modulate endogenous glucocorticoid levels. Accelerated anti-GBM glomerulonephritis was induced in six littermate pairs of rats. Once crescentic disease was established on day 7, one animal in each pair was given a daily injection of neutralizing anti-MIF antibody (Ab) or irrelevant isotype control Ab for 14 days and then killed on day 21. In addition, a group of 6 animals was killed on day 7 of disease without any treatment. Animals receiving the control Ab exhibited a rapidly progressive glomerulonephritis with severe renal injury (proteinuria), loss of renal function (creatinine clearance), anemia, and marked histologic damage (including glomerular crescent formation), compared with animals killed on day 7 without treatment. In contrast, anti-MIF Ab treatment partially reversed the disease by restoring normal renal function and reducing histological damage compared with untreated animals killed on day 7 (p < 0.05). Interestingly, anti-MIF Ab treatment also prevented severe anemia (p < 0.05). Reversal of disease was associated with a significant reduction in leukocyte infiltration and activation and renal interleukin-1 (IL-1) production. Importantly, anti-MIF Ab treatment caused a significant increase in endogenous serum corticosterone levels, which correlated with the reversal of disease parameters. In conclusion, this study has demonstrated that blocking MIF activity can partially reverse established crescentic glomerulonephritis and suggests that MIF operates by both enhancing the cellular immune response and suppressing the endogenous anti-inflammatory glucocorticoid response.
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Affiliation(s)
- N Yang
- The First Hospital, Sun Yat-Sen University of Medical Sciences, Ghongzhou, China
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Chang IT, Chen TW, Ng YY, Yang WC. Recurrent intestinal angiodysplastic bleeding in a patient on hemodialysis ceasing spontaneously with CAPD. ARCH ESP UROL 1998; 18:342-3. [PMID: 9663905] [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: 02/08/2023]
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Hsu YH, Ng YY, Yang AH, Chen TW, Huang TP. Focal segmental glomerulosclerosis after poststreptococcal glomerulonephritis in the elderly: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1998; 61:301-5. [PMID: 9650435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Acute poststreptococcal glomerulonephritis (PSGN) is quite rare in the elderly population. It is very difficult to recognize because the initial symptoms are similar to those of more common diseases of this age group. Compared with younger patients, elderly patients with PSGN tend to have a high incidence of renal function impairment and anuria or prolonged oliguria. Recovery from acute PSGN in the elderly is less predictable than in children and younger adults, especially when associated with severe impairment of renal function. We present the case of an elderly patient with PSGN, who had a skin infection of the face and anuria on admission. Percutaneous left renal biopsy was performed in the initial hospitalization period and in the recovery phase of the disease. Renal function recovered within two months. However, increased urinary white blood cell sediments with normal serum creatinine concentrations persisted in the successive three years of follow-up. Renal biopsy was repeated and showed evidence of focal segmental glomerulosclerosis.
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Affiliation(s)
- Y H Hsu
- Department of Medicine, Veterans General Hospital-Taipei, Taiwan, ROC
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Hou CC, Lee YJ, Yu KW, Yang WC, Chen TW, Ng YY. Peritonitis due to Listeria monocytogenes in a patient receiving maintenance hemodialysis. Clin Infect Dis 1998; 26:514-6. [PMID: 9502491 DOI: 10.1086/517103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- C C Hou
- Department of Medicine, Veterans General Hospital-Taipei, National Yang Ming University, Taiwan, Republic of China
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