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Ng YH, Chai YC, Mazli N, Jaafar NF, Ibrahim S. Outcome of Endoprosthesis used in Limb Salvage Surgery in a Malaysian Orthopaedic Oncology Centre. Malays Orthop J 2024; 18:60-65. [PMID: 38638655 PMCID: PMC11023336 DOI: 10.5704/moj.2403.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/14/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction To describe the duration of survival among bone tumour patients with endoprosthesis reconstruction and to determine frequency of implant failure, revision of surgery, and amputation after endoprosthesis reconstruction. Materials and methods A retrospective cross-sectional review of all patients with either primary bone tumour or secondary bone metastases treated with en bloc resection and endoprosthesis reconstruction from January 2008 to December 2020. Results A total of 35 failures were recorded among the 27 (48.2%) patients with endoprostheses. Some of the patients suffered from one to three types of modes of failure on different timelines during the course of the disease. Up to eight patients suffered from more than one type of failure throughout the course of the disease. Out of all modes of failure, local recurrence (type 5 failure) was the most common, accounting for 25.0% of all failure cases. Four patients (7.1%) eventually underwent amputation, which were either due to infection (2 patients) or disease progression causing local recurrence (2 patients). Conclusion The overall result of endoprosthesis reconstruction performed in our centre was compatible with other centres around the world. Moreover, limb salvage surgery should be performed carefully in a selected patient group to maximise the benefits of surgery.
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Affiliation(s)
- Y H Ng
- Department of Orthopaedic, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | - Y C Chai
- General Psychiatry Division, Hospital Permai Johor Bahru, Johor Bahru, Malaysia
| | - N Mazli
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - N F Jaafar
- Department of Orthopaedic, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | - S Ibrahim
- Department of Orthopaedic, Hospital Sultan Ismail, Johor Bahru, Malaysia
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Morenz A, Ng YH, Butler CR. Learning From the Experiences of Undocumented Immigrant Kidney Transplant Recipients-From Exceptional Individuals to Equitable Systems. JAMA Netw Open 2024; 7:e2354548. [PMID: 38421654 DOI: 10.1001/jamanetworkopen.2023.54548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Anna Morenz
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Yue-Harn Ng
- Division of Nephrology, Department of Medicine, University of Washington, Seattle
| | - Catherine R Butler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle
- VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington
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Boonpheng B, De Castro ICC, Ng YH, Blosser C, Bakthavatsalam R, Gimferrer I, Smith K, Leca N. Tocilizumab for treatment of chronic active antibody-mediated rejection in kidney transplant recipients. Clin Transplant 2023; 37:e14936. [PMID: 36787372 DOI: 10.1111/ctr.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The optimal treatment for chronic active antibody-mediated rejection (ca-AMR) remains unclear. Tocilizumab (TCZ), a monoclonal antibody against IL-6, has been proposed as a therapeutic option. We reported our experience treating ca-AMR with TCZ either as the first line option or as a rescue therapy. METHODS We studied 11 adult kidney transplant recipients with biopsy-proven ca-AMR and preserved kidney function (eGFR 57 ± 18) who were treated with TCZ (8 mg/kg IV monthly). All biopsies were prompted by abnormal surveillance biomarker testing with DSA and/or dd-cfDNA. Clinical monitoring included dd-cfDNA and DSA testing every 3 months during the treatment with TCZ. RESULTS In this cohort, ca-AMR was diagnosed at a median of 90 months (range 14-224) post-transplant, and 4 of 11 patients had DSA negative ca-AMR. Patients received a minimum of 3 months of TCZ, with 6 patients receiving at least 12 months of TCZ. Dd-cfDNA was elevated in all patients, with a median 2.24% at the start of TCZ treatment. After 6 months of TCZ treatment, 8/11 patients had dd- cfDNA <1%, and 3/11 had values <0.5%. Among those who completed at least 12 months of TCZ, dd-cfDNA decreased by 29% at 6 months (p = .05) and 47% by 12 months (p = .04). DSA also stabilized and, by 12 months, was reduced by 29% (p = .047). Graft function remained stable with no graft loss during treatment. There was a nonsignificant trend towards proteinuria reduction. During the course of treatment with tocilizumab, two patients experienced moderate to severe infections. CONCLUSIONS In our early short-term experience, TCZ appears to reduce graft injury as measured by dd-cfDNA and modulate the immune response as evident by a modest reduction in immunodominant DSA MFI. Allograft function and proteinuria also stabilized.
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Affiliation(s)
- Boonphiphop Boonpheng
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | | | - Yue-Harn Ng
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Christopher Blosser
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Ramasamy Bakthavatsalam
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA.,Department of Urology, University of Washington, Seattle, Washington, USA
| | | | - Kelly Smith
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Nicolae Leca
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
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Morenz A, Perkins J, Dick A, Young B, Ng YH. Reexamining the Impact of Insurance Type on Kidney Transplant Waitlist Status and Posttransplantation Outcomes in the United States After Implementation of the Affordable Care Act. Transplant Direct 2023; 9:e1442. [PMID: 36743233 PMCID: PMC9891441 DOI: 10.1097/txd.0000000000001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 01/27/2023] Open
Abstract
Insurance type, a marker of socioeconomic status, has been associated with poor access to kidney transplant (KT) and worse KT outcomes before the implementation of the Affordable Care Act (ACA) and the revised Kidney Allocation System (KAS). In this study, we assessed if insurance type remained a risk marker for worse waitlist and transplant outcomes after ACA and KAS. Methods Using Scientific Registry of Transplant Recipients data, we assessed insurance type of waitlisted candidates pre- (2008-2014) versus post- (2014-2021) KAS/ACA using chi-square tests. Next, we performed a competing risk analysis to study the effect of private versus public (Medicare, Medicaid, or government-sponsored) insurance on waitlist outcomes and a Cox survival analysis to study posttransplant outcomes while controlling for candidate, and recipient and donor variables, respectively. Results The proportion of overall KT candidates insured by Medicaid increased from pre-KAS/ACA to post-KAS/ACA (from 12 667 [7.3%] to 21 768 [8.8%], P < 0.0001). However, KT candidates with public insurance were more likely to have died or become too sick for KT (subdistribution hazard ratio [SHR] = 1.33, confidence interval [CI], 1.30-1.36) or to receive a deceased donor KT (SHR = 1.57, CI, 1.54-1.60) but less likely to receive a living donor KT (SHR = 0.87, CI, 0.85-0.89). Post-KT, KT recipients with public insurance had greater risk of mortality (relative risks = 1.22, CI, 1.15-1.31) and allograft failure (relative risks = 1.10, CI, 1.03-1.29). Conclusions Although the implementation of ACA marginally increased the proportion of waitlisted candidates with Medicaid, publicly insured KT candidates remained at greater risk of being removed from the waitlist, had lower probability of living donor kidney transplantation, and had greater probability of dying post-KT and allograft failure. Concerted efforts to address factors contributing to these inequities in future studies are needed, with the goal of achieving equity in KT for all.
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Affiliation(s)
- Anna Morenz
- Department of Medicine, University of Washington, Seattle, WA
| | - James Perkins
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), Department of Surgery, University of Washington, Seattle, WA
- Division of Transplantation, Department of Surgery, University of Washington, Seattle, WA
| | - André Dick
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), Department of Surgery, University of Washington, Seattle, WA
- Division of Transplantation, Department of Surgery, Seattle Children’s Hospital, Seattle, WA
| | - Bessie Young
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Yue-Harn Ng
- Clinical and Bio-Analytics Transplant Laboratory (CBATL), Department of Surgery, University of Washington, Seattle, WA
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
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Ng YH, Litvinovich I, Leyva Y, Ford CG, Zhu Y, Kendall K, Croswell E, Puttarajappa CM, Dew MA, Shapiro R, Unruh ML, Myaskovsky L. Medication, Healthcare Follow-up, and Lifestyle Nonadherence: Do They Share the Same Risk Factors? Transplant Direct 2022; 8:e1256. [PMID: 34912945 PMCID: PMC8670587 DOI: 10.1097/txd.0000000000001256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/14/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022] Open
Abstract
Barriers to medication adherence may differ from barriers in other domains of adherence. In this study, we assessed the association between pre-kidney transplantation (KT) factors with nonadherent behaviors in 3 different domains post-KT. METHODS We conducted a prospective cohort study with patient interviews at initial KT evaluation (baseline-nonadherence predictors in sociodemographic, condition-related, health system, and patient-related psychosocial factors) and at ≈6 mo post-KT (adherence outcomes: medications, healthcare follow-up, and lifestyle behavior). All patients who underwent KT at our institution and had ≈6-mo follow-up interview were included in the study. We assessed nonadherence in 3 different domains using continuous composite measures derived from the Health Habit Survey. We built multiple linear and logistic regression models, adjusting for baseline characteristics, to predict adherence outcomes. RESULTS We included 173 participants. Black race (mean difference in adherence score: -0.72; 95% confidence interval [CI], -1.12 to -0.32) and higher income (mean difference: -0.34; 95% CI, -0.67 to -0.02) predicted lower medication adherence. Experience of racial discrimination predicted lower adherence (odds ratio, 0.31; 95% CI, 0.12-0.76) and having internal locus of control predicted better adherence (odds ratio, 1.46; 95% CI, 1.06-2.03) to healthcare follow-up. In the lifestyle domain, higher education (mean difference: 0.75; 95% CI, 0.21-1.29) and lower body mass index (mean difference: -0.08; 95% CI, -0.13 to -0.03) predicted better adherence to dietary recommendations, but no risk factors predicted exercise adherence. CONCLUSIONS Different nonadherence behaviors may stem from different motivation and risk factors (eg, clinic nonattendance due to experiencing racial discrimination). Thus adherence intervention should be individualized to target at-risk population (eg, bias reduction training for medical staff to improve patient adherence to clinic visit).
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Affiliation(s)
- Yue-Harn Ng
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Igor Litvinovich
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Yuridia Leyva
- Center for the Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, Albuquerque, NM
| | - C. Graham Ford
- Center for the Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, Albuquerque, NM
| | - Yiliang Zhu
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | | | - Emilee Croswell
- Department of Medicine, School of Medicine, University of Pittsburgh, PA
| | | | - Mary Amanda Dew
- Department of Psychiatry, School of Medicine, University of Pittsburgh, PA
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine
| | - Mark L. Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Larissa Myaskovsky
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
- Center for the Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, Albuquerque, NM
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Kapp ME, Fogo AB, Roufouse C, Najafian B, Radhakrishnan J, Mohan S, Miller SE, D’Agati VD, Silberzweig J, Barbar T, Gopalan T, Srivatana V, Mokrzycki MH, Benstein JA, Ng YH, Lentine KL, Aggarwal V, Perl J, Salenger P, Koyner JL, Josephson MA, Heung M, Velez JC, Ikizler A, Vijayan A, William P, Thajudeen B, Slepian MJ. Renal Considerations in COVID-19: Biology, Pathology, and Pathophysiology. ASAIO J 2021; 67:1087-1096. [PMID: 34191753 PMCID: PMC8478105 DOI: 10.1097/mat.0000000000001530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged into a worldwide pandemic of epic proportion. Beyond pulmonary involvement in coronavirus disease 2019 (COVID-19), a significant subset of patients experiences acute kidney injury. Patients who die from severe disease most notably show diffuse acute tubular injury on postmortem examination with a possible contribution of focal macro- and microvascular thrombi. Renal biopsies in patients with proteinuria and hematuria have demonstrated a glomerular dominant pattern of injury, most notably a collapsing glomerulopathy reminiscent of findings seen in human immunodeficiency virus (HIV) in individuals with apolipoprotein L-1 (APOL1) risk allele variants. Although various mechanisms have been proposed for the pathogenesis of acute kidney injury in SARS-CoV-2 infection, direct renal cell infection has not been definitively demonstrated and our understanding of the spectrum of renal involvement remains incomplete. Herein we discuss the biology, pathology, and pathogenesis of SARS-CoV-2 infection and associated renal involvement. We discuss the molecular biology, risk factors, and pathophysiology of renal injury associated with SARS-CoV-2 infection. We highlight the characteristics of specific renal pathologies based on native kidney biopsy and autopsy. Additionally, a brief discussion on ancillary studies and challenges in the diagnosis of SARS-CoV-2 is presented.
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Affiliation(s)
- Meghan E. Kapp
- From the Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Agnes B. Fogo
- From the Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Candice Roufouse
- Department of Immunology and Inflammation, Centre for Inflammatory Diseases, Imperial College, London, UK
| | - Behzad Najafian
- Department of Laboratory Medicine & Pathology, University of Washington Medicine, Seattle, Washington
| | - Jai Radhakrishnan
- Division of Nephrology, Columbia University Medical Center, New York, New York
| | - Sumit Mohan
- Division of Nephrology, Columbia University Medical Center, New York, New York
| | - Sara E. Miller
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Vivette D. D’Agati
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | | | - Tarek Barbar
- Division of Nephrology, Weill Cornell Medical College, New York, New York
| | - Tulasi Gopalan
- Division of Nephrology, Weill Cornell Medical College, New York, New York
| | - Vesh Srivatana
- Division of Nephrology, Weill Cornell Medical College, New York, New York
| | - Michele H. Mokrzycki
- Division of Nephrology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Judith A. Benstein
- Department of Medicine, New York University Tisch Hospital, New York, New York
| | - Yue-Harn Ng
- Division of Nephrology, University of Washington, Seattle, Washington
| | - Krista L. Lentine
- Division of Nephrology (9-FDT), Center for Abdominal Transplantation, St. Louis, Missouri
| | - Vikram Aggarwal
- Division of Nephrology, Northwestern Medicine, Chicago, Illinois
| | - Jeffrey Perl
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | | | - Jay L. Koyner
- Department of Nephrology, University of Chicago, Chicago, Illinois
| | | | - Michael Heung
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Juan Carlos Velez
- Department of Nephrology, Ochsner Health System, New Orleans, Louisiana
| | - Alp Ikizler
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anitha Vijayan
- Department of Medicine – Nephrology, Washington University School of Medicine in St Louis, St. Louis, Missouri
| | - Preethi William
- Division of Cardiology, Banner University of Arizona, Tucson, Arizona
| | - Bijin Thajudeen
- Division of Nephrology, Banner University of Arizona, Tucson, Arizona
| | - Marvin J. Slepian
- Departments of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, Arizona
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7
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Chong K, Litvinovich I, Chen SS, Zhu Y, Argyropoulos C, Ng YH. Reconsidering Donor Race in Predicting Allograft and Patient Survival Among Kidney Transplant Recipients. Kidney360 2021; 2:1831-1835. [PMID: 35373002 PMCID: PMC8785831 DOI: 10.34067/kid.0002932021] [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] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/19/2021] [Indexed: 02/04/2023]
Abstract
Donor race should not be used in models to predict allograft and patient survival.Removing donor race from the Kidney Donor Risk Index may reduce kidney discard by reclassifying approximately 50% of high kidney donor profile index kidneys.Future prediction models should focus on using relevant biologic factors rather than social constructs when trying to predict outcomes.
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Affiliation(s)
- Kelly Chong
- Nephrology Division, University of New Mexico, Albuquerque, New Mexico
| | - Igor Litvinovich
- Nephrology Division, University of New Mexico, Albuquerque, New Mexico
| | - Shan Shan Chen
- Nephrology Division, University of New Mexico, Albuquerque, New Mexico
| | - Yiliang Zhu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, University of New Mexico, Albuquerque, New Mexico
| | | | - Yue-Harn Ng
- Nephrology Division, University of Washington, Seattle, Washington
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8
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Cheok GJW, Gatot C, Sim CHS, Ng YH, Tay KXK, Howe TS, Koh JSB. Appropriate attitude promotes mask wearing in spite of a significant experience of varying discomfort. Infect Dis Health 2021; 26:145-151. [PMID: 33612451 PMCID: PMC7891075 DOI: 10.1016/j.idh.2021.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/31/2020] [Accepted: 01/10/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Despite increasing evidence to support mask effectiveness in mitigating the spread of COVID-19, there is still raging controversy regarding the use of masks. Evaluation of public perceptions, attitudes and the individuals' experience towards mask-wearing is integral to ensuring reasonable compliance and allows authorities to address concerns held by the population. METHODS A cross-sectional survey of lay-people was conducted within a high volume tertiary level institution in Singapore, from 16 October to 16 November 2020. Surveys administered evaluated five questions: 1) duration of mask wear per day, 2) mask-type used, 3) perceived necessity, 4) discomfort level experienced and 5) causes for discomfort. RESULTS Out of 402 respondents, 67.2% primarily wore disposable surgical masks. 72% felt mask-wearing was necessary to control COVID-19 transmission. 78.4% reported discomfort while wearing masks, with mean discomfort levels of 4.21 out of 10. Impairment to breathing and communication difficulties were the most common discomforts faced. Younger respondents complained of higher incidence of dermatological issues and sweating (p < 0.05). Respondents who wore masks for longer duration reported higher incidence of dermatological issues (p = 0.001) and sweating (p = 0.032). CONCLUSION AND RELEVANCE Even with an available vaccine, adjunctive public health measures such as mask-wearing will likely continue in order to curb COVID-19 transmission. Experience from past pandemics is likely to propagate self-protective behavior within a community. Our study identified several common mask-wearing discomforts, allowing respective organizations valuable market feedback for research and development. With appropriate public attitudes, effective mask-wearing compliance can be attained in a concerted effort against the coronavirus.
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Affiliation(s)
- Gideon J W Cheok
- Department of Orthopaedic Surgery, Singapore General Hospital, Level 4, Academia, 20 College Road, Singapore 169856, Singapore.
| | - Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, Level 4, Academia, 20 College Road, Singapore 169856, Singapore
| | - Craigven H S Sim
- Department of Orthopaedic Surgery, Singapore General Hospital, Level 4, Academia, 20 College Road, Singapore 169856, Singapore
| | - Y H Ng
- Department of Orthopaedic Surgery, Singapore General Hospital, Level 4, Academia, 20 College Road, Singapore 169856, Singapore
| | - Kenny X K Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Level 4, Academia, 20 College Road, Singapore 169856, Singapore
| | - T S Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Level 4, Academia, 20 College Road, Singapore 169856, Singapore
| | - Joyce S B Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Level 4, Academia, 20 College Road, Singapore 169856, Singapore
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9
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Ng YH, Hong CC, Ng DZ, Kumar VP. Percutaneous distal clavicle excision for acromioclavicular joint arthritis: our experience and early results of a novel surgical technique. Musculoskelet Surg 2021; 106:247-255. [PMID: 33759141 DOI: 10.1007/s12306-021-00708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Symptomatic acromioclavicular joint (ACJ) osteoarthritis causes pain and limitations in activities of daily living. Open and arthroscopic distal clavicle excision techniques have been described with good outcomes. However, both techniques have their own sets of advantages and disadvantages. This study describes a novel technique of percutaneous distal clavicle excision for symptomatic ACJ osteoarthritis and our two-year results. METHODS Fifteen consecutive patients underwent percutaneous distal clavicle excision for ACJ arthritis. These patients had failed a trial of conservative treatment. The ACJ was confirmed as the pain generator with an intraarticular steroid/lignocaine injection, and shoulder MRI was used to exclude alternative pain generators in the shoulder. They had a minimum of two years of follow-up. RESULTS At a mean of 26.8 months postoperatively, the mean VAS pain score was 0, and the mean Constant score for the shoulder was 87.3 points (range 50-94), which corresponded to 1 good, 1 very good and 13 excellent results. The mean SF-36 score was 94.9 points (range 65-100). There were statistically significant improvements in the VAS scores, Constant shoulder scores and SF-36 scores at one year and two years of follow-up (p < 0.05). Three unique complications, namely subcutaneous emphysema, "missing" of the distal clavicle and thermal skin injury, were encountered. Our surgical technique has since been modified to circumvent these complications. CONCLUSION Our novel technique of percutaneous distal clavicle excision yields a 93.3% good-to-excellent results based on the Constant shoulder score and durable pain relief based on VAS at two years.
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Affiliation(s)
- Y H Ng
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - C C Hong
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - D Z Ng
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - V P Kumar
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
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10
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Lee AYS, Beroukas D, Brown L, Lucchesi C, Kaur A, Gyedu L, Hughes N, Ng YH, Saran O, Gordon TP, Wang JJ. Identification of a unique anti-Ro60 subset with restricted serological and molecular profiles. Clin Exp Immunol 2020; 203:13-21. [PMID: 32852779 DOI: 10.1111/cei.13508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 12/30/2022] Open
Abstract
Anti-Ro60 is one of the most common and clinically important serum autoantibodies that has a number of diagnostic and predictive capabilities. Most diagnostic laboratories report this simply as a qualitative positive/negative result. The objective of this study was to examine the clinical and serological relevance of a novel subset of anti-Ro60 in patients who display low levels of anti-Ro60 (anti-Ro60low ). We retrospectively identified anti-Ro60 sera during a 12-month period at a major immunopathology diagnostic laboratory in Australia. These all were anti-Ro60-precipitin-positive on the diagnostic gold standard counter-immuno-electrophoresis (CIEP). Lineblot immunoassay was used to stratify patients into either anti-Ro60low or anti-Ro60high subsets. We compared the medical and laboratory parameters associated with each group. Enzyme-linked immunosorbent assay (ELISA) and mass spectrometry techniques were used to analyse the serological and molecular basis behind the two subsets. Anti-Ro60low patients displayed less serological activity than anti-Ro60high patients with less intermolecular spreading, hypergammaglobulinaemia and less tendency to undergo anti-Ro60 isotype-switching than anti-Ro60high patients. Mass spectrometric typing of the anti-Ro60low subset showed restricted variable heavy chain subfamily usage and amino acid point mutations. This subset also displayed clinical relevance, being present in a number of patients with systemic autoimmune rheumatic diseases (SARD). We identify a novel anti-Ro60low patient subset that is distinct from anti-Ro60high patients serologically and molecularly. It is not clear whether they arise from common or separate origins; however, they probably have different developmental pathways to account for the stark difference in immunological maturity. We hence demonstrate significance to anti-Ro60low and justify accurate detection in the diagnostic laboratory.
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Affiliation(s)
- A Y S Lee
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - D Beroukas
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - L Brown
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia
| | - C Lucchesi
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia
| | - A Kaur
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia
| | - L Gyedu
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia
| | - N Hughes
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia
| | - Y H Ng
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia
| | - O Saran
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia
| | - T P Gordon
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - J J Wang
- Department of Immunology, SA Pathology and Flinders Medical Centre, Bedford Park, SA, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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11
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Low S, Chua HR, Wong R, Goh A, Ng YH, Teo BW, Vathsala A. Myocardial ischemia by radionuclide imaging and long-term outcomes after kidney transplantation. Int Urol Nephrol 2020; 52:1995-2003. [PMID: 32661630 DOI: 10.1007/s11255-020-02542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We examined the incidence of myocardial ischemia (MI) in kidney transplant recipients (KTR) using myocardial perfusion imaging (MPI), and its association with long-term outcomes after transplantation. METHODS A retrospective observational study was conducted of asymptomatic KTRs who underwent post-transplant MPI screening for MI, as defined by moderate to severe myocardial perfusion defects, post-stress myocardial stunning or balanced ischemia. A composite outcome of all-cause mortality, graft loss, and major adverse cardiovascular events (MACE) was examined over minimum 5 years. RESULTS We studied 135 KTRs who underwent 226 MPIs, with follow-up duration of 10 (7-13) years. 110 (81%) patients had normal MPIs, 11 (8%) had mild perfusion defects, and 14 (10%) had MI. Correspondingly, composite outcome developed in 6%, 27%, and 43% (p = 0.04), and MACE occurred in 7%, 0%, and 21% (p = 0.11), of the respective subgroups. Twenty-six patients developed the composite outcome after 5 (3-7) years post-transplantation, including 11 patients with MACE. On multivariate analysis, MI, higher low-density lipoprotein levels, and proteinuria > 0.3 g/day independently predicted the composite outcome; only MI predicted MACE (all p < 0.05). Ninety-one patients had two serial MPIs, which increased the positive predictive value for MACE from 17 to 25%. Absence of MI had negative predictive value of 83% for MACE and 93% for the composite outcome. CONCLUSION MI that is detected early post-kidney transplantation predicts long-term mortality, graft loss, and MACE in KTRs, with excellent negative but poor positive predictive values.
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Affiliation(s)
- Sanmay Low
- Department of Medicine, Level 10 Medicine Office, National University Centre for Organ Transplantation, National University Hospital, National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore.,Division of Renal Medicine, Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Horng-Ruey Chua
- Department of Medicine, Level 10 Medicine Office, National University Centre for Organ Transplantation, National University Hospital, National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore. .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Raymond Wong
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Angeline Goh
- Department of Medicine, Level 10 Medicine Office, National University Centre for Organ Transplantation, National University Hospital, National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yue-Harn Ng
- Department of Medicine, Level 10 Medicine Office, National University Centre for Organ Transplantation, National University Hospital, National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore
| | - Boon-Wee Teo
- Department of Medicine, Level 10 Medicine Office, National University Centre for Organ Transplantation, National University Hospital, National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anantharaman Vathsala
- Department of Medicine, Level 10 Medicine Office, National University Centre for Organ Transplantation, National University Hospital, National University Health System, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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12
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Chen SS, Pankratz VS, Litvinovich I, Al-Odat RT, Unruh ML, Ng YH. Expanded Criteria Donor Kidneys With Kidney Donor Profile Index ≤ 85%: Are We Doing Enough to Counsel Our Patients? Transplant Proc 2020; 52:54-60. [PMID: 31901324 DOI: 10.1016/j.transproceed.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/02/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Kidneys at higher risk for allograft failure are defined by the Kidney Donor Profile Index (KDPI) > 85% in the current kidney allocation system (KAS), replacing the historical concept of expanded criteria donor (ECD) kidneys in the previous KAS. Discrepancies exist in the classification of "high-risk kidneys" between the 2 KAS. In the current KAS, only recipients of KDPI > 85% kidneys are counseled about the high risk of allograft failure and are required to sign a consent. In this study, we evaluated the outcomes and allocation of kidneys with discordant classification. METHODS Using the Scientific Registry of Transplant Recipients, kidneys transplanted between 01/2002 and 09/2016 were classified according to the old (standard criteria donor [SCD]/ECD) and current (KDPI) KAS. We then grouped them as concordant (KDPI ≤ 85% + SCD or KDPI > 85% + ECD) and discordant (KDPI ≤ 85% + ECD or KDPI > 85% + SCD) kidneys. RESULTS Approximately 11% of transplanted kidneys were discordant in classification. Among kidneys with KDPI ≤ 85%, ECD status conferred a 64% (95% CI: 56%-73%) higher risk of allograft failure compared to SCD status. However, SCD/ECD status was not associated with differential outcomes in KDPI > 85% kidneys. These ECD kidneys have KDPIs > 50% and have been transplanted across all estimated post-transplant survival (EPTS) deciles. CONCLUSION Adequate counseling about the risk and benefit of accepting ECD kidneys with KDPI ≤ 85% versus waiting on dialysis should be explored with the patients, especially those with lower EPTS.
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Affiliation(s)
- Shan Shan Chen
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - V Shane Pankratz
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Igor Litvinovich
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Rawan T Al-Odat
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Mark L Unruh
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA; Section of Nephrology, Medicine Service, New Mexico VA Health Care System, Albuquerque, NM
| | - Yue-Harn Ng
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA.
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13
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Ng YH, Al Mawed S, Pankratz VS, Argyropoulos C, Singh P, Shaffi SK, Myaskovsky L, Unruh M, Harford A. Cognitive assessment in a predominantly Hispanic and Native American population in New Mexico and its association with kidney transplant wait-listing. Clin Transplant 2019; 33:e13674. [PMID: 31332845 DOI: 10.1111/ctr.13674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 06/30/2019] [Accepted: 07/15/2019] [Indexed: 02/04/2023]
Abstract
The association between cognitive function and the likelihood of kidney transplant (KT) wait-listing, especially in minority populations, has not been clearly delineated. We performed a retrospective review of our pre-KT patients, who consist mainly of Hispanics and Native Americans, over a 16-month period. We collected data on baseline demographics and the Montreal Cognitive Assessment (MoCA) score, at the initial KT evaluation. We defined cognitive impairment as MoCA scores of <24. We constructed linear regression models to identify associations between baseline characteristics with MoCA scores and used Cox proportional hazards models to assess associations between MoCA score and KT wait-listing. During the study period, 154 patients completed the MoCA during their initial evaluation. Mean (standard deviation) MoCA scores were 23.9 (4.6), with 58 (38%) participants scoring <24. Advanced age, lower education and being on dialysis were associated with lower MoCA scores. For every one-point increase in MoCA, the likelihood of being wait-listed increased 1.10-fold (95% CI 1.01-1.19, P = .022). Being Native American and having kidney disease due to diabetes or hypertension were associated with longer time to wait-listing. Cognitive impairment was common in our pre-KT patients and was associated with a lower likelihood of KT wait-listing.
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Affiliation(s)
- Yue-Harn Ng
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Saleem Al Mawed
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Vernon Shane Pankratz
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Pooja Singh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Saeed Kamran Shaffi
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Larissa Myaskovsky
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Mark Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Antonia Harford
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
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14
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Ng YH, Myers O, Shore X, Pankratz VS, Norris KC, Vassalotti JA, Argyropoulos C. The Association of Altitude and the Prevalence of Anemia Among People With CKD. Am J Kidney Dis 2019; 74:715-718. [PMID: 31200976 DOI: 10.1053/j.ajkd.2019.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/07/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Yue-Harn Ng
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM
| | - Orrin Myers
- Department of Medicine, University of New Mexico, Albuquerque, NM
| | - Xin Shore
- Family and Community Medicine, University of New Mexico, Albuquerque, NM
| | - V Shane Pankratz
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM
| | | | - Joseph A Vassalotti
- National Kidney Foundation Inc and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christos Argyropoulos
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM.
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15
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Ng YH, Pilcher DV, Bailey M, Bain CA, MacManus C, Bucknall TK. Predicting medical emergency team calls, cardiac arrest calls and re-admission after intensive care discharge: creation of a tool to identify at-risk patients. Anaesth Intensive Care 2018; 46:88-96. [PMID: 29361261 DOI: 10.1177/0310057x1804600113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We aimed to develop a predictive model for intensive care unit (ICU)-discharged patients at risk of post-ICU deterioration. We performed a retrospective, single-centre cohort observational study by linking the hospital admission, patient pathology, ICU, and medical emergency team (MET) databases. All patients discharged from the Alfred Hospital ICU to wards between July 2012 and June 2014 were included. The primary outcome was a composite endpoint of any MET call, cardiac arrest call or ICU re-admission. Multivariable logistic regression analysis was used to identify predictors of outcome and develop a risk-stratification model. Four thousand, six hundred and thirty-two patients were included in the study. Of these, 878 (19%) patients had a MET call, 51 (1.1%) patients had cardiac arrest calls, 304 (6.5%) were re-admitted to ICU during the same hospital stay, and 964 (21%) had MET calls, cardiac arrest calls or ICU re-admission. A discriminatory predictive model was developed (area under the receiver operating characteristic curve 0.72 [95% confidence intervals {CI} 0.70 to 0.73]) which identified the following factors: increasing age (odds ratio [OR] 1.012 [95% CI 1.007 to 1.017] <i>P</i> <0.001), ICU admission with subarachnoid haemorrhage (OR 2.26 [95% CI 1.22 to 4.16] <i>P</i>=0.009), admission to ICU from a ward (OR 1.67 [95% CI 1.31 to 2.13] <i>P</i> <0.001), Acute Physiology and Chronic Health Evaluation (APACHE) III score without the age component (OR 1.005 [95% CI 1.001 to 1.010] <i>P</i>=0.025), tracheostomy on ICU discharge (OR 4.32 [95% CI 2.9 to 6.42] <i>P</i> <0.001) and discharge to cardiothoracic (OR 2.43 [95%CI 1.49 to 3.96] <i>P</i> <0.001) or oncology wards (OR 2.27 [95% CI 1.05 to 4.89] <i>P</i>=0.036). Over the two-year period, 361 patients were identified as having a greater than 50% chance of having post-ICU deterioration. Factors are identifiable to predict patients at risk of post-ICU deterioration. This knowledge could be used to guide patient follow-up after ICU discharge, optimise healthcare resources, and improve patient outcomes and service delivery.
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Affiliation(s)
- Y H Ng
- School of Nursing and Midwifery, Deakin University, Melbourne, Victoria
| | - D V Pilcher
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - M Bailey
- Statistician, The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
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16
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Roumelioti ME, Trietley G, Nolin TD, Ng YH, Xu Z, Alaini A, Figueroa R, Unruh ML, Argyropoulos CP. Beta-2 microglobulin clearance in high-flux dialysis and convective dialysis modalities: a meta-analysis of published studies. Nephrol Dial Transplant 2018; 33:542. [DOI: 10.1093/ndt/gfx373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Roumelioti ME, Trietley G, Nolin TD, Ng YH, Xu Z, Alaini A, Figueroa R, Unruh ML, Argyropoulos CP. Beta-2 microglobulin clearance in high-flux dialysis and convective dialysis modalities: a meta-analysis of published studies. Nephrol Dial Transplant 2017; 33:1025-1039. [DOI: 10.1093/ndt/gfx311] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 10/04/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- Maria-Eleni Roumelioti
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Gregory Trietley
- Department of Pharmacy and Therapeutics, Renal-Electrolyte Division, University of Pittsburgh Schools of Pharmacy and Medicine, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh Schools of Pharmacy and Medicine, Pittsburgh, PA, USA
| | - Thomas D Nolin
- Department of Pharmacy and Therapeutics, Renal-Electrolyte Division, University of Pittsburgh Schools of Pharmacy and Medicine, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh Schools of Pharmacy and Medicine, Pittsburgh, PA, USA
| | - Yue-Harn Ng
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Zhi Xu
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Ahmed Alaini
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Rocio Figueroa
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Mark L Unruh
- Nephrology Division, Department of Medicine, University of New Mexico, Albuquerque, NM, USA
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18
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Argyropoulos CP, Chen SS, Ng YH, Roumelioti ME, Shaffi K, Singh PP, Tzamaloukas AH. Rediscovering Beta-2 Microglobulin As a Biomarker across the Spectrum of Kidney Diseases. Front Med (Lausanne) 2017; 4:73. [PMID: 28664159 PMCID: PMC5471312 DOI: 10.3389/fmed.2017.00073] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [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: 04/12/2017] [Accepted: 05/26/2017] [Indexed: 12/28/2022] Open
Abstract
There is currently an unmet need for better biomarkers across the spectrum of renal diseases. In this paper, we revisit the role of beta-2 microglobulin (β2M) as a biomarker in patients with chronic kidney disease and end-stage renal disease. Prior to reviewing the numerous clinical studies in the area, we describe the basic biology of β2M, focusing in particular on its role in maintaining the serum albumin levels and reclaiming the albumin in tubular fluid through the actions of the neonatal Fc receptor. Disorders of abnormal β2M function arise as a result of altered binding of β2M to its protein cofactors and the clinical manifestations are exemplified by rare human genetic conditions and mice knockouts. We highlight the utility of β2M as a predictor of renal function and clinical outcomes in recent large database studies against predictions made by recently developed whole body population kinetic models. Furthermore, we discuss recent animal data suggesting that contrary to textbook dogma urinary β2M may be a marker for glomerular rather than tubular pathology. We review the existing literature about β2M as a biomarker in patients receiving renal replacement therapy, with particular emphasis on large outcome trials. We note emerging proteomic data suggesting that β2M is a promising marker of chronic allograft nephropathy. Finally, we present data about the role of β2M as a biomarker in a number of non-renal diseases. The goal of this comprehensive review is to direct attention to the multifaceted role of β2M as a biomarker, and its exciting biology in order to propose the next steps required to bring this recently rediscovered biomarker into the twenty-first century.
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Affiliation(s)
- Christos P Argyropoulos
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Shan Shan Chen
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Yue-Harn Ng
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Maria-Eleni Roumelioti
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Kamran Shaffi
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Pooja P Singh
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Antonios H Tzamaloukas
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States.,Raymond G. Murphy VA Medical Center Albuquerque, Albuquerque, NM, United States
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19
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Ng YH, Ganta K, Davis H, Pankratz VS, Unruh M. Vascular Access Site for Renal Replacement Therapy in Acute Kidney Injury: A Post hoc Analysis of the ATN Study. Front Med (Lausanne) 2017; 4:40. [PMID: 28443283 PMCID: PMC5387053 DOI: 10.3389/fmed.2017.00040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/24/2017] [Indexed: 11/17/2022] Open
Abstract
Background Acute kidney injury requiring renal replacement therapy (RRT) in the intensive care unit portends a poor prognosis. The decisions regarding dialysis catheter placement is based mainly on physician discretion with little evidence to support the choice of dialysis catheter location. Methods The Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study was a multicenter, prospective, randomized trial of intensive vs. less intensive RRT in critically ill patients with AKI. We assessed the association of dialysis catheter location with dialysis catheter-related outcomes including catheter-related complications, mortality, dialysis dependence, and dialysis dose delivered. Results Of the 1,124 patients enrolled in the ATN study, catheter data were available in 1,016 (90.39%) patients. A total of 91 (8.96%) subclavian, 387 (38.09%) internal jugular, and 538 (52.95%) femoral dialysis catheters were inserted. The femoral group was younger (58.39 ± 16.27), had greater bleeding tendency [lower platelet count (96.00 ± 109.35) with higher INR (2.01 ± 2.19)], and had a higher baseline sequential organ failure assessment score on admission (14.59 ± 3.61) compared to the other two groups. Dialysis catheter-related complications were low in this study with no significant difference in the rates of complications among all catheter locations. Mortality and dialysis dependence was lowest in the subclavian group, while the dose of dialysis delivered (Kt/V) remained lowest in the femoral group, after propensity score and center adjustments. Conclusion Patient characteristics influence the choice of dialysis catheter location with a tendency to place femoral catheters in younger, sicker, and more coagulopathic patients. There were no statistically significant differences in complication rates among the three catheter locations, although femoral catheters may be associated with a lower delivered dose of dialysis during intermittent hemodialysis. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT00076219.
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Affiliation(s)
- Yue-Harn Ng
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Kavitha Ganta
- New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Herbert Davis
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - V Shane Pankratz
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Mark Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.,New Mexico VA Health Care System, Albuquerque, NM, USA
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20
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Foo CY, Lim HN, Pandikumar A, Huang NM, Ng YH. Utilization of reduced graphene oxide/cadmium sulfide-modified carbon cloth for visible-light-prompt photoelectrochemical sensor for copper (II) ions. J Hazard Mater 2016; 304:400-408. [PMID: 26595899 DOI: 10.1016/j.jhazmat.2015.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/27/2015] [Accepted: 11/04/2015] [Indexed: 06/05/2023]
Abstract
A newly developed CdS/rGO/CC electrode was prepared based on a flexible carbon cloth (CC) substrate with cadmium sulfide (CdS) nanoparticles and reduced graphene oxide (rGO). The CdS was synthesized using an aerosol-assisted chemical vapor deposition (AACVD) method, and the graphene oxide was thermally reduced on the modified electrode surface. The existence of rGO in the CdS-modified electrode increased the photocurrent intensity of the CdS/rGO/CC-modified electrode by three orders of magnitude, compared to that of the CdS/ITO electrode and two orders of magnitude higher than the CdS/CC electrode. A new visible-light-prompt photoelectrochemical sensor was developed based on the competitive binding reaction of Cu(2+) and CdS on the electrode surface. The results showed that the effect of the Cu(2+) on the photocurrent response was concentration-dependent over the linear ranges of 0.1-1.0 μM and 1.0-40.0 μM with a detection limit of 0.05 μM. The results of a selectivity test showed that this modified electrode has a high response toward Cu(2+) compared to other heavy metal ions. The proposed CdS/rGO/CC electrode provided a significantly high potential current compared to other reported values, and could be a practical tool for the fast, sensitive, and selective determination of Cu(2+).
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Affiliation(s)
- C Y Foo
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - H N Lim
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Functional Device Laboratory, Institute of Advance Technology, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - A Pandikumar
- Low Dimensional Materials Research Centre, Department of Physics, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - N M Huang
- Low Dimensional Materials Research Centre, Department of Physics, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Y H Ng
- Particles and Catalysis Research Group, School of Chemical Engineering, The University of New South Wales, NSW 2052, Australia
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Singh P, Ng YH, Unruh M. Kidney Transplantation Among the Elderly: Challenges and Opportunities to Improve Outcomes. Adv Chronic Kidney Dis 2016; 23:44-50. [PMID: 26709062 DOI: 10.1053/j.ackd.2015.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/01/2015] [Accepted: 11/02/2015] [Indexed: 01/08/2023]
Abstract
Elderly patients (>65 years old) represent the fastest growing population among the ESRD patients and those awaiting kidney transplantation. There is ample evidence to suggest that kidney transplant in the elderly population offers the best chance of survival and improves health-related quality of life compared to remaining on dialysis. Although all these emerging facts are encouraging, this population brings with them complex medical problems including frailty, cognitive impairment, and multiple comorbidities. These issues can be barriers to transplantation and threaten the well-being of the patients after transplantation. Furthermore, aging results in changes to the immune system and affects the pharmacokinetics of immunosuppressants. All these changes can increase risk of complications such as infections and malignancy. Because death with a functioning graft is a common cause of graft loss, the new kidney allocation system has been implemented in an attempt to maximize allograft utilization and minimize unrealized graft years. This may result in longer wait-times for the elderly. In this review, we will highlight the barriers to kidney transplant, characterize transplant-related issues in the elderly, and propose alternative strategies under the new allocation system.
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22
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Singh T, Ng YH, Ramaswami B, Ippolito R, Chalasani G. Intrinsic MyD88-activation in B cells is necessary for development of alloreactive memory T cells (TRAN3P.902). The Journal of Immunology 2014. [DOI: 10.4049/jimmunol.192.supp.202.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
B cells help alloreactive T cells to differentiate into memory T cells. Since B cells express TLRs, we asked whether MyD88-mediated activation of B cells is required for T cell activation and differentiation to memory T cells. Methods: Irradiated μMTCD45.1 mice were transplanted with bone marrow cells from μMTCD45.1 and wtCD45.2 (μMT+wt) or μMTCD45.1 and MyD88-/-CD45.2 (μMT+MyD88-/-). Differences in congenic background allowed us to confirm that following reconstitution, MyD88 deficiency was essentially restricted to B cells. μMT+MyD88-/- and μMT+wt received Balb/c skin transplants. Results: Rejection of allografts was comparable between μMT+MyD88-/- and μMT+wt chimeras (MST=18 days). μMT+MyD88-/- recipients showed 3-fold more alloreactive IFNγ+ CD4 and CD8 effector T cells when compared to μMT+wt mice at day 14 (p<0.05). IL-10+ B cells were diminished (p<0.005) in μMT+MyD88-/- than in μMT+wt chimeras. CD8 memory precursor T cells (CD44hi CD62Llo CD127hi) in μMT+MyD88-/- showed predominantly Bcl2lo expression in both KLRG1lo memory precursor effector cell (MPEC) and KLRG1hi short-lived effector cell (SLEC) populations. Consistent with these findings, fewer alloreactive CD4 and CD8 IFNγ+ memory T cells were seen in μMT+MyD88-/- (p<0.005) resulting in impaired memory recall (MST = 27 vs. 15 days, p < 0.005) than in μMT+wt chimeras. Conclusions: Intrinsic MyD88-dependent B cell functions are important for alloreactive T cell differentiation into long-lived memory T cells.
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Affiliation(s)
- Tripti Singh
- 1Medicine (Renal), Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Yue-Harn Ng
- 1Medicine (Renal), Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | | | - Renee Ippolito
- 1Medicine (Renal), Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Geetha Chalasani
- 1Medicine (Renal), Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
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Zeng Q, Ng YH, Singh T, Jiang K, Sheriff KA, Ippolito R, Zahalka S, Li Q, Randhawa P, Hoffman RA, Ramaswami B, Lund FE, Chalasani G. B cells mediate chronic allograft rejection independently of antibody production. J Clin Invest 2014; 124:1052-6. [PMID: 24509079 DOI: 10.1172/jci70084] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 11/22/2013] [Indexed: 12/22/2022] Open
Abstract
Chronic rejection is the primary cause of long-term failure of transplanted organs and is often viewed as an antibody-dependent process. Chronic rejection, however, is also observed in mice and humans with no detectable circulating alloantibodies, suggesting that antibody-independent pathways may also contribute to pathogenesis of transplant rejection. Here, we have provided direct evidence that chronic rejection of vascularized heart allografts occurs in the complete absence of antibodies, but requires the presence of B cells. Mice that were deficient for antibodies but not B cells experienced the same chronic allograft vasculopathy (CAV), which is a pathognomonic feature of chronic rejection, as WT mice; however, mice that were deficient for both B cells and antibodies were protected from CAV. B cells contributed to CAV by supporting splenic lymphoid architecture, T cell cytokine production, and infiltration of T cells into graft vessels. In chimeric mice, in which B cells were present but could not present antigen, both T cell responses and CAV were markedly reduced. These findings establish that chronic rejection can occur in the complete absence of antibodies and that B cells contribute to this process by supporting T cell responses through antigen presentation and maintenance of lymphoid architecture.
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Leung YH, Chan CMN, Ng AMC, Chan HT, Chiang MWL, Djurišić AB, Ng YH, Jim WY, Guo MY, Leung FCC, Chan WK, Au DTW. Antibacterial activity of ZnO nanoparticles with a modified surface under ambient illumination. Nanotechnology 2012; 23:475703. [PMID: 23103840 DOI: 10.1088/0957-4484/23/47/475703] [Citation(s) in RCA: 62] [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] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In various practical applications, nanomaterials typically have functionalized surfaces. Yet, the studies of toxicity and antibacterial activity of functionalized nanoparticles are scarce. We investigated the effect of surface modifications on antibacterial activity of ZnO under ambient illumination, and we found that nanoparticles coated with different surface modifying reagents could exhibit higher or lower toxicity compared to bare ZnO, depending on the surface modifying reagent used. Different surface modifying reagent molecules resulted in differences in the release of Zn(2+) ions and the production of reactive oxygen species (ROS). However, the antibacterial activity did not correlate with the ROS levels or the Zn(2+) ion release. One of the surface-modified ZnO samples exhibited significantly lower Zn(2+) ion release while at the same time exhibiting improved antibacterial activity. In all cases, damage of the cell wall membranes and/or changes in the membrane permeability have been observed, together with the changes in ATR-FTIR spectra indicating differences in protein conformation. Mechanisms of antibacterial activity are discussed.
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Affiliation(s)
- Y H Leung
- Department of Physics, The University of Hong Kong, Hong Kong
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Yang C, Chalasani G, Ng YH, Robbins PD. Exosomes released from Mycoplasma infected tumor cells activate inhibitory B cells. PLoS One 2012; 7:e36138. [PMID: 22558358 PMCID: PMC3338602 DOI: 10.1371/journal.pone.0036138] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 03/31/2012] [Indexed: 01/28/2023] Open
Abstract
Mycoplasmas cause numerous human diseases and are common opportunistic pathogens in cancer patients and immunocompromised individuals. Mycoplasma infection elicits various host immune responses. Here we demonstrate that mycoplasma-infected tumor cells release exosomes (myco+ exosomes) that specifically activate splenic B cells and induce splenocytes cytokine production. Induction of cytokines, including the proinflammatory IFN-γ and the anti-inflammatory IL-10, was largely dependent on the presence of B cells. B cells were the major IL-10 producers. In splenocytes from B cell deficient μMT mice, induction of IFN-γ+ T cells by myco+ exosomes was greatly increased compared with wild type splenocytes. In addition, anti-CD3-stimulated T cell proliferation was greatly inhibited in the presence of myco+ exosome-treated B cells. Also, anti-CD3-stimulated T cell signaling was impaired by myco+ exosome treatment. Proteomic analysis identified mycoplasma proteins in exosomes that potentially contribute to the effects. Our results demonstrate that mycoplasma-infected tumor cells release exosomes carrying mycoplasma components that preferentially activate B cells, which in turn, are able to inhibit T cell activity. These results suggest that mycoplasmas infecting tumor cells can exploit the exosome pathway to disseminate their own components and modulate the activity of immune cells, in particular, activate B cells with inhibitory activity.
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Affiliation(s)
- Chenjie Yang
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Geetha Chalasani
- Renal-Electrolyte Division, Departments of Medicine and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Yue-Harn Ng
- Renal-Electrolyte Division, Departments of Medicine and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Paul D. Robbins
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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Abstract
INTRODUCTION There is a recent surge in interest on bisphosphonate related femoral fractures. Most studies have examined subtrochanteric fractures in patients on long-term bisphosphonates. This study evaluates the characteristics of low-impact femoral shaft fractures in elderly patients on long-term alendronate. MATERIALS AND METHODS All patients above 60 years old admitted to the National University Hospital for femoral shaft fracture from January 2003 to January 2007 were retrospectively analysed. Of the 55 patients included, 7 had prior alendronate therapy and were examined in detail. RESULTS All 7 patients on prior alendronate therapy sustained their fractures by low-impact or atraumatic mechanisms of injury. 5 of these 7 patients exhibited a characteristic fracture pattern of thickened lateral cortices at the proximal fracture fragment (p<0.05) and all 7 patients had either transverse or short oblique fractures. Notably, none of the 7 patients had bone mineral density scans prior to their fractures. One patient was started on alendronate after a vertebral compression fracture, whilst the other 6 patients were started on alendronate without any clear clinical indication. All 7 patients reported prodromal thigh pain 3 weeks to 2 years prior to the fracture. CONCLUSIONS Low-impact femoral shaft fractures in elderly patients on long-term alendronate therapy represent a new entity of insufficiency fractures, with characteristic low-impact modes of injury and fracture patterns on radiograph. Prodromal thigh pain is a warning sign for impending fracture in this group of patients and should be evaluated closely. Teriparatide is a possible alternative to alendronate following such a fracture though more long-term clinical studies are required.
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Affiliation(s)
- Y H Ng
- Department of Orthopaedic Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
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Abstract
B cells are recognized as effector cells in allograft rejection that are dependent upon T cell help to produce alloantibodies causing graft injury. It is not known if B cells can also help T cells differentiate into memory cells in the alloimmune response. We found that in B-cell-deficient hosts, differentiation of alloreactive T cells into effectors was intact whereas their development into memory T cells was impaired. To test if B cell help for T cells was required for their continued differentiation into memory T cells, activated T cells were sorted from alloimmunized mice and transferred either with or without B cells into naïve adoptive hosts. Activated T cells cotransferred with B cells gave rise to more memory T cells than those transferred without B cells and upon recall, mediated accelerated rejection of skin allografts. Cotransfer of B cells led to increased memory T cells by enhancing activated CD4 T-cell proliferation and activated CD8 T-cell survival. These results indicate that B cells help alloreactive T-cell differentiation, proliferation and survival to generate optimal numbers of functional memory T cells.
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Affiliation(s)
- Yue-Harn Ng
- Departments of Medicine (Renal-Electrolyte) and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261,Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261
| | - Martin H. Oberbarnscheidt
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261
| | | | - Rosemary Hoffman
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261
| | - Geetha Chalasani
- Departments of Medicine (Renal-Electrolyte) and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261,Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261,Address correspondence and reprint requests to: Dr. Geetha Chalasani, University of Pittsburgh School of Medicine, BST W1554, 200 Lothrop Street, Pittsburgh, PA 15261. Phone: (412) 383-5924; Fax: (412) 383-9990;
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Ng YH, Chong KW, Tan GM, Rao M. Distally pedicled peroneus brevis muscle flap: a versatile lower leg and foot flap. Singapore Med J 2010; 51:339-342. [PMID: 20505914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the outcome of our early experience with the distally pedicled peroneus brevis flap in the management of soft tissue defects of the lower leg, ankle and foot. METHODS This was a non-randomised, retrospective study involving five patients who were treated with the peroneus brevis muscle flap for soft tissue defects over the lower leg. RESULTS In all five patients, the flaps were viable and successful in providing satisfactory soft tissue coverage for the defects. In one diabetic patient, distal flap necrosis was observed, which was treated successfully with a local rotational skin flap. CONCLUSION The distally pedicled peroneus brevis muscle flap is an economical, reliable and relatively easy procedure for treating defects of the distal third of the leg, ankle and foot.
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Affiliation(s)
- Y H Ng
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
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Abstract
Secondary lymphoid tissues are the hub of adaptive immune responses wherein rare cognate lymphocytes encounter dendritic cells bearing antigen from peripheral tissues and differentiate into effector and memory cells that eliminate antigen. It is accepted that immune responses against microbial and tumor antigens are initiated within secondary lymphoid tissues. There is less agreement on whether the same principle applies to immune responses to a transplanted organ because an allograft expresses foreign major histocompatibility complex and contains donor antigen presenting cells that could activate T cells directly in situ leading to rejection. Recent studies confirm that although naïve T cells can be primed within the allograft, their differentiation to effect rejection is dependent on secondary lymphoid tissues. Antigen-experienced memory T cells, unlike Naïve T cells, function largely independent of secondary lymphoid tissues to cause allograft rejection. In an alloimmune response, secondary lymphoid tissues support not only immune activation but also immune regulation essential for allograft survival. Here, we will review recent findings and discuss the role of secondary lymphoid tissues in primary and memory alloimmune responses.
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Affiliation(s)
- Yue-Harn Ng
- Department of Medicine (Renal-Electrolyte), Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
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Yang C, Ng YH, Chalasani G, Robbins P. S.93. Characterization of Tumor-derived Exosomes and Their Role in Immunoregulation. Clin Immunol 2009. [DOI: 10.1016/j.clim.2009.03.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
The contribution of secondary lymphoid tissue-homing central memory T cells (T(CM)) and peripheral tissue-homing effector memory T cells (T(EM)) to allograft rejection is not known. We tested whether T(EM) is the principal subset responsible for allograft rejection due to the nonlymphoid location of target antigens. Skin allograft rejection was studied after transferring either CD8 T(CM) or T(EM) to wild-type mice and to mice that lack secondary lymphoid tissues. We found that CD8 T(CM) and T(EM) were equally effective at rejecting allografts in wild-type hosts. However, CD8 T(EM) were significantly better than T(CM) at rejecting allografts in the absence of secondary lymphoid tissues. CD8 T(CM) were dependent upon secondary lymphoid tissues more than T(EM) for optimal differentiation into effectors that migrate into the allograft. Recall of either CD8 T(CM) or T(EM) led to accumulation of T(EM) after allograft rejection. These findings indicate that either CD8 T(CM) or T(EM) mediate allograft rejection but T(EM) have an advantage over T(CM) in immune surveillance of peripheral tissues, including transplanted organs.
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Affiliation(s)
| | - Yue-Harn Ng
- Departments of Medicine (Renal-Electrolyte) and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261
| | - Geetha Chalasani
- Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261,Address correspondence and reprint requests to Dr. Geetha Chalasani, University of Pittsburgh School of Medicine, W1554 BST, 200 Lothrop Street, Pittsburgh, PA 15261.
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Ng YH, Meyer KB, Kusek JW, Yan G, Rocco MV, Kimmel PL, Benz RL, Beddhu S, Dwyer JT, Toto RD, Eknoyan G, Unruh ML. Hemodialysis timing, survival, and cardiovascular outcomes in the Hemodialysis (HEMO) Study. Am J Kidney Dis 2006; 47:614-24. [PMID: 16564939 DOI: 10.1053/j.ajkd.2005.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 12/12/2005] [Indexed: 11/11/2022]
Abstract
BACKGROUND The timing of medical therapies has been shown to influence the outcomes and side effects of treatments for disease. This report examines the extent to which hemodialysis treatment time of day was associated with cardiovascular mortality and morbidity and all-cause mortality in a secondary analysis of the Hemodialysis Study. METHODS Dialysis start time defined dialysis shift: morning beginning between 0400 and 0930 hours (n = 822); midday, between 0930 and 1530 hours (n = 851); and evening, between 1530 and 2200 hours (n = 172). Outcome measures included all-cause mortality, cardiac death, composite end point of all-cause mortality or first cardiac hospitalization, and composite end point of first cardiac hospitalization or cardiac death. RESULTS Morning hemodialysis was associated with a lower likelihood of cardiovascular events compared with the evening shift in all-cause mortality or first cardiac hospitalization (evening versus morning, relative risk [RR], 1.29; 95% confidence interval [CI], 1.01 to 1.65; P = 0.043), as well as first cardiac hospitalization or cardiac death (evening versus morning, RR, 1.44; 95% CI, 1.11 to 1.89; P = 0.007). No differences were noted in the other 2 outcomes, and there was no statistically significant difference between the morning and midday shifts. Although crude mortality rates were greater in the midday compared with morning (RR, 1.21; 95% CI, 1.05 to 1.39; P = 0.008), this association was attenuated after adjustment (RR, 1.04; 95% CI, 0.89 to 1.22; P = 0.64). CONCLUSION Making extensive adjustment for patient characteristics, this report does not support the association of lower all-cause mortality with morning hemodialysis or a particular benefit for older patients.
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Affiliation(s)
- Yue-Harn Ng
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abstract
Disseminated tuberculous lesions post intravesical BCG therapy are rare but need to be identified and treated quickly. We report the first case of a tuberculous cutaneous lesion in a patient receiving the above treatment.
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Affiliation(s)
- Y H Ng
- Department of Urology, Raigmore Hospital, Inverness, UK
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Wen HL, Ho WK, Ling N, Mehal ZD, Ng YH. Immunoassayable beta-endorphin level in the plasma and CSF of heroin addicted and normal subjects before and after electroacupuncture. Am J Chin Med 1980; 8:154-9. [PMID: 6967253 DOI: 10.1142/s0192415x80000104] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The present study was undertaken to evaluate if plasma or CSF beta-endorphin level can be induced to rise during the treatment of heroin addiction by electroacupuncture. Based on the examination of 30 addicts, we obtained no evidence indicating an increase of beta-endorphin level in either the plasma or the CSF after 30 min of acupuncture. In spite of this, the majority of the addicts experienced a reduction of withdrawal symptoms during treatment. Since electroacupuncture may only induce a highly localized secretion of beta-endorphin in the brain, our results cannot unequivocally exclude the possibility that this peptide is involved in mediating the action of acupuncture.
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Wen HL, Lo CW, Ho WK, Mehal ZD, Ng YH, Lam S, Ma L. Naloxone in the treatment of schizophrenia. Mod Med Asia 1978; 14:51-5. [PMID: 750907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wen HL, Ng YH, Ho WK, Fung KP, Wong HK, Ma L, Wong HC. Acupuncture in narcotic withdrawal: a preliminary report on biochemical changes in the blood and urine of heroin addicts. Bull Narc 1978; 30:31-9. [PMID: 216444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Eight female heroin-addicted subjects were treated over a 10-day period by acupuncture and electrical stimulation (AES). Their plasma ACTH, cortisol and c-AMP levels were reduced after initial AES treatment. The reduction of c-AMP was significant the most of the three. The suppression of these compounds may be associated with the temporary relief of withdrawl symptoms on and after each AES treatment in the first three days. On the third day, ACTH, cortisol and c-AMP levels did not show significant changes after AES. This was presumably due to the disappearance of withdrawal symptoms and possibly to the stabilizing effect of the treatment. Both the ACTH and c-AMP levels were generally lower at the end of the treatment period. Results of the present investigation suggest that plasma c-AMP may be the best parameter by which to gauge the response of heroin addicts to AES.
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Wen HL, Ho WK, Wong HK, Mehal ZD, Ng YH, Ma L. Reduction of adrenocorticotropic hormone (ACTH) and cortisol in drug addicts treated by acupuncture and electrical stimulation (AES). Comp Med East West 1978; 6:61-6. [PMID: 213234 DOI: 10.1142/s0147291778000095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Forty-two heroin addicts and 31 normal persons were examined for the effect of acupuncture and electrical stimulation (AES) on plasma ACTH, cortisol and cyclic-AMP levels. Both ACTH and cortisol levels were reduced significantly in the addicts after treatment whereas no such significant reduction was observed in the normals. Plasma cyclic-AMP level was not affected in either group. Taken together, results from the present study suggest that the mechanism of AES in the treatment of addiction may have a neuroendocrinological basis. This hypothesis is particularly attractive in view of the isolation of opiate-like peptides from the brain.
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Wen HL, Ho WK, Wong HK, Mehal ZD, Ng YH, Ma L. Changes in adrenocorticotropic hormone (ACTH) and cortisol levels in drug addicts treated by a new and rapid detoxification procedure using acupuncture and naloxone. Comp Med East West 1978; 6:241-5. [PMID: 225122 DOI: 10.1142/s0147291778000319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Plasma ACTH, cortisol, and cyclic-AMP levels of eleven heroin addicts were dertermined before and after treatment with a fast detoxification procedure using acupuncture and electrical stimulation (AES) together with the administration of limited doses of naloxone. At the end of the treatment period, the average plasma ACTH, cortisol, and cyclic-AMP level rose 130,83, and 24 percent, respectively. In view of the appearance of mild withdrawal signs during this method of treatment, the observed increases in ACTH and cortisol levels probably reflect the inability of AES to suppress withdrawal symptoms induced by naloxone completely. The mechanism underlying this new method of treatment is discussed in relation to AES's ability to stimulate the secretion of endorphins.
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Abstract
The serum concentrations of ACTH, cortisol, aldosterone, thyroxine, cyclic AMP and cholesterol were compared between normal and heroin-addicted subjects. Significantly lower ACTH, cyclic AMP and cholesterol levels were observed to be associated with the heroin addicts, but their plasma thyroxine level was significantly elevated. The possible physiopsychological effect resulting from these changes is discussed.
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