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Boey JY, Kong U, Lee CK, Lim GK, Oo CW, Tan CK, Ng CY, Azniwati AA, Tay GS. The effect of spent coffee ground (SCG) loading, matrix ratio and biological treatment of SCG on poly(hydroxybutyrate) (PHB)/poly(lactic acid) (PLA) polymer blend. Int J Biol Macromol 2024; 266:131079. [PMID: 38537860 DOI: 10.1016/j.ijbiomac.2024.131079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
This study investigates the effects of SCG embedded into biodegradable polymer blends and aimed to formulate and characterise biomass-reinforced biocomposites using spent coffee ground (SCG) as reinforcement in PHB/PLA polymer blend. The effect of SCG filler loading and varying PHB/PLA ratios on the tensile properties and morphological characteristics of the biocomposites were examined. The results indicated that tensile properties reduction could be due to its incompatibility with the PHB/PLA matrixSCG aggregation at 40 wt% content resulted in higher void formation compared to lower content at 10 wt%. A PHB/PLA ratio of 50/50 with SCG loading 20 wt% was chosen for biocomposites with treated SCG. Biological treatment of SCG using Phanerochaete chrysosporium CK01 and Aspergillus niger DWA8 indicated P. chrysosporium CK01 necessitated a higher moisture content for optimum growth and enzyme production, whereas the optimal conditions for enzyme production (50-55 %, w/w) differed from those promoting A. niger DWA8 growth (40 %, w/w). SEM micrographs highlighted uniform distribution and effective wetting of treated SCG, resulting in improvements of tensile strength and modulus of biocomposites, respectively. The study demonstrated the effectiveness of sustainable fungal treatment in enhancing the interfacial adhesion between treated SCG and the PHB/PLA matrix.
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Affiliation(s)
- J Y Boey
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - U Kong
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - C K Lee
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - G K Lim
- School of Chemical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - C W Oo
- School of Chemical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - C K Tan
- PMI Packaging Sdn. Bhd., Taman Perindustrian Senai, 81400 Senai, Johor, Malaysia
| | - C Y Ng
- CY Enterprise Sdn. Bhd., Taman Perindustrian Murni, 81400 Senai, Johor, Malaysia
| | - A A Azniwati
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - G S Tay
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia.
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Hur YJ, Kim J, Seong J, Lee CK, Kim BK, Kim DY. Combination of Radiotherapy and Atezolizumab plus Bevacizumab in Patients with Advanced Hepatocellular Carcinoma: A Pilot Study. Int J Radiat Oncol Biol Phys 2023; 117:e304-e305. [PMID: 37785109 DOI: 10.1016/j.ijrobp.2023.06.2325] [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) Following the results of the IMbrave150 study, Atezolizumab plus bevacizumab (Atezo/beva) became the first-line treatment in patients with advanced hepatocellular carcinoma (HCC). However, its real-world efficacy has been less satisfied. In this study, we investigated the efficacy of radiotherapy (RT) combined with Atezo/beva in patients with advanced HCC. MATERIALS/METHODS Twenty patients received combination of RT and Atezo/beva between December 2021 and December 2022 at our institution. RT was administered in 10 fractions of 5 Gy between Atezo/beva cycles. Tumor response were evaluated on both imaging and tumor marker basis. The iRECIST guideline was used to assess treatment response after the combination treatment of RT and Atezo/beva. Primary endpoints were disease control rate (DCR) and overall response rate (ORR), and secondary endpoint was treatment related toxicity. RESULTS All patients were BCLC C with advanced tumors associated with lymph node metastasis (7, 35%) or distant metastasis (8, 40%). Patients received RT between cycles of Atezo/beva, mostly (14, 70%) between 2nd and 3rd cycles. After a median follow-up of 3.2 months, DCR was 65% and ORR was 20%. Significant decrease in tumor marker of over 2-fold was shown in 10 patients (50%). Regarding treatment related toxicity, only 1 patient (5%) showed grade 3 neutropenic fever, and no grade 4 or 5 toxicity was seen. CONCLUSION Combination of radiotherapy and Atezo/beva showed high response rate with tolerable treatment related toxicity in advanced HCC patients. Further prospective studies with larger patient cohort are warranted.
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Affiliation(s)
- Y J Hur
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - J Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - J Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - C K Lee
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - B K Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - D Y Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
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Cheung SKF, Choi LCW, Chan YS, Ho JCY, Lee CK, Kwok JSY. Identification of 58 novel HLA alleles identified in Chinese individuals by next-generation sequencing. HLA 2023. [PMID: 37376846 DOI: 10.1111/tan.15127] [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: 03/22/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023]
Abstract
HLA genes are the most polymorphic in the human genome. High resolution HLA typing from 13,870 bone marrow donors in Hong Kong was obtained using Next-generation sequencing (NGS) technology. Among the 67 novel alleles identified, official HLA allele names of 50 novel class I alleles (HLA-A, -B, -C) and 8 novel class II alleles (HLA-DRB1, -DQB1) were assigned by the World Health Organization (WHO) Nomenclature Committee for Factors of the HLA System.
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Affiliation(s)
- Stephen K F Cheung
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - Leo C W Choi
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - Y S Chan
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - Jenny C Y Ho
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Services, Hong Kong SAR, China
| | - Janette S Y Kwok
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
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Ng SC, Chu AWH, Chan WM, Yip CCY, Leung KH, So CK, Leung JNS, To KKW, Lee CK. Re-examine the transfusion transmitted risk of SARS-CoV-2 virus during a major COVID-19 outbreak in 2022. Transfus Med 2023. [PMID: 37286528 DOI: 10.1111/tme.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Although no case of COVID-19 transmission through transfusion has been reported, blood transfusion service (BTS) continues to implement pre-donation and post-donation measures to minimise the risk. In year 2022, when local healthcare system was badly impacted by a major outbreak, it opened an opportunity to re-examine the viraemia risk in these asymptomatic donors. MATERIALS AND METHODS Records were retrieved from blood donors who reported COVID-19 after donation and follow-up was also made for recipients who received their blood. Blood samples at donation were tested for SARS-CoV-2 viraemia by single-tube nested real-time RT-PCR assay designed to detect most SARS-CoV-2 variants including the prevailing delta and omicron variants. RESULTS From 1 January to 15 August 2022, the city with 7.4 M inhabitants recorded 1 187 844 COVID-19 positive cases and 125 936 successful blood donations were received. 781 donors reported to the BTS after donation with 701 being COVID-19 related (including close contact and symptoms respiratory tract infection). 525 COVID-19 were positive at the time of call back or follow-up. Of the 701 donations, they were processed into 1480 components with 1073 discarded upon donors' call back. For remaining 407 components, no recipient was found to have adverse event or COVID-19 positive. 510 samples from the above 525 COVID-19 positive donors were available and all tested negative for SARS-CoV-2 RNA. DISCUSSION With the negative SARS-CoV-2 RNA in blood donation samples and follow up data in transfusion recipients, the risk of transfusion transmitted COVID-19 appears negligible. However, current measures remains important in securing blood safety with ongoing surveillance of their effectiveness.
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Affiliation(s)
- S C Ng
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - A W H Chu
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - W M Chan
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C C Y Yip
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - K H Leung
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C K So
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - K K W To
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
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Chan MY, Man SC, Lam M, Lai WH, Qin ZS, Ng MKR, Lee CK, Chen YHE, Lee HME, Liu LY, Wong HK, Zhang ZJ. Berberine for antipsychotic-induced metabolic syndrome in patients with schizophrenia spectrum disorders: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 3:4-7. [PMID: 37357582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Affiliation(s)
- M Y Chan
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - S C Man
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - M Lam
- Department of Adult Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - W H Lai
- Department of Adult Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - Z S Qin
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - M K R Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR, China
| | - C K Lee
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR, China
| | - Y H E Chen
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - H M E Lee
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - L Y Liu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - H K Wong
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Z J Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Yusof MR, Mohd Sharin MF, Aizat Sabri I, Jagwani AV, Lee FY, Ahmad Zaidi AI, Saiful Azli MZ, Rk Rishitra RR, Fahmey O, Lee CK, Khairul-Asri MG. [Iatrogenic hypospadias a preventable rare complication with two-stage repair with buccal mucosa graft: a case presen- tation]. Urologiia 2023:115-117. [PMID: 37401715] [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] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Urethral catheterization is a common procedure, but it is associated with a number of complications. Iatrogenic hypospadias can rarely occur. There is a limited literature dedicated to this condition. We report a young patient with COVID-19 with iatrogenic hypospadias of grade 3. He was undergone to a two-stage procedure with acceptable outcome. Surgical repair should be offered and performed for young patients to ensure good function with acceptable penile appearance. A surgical treatment will improve psychological, sexual and social outcomes.
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Affiliation(s)
- M R Yusof
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - M F Mohd Sharin
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - I Aizat Sabri
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - A V Jagwani
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - F Y Lee
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - A I Ahmad Zaidi
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - M Z Saiful Azli
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - Rk Rishitra Rk Rishitra
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - O Fahmey
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - C K Lee
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - M G Khairul-Asri
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
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Fong KF, Lee CK. Biofuel-driven trigeneration systems for non-residential building applications: A holistic assessment from the energy, environmental and economic perspectives. Build Simul 2023; 16:557-576. [PMID: 36686570 PMCID: PMC9844161 DOI: 10.1007/s12273-022-0958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
In the metropolises, it is unlikely to use merely solar and wind energy to pursue zero carbon building design. However, it would become possible if biofuel-driven trigeneration systems (BDTS) are adopted. It is thus essential to assess the application opportunity of BDTS in a holistic way. In this study, BDTS offered definite primary energy saving of up to 15% and carbon emissions reduction of at least 86% in different types of non-residential buildings as compared to the conventional systems. With 24/7 operation for the hotel and hospital buildings, the corresponding BDTS could even achieve zero carbon emissions. All the BDTS primed with compression-ignition internal combustion engine were not economically viable even in running cost due to the high local biodiesel price level. The BDTS primed with spark-ignition engine and fueled by biogas, however, would have economic merit when carbon price was considered for the conventional systems that fully utilize fossil fuels. Adoption of carbon tax and social cost could have the payback ceilings of 8 years and 2 years respectively for most of building types. Consequently, the results could reflect the application potential of BDTS for non-residential buildings, leading the pathway to carbon neutrality for sustainable sub-tropical cities.
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Affiliation(s)
- K. F. Fong
- Division of Building Science and Technology, College of Engineering, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
| | - C. K. Lee
- Division of Building Science and Technology, College of Engineering, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
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Aizat Sabri I, Yusof MR, Jagwani AV, Fahmy O, Lee CK, Mg-Khairul Asri MKA, Wan Muhamad Mokhzani WM, Dharmendra G, Ahmad Zhariff H. [A rare case of bladder leiomyoma in pregnancy: a case report]. Urologiia 2022:118-121. [PMID: 36625624] [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] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We present a rare case of leiomyoma of the urinary bladder that was diagnosed during pregnancy. The case of a 29-year-old woman primigravida at 13 weeks of pregnancy who presented with 6 months history of abdominal swelling which was gradually increasing in size. Computed tomography done revealed a large heterogenous mass(enhancing) with an area of non-enhancing (necrosis) suggestive of malignant ovarian tumor. The histological findings of the surgical specimen confirmed a leiomyoma of the urinary bladder. The clinical presentation, imaging findings, and management of this relatively rare benign tumor are discussed in this case report.
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Affiliation(s)
- I Aizat Sabri
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - M R Yusof
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - A V Jagwani
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - O Fahmy
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - C K Lee
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Mg-Khairul Asri Mg-Khairul Asri
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W M Wan Muhamad Mokhzani
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - G Dharmendra
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - H Ahmad Zhariff
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
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9
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Kok PS, Antill YC, Scott CL, Lee CK. The impact of single agent PD-1 or PD-L1 inhibition on advanced endometrial cancers: meta-analysis. ESMO Open 2022; 7:100635. [PMID: 36410086 PMCID: PMC9808459 DOI: 10.1016/j.esmoop.2022.100635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitor (ICI) therapy is an emerging option for advanced endometrial cancer (EC). Mismatch repair (MMR) status is widely regarded as a biomarker predictive of response to ICIs. The predictive value of MMR based on small, single-arm trials, however, is conflicting. In this meta-analysis, we aimed to assess the activity of single-agent ICI in advanced EC, and compared the magnitude of treatment benefit in MMR deficient (dMMR) and MMR proficient (pMMR) EC. METHODS We carried out an electronic search to identify prospective trials of single-agent ICI in advanced EC. Data on objective response rate (ORR) and progression-free survival (PFS) were extracted and pooled. ORR was estimated using the inverse variance method and subgroup difference by MMR status was examined. PFS difference according to MMR status was summarized using the Kaplan-Meier approach. RESULTS From eight trials with 492 women, the pooled ORR was 19% [95% confidence interval (CI) 16% to 22%]. ORR was significantly greater in dMMR (n = 281) than pMMR EC (n = 211) (dMMR: 46%, pMMR: 8%; risk ratio 5.74, 95% CI 3.58-9.21; interaction P < 0.001). Complete response was 11% and 0.05% and median PFS was 8.3 and 2.1 months in dMMR and pMMR EC, respectively (hazard ratio PFS 0.58, 95% CI 0.38-0.89; P = 0.01). The 12-month PFS rates were 42.0% and 20.7%, respectively. CONCLUSION Single-agent ICI is associated with a 5.74 times greater objective response and 42% reduction in risk of disease progression or death in dMMR compared with pMMR EC. MMR status should be determined prospectively and be used as a stratification factor in future trials of advanced EC. Further translational analysis is urgently required to identify the cause of dMMR and allow subclassification of EC into different dMMR molecular subtypes.
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Affiliation(s)
- P-S Kok
- Australia New Zealand Gynaecological Oncology Group, Sydney, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia; Prince of Wales Hospital, Randwick, Australia.
| | - Y C Antill
- Australia New Zealand Gynaecological Oncology Group, Sydney, Australia; Faculty of Medicine, Dentistry and Health Sciences, Monash University, Melbourne, Australia
| | - C L Scott
- Australia New Zealand Gynaecological Oncology Group, Sydney, Australia; Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia; Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Parkville, Australia
| | - C K Lee
- Australia New Zealand Gynaecological Oncology Group, Sydney, Australia; Cancer Care Centre, St George Hospital, Sydney, Australia
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Frenel JS, Kim JW, Aryal N, Asher R, Berton D, Vidal L, Pautier P, Ledermann JA, Penson RT, Oza AM, Korach J, Huzarski T, Pignata S, Colombo N, Park-Simon TW, Tamura K, Sonke GS, Freimund AE, Lee CK, Pujade-Lauraine E. Efficacy of subsequent chemotherapy for patients with BRCA1/2-mutated recurrent epithelial ovarian cancer progressing on olaparib versus placebo maintenance: post-hoc analyses of the SOLO2/ENGOT Ov-21 trial. Ann Oncol 2022; 33:1021-1028. [PMID: 35772665 DOI: 10.1016/j.annonc.2022.06.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the SOLO2 trial (ENGOT Ov-21; NCT01874353), maintenance olaparib in patients with platinum-sensitive relapsed ovarian cancer (PSROC) and BRCA mutation significantly improved progression-free survival (PFS) and prolonged overall survival (OS). Following disease progression on olaparib, efficacy of subsequent chemotherapy remains unknown. PATIENTS AND METHODS We conducted a post-hoc hypothesis-generating analysis of SOLO2 data to determine the efficacy of different chemotherapy regimens following RECIST disease progression in patients who received olaparib or placebo. We evaluated time to second progression (TTSP) calculated from the date of RECIST progression to the next progression/death. RESULTS The study population comprised 147 patients who received chemotherapy as their first subsequent treatment after RECIST progression. Of these, 69 (47%) and 78 (53%) were originally randomized to placebo and olaparib arms, respectively. In the placebo-treated cohort, 27/69 and 42/69 received non-platinum and platinum-based chemotherapy, respectively, compared with 24/78 and 54/78, respectively, in the olaparib-treated cohort. Among patients treated with chemotherapy (N = 147), TTSP was significantly longer in the placebo than in the olaparib arm: 12.1 versus 6.9 months [hazard ratio (HR) 2.17, 95% confidence interval (CI) 1.47-3.19]. Similar result was obtained on multivariable analysis adjusting for prognostic factors at RECIST progression (HR 2.13, 95% CI 1.41-3.22). Among patients treated with platinum-based chemotherapy (n = 96), TTSP was significantly longer in the placebo arm: 14.3 versus 7.0 months (HR 2.89, 95% CI 1.73-4.82). Conversely, among patients treated with non-platinum-based chemotherapy (n = 51), the TTSP was comparable in the placebo and olaparib arms: 8.3 versus 6.0 months (HR 1.58, 95% CI 0.86-2.90). CONCLUSIONS Following progression from maintenance olaparib in the recurrent setting, the efficacy of platinum-based subsequent chemotherapy seems to be reduced in BRCA1/2-mutated patients with PSROC compared to patients not previously receiving poly (ADP-ribose) polymerase inhibitors (PARPi). The optimal strategy for patients who relapse after PARPi is an area of ongoing research.
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Affiliation(s)
- J S Frenel
- Institut de Cancerologie de l'Ouest, GINECO, GINEGEPS, Centre René Gauducheau, Saint-Herblain, France.
| | - J W Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - N Aryal
- NHMRC CTC Centre, University of Sydney, Camperdown, Sydney, Australia
| | - R Asher
- NHMRC CTC Centre, University of Sydney, Camperdown, Sydney, Australia
| | - D Berton
- Institut de Cancerologie de l'Ouest, GINECO, GINEGEPS, Centre René Gauducheau, Saint-Herblain, France
| | - L Vidal
- GEICO & H Clínic de Barcelona, Barcelona, Spain
| | - P Pautier
- GINECO & Gustave Roussy Cancer Center, Villejuif, France
| | | | - R T Penson
- Massachusetts General Hospital, Boston, USA
| | - A M Oza
- Princess Margaret Cancer Centre, Toronto, Canada
| | - J Korach
- ISGO & Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - T Huzarski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - S Pignata
- MITO & Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Naples, Italy
| | - N Colombo
- MaNGO & European Institute of Oncology IRCCS and University of Milan-Bicocca, Milano, Italy
| | - T W Park-Simon
- AGO & Medical School, Department of Gynecologic Oncology, Hannover, Hannover, Germany
| | - K Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - G S Sonke
- DGOG & Netherlands Cancer Institute, Amsterdam, Netherlands
| | - A E Freimund
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C K Lee
- NHMRC CTC Centre, University of Sydney, Camperdown, Sydney, Australia
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Kang E, Kim YG, Oh JS, Hong S, Lee CK, Yoo B, Ahn SM. POS1247 THE EFFECT OF IMMUNOSUPPRESSIVE AGENTS ON ANTIBODY FORMATION AFTER COVID-19 VACCINATION IN RHEUMATOID ARTHRITIS PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThere is still controversy about the efficacy of COVID-19 vaccination and its extent in lowering immunogenicity of Rheumatoid Arthritis (RA) patients. The guideline in whether immunosuppressive agents need to be discontinued before the vaccination is continuously updated because it is considered to lower immunogenicity. Furthermore, there is great discussion on the effectiveness of the COVID-19 booster vaccine and interest in antibody generation in different types of vaccine, as in South Korea there are many patients who were prescribed the mRNA booster vaccine after two doses of ChAdOx1-S nCoV-19 vaccine.ObjectivesThus, we investigated the differences of antibody production between patients who received only two doses of ChAdOx1-S nCoV-19 and those who received the mRNA booster vaccine. Also, antibody production under different types of immunosuppressive agents was analyzed.MethodsFrom October 14, 2021 to January 21, 2022 at a tertiary referral center, two patient groups diagnosed with RA were studied prospectively; one group that completed 1st and 2nd doses of ChAdOx1-S nCoV-19 vaccine, second group that completed mRNA booster vaccine as well as two doses of ChAdOx1-S nCoV-19 vaccine. SARS-CoV-2 antibody testing on the semiquantitative anti-SARS-CoV-2 S enzyme immunoassay was done, and differences in antibody titers were analyzed in patients who received different immunosuppressive agents such as csDMARD, TNF inhibitor, JAK inhibitor, Tocilizumab, Abatacept and Corticosteroid. Statistical analysis with a multivariate logistic regression model was performed.ResultsIn a total of 261 patients, 153 patients had completed two doses of ChAdOx1-S nCoV-19, 108 patients had completed third mRNA booster vaccine. Anti-SARS-CoV-2 RBD antibody positive rate (titer>0.8U/mL) was 97%(149/153) and 99%(107/108) respectively, and only 5 patients showed negative result. In the aspect of high antibody titer(>250U/mL), which is the upper limit of the RBD antibody immunoassay, the result showed rate of 31% (47/153) in the non-booster group and 94%(102/108) in the booster group respectively.Among the different immunosuppressive agents and other clinical aspects, multivariate analysis revealed that corticosteroid use (OR 0.91; 95% CI: 0.86-0.98), older age(OR 4.33; 95% CI: 1.34-13.91), and male gender(OR 0.35; 95% CI 0.16-0.75) were significantly associated with low rate of high antibody titer.Furthermore, out of 14 patients who underwent antibody test twice before and after the mRNA booster vaccine, other than four patients who already showed high titer of >250U/mL before the mRNA booster vaccine, 10 patients showed an increase in titer after the booster vaccine and 7 patients were acquired high titer of >250U/mL.Figure 1.Anti-SARS-CoV RBD antibody titer of two groupsTable 1.Analysis of immunosuppressive agents and other clinical aspects for high antibody titer(>250U/mL) after two doses of ChAdOx1-S nCoV-19Univariate analysisMultivariate analysisParameterOR95% CIp valueOR95% CIp valueClinical features Age0.9170.860-0.9780.0080.9170.857-0.9810.012 Sex3.6741.206-11.1910.0224.3301.348-13.9120.014 DAS 281.1440.670-1.9500.622 Duration0.9300.830-1.0430.214Medications csDMARD1.2730.639-2.5331.273 TNF inhibitor2.2110.795-6.1450.128 JAK inhibitor0.6650.275-1.6070.365 Abatacept0.3680.038-3.6020.391 Tocilizumab1.2640.438-3.6480.665 Corticosteroid0.4720.235-0.9490.0350.3490.163-0.7480.007Medication dose Methotrexate0.9930.919-1.0720.855 Corticosteroid0.8490.719-1.0030.054ConclusionAnti-SARS-CoV-2 RBD antibody positive rate was 97% or more regardless of the mRNA booster vaccination. However, patients who received the mRNA booster vaccine after two doses of ChAdOx1-S nCoV-19 vaccine showed high antibody titer (>250U/mL) three times more than those who did not receive the booster shot.Our findings also showed that corticosteroid use, old age, and male gender is significantly associated with low rate of acquiring high antibody titer.Disclosure of InterestsNone declared
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Ahn SM, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. AB0476 PREDICTIVE FACTORS FOR THE DEVELOPMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS IN PATIENTS WITH IMMUNE THROMBOCYTOPENIA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with immune thrombocytopenia (ITP) have a risk of developing systemic lupus erythematosus (SLE). We sought to examine the clinical characteristics of patients with primary ITP who later developed SLE, and identified the risk factors for the development of SLE.ObjectivesWe retrospectively examined patients who were diagnosed with primary ITP at a tertiary hospital between August 2001 and November 2019. We compared the clinical characteristics according to the development of SLE. Logistic regression analysis was performed to identify the factors associated with the development of SLE.MethodsOf 130 patients with primary ITP, 10 (7.7%) were later diagnosed with SLE during follow-up (median, 30 months [IQR, 15.5–105]). The presence of skin bleeding, organ bleeding, lymphopenia, anemia, and positive antinuclear antibody (ANA) titer (> 1:160) were more common among patients who later developed SLE than did those who did not develop SLE. Multivariate analysis showed that young age (< 40 years; odds ratio [OR], 8.359 [95% confidence interval (CI), 1.230–56.793]; p = 0.033), organ bleeding (OR, 18.349 [95% CI, 2.771–121.517]; p = 0.003), and ANA positivity (>1:160; OR, 7.692 [95% CI, 1.482–39.910]; p = 0.015) were significantly associated with the development of SLE.ResultsYoung age (< 40 years), organ bleeding, and ANA positivity (> 1:160) were risk factors for the development of SLE in patients with primary ITP.ConclusionThese results suggest that continued follow-up for the detection of SLE development is needed for patients with ITP, particularly those with young age, ANA positivity, or organ bleeding.References[1]Zhu, Fang-Xiao, et al. “Risk of systemic lupus erythematosus in patients with idiopathic thrombocytopenic purpura: a population-based cohort study.” Annals of the rheumatic diseases 79.6 (2020): 793-799.Table 1.Factors associated with the development of SLE in patients with primary ITPUnivariateMultivariateOR95% CIP valueOR95% CIP valueYoung agea5.4441.332–22.2500.0188.3591.230–56.7930.033Female4.3330.530–35.4220.17BMI0.8730.717–1.0700.20Skin bleeding8.4191.034–68.5330.046Mucosa bleeding1.2500.247–6.3300.79Organ bleeding14.8643.633–60.815< 0.00118.3492.771–121.5170.003Platelet counts0.9110.828–1.0020.06ANA positivityb16.5003.984–68.341< 0.0017.6921.482–39.9100.015Neutropeniac2.1110.229–19.4990.51Lymphopeniad4.8461.189–19.7590.028Anemiae10.1182.044–50.0910.005SLE: systemic lupus erythematosus, ITP: immune thrombocytopenia, BMI: body mass index, ANA: antinuclear antibody, OR: odds ratio, CI: confidence interval.aYoung age = age < 40 yearsbANA positivity ≥ 1:160cNeutropenia = Absolute neutrophil count < 1500 μLdLymphopenia = Absolute lymphocyte count < 1500 μLeAnemia = Hemoglobin < 12 g/dLDisclosure of InterestsNone declared
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Kim YE, Choi SJ, Lim DH, Ahn SM, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. AB0456 DISEASE FLARE OF SYSTEMIC LUPUS ERYTHEMATOSUS IN PATIENTS WITH END-STAGE RENAL DISEASE ON DIALYSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe systemic lupus erythematosus (SLE) disease activity in patients with lupus nephritis (LN) generally declines after the initiation of renal replacement therapy (RRT); this is known as the “burn out” phenomenon that possibly occurs due to the suppression of cellular and humoral immunity in the end-stage renal disease (ESRD) state and elimination of disease pathogenic factor by dialysis [1-4]. However, several studies showed that SLE flares could occur even during RRT [5-8]. Nevertheless, the details of disease flares of SLE in patients under dialysis have not been studied yet.ObjectivesThis study aimed to investigate the clinical features, risk factors, and treatment details of SLE patients experiencing disease flare under RRT.MethodsThe medical records of SLE patients who received dialysis at two tertiary referral hospitals in Seoul and Ulsan, South Korea were reviewed. All patients in this study were either clinically or histologically diagnosed with LNResultsOf a total of 121 patients with SLE on dialysis, 96 (79.3%) were on hemodialysis (HD) and 25 (20.6%) were on peritoneal dialysis (PD). During a median follow-up of 45 months (IQR, 23–120) after the initiation of dialysis, 32 (26.4%) patients experienced SLE flare (HD, n = 25; PD, n = 7). The most common features of SLE flare were hematologic (40.6%) and constitutional manifestations (40.6%). Treatments for disease flares were based on corticosteroids, and 11 (34.3%) patients required additional immunosuppressants including cyclophosphamide and mycophenolate mofetil. There was no case of severe adverse events related to medication. non-renal SLE Disease Activity Index (SLEDAI) score before dialysis initiation (HR 1.235; 95% CI, 1.122–1.359; P = 0.001) was a significant risk factor for disease flare during dialysis.Table 1.Multivariable analysis of factors associated with SLE flare under dialysisHazard ratio95% CIP-valueNon-renal SLEDAI at the initiation of dialysis1.2351.122–1.3590.001Hematologic manifestation prior to dialysis1.2560.690–2.8260.150Cumulative amount of steroid during 1 year prior to the initiation of dialysis1.0400.995–1.0870.086Dialysis modality: hemodialysis0.7660.262–2.2430.630ConclusionMore than one-quarter of SLE patients experienced disease flare during dialysis, which most commonly had hematologic manifestations. Continued follow-up and appropriate treatments including immunosuppressants should be considered for patients with SLE under dialysis.References[1]Coplon NS, Diskin CJ, Petersen J, Swenson RS. The Long-Term Clinical Course of Systemic Lupus Erythematosus in End-Stage Renal Disease. New England Journal of Medicine 1983;308:186-90.[2]Lee P-T, Fang H-C, Chen C-L, Chiou Y-H, Chou K-J, Chung H-M. Poor prognosis of end-stage renal disease in systemic lupus erythematosus: a cohort of Chinese patients. Lupus 2003;12:827-32.[3]Pahl MV, Gollapudi S, Sepassi L, Gollapudi P, Elahimehr R, Vaziri ND. Effect of end-stage renal disease on B-lymphocyte subpopulations, IL-7, BAFF and BAFF receptor expression. Nephrology Dialysis Transplantation 2010;25:205-12.[4]Ribeiro FM, Fabris CL, Bendet I, Lugon JR. Survival of lupus patients on dialysis: a Brazilian cohort. Rheumatology 2013;52:494-500.[5]Okano K, Yumura W, Nitta K et al. Analysis of Lupus Activity in End-Stage Renal Disease Treated by Hemodialysis. Internal Medicine 2001;40:598-602.[6]Barrera-Vargas A, Quintanar-Martínez M, Merayo-Chalico J, Alcocer-Varela J, Gómez-Martín D. Risk factors for systemic lupus erythematosus flares in patients with end-stage renal disease: a case–control study. Rheumatology 2015:kev349.[7]Cucchiari D, Graziani G, Ponticelli C. The dialysis scenario in patients with systemic lupus erythematosus. Nephrology Dialysis Transplantation 2014;29:1507-13.[8]Kang S-H, Chung B-H, Choi S-R et al. Comparison of Clinical Outcomes by Different Renal Replacement Therapy in Patients with End-Stage Renal Disease Secondary to Lupus Nephritis. The Korean Journal of Internal Medicine 2011;26:60.Disclosure of InterestsNone declared
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Nam SH, Ahn SM, Oh JS, Hong S, Lee CK, Yoo B, Kim YG. AB1273 MACROPHAGE ACTIVATION SYNDROME IN RHEUMATIC DISEASE: CLINICAL CHARACTERISTICS AND PROGNOSIS OF 20 PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundMacrophage activation syndrome (MAS) is a hyperinflammatory condition that is known to be secondary hemophagocytic lymphohistiocytosis (HLH) in patients with rheumatic disease.ObjectivesThe aim of study was to evaluate the clinical manifestations and outcomes in patients with MAS with rheumatic disease.MethodsWe performed a retrospective study of 20 adult patients who were diagnosed with MAS from 2012 to 2020. MAS was classified according to the HLH-2004 criteria. Patients’ information, including clinical features, laboratory findings, and treatment regimens, was collected, and the overall survival rate was estimated by the Kaplan–Meier method.ResultsTwenty patients (18 women, 35.6 ± 18.3 years) who met the HLH-2004 criteria also fulfilled the 2016 EULAR/ACR/PRINTO classification criteria for MAS, and HScore was higher than 169 (median, 238.5). Fourteen patients with systemic lupus erythematosus and 6 patients with adult-onset Still’s disease were included. All patients were treated initially with corticosteroids, and 16 patients required additional immunosuppressants. The overall survival at 3 and 6 months was 75.2% and 64.3%. In survivors, renal impairment was less common (23.1% versus 42.9%, p = 0.007), the levels of AST (202.0 versus 72.0 IU/L, p = 0.006) and LDH (1144.0 versus 343.0IU/L, p = 0.001), and platelet count (90.0 versus 46.0 × 109/L, p = 0.016) were higher in compared to non-survivors. Nine patients had opportunistic infections, five of whom died during admission.ConclusionThe mortality of patients with MAS remains high. Renal impairment, levels of AST and LDH, and platelet count might be associated with prognosis.Table 1.Treatments and management characteristics of patients with MASNo.Age/sexDiseaseDisease duration (months)1st Treatment (corticosteroids)2nd Treatment3rd TreatmentCombined infectionAlive/dead119/FSLE11 mg/kgIVIG + PPTCZ, RTXBacteremiaDead220/MSLE01 mg/kg---Alive320/FAOSD11 mg/kgVP16--Alive422/FSLE1100 mgIVIG + PP-PneumoniaDead522/FAOSD0500 mgIVIG--Alive623/FSLE1821 mg/kg---Alive723/FSLE411 mg/kg---Alive830/FSLE1461 mg/kgIVIGCsA-Alive932/FSLE1271 mg/kgIVIG + PPCsA, TCZPneumoniaAlive1035/FAOSD01 mg/kgCsA-Viral infectionAlive1137/FSLE651 mg/kgCsA, VP16-BacteremiaAlive1238/FSLE01 mg/kgIVIG + PPRTX-Dead1340/FAOSD00.5 mg/kgCsA--Alive1443/FSLE601 mg/kgIVIG + PPTCZ, RTX, CsA,PCP,DeadVP16, IFXViral infection1549/FSLE01 mg/kgCYC-BacteremiaAlive1651/FAOSD01 mg/kg---Alive1757/FSLE01 mg/kgIVIG + PPCsA, VP16Fungal infectionDead1861/FSLE21 mg/kgIVIG + PPTCZ-Dead1968/FSLE21 mg/kgIVIG + PPCsAFungal infectionAlive2070/MAOSD01 mg/kgIVIG + PPCsA, VP16Fungal infectionDeadSLE: Systemic lupus erythematosus, IVIG: Intravenous immunoglobulin, PP: Plasmapheresis, TCZ: Tocilizumab, RTX: Rituximab, AOSD: Adult-onset still’s disease, VP16: Etoposide, PCP: Pneumocystis pneumonia, CsA: Cyclosporin, IFX: Infliximab, MCTD: Mixed connective tissue disease.Disclosure of InterestsNone declared
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Kang E, Hong S, Kim YG, Lee CK, Oh JS, Yoo B, Ahn SM. POS0762 LONG-TERM RENAL OUTCOMES OF PATIENTS WITH NON-PROLIFERATIVE LUPUS NEPHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAlthough proliferative (class III or IV) lupus nephritis (LN) is the most common finding in the classification of LN, pure membranous (class V) or mesangial (class I or II) LN can occur as a form of LN. Even though non-proliferative LN (class I, II, or V) is a less severe form with good outcomes, data on long-term renal prognosis are limited.ObjectivesThis study investigated the long-term outcomes and prognostic factors in non-proliferative LN.MethodsWe retrospectively reviewed the medical records of patients with systemic lupus erythematosus who were diagnosed with LN class I, II, V or II+IV by kidney biopsy between 1997 and 2021 at a tertiary referral center. Clinical and laboratory data were compared between patients with and without poor renal outcomes. Poor renal outcome was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2 or death due to renal cause. Univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the factors associated with poor renal outcomes.ResultsWe included 71 patients with non-proliferative LN (4: class I; 17: class II; 48: class V, 17; 2: class II+V). Median follow-up duration was 103 months (interquartile range 27–185) and the overall rate of poor renal outcomes at last follow-up was 29% (21/71), including end-stage renal disease (n=2) and renal death (n=1).Univariate analysis indicated that older age (HR 1.05; 95% CI: 1.00–1.09), low eGFR (HR 0.97; 95% CI: 0.95–0.99) and failure to reach complete remission at 6 months (HR 0.332; 95% CI: 0.12–0.92) were significantly associated with poor renal outcomes. Multivariate analysis revealed that low eGFR at 6 months (HR 0.97; 95% CI: 0.95–0.99) was significantly associated with poor renal outcomes.Figure 1.Renal outcomes at last follow upeGFR, estimated glomerular filtration rate (ml/min/1.73m2)Table 1.Univariate and multivariate Cox proportional hazard regression analyses of the factor associated with poor renal outcomesParameterUnivariate analysisMultivariate analysisHR95% CIp valueHR95% CIp valueClinical features Age1.0461.003-1.0910.0361.0020.960-1.0470.921 Sex1.6540.375-7.2980.506 SLEDAI1.0360.965-1.1120.327 Extra renal SLEDAI1.0380.971-1.110.272Renal profiles eGFR at LN diagnosis0.9930.976-1.0110.456 Proteinuria at LN diagnosis1.0001.000-1.0000.444 > 1g/24 hours0.6690.243-1.8410.437 > 3g/24 hours0.6240.229-1.6990.356 eGFR at 6M0.9670.948-0.9860.0010.9680.948-0.9880.002 eGFR at 12M0.9640.947-0.9810.000 Complete remission at 6M0.3320.119-0.9240.0350.5530.179-1.7070.303 Complete remission at 12M0.6670.232-1.9140.451 Transformation1.2460.423-0.7010.692Laboratory data Anti-dsDNA1.0010.999-1.0030.196 C31.0201.000-1.0410.051 C41.0270.969-1.0890.367 Albumin1.1800.661-2.1090.576ClassificationaClass I0.8020.102-6.3030.834Class II1.2980.412-4.0880.656Class V0.8870.308-2.5570.824Class II+V0.0480.000-16850.837Medicationsb ACEi/ARB1.6520.603-4.5280.329 Hydroxychloroquine1.3260.414-4.2420.635 Corticosteroid1.1860.154-9.1080.870 CNI2.4390.464-12.8240.292 MMF3.7880.959-14.9650.057 AZA0.5890.133-2.6110.486a LN classifications were based on the International Society of Pathology/Renal Pathology Society (ISN/RPS) classification.b Medications maintained at least one year since Lupus Nephritis diagnosis.HR, hazard ratio; 95% CI, 95% confidence interval; SLEDAI, systemic lupus erythematosus disease activity index; eGFR, estimated glomerular filtration rate; LN, lupus nephritis; anti-dsDNA, anti-double strand DNA; C3/C4; complement 3/4; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CNI, carcineurin inhibitor; MMF, mycophenolate mofetil; AZA, azathioprine.ConclusionPoor renal outcomes occurred in approximately 30% of patients with non-proliferative LN (class I, II or V) after long-term follow-up.Our findings suggest that more active management may be needed for non-proliferative LN, particularly in patients with low eGFR at 6 months.Disclosure of InterestsNone declared
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Yusof MR, Fairuz MS, Lee FY, Arvind VJ, Fahmy O, Lee CK, Saiful Azli MZ, Arunasalam AP, Khairul-Asri MG. [The tale of two stones in an obstructed partial duplex kidney: case presentation]. Urologiia 2022:78-80. [PMID: 35274865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Duplex renal systems is a common anomalies. Incidence rate of 0.8% in healthy adult population and 2-4% in patients investigated for urinary tract symptoms. Urolithiasis management for patients with anomalies is complex and require proper imaging and planning. We have a patient with a partial duplex collecting system presented with a right renal calculus in a non-functioning lower moiety and multiple distal ureteric calculi. Preoperative planning done and surgery performed with good outcome without any early and late complications.
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Affiliation(s)
- M R Yusof
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - M S Fairuz
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - F Y Lee
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - V J Arvind
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - O Fahmy
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - C K Lee
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - M Z Saiful Azli
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - A P Arunasalam
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - M G Khairul-Asri
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
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Dayan I, Roth HR, Zhong A, Harouni A, Gentili A, Abidin AZ, Liu A, Costa AB, Wood BJ, Tsai CS, Wang CH, Hsu CN, Lee CK, Ruan P, Xu D, Wu D, Huang E, Kitamura FC, Lacey G, de Antônio Corradi GC, Nino G, Shin HH, Obinata H, Ren H, Crane JC, Tetreault J, Guan J, Garrett JW, Kaggie JD, Park JG, Dreyer K, Juluru K, Kersten K, Rockenbach MABC, Linguraru MG, Haider MA, AbdelMaseeh M, Rieke N, Damasceno PF, E Silva PMC, Wang P, Xu S, Kawano S, Sriswasdi S, Park SY, Grist TM, Buch V, Jantarabenjakul W, Wang W, Tak WY, Li X, Lin X, Kwon YJ, Quraini A, Feng A, Priest AN, Turkbey B, Glicksberg B, Bizzo B, Kim BS, Tor-Díez C, Lee CC, Hsu CJ, Lin C, Lai CL, Hess CP, Compas C, Bhatia D, Oermann EK, Leibovitz E, Sasaki H, Mori H, Yang I, Sohn JH, Murthy KNK, Fu LC, de Mendonça MRF, Fralick M, Kang MK, Adil M, Gangai N, Vateekul P, Elnajjar P, Hickman S, Majumdar S, McLeod SL, Reed S, Gräf S, Harmon S, Kodama T, Puthanakit T, Mazzulli T, de Lavor VL, Rakvongthai Y, Lee YR, Wen Y, Gilbert FJ, Flores MG, Li Q. Federated learning for predicting clinical outcomes in patients with COVID-19. Nat Med 2021; 27:1735-1743. [PMID: 34526699 PMCID: PMC9157510 DOI: 10.1038/s41591-021-01506-3] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [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: 12/21/2020] [Accepted: 08/13/2021] [Indexed: 02/08/2023]
Abstract
Federated learning (FL) is a method used for training artificial intelligence models with data from multiple sources while maintaining data anonymity, thus removing many barriers to data sharing. Here we used data from 20 institutes across the globe to train a FL model, called EXAM (electronic medical record (EMR) chest X-ray AI model), that predicts the future oxygen requirements of symptomatic patients with COVID-19 using inputs of vital signs, laboratory data and chest X-rays. EXAM achieved an average area under the curve (AUC) >0.92 for predicting outcomes at 24 and 72 h from the time of initial presentation to the emergency room, and it provided 16% improvement in average AUC measured across all participating sites and an average increase in generalizability of 38% when compared with models trained at a single site using that site's data. For prediction of mechanical ventilation treatment or death at 24 h at the largest independent test site, EXAM achieved a sensitivity of 0.950 and specificity of 0.882. In this study, FL facilitated rapid data science collaboration without data exchange and generated a model that generalized across heterogeneous, unharmonized datasets for prediction of clinical outcomes in patients with COVID-19, setting the stage for the broader use of FL in healthcare.
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Affiliation(s)
- Ittai Dayan
- MGH Radiology and Harvard Medical School, Boston, MA, USA
| | | | - Aoxiao Zhong
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | | | | | | | | | | | - Bradford J Wood
- Radiology & Imaging Sciences/Clinical Center, National Institutes of Health, Bethesda, MD, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Nan Hsu
- Center for Research in Biological Systems, University of California, San Diego, CA, USA
| | - C K Lee
- NVIDIA, Santa Clara, CA, USA
| | | | | | - Dufan Wu
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Hao-Hsin Shin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Hui Ren
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason C Crane
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | | | - John W Garrett
- Departments of Radiology and Medical Physics, The University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Joshua D Kaggie
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge, Cambridge, UK
| | - Jung Gil Park
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | - Keith Dreyer
- MGH Radiology and Harvard Medical School, Boston, MA, USA
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | - Krishna Juluru
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
- Departments of Radiology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Masoom A Haider
- Joint Dept. of Medical Imaging, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | | | | | - Pablo F Damasceno
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | - Pochuan Wang
- MeDA Lab Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Sheng Xu
- Radiology & Imaging Sciences/Clinical Center, National Institutes of Health, Bethesda, MD, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Sira Sriswasdi
- Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center for Artificial Intelligence in Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Thomas M Grist
- Departments of Radiology, Medical Physics, and Biomedical Engineering, The University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Varun Buch
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | - Watsamon Jantarabenjakul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Weichung Wang
- MeDA Lab Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Won Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Xiang Li
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Xihong Lin
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Young Joon Kwon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Andrew N Priest
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, Cambridge University Hospital, Cambridge, UK
| | - Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Benjamin Glicksberg
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bernardo Bizzo
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | - Byung Seok Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Carlos Tor-Díez
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Chia-Cheng Lee
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Jung Hsu
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin Lin
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chiu-Ling Lai
- Medical Review and Pharmaceutical Benefits Division, National Health Insurance Administration, Taipei, Taiwan
| | - Christopher P Hess
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | | | - Eric K Oermann
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Evan Leibovitz
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | | | - Hitoshi Mori
- Self-Defense Forces Central Hospital, Tokyo, Japan
| | | | - Jae Ho Sohn
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | - Li-Chen Fu
- MOST/NTU All Vista Healthcare Center, Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, Taiwan
| | | | - Mike Fralick
- Division of General Internal Medicine and Geriatrics (Fralick), Sinai Health System, Toronto, Ontario, Canada
| | - Min Kyu Kang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | | | - Natalie Gangai
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | | | - Sarah Hickman
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge, Cambridge, UK
| | - Sharmila Majumdar
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheridan Reed
- Radiology & Imaging Sciences/Clinical Center, National Institutes of Health, Bethesda, MD, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefan Gräf
- Department of Medicine and NIHR BioResource for Translational Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Stephanie Harmon
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Clinical Research Directorate, Frederick National Laboratory for Cancer, National Cancer Institute, Frederick, MD, USA
| | | | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Tony Mazzulli
- Department of Microbiology, Sinai Health/University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
| | | | - Yothin Rakvongthai
- Chulalongkorn University Biomedical Imaging Group and Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yu Rim Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | | | - Fiona J Gilbert
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge, Cambridge, UK
| | | | - Quanzheng Li
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Planchard D, Feng PH, Karaseva N, Kim SW, Kim TM, Lee CK, Poltoratskiy A, Yanagitani N, Marshall R, Huang X, Howarth P, Jänne PA, Kobayashi K. Osimertinib plus platinum-pemetrexed in newly diagnosed epidermal growth factor receptor mutation-positive advanced/metastatic non-small-cell lung cancer: safety run-in results from the FLAURA2 study. ESMO Open 2021; 6:100271. [PMID: 34543864 PMCID: PMC8453202 DOI: 10.1016/j.esmoop.2021.100271] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background The phase III FLAURA2 (NCT04035486) study will evaluate efficacy and safety of first-line osimertinib with platinum–pemetrexed chemotherapy versus osimertinib monotherapy in epidermal growth factor receptor mutation-positive (EGFRm) advanced/metastatic non-small-cell lung cancer (NSCLC). The safety run-in, reported here, assessed the safety and tolerability of osimertinib with chemotherapy prior to the randomized phase III evaluation. Patients and methods Patients (≥18 years; Japan: ≥20 years) with EGFRm locally advanced/metastatic NSCLC received oral osimertinib 80 mg once daily (QD), with either intravenous (IV) cisplatin 75 mg/m2 or IV carboplatin target area under the curve 5, plus pemetrexed 500 mg/m2 every 3 weeks (Q3W) for four cycles. Maintenance was osimertinib 80 mg QD with pemetrexed 500 mg/m2 Q3W until progression/discontinuation. The primary objective was to evaluate safety and tolerability of the osimertinib–chemotherapy combination. Results Thirty patients (15 per group) received treatment [Asian, 73%; female, 63%; median age (range) 61 (45-84) years]. Adverse events (AEs) were reported by 27 patients (90%): osimertinib–carboplatin–pemetrexed, 100%; osimertinib–cisplatin–pemetrexed, 80%. Most common AEs were constipation (60%) with osimertinib–carboplatin–pemetrexed and nausea (60%) with osimertinib–cisplatin–pemetrexed. In both groups, 20% of patients reported serious AEs. No specific pattern of AEs leading to dose modifications/discontinuations was observed; one patient discontinued all study treatments including osimertinib due to pneumonitis (study-specific discontinuation criterion). Hematologic toxicities were as expected and manageable. Conclusions Osimertinib–chemotherapy combination had a manageable safety and tolerability profile in EGFRm advanced/metastatic NSCLC, supporting further assessment in the FLAURA2 randomized phase. FLAURA2 aims to assess efficacy and safety of first-line osimertinib with platinum–pemetrexed in EGFRm advanced NSCLC. In the FLAURA2 safety run-in period, 30 patients received osimertinib and pemetrexed with carboplatin or cisplatin. Most common AEs were constipation and nausea; no AE patterns leading to dose modifications/discontinuations were observed. The FLAURA2 safety run-in study showed that the safety profile of this combination was as expected and manageable.
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Affiliation(s)
- D Planchard
- Institut Gustave Roussy, Department of Medical Oncology, Thoracic Oncology Unit, Villejuif, France.
| | - P-H Feng
- Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - N Karaseva
- City Clinical Oncology Dispensary, St. Petersburg, Russia
| | - S-W Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - T M Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - C K Lee
- Clinical Research Unit, Division of Cancer Services, St. George Hospital, Kogarah, Australia
| | - A Poltoratskiy
- Department of Clinical Trials, Petrov Research Institute of Oncology, St. Petersburg, Russia
| | - N Yanagitani
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | | | | | | | - P A Jänne
- Dana-Farber Cancer Institute, Boston, USA
| | - K Kobayashi
- Department of Respiratory Medicine, Saitama Medical School International Medical Center, Saitama, Japan
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19
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Zeng X, Zhao D, Radominski S, Keiserman M, Lee CK, Martin N, Meerwein S, Sui Y, Park W. AB0260 LONG-TERM EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS FROM CHINA, BRAZIL, AND SOUTH KOREA WITH RHEUMATOID ARTHRITIS AND AN INADEQUATE RESPONSE TO CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS: RESULTS AT 64 WEEKS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Upadacitinib (UPA), an oral Janus kinase inhibitor, in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), showed significant improvements in clinical and functional measures compared with placebo (PBO) up to 12 weeks (wks), in patients (pts) from China, Brazil, and South Korea with rheumatoid arthritis (RA) and prior inadequate response to csDMARDs (csDMARD-IR).1Objectives:To assess the efficacy and safety of UPA up to 64 wks (long-term extension; LTE) in csDMARD-IR pts with RA from China, Brazil, and South Korea.Methods:Pts were randomized to 12 wks of blinded treatment with UPA 15 mg once daily (QD) or PBO, in combination with csDMARDs. From Wk 12 onward, pts could continue to receive open-label UPA 15 mg QD. Efficacy endpoints were analyzed by original randomized treatment group sequences over 64 wks and included American College of Rheumatology (ACR) responses, and key remission and low disease activity measures. Non-responder imputation was used to handle missing data for binary endpoints. Treatment-emergent adverse events (TEAEs) per 100 patient-years (PY) were summarized for pts receiving ≥1 dose of UPA from baseline through to Wk 64.Results:Of 338 randomized pts who received ≥1 dose of study drug, 310 (91.7%) entered the LTE and 275 (81.4%) completed 64 wks of treatment. Among those initially randomized to UPA, the proportion of pts achieving 20%/50%/70% improvement in ACR criteria, and key remission and low disease activity measures increased over 64 wks of treatment (Figure 1). Improvements from baseline in the Health Assessment Questionnaire-Disability Index and pts’ assessment of pain were observed over 64 wks of UPA treatment (data not shown). By Wk 64, efficacy results for pts who switched from PBO to UPA at Wk 12 followed a similar trajectory to those originally randomized to UPA.The observed rate of serious infections was 8.1 events/100 PY. Herpes zoster events were mostly non-serious, involving only 1 or 2 dermatomes. Most cases of hepatic disorders were Grade 1 or 2 hepatic transaminase elevations. There was 1 case of venous thromboembolic event (VTE; concurrent pulmonary embolism and deep vein thrombosis [DVT] in a patient with a history of DVT) and 3 cases of malignancy. Adjudicated major adverse cardiovascular events (Table 1) occurred in 2 pts (1 with non-fatal myocardial infarction and 1 with non-fatal stroke) who had underlying risk factors for cardiovascular disease. There were no deaths, active tuberculosis, or renal dysfunction.Conclusion:UPA 15 mg was effective in treating the signs and symptoms of RA and in improving physical function over 64 wks with no new safety signals1 in csDMARD-IR pts with RA from China, Brazil, and South Korea.References:[1]Zeng A, et al. Ann Rheum Dis 2020;79(Suppl 1):1016 [abstract SAT0160]Table 1.TEAEs at Wk 64Event (E/100 PY)UPA 15 mg(n=322; PY=334.5)Any AE421.5 (399.8–444.1) Serious AE19.1 (14.7–24.4) AE leading to discontinuation of study drug9.0 (6.1–12.8) Deathsa0AEs of special interest Serious infection8.1 (5.3–11.7) Opportunistic infection0.9 (0.2–2.6) Herpes zoster9.0 (6.1–12.8) Hepatic disorder42.2 (35.5–49.7) Gastrointestinal perforation (adjudicated)0.3 (0.0–1.7) Any malignancy (excluding NMSC)0.6 (0.1–2.2) NMSC0.3 (0.0–1.7) MACE (adjudicated)b0.6 (0.1–2.2) VTE (adjudicated)c0.3 (0.0–1.7) Anemia11.1 (7.8–15.2) Neutropenia11.7 (8.3–15.9) Lymphopenia7.8 (5.1–11.4) CPK elevation11.1 (7.8–15.2)aIncluding non-treatment-emergent deaths. bDefined as cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. cIncluding DVT and pulmonary embolism.AE, adverse event; CPK, creatine phosphokinase; E, events; MACE, major adverse cardiovascular event; NMSC, non-melanoma skin cancerAcknowledgements:AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Yanna Song, PhD, of AbbVie provided statistical support. Medical writing support was provided by Laura Chalmers, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.Disclosure of Interests:Xiaofeng Zeng: None declared, Dongbao Zhao: None declared, Sebastiao Radominski: None declared, MAURO KEISERMAN: None declared, Chang-Keun Lee: None declared, Naomi Martin Employee of: AbbVie employee and may own stock or options, Sebastian Meerwein Employee of: AbbVie employee and may own stock or options, Yunxia Sui Employee of: AbbVie employee and may own stock or options, Won Park: None declared
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Wong MMC, Chung AKK, Yeung TMH, Wong DTW, Lee CK, Lai E, Chan GFY, Mak GKL, Wong JOY, Ng RMK, Tam KL, Mak KY. Consensus statements on the clinical usage and characteristics of aripiprazole for Hong Kong. Intern Med J 2021; 50 Suppl 3:6-14. [PMID: 32985093 DOI: 10.1111/imj.14896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aripiprazole, a dopamine partial agonist, is a second-generation anti-psychotic that is widely used for the treatment of schizophrenia and other psychotic disorders. A group of psychiatric experts in Hong Kong developed a set of consensus statements, aiming to facilitate the understanding of clinical properties and usages of aripiprazole among local physicians. Of note, because aripiprazole long-acting injectable has been available locally not long before the establishment of the consensus panel, which limited the discussion on its use in the local context, the consensus statements were focused primarily on oral aripiprazole. To draft the consensus statements, the panellists discussed the published evidence and their clinical experience regarding aripiprazole in a series of meetings based on several areas. At the final meeting, each drafted statement was voted on anonymously by all panellists based on its practicability of recommendation in Hong Kong. A set of consensus statements on the characteristics and clinical use of aripiprazole was established and accepted by the panel. These statements serve to provide a practical reference for physicians in Hong Kong, and possibly other parts of the Asia-Pacific region, on the use of aripiprazole in people with schizophrenia spectrum disorders and other psychotic problems.
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Affiliation(s)
| | | | | | | | - C K Lee
- Asian Association of Neuropsychopharmacology
| | - Eric Lai
- Asian Association of Neuropsychopharmacology
| | | | | | | | | | - K L Tam
- Asian Association of Neuropsychopharmacology
| | - K Y Mak
- Asian Association of Neuropsychopharmacology
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21
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Flores M, Dayan I, Roth H, Zhong A, Harouni A, Gentili A, Abidin A, Liu A, Costa A, Wood B, Tsai CS, Wang CH, Hsu CN, Lee CK, Ruan C, Xu D, Wu D, Huang E, Kitamura F, Lacey G, César de Antônio Corradi G, Shin HH, Obinata H, Ren H, Crane J, Tetreault J, Guan J, Garrett J, Park JG, Dreyer K, Juluru K, Kersten K, Bezerra Cavalcanti Rockenbach MA, Linguraru M, Haider M, AbdelMaseeh M, Rieke N, Damasceno P, Cruz E Silva PM, Wang P, Xu S, Kawano S, Sriswasdi S, Park SY, Grist T, Buch V, Jantarabenjakul W, Wang W, Tak WY, Li X, Lin X, Kwon F, Gilbert F, Kaggie J, Li Q, Quraini A, Feng A, Priest A, Turkbey B, Glicksberg B, Bizzo B, Kim BS, Tor-Diez C, Lee CC, Hsu CJ, Lin C, Lai CL, Hess C, Compas C, Bhatia D, Oermann E, Leibovitz E, Sasaki H, Mori H, Yang I, Sohn JH, Keshava Murthy KN, Fu LC, Furtado de Mendonça MR, Fralick M, Kang MK, Adil M, Gangai N, Vateekul P, Elnajjar P, Hickman S, Majumdar S, McLeod S, Reed S, Graf S, Harmon S, Kodama T, Puthanakit T, Mazzulli T, de Lima Lavor V, Rakvongthai Y, Lee YR, Wen Y. Federated Learning used for predicting outcomes in SARS-COV-2 patients. Res Sq 2021:rs.3.rs-126892. [PMID: 33442676 PMCID: PMC7805458 DOI: 10.21203/rs.3.rs-126892/v1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
'Federated Learning' (FL) is a method to train Artificial Intelligence (AI) models with data from multiple sources while maintaining anonymity of the data thus removing many barriers to data sharing. During the SARS-COV-2 pandemic, 20 institutes collaborated on a healthcare FL study to predict future oxygen requirements of infected patients using inputs of vital signs, laboratory data, and chest x-rays, constituting the "EXAM" (EMR CXR AI Model) model. EXAM achieved an average Area Under the Curve (AUC) of over 0.92, an average improvement of 16%, and a 38% increase in generalisability over local models. The FL paradigm was successfully applied to facilitate a rapid data science collaboration without data exchange, resulting in a model that generalised across heterogeneous, unharmonized datasets. This provided the broader healthcare community with a validated model to respond to COVID-19 challenges, as well as set the stage for broader use of FL in healthcare.
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Affiliation(s)
| | | | | | - Aoxiao Zhong
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Bradford Wood
- Radiology & Imaging Sciences / Clinical Center, National Institutes of Health
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chih-Hung Wang
- Tri-Service General Hospital, National Defense Medical Center
| | - Chun-Nan Hsu
- Center for Research in Biological Systems, University of California, San Diego
| | | | | | | | - Dufan Wu
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Hui Ren
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jason Crane
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | | | | | - John Garrett
- The University of Wisconsin-Madison School of Medicine and Public Health
| | | | - Keith Dreyer
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA
| | | | | | | | - Marius Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Masoom Haider
- Joint Dept. of Medical Imaging, Sinai Health System, University of Toronto, Toronto, Canada and Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | | | | | - Pablo Damasceno
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | | | - Pochuan Wang
- MeDA Lab and Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan
| | - Sheng Xu
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | | | - Varun Buch
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA
| | - Watsamon Jantarabenjakul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand and Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bang
| | | | - Won Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Xiang Li
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Xihong Lin
- Harvard T.H. Chan School of Public Health
| | | | | | - Josh Kaggie
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge
| | - Quanzheng Li
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | - Andrew Priest
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, Cambridge University Hospital
| | | | | | - Bernardo Bizzo
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA
| | - Byung Seok Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Carlos Tor-Diez
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC
| | - Chia-Cheng Lee
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C. and Division of Colorectal Surgery, Department of Surgery, Tri-Service General H
| | - Chia-Jung Hsu
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin Lin
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C. and School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C. and Graduate Institute of Life Scienc
| | - Chiu-Ling Lai
- Medical Review and Pharmaceutical Benefits Division, National Health Insurance Administration, Taipei. Taiwan
| | | | | | | | | | - Evan Leibovitz
- The Center for Clinical Data Science, Mass General Brigham
| | | | | | | | - Jae Ho Sohn
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | | | - Li-Chen Fu
- MOST/NTU All Vista Healthcare Center, Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, Taiwan
| | | | - Mike Fralick
- Division of General Internal Medicine and Geriatrics (Fralick), Sinai Health System, Toronto, Canada
| | - Min Kyu Kang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | | | | | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University
| | | | - Sarah Hickman
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge
| | - Sharmila Majumdar
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Shelley McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada and Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sheridan Reed
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Center of Excellence in Pediatric Infectious Diseases and Vaccine, Chulalongkorn University
| | - Tony Mazzulli
- Department of Microbiology, Sinai Health/University Health Network, Toronto, Canada and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto. Canada Public Health Ontar
| | | | - Yothin Rakvongthai
- Chulalongkorn University Biomedical Imaging Group and Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yu Rim Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
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Lee CK, Leung JNS, Cheng P, Lung DC, To KKW, Tsang DNC. Absence of SARS-CoV-2 viraemia in a blood donor with COVID-19 post-donation. Transfus Med 2020; 31:223-224. [PMID: 33015920 PMCID: PMC7677860 DOI: 10.1111/tme.12724] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, SAR, China
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, SAR, China
| | - P Cheng
- Public Health Laboratory Centre, Centre for Health Protection, Department of Health, Hong Kong, SAR, China
| | - D C Lung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong, SAR, China
| | - K K W To
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - D N C Tsang
- Public Health Laboratory Centre, Centre for Health Protection, Department of Health, Hong Kong, SAR, China
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Chow YF, Cheng BCP, Cheng HK, Ho B, Lee CK, Ng SK, So R, Tse KC, Tsui C, Wan R, Wong S. Hong Kong Society of Clinical Blood Management recommendations for implementation of patient blood management. Hong Kong Med J 2020; 26:331-338. [PMID: 32807736 DOI: 10.12809/hkmj208397] [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: 11/05/2022] Open
Abstract
Patient blood management (PBM) is a patient-centred, multidisciplinary approach to optimise red cell mass, minimise blood loss, and manage tolerance to anaemia in an effort to improve patient outcomes. Well-implemented PBM improves patient outcomes and reduces demand for blood products. The multidisciplinary approach of PBM can often allow patients to avoid blood transfusions, which are associated with less favourable clinical outcomes. In Hong Kong, there has been increasing demand for blood in the ageing population, and there are simultaneous blood safety and donor issues that are adversely affecting the blood supply. To address these challenges, the Hong Kong Society of Clinical Blood Management recommends implementation of a PBM programme in Hong Kong, including strategies such as optimising red blood cell mass, improving anaemia management, minimising blood loss, and rationalising the use of blood and blood products.
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Affiliation(s)
- Y F Chow
- Department of Anaesthesiology and OT Services, Queen Elizabeth Hospital, Hong Kong
| | - B C P Cheng
- Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital, Hong Kong
| | - H K Cheng
- Department of Anaesthesia and Operating Theatre Services, Tseung Kwan O Hospital, Hong Kong
| | - B Ho
- Department of Anaesthesiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - S K Ng
- Private Practice, Hong Kong
| | - R So
- Department of Anaesthesia, Princess Margaret Hospital, Hong Kong
| | - K C Tse
- Department of Anaesthesia and Operating Theatre Services, Tseung Kwan O Hospital, Hong Kong
| | - C Tsui
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong
| | - R Wan
- Private Practice, Hong Kong
| | - S Wong
- Department of Anaesthesiology and OT Services, Queen Elizabeth Hospital, Hong Kong
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Tsan SEH, Kamalanathan A, Lee CK, Zakaria SA, Wang CY. A survey on burnout and depression risk among anaesthetists during COVID-19: the tip of an iceberg? Anaesthesia 2020; 76 Suppl 3:8-10. [PMID: 32776524 PMCID: PMC7436440 DOI: 10.1111/anae.15231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- S E H Tsan
- University of Malaysia Sarawak, Sarawak, Malaysia
| | | | - C K Lee
- Sungai Buloh Hospital, Ministry of Health, Malaysia
| | - S A Zakaria
- Sungai Buloh Hospital, Ministry of Health, Malaysia
| | - C Y Wang
- University of Malaya, Kuala Lumpur, Malaysia
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25
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Luen SJ, Asher R, Lee CK, Savas P, Kammler R, Dell'Orto P, Biasi OM, Demanse D, Hackl W, Thuerlimann B, Viale G, Di Leo A, Colleoni M, Regan MM, Loi S. Identifying oncogenic drivers associated with increased risk of late distant recurrence in postmenopausal, estrogen receptor-positive, HER2-negative early breast cancer: results from the BIG 1-98 study. Ann Oncol 2020; 31:1359-1365. [PMID: 32652112 DOI: 10.1016/j.annonc.2020.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/08/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In postmenopausal, estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer, the risk for distant recurrence can extend beyond 5 years of adjuvant endocrine therapy. This study aims to identify genomic driver alterations associated with late distant recurrence. PATIENTS AND METHODS Next generation sequencing was used to characterize driver alterations in primary tumors from a subset of 764 postmenopausal estrogen receptor-positive/HER2-negative patients from the BIG 1-98 randomized trial. Late distant recurrence events were defined as ≥5 years from time of randomization). The association of driver alterations with distant recurrence-free interval in early and late time periods was assessed using Cox regression models. Multivariable analyses were carried out to adjust for clinicopathological factors. Weighted analysis methods were used in order to correct for over-sampling of distant recurrences. RESULTS A total of 538 of 764 (70%) samples were successfully sequenced including 88 (63%) early and 52 (37%) late distant recurrence events after a median follow up of 8.1 years. In univariable analysis for late distant recurrence, PIK3CA mutations (58.8%) were significantly associated with reduced risk [hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.20-0.82, P = 0.012], whereas amplifications on chromosome 8p11 (10.9%) (HR 4.79, 95% CI 2.30-9.97, P < 0.001) and BRCA2 mutations (2.3%) (HR 5.39, 95% CI 1.51-19.29, P = 0.010) were significantly associated with an increased risk. In multivariable analysis, only amplifications on 8p11 (P = 0.002) and BRCA2 mutations (P = 0.013) remained significant predictors. CONCLUSIONS In estrogen receptor-positive/HER2-negative postmenopausal early breast cancer, PIK3CA mutations were associated with reduced risk of late distant recurrence, whereas amplifications on 8p11 and BRCA2 mutations were associated with increased risk of late distant recurrence. The characterization of oncogenic driver alterations may aid in refining treatment choices in the late disease setting, and help identify potential drug targets for testing in future trials.
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Affiliation(s)
- S J Luen
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - R Asher
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - C K Lee
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - P Savas
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - R Kammler
- International Breast Cancer Study Group, Coordinating Center, Central Pathology Office, Bern, Switzerland
| | - P Dell'Orto
- International Breast Cancer Study Group Central Pathology Office, Department of Pathology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - O M Biasi
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - D Demanse
- Novartis Pharma AG, Basel, Switzerland
| | - W Hackl
- OncogenomX Inc., Allschwil, Basel, Switzerland
| | - B Thuerlimann
- Breast Center, Cantonal Hospital, St Gallen, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - G Viale
- Department of Pathology, University of Milan, Milan, Italy; IEO European Institute of Oncology IRCCS, Milan, Italy
| | - A Di Leo
- Sandro Pitigliani Department of Medical Oncology, Hospital of Prato, Prato, Italy
| | - M Colleoni
- Division of Medical Senology, European Institute of Oncology, Milan, Italy
| | - M M Regan
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Loi
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
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Nam SH, Lee JS, Choi SJ, Seo WJ, Oh JS, Hong S, Kim YG, Lee CK, Yoo B. AB0212 FLARE RISK AFTER DISCONTINUING LONG-TERM METHOTREXATE TREATMENT IN PATIENTS HAVING RHEUMATOID ARTHRITIS WITH LOW DISEASE ACTIVITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Several recent studies have reported that MTX could be discontinued in patients with low disease activity who are taking biologic DMARDs or tofacitinib. However, there are limited studies on whether MTX could be discontinued in patients with low disease activity who have taken MTX for a long term.Objectives:We investigated the disease flare rate in patients with rheumatoid arthritis (RA) who achieved low disease activity following long-term methotrexate (MTX) treatment and the factors related to flare.Methods:This retrospective longitudinal cohort study included patients with RA and low disease activity who were exposed to MTX for >10 years. Disease flare was defined as an increase in DAS28 of >1.2 within 6 months of discontinuation of MTX. Logistic regression analysis was performed to identify the factors associated with flare.Results:In total, 97 patients with RA were included in the study. The mean baseline DAS28 was 1.96 ± 0.56. The median cumulative MTX dose was 11.7g; the median duration of exposure to MTX was 19 years. Following MTX discontinuation, flare occurred in 43 (44.3%) patients; the mean time to flare was 98 ± 37.7 days. According to univariable logistic regression analysis, C-reactive protein, erythrocyte sedimentation rate (ESR) at discontinuation, the average ESR in the 6 months before discontinuation of MTX, a weekly dose of MTX before discontinuation, and use of other conventional synthetic DMARDs were associated with a higher risk of disease flare. In multivariable analysis, a weekly dose of MTX before discontinuation (OR, 1.014; 95% CI, 1.014–1.342; p = 0.031) was significantly associated with flare risk.Conclusion:Among patients with RA who achieved low disease activity with long-term treatment with MTX, more than half of the patients remained flare free after MTX discontinuation. A higher MTX dose before discontinuation was associated with a high flare risk.Disclosure of Interests:None declared
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Choi SJ, Lee JS, Nam SH, Seo WJ, Oh JS, Hong S, Kim YG, Lee CK, Yoo B. FRI0118 RISK OF LIVER FIBROSIS ON TRANSIENT ELASTOGRAPHY IN PATIENTS WITH RHEUMATIC DISEASE UNDER LONG-TERM METHOTREXATE TREATMENT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Methotrexate (MTX) is a cornerstone drug for the treatment of rheumatic disease and low doses of MTX are both tolerable and safe, with monitored toxicity, assessed via the liver function test. However, there is still controversy regarding the risk of liver fibrosis with long-term use of MTX. Transient elastography is commonly used to assess and monitor fibrosis progression in patients with chronic liver disease.Objectives:The present study aims to investigate liver fibrosis using transient elastography and related factors in patients with rheumatic disease receiving long-term MTX.Methods:The present retrospective, longitudinal, cross-sectional study included patients with an autoimmune disease who are taking cumulative MTX dosed over 7 g, and who had liver fibrosis upon examination using transient elastography. Liver fibrosis was defined as liver stiffness, valued over 7.2 kPa. Logistic regression analysis was performed to identify factors associated with liver fibrosis, and receiver operating characteristics analysis was used to determine the predictive value of each factor.Results:We included 83 patients with autoimmune disease, with a median MTX cumulative dose of 11.6 (range 7.3-16.0) g. Sixty-eight patients (81.9%) had rheumatoid arthritis (RA), and 13 patients (15.7%) had Takayasu arteritis. The median MTX exposure duration was 18 (range 9-31) years. The median liver stiffness value was 4 (range 1.8-10.2) kPa. Five patients (6%) showed liver fibrosis (3 patients; RA, 2 patients; Takayasu arteritis). In the linear regression analysis, cumulative MTX dose showed a tendency towards a positive correlation with increasing liver stiffness value (r2 =0.039, p = 0.074). In the logistic regression analysis, cumulative MTX dose was associated with a higher risk of liver fibrosis (OR: 1.734, 95% CI: 1.060–2.837, p = 0.029). In addition, cumulative MTX dose had an area under the curve (AUC) of 0.813 (95% CI 0.695-0.930) and a sensitivity of 80% and specificity of 71.8% at a cut-off value of 12.7 g.Conclusion:Liver fibrosis was observed in 6% of patients with long-term MTX use and higher cumulative MTX doses increased the risk of liver fibrosis. Thus, transient elastography should be considered in patients exposed to high cumulative doses of MTX.Disclosure of Interests:None declared
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Zeng X, Zhao D, Radominski S, Keiserman M, Lee CK, Meerwein S, Enejosa J, Sui Y, Mohamed ME, Park W. SAT0160 EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS FROM CHINA, BRAZIL, AND SOUTH KOREA WITH RHEUMATOID ARTHRITIS WHO HAVE HAD INADEQUATE RESPONSE TO CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Upadacitinib (UPA), an oral, selective JAK-1 inhibitor was effective in global ph 3 trials in rheumatoid arthritis (RA) patients with inadequate response (IR)/intolerance to csDMARDs and bDMARDs.Objectives:This Phase 3, randomized, double-blind, placebo (PBO)-controlled study assessed the efficacy and safety of UPA in combination with csDMARDs in csDMARD-IR patients with RA from China, Brazil, and South Korea.Methods:Patients were randomized 1:1 to receive UPA 15 mg once daily (QD) or PBO in combination with csDMARDs. The primary endpoint was ACR20 response at Week 12, using non-responder imputation.Results:338 patients were randomized, and 310 (91.7%) completed Week 12. At Week 12, statistically significantly more patients receiving UPA vs PBO achieved the primary endpoint of ACR20 (71.6% vs 31.4%, p<0.001). UPA also demonstrated statistically significant improvements in all ranked secondary endpoints vs PBO at Week 12 (Table 1), including mean change in DAS28(CRP), HAQ-DI, and SF-36 PCS, and patients achieving DAS28(CRP) ≤3.2, DAS28(CRP) <2.6, and CDAI ≤10. Greater responses were also seen with UPA vs PBO for other key secondary endpoints including ACR50 and ACR70. Onset of UPA action was rapid with more patients on UPA achieving ACR20 by Week 1 (25.4% vs 5.9%, p<0.001). The frequency of AEs (61.5% vs 49.1%) and serious AEs (7.1% vs 3.0%) was higher with UPA vs PBO. The frequency of AEs of special interest was generally similar between UPA and PBO, with the exception of herpes zoster (1.8% vs 0.6%), hepatic disorders (9.5% vs 7.1%), neutropenia (3.0% vs 0%), and elevated creatine phosphokinase (1.8% vs 0.6%), which were higher with UPA. One case of breast cancer (on Day 1 of study) and one VTE (pulmonary embolism and deep vein thrombosis in a patient with history of deep vein thrombosis) were reported with UPA treatment.Table 1.Efficacy endpoints at Week 12EndpointaUPA 15 mg QD (n=169)PBO(n=169)Primary endpointACR20, %71.6***31.4Secondary endpointsΔ DAS28(CRP)-2.56***-0.95Δ HAQ-DI-0.62***-0.18Δ SF-36 PCS8.93c***3.36dDAS28(CRP) ≤3.2, %46.2***13.6DAS28(CRP) <2.6, %29.6***5.3CDAI ≤10, %35.5***11.2ACR50, %b40.8***8.3ACR70, %b21.3***3.6ACR20 at Week 1, %b25.4***5.9***p<0.001 vs PBOaNRI for binary endpoints; ANCOVA with multiple imputation for DAS28(CRP) and HAQ-DI; mixed model repeated measures for other continuous endpointsbUnranked secondary endpoint.cn=143.dn=149Conclusion:Efficacy of UPA was demonstrated in this csDMARD-IR population from China, Brazil, and South Korea. The safety of UPA was comparable with the global Phase 3 program.Disclosure of Interests: :Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Dongbao Zhao: None declared, Sebastiao Radominski: None declared, MAURO KEISERMAN Speakers bureau: Pfizer, Abbott, Actelion, AstraZeneca, Amgen, Roche, Bristol Myers Squibb, and Janssen and has received clinical trial honoraria from Pfizer, Amgen, AstraZeneca, Anthera Pharmaceuticals, Bristol-Myers Squibb, Biogen Idec Inc, Celltrion Inc., Eli Lilly, Human Genome Sciences, Novartis, Roche, Sanofi, UCB Inc., Chang-Keun Lee: None declared, Sebastian Meerwein Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jeffrey Enejosa Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Yunxia Sui Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Mohamed-Eslam Mohamed Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Won Park: None declared
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Nam SH, Choi SJ, Lee JS, Oh JS, Hong S, Seo WJ, Lee CK, Yoo B, Kim YG. THU0210 EARLY DISCONTINUATION OF TOFACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS CO-TREATED WITH RIFAMPIN FOR LATENT TUBERCULOSIS: RESULTS FROM THE REAL-WORLD DATA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatoid arthritis (RA) patients need to undergo screening and receive treatment for latent tuberculosis infection (LTBI) before starting tofacitinib, which is primarily metabolized by cytochrome P450 (CYP) 3A4. Among chemoprophylactic agents, rifampin is known to be a potent CYP3A4 inducer; therefore, it is expected to decrease the efficacy of tofacitinib. However, tofacitinib and rifampin have been co-administered practically because of the short duration of chemoprophylaxis.Objectives:The aim of this study was to determine the efficacy of tofacitinib on co-administration with rifampin.Methods:Biologic-naïve RA patients treated with tofacitinib were selected, and electronic medical reports were reviewed retrospectively. All patients underwent screening for LTBI before starting tofacitinib, and patients with positive results were treated to prevent progression to active tuberculosis. To evaluate the efficacy of tofacitinib with or without rifampin, the discontinuation rates of tofacitinib were examined during the first 6 months. Kaplan–Meier analysis was used to construct cumulative discontinuation curves, and comparisons were performed using the log-rank test.Results:Among 81 patients who started tofacitinib, 21 (25.9%) were LTBI-positive and 18 (22.2%) were administered rifampin concomitantly with tofacitinib. The median follow-up time was 6 months in both patients who received rifampin (interquartile range [IQR] 2.21, 6.00) and those who did not receive rifampin (IQR 5.97, 6.00) (p = 0.083). There were no significant differences between patients who received rifampin and those who did not receive rifampin in all baseline characteristics, except the swollen joint count (3.00 [1.75, 5.25] vs. 5.00 [4.00, 7.00]; p = 0.025), at the time of starting tofacitinib. In patients who received rifampin at the time of starting tofacitinib, the mean duration of co-administration was 47.00 ± 23.54 days (median 56; IQR 28.75, 59.00). During follow-up, 14 of the 81 patients (17.3%) discontinued tofacitinib. As shown in the Figures 1 and 2, the discontinuation rate of tofacitinib within the first 6 months was significantly higher among patients who received rifampin for LTBI than among those who did not receive rifampin (lack of efficacy: 24.7% vs. 5.1%, p = 0.008; all causes: 38.9% vs. 11.2%, p = 0.002). Seven patients discontinued tofacitinib because of uncontrolled RA activity, and rifampin had been administered concomitantly in four of these seven patients. Of the four patients, three stopped taking tofacitinib in the middle of LTBI treatment, and the DAS28-ESR scores of these patients were higher at discontinuation than at baseline.Conclusion:Discontinuation rates were higher in RA patients who started tofacitinib during chemoprophylaxis involving rifampin than in those who did not receive rifampin. Physicians should be aware that the efficacy of tofacitinib could be decreased by the chemoprophylactic regimen for tuberculosis.Disclosure of Interests:None declared
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Ghang B, Nam SH, Kim YG, Yoo B, Lee CK. FRI0485 RISK OF PROGRESSION OF IDIOPATHIC PULMONARY FIBROSIS TO CONNECTIVE TISSUE DISEASE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Connective tissue disease (CTD) may be observed during the course of idiopathic pulmonary fibrosis (IPF). However, clinical factors associated with the development of CTD in patients with IPF have not yet been identified. These factors might be valuable clues for determining the pathogenesis of pulmonary fibrosis in patients with CTD. We hypothesize that some IPF patients have a clinically significant association with autoimmunity, and that autoantibodies are important biomarkers for identifying these patients.Objectives:Based on this hypothesis, we investigated whether the serology criteria (anti-neutrophil cytoplasmic antibody (ANCA) or autoantibodies that met the serology criteria for interstitial pneumonitis with autoimmune features (IPAF)) were associated with the development of CTD during the clinical course of IPF in the patients from our previous study(1), with a particular focus on which antibodies have a significant association with the development of CTD.Methods:We retrospectively reviewed the records of 527 patients with a first diagnosis of IPF between January 2007 and March 2014, and investigated the length of time from first visit to the clinic for IPF diagnosis (baseline) to CTD diagnosis by an expert rheumatologist in patients with IPF. Multivariable Cox proportional-hazards models with backward elimination were used to investigate the risk factors for the development of CTD.Results:CTD developed in 15 patients at a median of 2.1 years (range 1.2 to 4.8) after IPF diagnosis. All these patients had ANCA or autoantibodies that met the serology criteria for IPAF. A significant number of IPF patients with high titers of RF, ACPA or MPO-ANCA tested at first visit to the clinic progressed to CTD(Figure 1). Survival duration for IPF patients with progression to CTD was 5.3 [3.8; 6.7] years, which was significantly longer than for the IPF patients without progression to CTD (2.9 [1.7; 4.8], p = 0.001). Independent risk factors for development of CTD in IPF patients included female gender (adjusted hazard ratio (HR) 5.319, p = 0.0082), titer of rheumatoid factor (RF) (adjusted HR 1.006, p = 0.022), titer of anti-citrullinated protein antibody (ACPA) (adjusted HR 1.009, p = 0.0011), and titer of myeloperoxidase (MPO) ANCA (adjusted HR 1.02, p < 0.0001).Figure 1.Connective tissue disease development in each autoantibody positive IPF patient. ACPA = anti–citrullinated protein antibody; ANA = antinuclear antibody; CTD = connective tissue disease; MPA = microscopic polyangiitis; PAN = polyarteritis nodosa; RA = rheumatoid arthritis; RF = rheumatoid factor; UCTD = Undifferentiated connective tissue disease; SjS = Sjögren’s syndrome.Conclusion:We observed development of CTD in IPF patients with ANCA or autoantibodies that met the IPAF serology criteria. Among these autoantibodies, RF, ACPA, and MPO-ANCA were significantly associated with the development of CTD in IPF patients. Progression to CTD is uncommon in IPF patients, but a significant number of IPF patients with high titers of RF, ACPA or MPO-ANCA progressed to connective tissue disease. IPF with high titers of RF, ACPA or MPO-ANCA might be the initial clinical manifestation of connective tissue disease. Further studies are needed to investigate the role of RF, ACPA, and MPO-ANCA in development of pulmonary fibrosis.References:[1]Ghang B, Lee J, Chan Kwon O, Ahn SM, Oh JS, Hong S, et al. Clinical significance of autoantibody positivity in idiopathic pulmonary fibrosis. Respir Med. 2019;155:43-8.Disclosure of Interests:None declared
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Lee EJ, Kim DH, Lee JH, Choi SJ, Nam SH, Oh JS, Chang EJ, Hong S, Lee CK, Yoo B, Kim YG. SAT0009 ROLE OF EC-18 IN AUTOIMMUNE ARTHRITIS AND INTERSTITIAL LUNG DISEASE IN CURDLAN-ADMINISTERED SKG MICE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Although the mortality of patients with rheumatoid arthritis (RA), for which interstitial lung disease (ILD) is one of the major contributors, has still not decreased, new target therapies for RA have shown good response in peripheral arthritis. EC-18 (acetylated diacylglycerol 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol) is a mono-acetyl-diglyceride that has been isolated from the antlers of sika deer and can be chemically synthesized from glycerol, palmitic acid, and linoleic acid. Research using LPS-induced acute lung injury murine model has reported that EC-18 stimulates a more rapid resolution of LPS-induced lung Inflammation. In addition, it has been reported that in a murine model of collagen-induced arthritis, EC-18 treatment ameliorated arthritis, with down-regulation of IL-6 level by regulating the activity of STAT3 in the synovium. Curdlan-administered SKG mice develop ILD spontaneously followed by peripheral arthritis, which resembles RA-ILD.Objectives:We evaluated the modulatory effect of the EC-18 on arthritis and ILD in autoimmune arthritis animal model.Methods:Male SKG mice were obtained from Dr. S. Sakaguchi. We injected curdlan (3 mg/mice) in 8-week-old SKG mice and identified the presence of ILD by histological analysis at 20 weeks post-injection. Arthritis score was measured every week for up to 20 weeks. EC-18 (250 mg/kg body weight/day, Enzychem Lifesciences Co., Daejeon, Korea) was administered every day orally. At 20 weeks post-injection, lung sections were stained with H&E and Masson’s trichrome. Using the Opal method, multiplexed immunofluorescent staining of lung tissue was performed. According to the scale by Ashcroft et al., fibrosis severity of lung sections was assessed by a system of eight grades. Analysis of serum cytokines by the luminex multiplex cytokine assay was performed at 20 weeks post-injection.Results:Oral administration of EC-18 decreased arthritis score significantly until 8 weeks post-injection and remained unchanged thereafter. At 20 weeks post-injection, histological analysis showed severe pulmonary destruction, including bronchial alveolar tissue damage and massive leukocyte infiltration, and fibrosis in the curdlan-administered mice, which was attenuated in EC-18 treated mice. In particular, 67% of curdlan-administered mice showed ILD-like phenotype, whereas the incidence rate in EC-18-treated mice was 17%. Furthermore, immunofluorescent-staining showed both IL-17A and neutrophil accumulation in lung in curdlan-administered mice; these were decreased in EC-18-treated mice. Interestingly, at 20weeks post-injection, EC-18 treatment down-regulated serum levels of IL-6 and TNF-α and up-regulated sIL-7Rα (anti-fibrotic molecule).Conclusion:Taken together, EC-18 exerts an anti-arthritic effect in early phase, but a long-term effect was not indicated. We emphasize the effect on ILD prevention of EC-18 via up-regulation of sIL-7Rα and inhibition of neutrophil accumulation, suggesting a therapeutic agent potentially for RA-ILD.Disclosure of Interests:None declared
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Koo BS, Eun S, Shin K, Yoon H, Hong CL, Kim DH, Hong S, Kim YG, Lee CK, Yoo B, Oh JS. OP0023 PREDICTION OF REMISSION FOR EACH BIOLOGICS BASED ON PATIENT’S CLINICAL INFORMATION BEFORE STARTING BIOLOGICS USING EXPLAINABLE ARTIFICIAL INTELLIGENCE: DATA FROM THE KOREAN COLLEGE OF RHEUMATOLOGY BIOLOGICS REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Many studies have identified predictive factors of response to biologics in patients wirh rheumatoid arthritis (RA). However, there is still a lack in using them in daily clinical practice. Therefore, it is necessary to develop a method that can assist the physician in selecting effective biologics.Objectives:The purpose of this study is to establish machine learning model that predicts remission in patients treated with biologics using data of RA patients from the Korean College of Rheumatology Biologics (KOBIO) registry, and to identify the important features that have the most influence on the response to biologics using explainable artificial intelligence (AI).Methods:A total of 1,527 patients who started with biologics such as etanercept, adalimumab, golimumab, infliximab, abatacept, and tocilizumab from December 2012 to June 2019 were enrolled. Remission was predicted using 46 variables corresponding to baseline profiles at the starting of each biologics. We used five machine learning methods such as lasso, ridge, SVM, random forest, and XGBoost. For explainability of those models, we used Shapley plot to interpret the feature importance for each biologics.Results:In all machine learning methods, the accuracy and the area under the receiver operating characteristic (AUROC) were 57.2%~74.5%, 0.547~0.747, respectively (Table 1). The accuracy and AUROC of each biologics were similar between machine learning methods. Figure 2 showed interpretation of feature importance with the Shapley plot for remission. The most important feature was age in adalimumab (younger were closer to remission), daily corticosteroid dose in etanercept, golimumab, and all TNF inhibitors (using fewer doses daily were closer to remission), baseline erythrocyte sedimentation rate in infliximab (lower ESR were closer to remission), disease duration in abatacept (longer disease durations showed difficulty determining remission), baseline c-reactive protein in tocilizumab (higher CRP were closer to remission).Table.Predicting remission for all biologics in various machine learning method.MeasureLassoRidgeSVMRandom ForestXGBoostNo info rateSampleAbataceptAccuracy74.1%74.1%70.6%71.8%68.8%70.6%216AUROC0.7250.7420.7070.6770.6470.500AdalimumabAccuracy73.6%72.0%70.4%72.0%70.4%68.8%315AUROC0.7100.7290.7000.6750.6630.500EtanerceptAccuracy72.0%72.0%70.0%71.5%70.0%68.0%250AUROC0.7410.7470.7260.7190.7040.500GolimumabAccuracy71.3%68.5%66.7%68.5%68.5%68.5%138AUROC0.7460.7270.7010.6900.6550.500InfliximabAccuracy72.8%73.5%67.6%73.5%69.1%72.5%172AUROC0.6630.6830.6160.5970.5270.500TNF inhibitorsAccuracy73.9%74.5%73.9%74.2%73.6%70.3%875AUROC0.7390.7410.7260.7470.7240.500TocilizumabAccuracy62.4%63.6%62.4%59.5%57.2%59.5%436AUROC0.6330.6400.6330.6150.5470.500Figure 2.Shapley plots and SHAP values for the feature importance from clinical information in patients with RA.Conclusion:We developed machine learning models for predicting remission as a response to each biologics in active RA patients based on their clinical profiles, and found important clinical features using explainable AI. This approach may support clinical decisions to improve treatment outcomes in patients with RA.Disclosure of Interests:None declared
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Choi SJ, Nam SH, Lee JS, Seo WJ, Oh JS, Hong S, Lee CK, Yoo B, Kim YG. AB1018 TREATMENT RESPONSE OF HYDRONEPHROSIS ASSOCIATED WITH IDIOPATHIC RETROPERITONEAL FIBROSIS, FOCUSING ON RATIO OF IgG4/IgG3 SERUM CONCENTRATION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Hydronephrosis, a common complication of idiopathic retroperitoneal fibrosis (iRPF), may lead to poor renal outcomes unless it is resolved. Pathological confirmation can help to identify the aetiology of the disease and determine the treatment strategy. But, in most cases, it is difficult to obtain sufficient tissue due to the location of fibrosis. In a recent study, parts of iRPF are correlated with IgG4-related disease characterised by elevated serum IgG4 levels (>135 mg/dL). Normal serum IgG3 level (21–176 mg/dL) has been known to be higher than normal serum IgG4 level (4–86 mg/dL). The reverse IgG4/IgG3 ratio has been suggested to be an IgG4-related disease component that distinguishes it from primary sclerosing cholangitis [1]. However, the ratio of IgG3 and IgG4 may be reversed in iRPF patients with hydronephrosis.Objectives:We aimed to investigate the ratio of IgG subclasses as a predictive factor associated with treatment response of hydronephrosis in patients with iRPF.Methods:We retrospectively recruited 19 iRPF patients with hydronephrosis who evaluated serum IgG subclasses in a tertiary hospital between 2004 and 2019. Hydronephrosis was evaluated on the basis of imaging findings. Medications and clinical and laboratory findings, including IgG subclasses, were reviewed following the diagnosis of hydronephrosis. Hydronephrosis improvement on subsequent images was evaluated to assess treatment response. Categorised data were compared using chi-square or Fisher’s exact test. Continuous variables were compared using Mann–Whitney U test.Results:At baseline, median serum IgG3 and IgG4 levels were 64 (IQR 37–82) mg/dL and 71 (IQR 40–171) mg/dL. Five patients had serum IgG4 levels > 135 mg/dL and 11 patients had the reverse serum level of IgG4/IgG3. On subsequent images (median follow-up at 3.2 [IQR 1.7–4.0] months), 11 patients showed hydronephrosis improvement. The proportions of positive ratio of serum IgG4/IgG3 (81.8% vs. 25%, p = 0.024), periaortic involvement (81.8% vs. 25%, p = 0.024) and high-dose glucocorticoid treatment (45.5% vs. 0%, p = 0.045) were significantly higher in patients with improvement than in those without improvement (Table 1). Interestingly, even in cases with normal serum IgG4 levels, patients with improvement showed a higher serum IgG4/IgG3 ratio than in those without improvement (median 1.5 vs. 0.7, p = 0.038).Table 1.Clinical characteristics and treatment according to the shortterm outcome of hydronephrosisImprovement(n = 11)No improvement(n = 8)p-valueTime to subsequent imaging (months)a2.2 (1.3–4.2)3.2 (2.0–3.8)0.778Males (n, %)8 (72.7%)7 (87.5%)0.603Periaortic involvement (n, %)9 (81.8%)2 (25%)0.024Impaired renal function (n, %)b5 (45.5%)2 (25%)0.633Serum IgG4 (mg/dL)a114 (59–172)43 (35–109)0.152Elevated serum IgG4 (n, %)4 (36.4%)1 (12.5%)0.338Serum IgG4/IgG3 ratioa2.1 (1.2–4.9)0.8 (0.4–1.0)0.041Positive ratio of serum IgG4/IgG3 (n, %)9 (81.8%)2 (25%)0.024Medical treatment (n, %)7 (63.6%)1 (12.5%)0.059High-dose glucocorticoid treatment (n, %)5 (45.5%)0 (0%)0.045Surgical intervention (n, %)8 (72.7%)4 (50%)0.377aValues are median and interquartile range (25th–75thpercentile)bDefined as serum creatinine level > 1.24 mg/dLConclusion:The reverse ratio of serum IgG4/IgG3 was associated with hydronephrosis treatment response, thus suggesting favourable responses to high-dose corticosteroid.References:[1]Boonstra K, Culver EL, de Buy Wenniger LM, et al. Serum immunoglobulin G4 and immunoglobulin G1 for distinguishing immunoglobulin G4-associated cholangitis from primary sclerosing cholangitis. Hepatology 2014;59:1954-63.Disclosure of Interests:None declared
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Choi SJ, Nam SH, Lee JS, Seo WJ, Oh JS, Hong S, Lee CK, Yoo B, Kim YG. FRI0088 CHANGE IN SERUM BILIRUBIN SUGGESTS TREATMENT RESPONSE IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH MOLECULAR-TARGETED AGENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Bilirubin is an antioxidant with anti-inflammatory properties. In previous reports, serum bilirubin levels were correlated with disease activity of autoimmune diseases including rheumatoid arthritis (RA). Various molecular-targeted agents have been developed for RA, and targets, such as IL-6 and TNFα, are associated with liver function. However, the association between serum bilirubin and treatment response in RA patients treated with molecular-targeted agents is still unknown.Objectives:We aimed to evaluate the role of serum bilirubin in the prediction of the early treatment response in RA patients who initiated molecular-targeted agents.Methods:We retrospectively recruited biologic naïve RA patients (n=292) with moderate-to-high disease activity from a tertiary hospital between Jan 2013 and Dec 2019. Patients with viral hepatitis, drug-induced hepatitis, or alcoholic liver disease were excluded. Molecular-targeted agents included tocilizumab (TCZ, n=40), adalimumab (ADA, n=59), etanercept (ETN, n=66), golimumab (GOL, n=60), abatacept (ABA, n=31), and tofacitinib (TOF, n=36). Clinical and laboratory data were collected from electronic medical records. Patients were categorised into an increased bilirubin group (higher serum bilirubin at 3 months than at baseline) and decreased bilirubin group (equal or lower serum bilirubin at 3 months than at baseline). At 6 months of treatment, good response (defined as a DAS28 score ≤3.2) was evaluated. Multivariate logistic regression analysis and multiple linear regression analysis were used to evaluate the association between serum bilirubin and treatment response. The variables included in the multiple logistic and linear regression analyses were age, female sex, rheumatoid factor, prednisolone, DMARDs, baseline liver enzymes, baseline DAS28 score, and components.Results:The mean serum bilirubin level at baseline was 4.7±1.8 mg/L. After 6 months of treatment, 180 (61.6%) patients achieved good responses. The mean serum bilirubin levels at 3 and 6 months were 5.3±2.3 and 5.5±2.2 mg/L, respectively. At 6 months, a good response was more frequent in the increased bilirubin group than in the decreased bilirubin group (71.2% [99/139] vs. 52.9% [81/153], p=0.001). In multivariate logistic regression analysis, the ORs among good responders at 6 months were 1.221 (95% CI 1.014–1.471, p=0.036) for baseline serum bilirubin and 1.377 (95% CI 1.146–1.654, p=0.001) for the change in serum bilirubin at 3 months. According to target agents, the mean changes in serum bilirubin from baseline to 6 months were 1.9±2.5 for TCZ, 1.0±1.5 for ADA, 0.7±1.9 for ETN, 0.6±2.2 for GOL, 0.3±1.2 for ABA, and 0.4±2.2 for TOF (Figure 1). Among the target agents, TCZ showed a significant increase in the mean serum bilirubin level at 3 and 6 months from baseline. In multiple linear regression analysis performed on TCZ, the change in bilirubin at 3 months was associated with the DAS28 score at 6 months (β=−0.349, p=0.020).Figure 1.Change in serum bilirubin during treatment with molecular-targeted agents in rheumatoid arthritis patientsConclusion:High baseline serum bilirubin and an increase in serum bilirubin during treatment are helpful to predict a good response to molecular-targeted agents, especially TCZ.Disclosure of Interests:None declared
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Lee JS, Nam SH, Choi SJ, Seo WJ, Hong S, Lee CK, Yoo B, Oh JS, Kim YG. FRI0248 PROGNOSTIC FACTORS FOR STEROID-FREE REMISSION IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES: IMPORTANCE OF ANTHROPOMETRIC MEASUREMENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Several studies have been conducted on factors associated with mortality in idiopathic inflammatory myopathies (IIM), but few studies have assessed prognostic factors for steroid-free remission in IIM.Objectives:We investigated the various clinical factors, including body measurements, that affect IIM treatment outcomes.Methods:Patients who were newly diagnosed with IIM between 2000 and 2018 were included. Steroid-free remission was defined as at least three months of normalisation of muscle enzymes and no detectable clinical disease activity. The factors associated with steroid-free remission were evaluated by a Cox regression analysis.Results:Of the 106 IIM patients, 35 displayed steroid-free remission during follow-up periods. In the multivariable Cox regression analyses, immunosuppressants’ early use within one month after diagnosis [hazard ratio (HR) 6.21, 95% confidence interval (CI) 2.61–14.74, p < 0.001] and sex-specific height quartiles (second and third quartiles versus first quartile, HR 3.65, 95% CI 1.40–9.51, p = 0.008 and HR 2.88, 95% CI 1.13–7.32, p = 0.027, respectively) were positively associated with steroid-free remission. Polymyositis versus dermatomyositis (HR 0.21, 95% CI 0.09–0.53, p = 0.001), presence of dysphagia (HR 0.15, CI 0.05–0.50, p = 0.002) and highest versus lowest quartile of waist circumference (WC) (HR 0.24, 95% CI 0.07–0.85, p = 0.027) were negatively associated with steroid-free remission.Conclusion:The early initiation of immunosuppressant therapy, type of myositis and presence of dysphagia are strong predictors of steroid-free remission in IIM; moreover, height and WC measurements at baseline may provide additional important prognostic value.Disclosure of Interests:None declared
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Ng SC, Wong HK, So CK, Lau CW, Leung JNS, Tsoi WC, Lee CK. Streptococcus bovis bacteraemia should be investigated for early detection of colorectal pathology. Hong Kong Med J 2019; 25:414. [PMID: 31761757 DOI: 10.12809/hkmj198135] [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] [Indexed: 11/05/2022] Open
Affiliation(s)
- S C Ng
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - H K Wong
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - C K So
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - C W Lau
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - W C Tsoi
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
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Kwon HY, Kim NJ, Lee CK, Yoon HG, Choi JW, Won C. An innovative magnetic state generator using machine learning techniques. Sci Rep 2019; 9:16706. [PMID: 31723230 PMCID: PMC6853879 DOI: 10.1038/s41598-019-53411-y] [Citation(s) in RCA: 5] [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: 04/12/2019] [Accepted: 10/28/2019] [Indexed: 12/02/2022] Open
Abstract
We propose a new efficient algorithm to simulate magnetic structures numerically. It contains a generative model using a complex-valued neural network to generate k-space information. The output information is hermitized and transformed into real-space spin configurations through an inverse fast Fourier transform. The Adam version of stochastic gradient descent is used to minimize the magnetic energy, which is the cost of our algorithm. The algorithm provides the proper ground spin configurations with outstanding performance. In model cases, the algorithm was successfully applied to solve the spin configurations of magnetic chiral structures. The results also showed that a magnetic long-range order could be obtained regardless of the total simulation system size.
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Affiliation(s)
- H Y Kwon
- Department of Physics, Kyung Hee University, Seoul, 02447, South Korea
- Center for Spintronics, Korea Institute of Science and Technology, Seoul, 02792, South Korea
| | - N J Kim
- Department of Physics, Kyung Hee University, Seoul, 02447, South Korea
| | - C K Lee
- Department of Physics, Kyung Hee University, Seoul, 02447, South Korea
| | - H G Yoon
- Department of Physics, Kyung Hee University, Seoul, 02447, South Korea
| | - J W Choi
- Center for Spintronics, Korea Institute of Science and Technology, Seoul, 02792, South Korea
| | - C Won
- Department of Physics, Kyung Hee University, Seoul, 02447, South Korea.
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Shu Y, Song Y, Wang D, Greene CM, Moen A, Lee CK, Chen Y, Xu X, McFarland J, Xin L, Bresee J, Zhou S, Chen T, Zhang R, Cox N. A ten-year China-US laboratory collaboration: improving response to influenza threats in China and the world, 2004-2014. BMC Public Health 2019; 19:520. [PMID: 32326921 PMCID: PMC6696701 DOI: 10.1186/s12889-019-6776-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The emergence of severe acute respiratory syndrome (SARS) underscored the importance of influenza detection and response in China. From 2004, the Chinese National Influenza Center (CNIC) and the United States Centers for Disease Control and Prevention (USCDC) initiated Cooperative Agreements to build capacity in influenza surveillance in China.From 2004 to 2014, CNIC and USCDC collaborated on the following activities: 1) developing human technical expertise in virology and epidemiology in China; 2) developing a comprehensive influenza surveillance system by enhancing influenza-like illness (ILI) reporting and virological characterization; 3) strengthening analysis, utilization and dissemination of surveillance data; and 4) improving early response to influenza viruses with pandemic potential.Since 2004, CNIC expanded its national influenza surveillance and response system which, as of 2014, included 408 laboratories and 554 sentinel hospitals. With support from USCDC, more than 2500 public health staff from China received virology and epidemiology training, enabling > 98% network laboratories to establish virus isolation and/or nucleic acid detection techniques. CNIC established viral drug resistance surveillance and platforms for gene sequencing, reverse genetics, serologic detection, and vaccine strains development. CNIC also built a bioinformatics platform to strengthen data analysis and utilization, publishing weekly on-line influenza surveillance reports in English and Chinese. The surveillance system collects 200,000-400,000 specimens and tests more than 20,000 influenza viruses annually, which provides valuable information for World Health Organization (WHO) influenza vaccine strain recommendations. In 2010, CNIC became the sixth WHO Collaborating Centre for Influenza. CNIC has strengthened virus and data sharing, and has provided training and reagents for other countries to improve global capacity for influenza control and prevention.The collaboration's successes were built upon shared mission and values, emphasis on long-term capacity development and sustainability, and leadership commitment.
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Affiliation(s)
- Yuelong Shu
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, 102206 People’s Republic of China
| | - Ying Song
- Influenza Division, U.S. Centers for Disease Control and Prevention, WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza, Atlanta, GA 30333 USA
| | - Dayan Wang
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, 102206 People’s Republic of China
| | - Carolyn M. Greene
- Influenza Division, U.S. Centers for Disease Control and Prevention, WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza, Atlanta, GA 30333 USA
| | - Ann Moen
- Influenza Division, U.S. Centers for Disease Control and Prevention, WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza, Atlanta, GA 30333 USA
| | - C. K. Lee
- On behalf of Emerging Disease Surveillance and Response (ESR), World Health Organization Western Pacific Region, Manila, Philippines
| | - Yongkun Chen
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, 102206 People’s Republic of China
| | - Xiyan Xu
- Influenza Division, U.S. Centers for Disease Control and Prevention, WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza, Atlanta, GA 30333 USA
| | - Jeffrey McFarland
- Influenza Division, U.S. Centers for Disease Control and Prevention, WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza, Atlanta, GA 30333 USA
| | - Li Xin
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, 102206 People’s Republic of China
| | - Joseph Bresee
- Influenza Division, U.S. Centers for Disease Control and Prevention, WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza, Atlanta, GA 30333 USA
| | - Suizan Zhou
- Influenza Division, U.S. Centers for Disease Control and Prevention, WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza, Atlanta, GA 30333 USA
| | - Tao Chen
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, 102206 People’s Republic of China
| | - Ran Zhang
- Influenza Division, U.S. Centers for Disease Control and Prevention, WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza, Atlanta, GA 30333 USA
| | - Nancy Cox
- Influenza Division, U.S. Centers for Disease Control and Prevention, WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza, Atlanta, GA 30333 USA
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Park YM, Lee CK, Kim HJ. Gastrointestinal: Colon cast with segmental stricture following colonic ischemia. J Gastroenterol Hepatol 2019; 34:630. [PMID: 30592093 DOI: 10.1111/jgh.14550] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/01/2018] [Accepted: 11/13/2018] [Indexed: 12/09/2022]
Affiliation(s)
- Y M Park
- Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea
| | - C K Lee
- Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea
| | - H J Kim
- Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea
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Kshrisagar S, Francis A, J. Yee J, Natarajan S, K. Lee C. Implementing the Node Based Smoothed Finite Element Method as User Element in Abaqus for Linear and Nonlinear Elasticity. ACTA ACUST UNITED AC 2019. [DOI: 10.32604/cmc.2019.07967] [Citation(s) in RCA: 5] [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: 11/15/2022]
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Mak LY, Lau CW, Hui YT, Ng C, Shan E, Li MK, Lau JY, Chiu PW, Leong HT, Ho J, Wu JC, Lee CK, Leung WK. Joint recommendations on management of anaemia in patients with gastrointestinal bleeding in Hong Kong. Hong Kong Med J 2018; 24:416-422. [PMID: 30100584 DOI: 10.12809/hkmj187348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The demand for blood products continues to grow in an unsustainable manner in Hong Kong. While anaemia associated with gastrointestinal bleeding (GIB) is the leading indication for transfusion, there is no local recommendation regarding best practices for transfusion. We aimed to provide evidence-based recommendations regarding management of anaemia in patients with acute and chronic GIB. We reviewed all original papers, meta-analyses, systematic reviews, or guidelines that were available in PubMed. For acute GIB, a restrictive transfusion strategy, targeting a haemoglobin threshold of 7 to 8 g/dL, should be adopted because overtransfusion is associated with significantly higher all-cause mortality and re-bleeding. A liberal transfusion strategy should only be considered in patients with co-existing symptomatic coronary artery disease, targeting a haemoglobin threshold of 9 to 10 g/dL. When acute GIB settles, patients should be prescribed iron supplements if iron deficiency is present. For chronic GIB, iron stores should be replenished aggressively via iron supplementation before consideration of blood transfusion, except in patients with symptoms of severe anaemia. Oral iron replacement is the preferred first-line therapy, while intravenous iron is indicated for patients with inflammatory bowel disease, poor response or poor tolerability to oral iron, and in whom a rapid correction of iron deficit is preferred. Intravenous iron is underutilised and the risk of anaphylactic reaction to current preparations is extremely low. These recommendations are provided to local clinicians to facilitate judicious and appropriate use of red cell products and iron replacement therapy in patients with GIB.
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Affiliation(s)
- L Y Mak
- Hong Kong Society of Gastroenterology.,Hong Kong IBD Society
| | - C W Lau
- Hong Kong Red Cross Blood Transfusion Service
| | | | | | | | | | - J Yw Lau
- Hong Kong Society of Digestive Endoscopy
| | - P Wy Chiu
- Hong Kong Society of Digestive Endoscopy
| | - H T Leong
- Hong Kong Society of Digestive Endoscopy
| | - J Ho
- Hong Kong Society of Gastroenterology
| | - J Cy Wu
- Hong Kong Society of Gastroenterology
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service
| | - W K Leung
- Hong Kong Society of Gastroenterology.,Hong Kong IBD Society
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Mooi JK, Wirapati P, Asher R, Lee CK, Savas P, Price TJ, Townsend A, Hardingham J, Buchanan D, Williams D, Tejpar S, Mariadason JM, Tebbutt NC. The prognostic impact of consensus molecular subtypes (CMS) and its predictive effects for bevacizumab benefit in metastatic colorectal cancer: molecular analysis of the AGITG MAX clinical trial. Ann Oncol 2018; 29:2240-2246. [PMID: 30247524 DOI: 10.1093/annonc/mdy410] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [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: 02/07/2023] Open
Abstract
BACKGROUND The consensus molecular subtypes (CMS) is a transcriptome-based classification of colorectal cancer (CRC) initially described in early-stage cohorts, but the associations of CMS with treatment outcomes in the metastatic setting are yet to be established. This study aimed to evaluate the prognostic impact of CMS classification and its predictive effects for bevacizumab benefit in metastatic CRC by correlative analysis of the AGITG MAX trial. PATIENTS AND METHODS The MAX trial previously reported improved progression-free survival (PFS) for the addition of bevacizumab (B) to chemotherapy [capecitabine (C)±mitomycin (M)]. Archival primary tumours from 237 patients (50% of trial population) underwent gene expression profiling and classification into CMS groups. CMS groups were correlated to PFS and overall survival (OS). The interaction of CMS with treatment was assessed by proportional hazards model. RESULTS The distribution of CMS in MAX were CMS1 18%, CMS2 47%, CMS3 12%, CMS4 23%. CMS1 was the predominant subtype in right-sided primary tumours, while CMS2 was the predominant subtype in left-sided. CMS was prognostic of OS (P = 0.008), with CMS2 associated with the best outcome and CMS1 the worst. CMS remained an independent prognostic factor in a multivariate analysis. There was a significant interaction between CMS and treatment (P-interaction = 0.03), for PFS, with hazard ratios (95% CI) for CB+CBM versus C arms in CMS1, 2, 3 and 4: 0.83 (0.43-1.62), 0.50 (0.33-0.76), 0.31 (0.13-0.75) and 1.24 (0.68-2.25), respectively. CONCLUSIONS This exploratory study found that CMS stratified OS outcomes in metastatic CRC regardless of first-line treatment, with prognostic effects of CMS groups distinct from those previously reported in early-stage cohorts. In CMS associations with treatment, CMS2 and possibly CMS3 tumours may preferentially benefit from the addition of bevacizumab to first-line capecitabine-based chemotherapy, compared with other CMS groups. Validation of these findings in additional cohorts is warranted. CLINICAL TRIAL NUMBER This is a molecular sub-study of MAX clinical trial (NCT00294359).
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Affiliation(s)
- J K Mooi
- Olivia Newton-John Cancer Research Institute, Heidelberg; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - P Wirapati
- Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - R Asher
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - C K Lee
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - P Savas
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne
| | - T J Price
- Medical Oncology, The Queen Elizabeth Hospital, Woodville; School of Medicine, University of Adelaide, Adelaide
| | - A Townsend
- Medical Oncology, The Queen Elizabeth Hospital, Woodville; School of Medicine, University of Adelaide, Adelaide
| | - J Hardingham
- School of Medicine, University of Adelaide, Adelaide; The Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville
| | - D Buchanan
- Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Melbourne; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville; Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville
| | - D Williams
- Olivia Newton-John Cancer Research Institute, Heidelberg; Department of Pathology, Austin Health, Heidelberg; Department of Pathology, University of Melbourne, Melbourne, Australia
| | - S Tejpar
- Oncology, University Hospital Leuven, Leuven, Belgium
| | - J M Mariadason
- Olivia Newton-John Cancer Research Institute, Heidelberg; School of Cancer Medicine, La Trobe University, Melbourne
| | - N C Tebbutt
- Medical Oncology, Austin Health, Heidelberg, Australia.
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Roncolato FT, Gibbs E, Lee CK, Asher R, Davies LC, Gebski VJ, Friedlander M, Hilpert F, Wenzel L, Stockler MR, King M, Pujade-Lauraine E. Quality of life predicts overall survival in women with platinum-resistant ovarian cancer: an AURELIA substudy. Ann Oncol 2018; 28:1849-1855. [PMID: 28595285 DOI: 10.1093/annonc/mdx229] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Women with platinum-resistant ovarian cancer are a heterogeneous group whose median overall survival is 12 months. We hypothesized that their quality of life (QoL) scores would be prognostic. Patients and methods Data from AURELIA (n = 326), a randomized trial of chemotherapy with or without bevacizumab, were used to identify baseline QoL domains [EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 and OV28] that were significantly associated with overall survival in multivariable Cox regression analyses. Patients were classified as having good, medium, or poor risk. Cutpoints were validated in an independent dataset, CARTAXHY (n = 136). Multivariable analyses of significant QoL domains on survival were adjusted for clinicopathological prognostic factors. The additional QoL information was assessed using C statistic. Results In AURELIA, all domains, except cognitive function, predicted overall survival in univariable analyses. Physical function (P < 0.001) and abdominal/gastrointestinal symptom (P < 0.001) scores remained significant in multivariable models. In high (score <67), medium (67-93), and low (>93) risk categories for physical function, median overall survival was 11.0, 14.7, and 19.3 months, respectively (P < 0.001). In CARTAXHY, median overall survival was 7.9, 16.2, and 23.9 months (P < 0.001), respectively. For high- (>44), medium- (13-44), and low- (<13) risk categories for abdominal/gastrointestinal symptoms, median overall survival was 11.9, 14.3, and 19.7 months in AURELIA (P < 0.001) and 10.5, 19.6, and 24.1 months in CARTAXHY (P = 0.02). Physical function (P = 0.02) and abdominal/gastrointestinal symptoms (P = 0.03) remained independent prognostic factors after adjustment for clinicopathological factors. The C statistic of the full model was 0.71. For QoL factors alone, patient factors alone and disease factors alone, the C statistics were 0.61, 0.61, and 0.67 respectively. Conclusions Physical function and abdominal/gastrointestinal symptom scores improved predictions of overall survival over clinicopathological factors alone in platinum-resistant ovarian cancer. This additional prognostic information could improve trial stratification, patient-doctor communication about prognosis, and clinical decision-making. Clinical trial registration NCT00976911.
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Affiliation(s)
- F T Roncolato
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
- Macarthur Cancer Therapy Centre, Campbelltown
| | - E Gibbs
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - C K Lee
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
- Medical Oncology, St George Hospital, Sydney
| | - R Asher
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - L C Davies
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - V J Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - M Friedlander
- Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - F Hilpert
- Gynecology & Obstetrics, University of Schleswig-Holstein, Kiel, Germany
| | - L Wenzel
- Public Health, University of California, Irvine, USA
| | - M R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - M King
- Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
| | - E Pujade-Lauraine
- Hematology & Medical Oncology, Hopital Hôtel-Dieu de Paris, Paris, France
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Lee CK, Choi SK, Shin DA, Yi S, Kim KN, Kim I, Ha Y. Parkinson's disease and the risk of osteoporotic vertebral compression fracture: a nationwide population-based study. Osteoporos Int 2018; 29:1117-1124. [PMID: 29460103 DOI: 10.1007/s00198-018-4409-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/24/2018] [Indexed: 01/23/2023]
Abstract
UNLABELLED Patients with Parkinson's disease (PD) were at higher risk of osteoporotic vertebral compression fractures (OVCF) compared to controls and had elevated mortality rates. Compared to conservative treatment, surgical treatment for OVCF in PD patients seemed to be associated with better outcomes. INTRODUCTION The purpose of this study was to evaluate the risk of OVCF in patients with PD. METHODS Data from patients over the age of 60 years who were diagnosed with PD were collected between 2004 and 2013 from the Korean National Health Insurance Database (n = 3370). The comparison group (non-PD) consisted of randomly selected patients (five per patient with PD; n = 16,850) matched to the PD group, who were newly diagnosed annually according to age and sex. Cox proportional hazard regressions were used to examine the relationships between osteoporosis, OVCF, surgery for OVCF, and PD. Household income and residential area of patients were also assessed. Overall survival rates were calculated after adjusting for confounding factors, such as hypertension, diabetes mellitus, and chronic kidney disease. RESULTS OVCF was developed in 12.5% of patients in the PD group and in 7.4% of patients in the control group. PD was associated with increased risk of osteoporosis (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.21-1.43; p < 0.001), OVCF (HR 1.66; 95% CI, 1.47-1.87; p < 0.001), and surgery for OVCF (HR 2.69; 95% CI, 1.78-4.08; p < 0.001). Household income was not significantly related with development of osteoporosis, incidence of OVCF, or surgery for OVCF. Residential area was statistically associated with osteoporosis, OVCF, and surgery for OVCF. The mortality rate of the PD group was about 1.7 times higher than that of the non-PD group after adjusting for potential confounders, and the mortality rate of the PD with OVCF group was higher than that of the non-PD group, but not significantly (p = 0.09). The survival rate of the PD group with surgery for OVCF showed a trend toward a more positive prognosis compared with that of the PD group with conservative treatment. CONCLUSIONS Patients with PD had significantly increased risk of osteoporosis and OVCF. Surgical treatment for OVCF in PD patients was associated with a better prognosis than conservative treatment.
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Affiliation(s)
- C K Lee
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S K Choi
- Biostatistics and Epidemiology, Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - D A Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - K N Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - I Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Y Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Kwok J, Guo M, Yang W, Ip P, Lee CK, Lu L, Chan GCF, Middleton D, van der Zanden HGM. Simulation of non-inherited maternal antigens acceptable HLA mismatches to increase the chance of matched cord blood units: Hong Kong's experience. Hum Immunol 2018; 79:539-544. [PMID: 29660452 DOI: 10.1016/j.humimm.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 01/13/2023]
Abstract
In Cord blood transplantation (CBT), the non-inherited maternal antigen (NIMA) virtual six HLA matched CB is found to have similar outcomes to six HLA inherited matched CB. Such virtual HLA matched CB units can be generated by substituting the inherited alleles with one to three NIMAs. In Hong Kong Cord Blood Bank, CB units have no NIMA defined. 100 CB samples were collected with NIMA defined. Retrospective searches of Hong Kong patients (n = 520) were matched against the inherited and virtual HLA phenotypes of NIMA CB file. One to three NIMA matches was analyzed, virtual six HLA matches were identified for 31.7% patients, 29.4% from CB units with 5/6 HLA match with 1 NIMA match and 1.7% CB units with a 4/6 HLA match and 2 NIMA matches. However, searches in the 167,201 Bone Marrow Donors Worldwide CB units with defined NIMA did not yield similar increases, possibly due to the ethnicity differences between populations. The match performance rises from 26% to 60% after including the NIMA match. Comparing the match performance of 32% in a previous Dutch study, we calculated with 60% matching in this smaller size study. This provides a solid ground to considering NIMA in stem cell donor selection which was adopted in some centers, to be extended to Asian and local CB registries to increase the chance for matches and also to improve patient outcomes, increase the utilization of CB units, enhance clinical flexibility and signify economic intelligence.
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Affiliation(s)
- Janette Kwok
- Division of Transplantation and Immunogenetics, Queen Mary Hospital, Hong Kong.
| | - Mengbiao Guo
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong.
| | - Wanling Yang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Services, Hong Kong
| | - Liwei Lu
- Department of Pathology, The University of Hong Kong, Hong Kong
| | - Godfrey C F Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Derek Middleton
- Transplant Immunology, Royal Liverpool Hospital, Liverpool, UK
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Wong NS, Lee CK, Ng SC, Wong HK, Chan DPC, Lee SS. Prevalence of hepatitis C infection and its associated factors in healthy adults without identifiable route of transmission. J Viral Hepat 2018; 25:161-170. [PMID: 29032634 DOI: 10.1111/jvh.12804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/01/2017] [Indexed: 12/20/2022]
Abstract
While hepatitis C virus (HCV) infection is long known to be associated with parenteral exposure, the specific route of transmission is not identified in a proportion of infected patients. Taking blood donors as the surrogate of healthy adults in the community in Hong Kong, we identified 91 HCV-infected donors (≤0.02% positive rate) in 2014-2016, of whom 46 were recruited in a mixed-method study to examine their transmission routes. A majority (75%) of the recruited donors were HCV RNA positive, with the predominant subtypes being 1b and 6a. From the results of the structured self-administered questionnaire and in-depth interviews, only 14 (30%) recruited donors could be traced to past history of contaminated blood transfusion (n = 9) or injection drug use (n = 5). Case-control analyses with 3 different control groups were performed to examine factors associated with HCV infection in multivariable analyses. High-risk sexual behaviour, body piercing, intramuscular injection and vaccine inoculation abroad, having lived abroad for >3 months were significantly associated with HCV in donors with otherwise nonidentifiable source of infection. While the specific route of transmission cannot be established for each person, associations with multiple parenteral exposures outside Hong Kong were observed. The World Health Organization has advocated for the global elimination of HCV by 2030. With a high proportion of HCV-infected persons who are unaware of their infections, HCV elimination could be hard to achieve.
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Affiliation(s)
- N S Wong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - S C Ng
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - H K Wong
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - D P C Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - S S Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Tam K, Tang I, Ho J, Yeung W, Lee CK, Ip P, Kwok J. A study of human neutrophil antigen genotype frequencies in Hong Kong. Transfus Med 2017; 28:310-318. [PMID: 29280200 DOI: 10.1111/tme.12494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/07/2017] [Accepted: 11/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alloantibodies against human neutrophil antigens (HNA) are associated with a variety of clinical conditions. Over the past decade, the allelic and genotypic frequencies of the five HNA systems have been evaluated. Although the HNA system is less polymorphic than human leukocyte antigens (HLA), significant differences in the genotypic and allele frequencies still exist in different populations, even those living in close proximity. OBJECTIVES To delineate HNA genotypic and allele frequencies to provide vital information on estimating the risk of HNA-associated diseases for our local population. METHODS Using a validated, in-house-developed assay, genotyping for HNA-1, HNA-3, HLA-4 and HNA-5 was performed on 300 samples from Chinese blood donors from Hong Kong. In addition, the frequency of the HNA-2 c.843A > T allele was also determined. RESULTS The allele frequencies of HNA-1a, -1b and -1c alleles were 67·8, 31·5 and 0%, respectively, whereas the frequencies of HNA-3a and HNA-3b were 71·0 and 29·0%, respectively. The frequencies of HNA-4a and -4b alleles were 99·5 and 0·5%, respectively, and for HNA-5a and -5b, alleles were 85·2 and 14·8%, respectively. Homozygotes for the HNA-2 c.843 TT variant were absent in our population, whereas only <4% of the population were c.843AT heterozygote carriers. CONCLUSIONS This is the first study to define HNA genotype and allele frequencies using a validated modified in-house PCR-SSP method in the Hong Kong Chinese blood donor population. Our approach provides a cost-effective assay for conducting routine HNA typing and facilitates the incorporation of these assays into routine clinical service. Our results are comparable with those reported in the Guangzhou Chinese population, but the allele frequencies in our Hong Kong Chinese population are significantly different from the reported European frequencies, confirming that a geographical difference exists for HNA allele frequencies.
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Affiliation(s)
- K Tam
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - I Tang
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - J Ho
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - W Yeung
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Kowloon, Hong Kong SAR, China
| | - P Ip
- Department of Paediatrics & Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - J Kwok
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
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Lee CK, Rainer TH. Application of APACHE II in the Assessment, Classification of Severity and Predictive Ability of Chinese Patients Presenting to an Emergency Department Resuscitation Room. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790200900402] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives To evaluate the use of APACHE II (Acute Physiology and Chronic Health Status Evaluation) in Chinese patients managed in the resuscitation room of an Accident & Emergency Department of one of the teaching hospitals in Hong Kong. Design Prospective study on Chinese patients. Setting Resuscitation Room in an Accident & Emergency Department of a university hospital in Hong Kong. Patients and measurements Consecutive patients managed in the resuscitation room between 14th August, 2000 and 20th August 2000 (excluding patients younger than 18 years old and patients who were not admitted to hospital after initial assessment and treatment). For each patient, demographic data, diagnosis, the chronic health points, and the worst physiological parameters in the A&E resuscitation room were recorded. The total APACHE II scores and the probability of death were calculated. The accuracy of APACHE II for predicting group mortality was assessed by receiver operating characteristic curve analysis and linear regression analysis. Results Of the 88 patients included in the study, 13 (15%) died and 75 (85%) survived. Significant factors associated with mortality included age, mean arterial pressure, heart rate, respiratory rate, arterial pH, serum sodium, Glasgow coma score, and chronic health points. For the three scoring subdivisions of APACHE II – total APS score, age points and chronic health points – higher mean values were found in those patients who died compared with patients who survived. Using logistic regression analysis, the APACHE II score determined in the emergency resuscitation room is a strong predictor of mortality (r2=0.712). At a cut off score of >28 the sensitivity is 100.0% (95% CI 100.0–100.0), specificity is 68.0% (95% CI 56.2–78.3), positive likelihood ratio is 3.13, positive predictive value is 35.1 and negative likelihood ratio is 100.0. Analysis of the ROC curve reveals an area under the curve of 0.910 (95% CI 0.829–0.960). In patients not admitted to ICU, there was a positive correlation between APACHE score and length of hospital stay in patient who survived (r=0.320, P=0.0075) and a negative correlation between APACHE score and length of hospital stay in patients who died (r=-0.760, P=0.0225). Conclusions The APACHE II scoring system may be usefully applied in emergency departments for predicting mortality, for classifying and assessing severity of disease, for evaluating performance and for planning departmental resource allocation.
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Affiliation(s)
| | - TH Rainer
- Prince of Wales Hospital, Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, 30–32 Ngan Shing Street, Shatin, N.T., Hong Kong
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49
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Chan YC, Fung HT, Lee CK, Tsui SH, Ngan HK, Sy MY, Tse ML, Kam CW, Wong GCK, Tong HK, Lit ACH, Wong TW, Lau FL. A Prospective Epidemiological Study of Acute Poisoning in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To update our epidemiological knowledge of acute poisoning in Hong Kong. Methods A multi-centred prospective study was conducted for six months in six major accident and emergency departments in Hong Kong. A specially designed form was used to collect demographic data, type of poison involved, cause of poisoning, management, disposal as well as final outcome of the poisoned patients. Results A total of 1,467 patients (male: 588, female: 879) were included in the study. Most of them were young adults (32% were between 20 and 40 years old). Suicidal attempt (64%) was the most common cause of poisoning. Notably, 379 (26%) patients took more than one poison. Among the 2,007 counts of poison taken, sleeping pills (24%) and analgesics (18%) were the most commonly used drugs and paracetamol was the commonest single ingredient involved in poisoning. Most patients were treated with supportive measures, and about 40% and 15% of the patients were given gastrointestinal decontamination and specific antidotes respectively in their management, in which activated charcoal and N-acetylcysteine were the most common. Concerning disposal from the emergency department, 91% of the poisoned cases required in-patient management. Most patients had an uneventful recovery but 5 (0.3%) had significant disability and 21 (1.4%) died. Suicidal carbon monoxide poisoning was the leading cause of mortality in our study. Conclusions Most acute poisonings in Hong Kong were suicidal in nature and paracetamol was the commonest agent. Activated charcoal was the most commonly used decontamination method and most patients had an uneventful recovery.
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Affiliation(s)
| | - HT Fung
- Tuen Mun Hospital, Accident & Emergency Department, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - CK Lee
- Queen Elizabeth Hospital, Accident & Emergency Department, 30 Gascoigne Road, Kowloon, Hong Kong
| | - SH Tsui
- Queen Mary Hospital, Accident & Emergency Department, Pokfulam Road, Hong Kong
| | - HK Ngan
- Yan Chai Hospital, Accident & Emergency Department, Tsuen Wan, N.T., Hong Kong
| | - MY Sy
- Pamela Youde Nethersole Eastern Hospital, Accident & Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| | | | - CW Kam
- Tuen Mun Hospital, Accident & Emergency Department, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - GCK Wong
- North District Hospital, Accident & Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong
| | - HK Tong
- Queen Mary Hospital, Accident & Emergency Department, Pokfulam Road, Hong Kong
| | - ACH Lit
- Yan Chai Hospital, Accident & Emergency Department, Tsuen Wan, N.T., Hong Kong
| | - TW Wong
- Pamela Youde Nethersole Eastern Hospital, Accident & Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
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Park SB, Kwok JB, Asher R, Lee CK, Beale P, Selle F, Friedlander M. Clinical and genetic predictors of paclitaxel neurotoxicity based on patient- versus clinician-reported incidence and severity of neurotoxicity in the ICON7 trial. Ann Oncol 2017; 28:2733-2740. [PMID: 29117336 DOI: 10.1093/annonc/mdx491] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of paclitaxel, with no reliable method to identify at-risk patients. We investigated the incidence and risk factors including genetic polymorphisms associated with the development of CIPN based on clinician and patient reporting of neuropathic symptoms. PATIENTS AND METHODS Risk factors for the development of CIPN were examined in 454 patients treated with paclitaxel/carboplatin from the International Collaboration on Ovarian Neoplasms 7 (ICON7) trial. Neuropathy was graded by clinicians by standard adverse event reporting and by patients utilising OV28 questionnaire. Genetic risk factors were examined by selecting six single nucleotide polymorphisms in genes associated with microtubule function. Risk factors were assessed via dose-to-event cox regression models. RESULTS Grade >2 neuropathy was reported by clinicians in 28% of patients, while 67% of patients reported 'quite a bit' or 'very much' tingling or numbness. Agreement between clinicians and patients was poor (κ = 0.236, 95% confidence interval, 0.177-0.296, P < 0.001). Older age, bevacizumab treatment and bowel resection were associated with clinician reported CIPN, while older age and volume of residual disease were associated with patient-reported neuropathy. There were no significant associations between clinician-reported neuropathy or patient-reported neuropathy and TUBB2, CEP72 or individual MAPT or GSK3B SNPs, however MAPT additive polymorphisms were associated with patient-reported neuropathy and GSK3B additive polymorphisms were associated with clinician reported CIPN. CONCLUSIONS There was significant discordance between patient- and clinician-reported neurotoxicity. The lack of consensus regarding optimal outcome measures and whose opinion with regard to CIPN takes precedence is a limitation in the investigation of risk factors for CIPN. Care must be taken to select and include patient-reported outcome measures in CIPN assessment to enable accurate identification of genetic and other risk factors for neuropathy.
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MESH Headings
- Adenocarcinoma, Clear Cell/complications
- Adenocarcinoma, Clear Cell/drug therapy
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Mucinous/complications
- Adenocarcinoma, Mucinous/drug therapy
- Adenocarcinoma, Mucinous/pathology
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Phytogenic/adverse effects
- Biomarkers, Tumor/genetics
- Cystadenocarcinoma, Serous/complications
- Cystadenocarcinoma, Serous/drug therapy
- Cystadenocarcinoma, Serous/pathology
- Endometrial Neoplasms/complications
- Endometrial Neoplasms/drug therapy
- Endometrial Neoplasms/pathology
- Female
- Follow-Up Studies
- Humans
- Incidence
- Middle Aged
- Neoplasm Invasiveness
- Neurotoxicity Syndromes/diagnosis
- Neurotoxicity Syndromes/epidemiology
- Neurotoxicity Syndromes/etiology
- Neurotoxicity Syndromes/genetics
- Outcome Assessment, Health Care
- Ovarian Neoplasms/complications
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Paclitaxel/adverse effects
- Patient Reported Outcome Measures
- Physicians
- Polymorphism, Single Nucleotide
- Prognosis
- Risk Factors
- Severity of Illness Index
- Surveys and Questionnaires
- Survival Rate
- Young Adult
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Affiliation(s)
- S B Park
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney; Prince of Wales Clinical School
| | - J B Kwok
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney; Neuroscience Research Australia, University of New South Wales, Sydney
| | - R Asher
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - C K Lee
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - P Beale
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney; Sydney Medical School, University of Sydney, Sydney, Australia
| | - F Selle
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens and Department of Medical Oncology, Alliance For Cancer Research, Hôpital Tenon, Paris, France
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