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Forster VJ, Aronson M, Zhang C, Chung J, Sudhaman S, Galati MA, Kelly J, Negm L, Ercan AB, Stengs L, Durno C, Edwards M, Komosa M, Oldfield LE, Nunes NM, Pedersen S, Wellum J, Siddiqui I, Bianchi V, Weil BR, Fox VL, Pugh TJ, Kamihara J, Tabori U. Biallelic EPCAM deletions induce tissue-specific DNA repair deficiency and cancer predisposition. NPJ Precis Oncol 2024; 8:69. [PMID: 38467830 PMCID: PMC10928233 DOI: 10.1038/s41698-024-00537-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
We report a case of Mismatch Repair Deficiency (MMRD) caused by germline homozygous EPCAM deletion leading to tissue-specific loss of MSH2. Through the use of patient-derived cells and organoid technologies, we performed stepwise in vitro differentiation of colonic and brain organoids from reprogrammed EPCAMdel iPSC derived from patient fibroblasts. Differentiation of iPSC to epithelial-colonic organoids exhibited continuous increased EPCAM expression and hypermethylation of the MSH2 promoter. This was associated with loss of MSH2 expression, increased mutational burden, MMRD signatures and MS-indel accumulation, the hallmarks of MMRD. In contrast, maturation into brain organoids and examination of blood and fibroblasts failed to show similar processes, preserving MMR proficiency. The combined use of iPSC, organoid technologies and functional genomics analyses highlights the potential of cutting-edge cellular and molecular analysis techniques to define processes controlling tumorigenesis and uncovers a new paradigm of tissue-specific MMRD, which affects the clinical management of these patients.
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Affiliation(s)
- V J Forster
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - M Aronson
- Zane Cohen Centre, Sinai Health System and Faculty of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - C Zhang
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - J Chung
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - S Sudhaman
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - M A Galati
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - J Kelly
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - L Negm
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - A B Ercan
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - L Stengs
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - C Durno
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
| | - M Edwards
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - M Komosa
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - N M Nunes
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - S Pedersen
- University Health Network, Toronto, ON, Canada
| | - J Wellum
- University Health Network, Toronto, ON, Canada
| | - I Siddiqui
- Department of Paediatric Laboratory Medicine and Pathobiology, Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - V Bianchi
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - B R Weil
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - V L Fox
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - T J Pugh
- University Health Network, Toronto, ON, Canada
| | - J Kamihara
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - U Tabori
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
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Ip PNP, Ng K, Wan OYK, Kwok JWK, Chung JPW, Chan SSC. Cross-sectional study to assess the psychological morbidity of women facing possible miscarriage. Hong Kong Med J 2023; 29:498-505. [PMID: 37981743 DOI: 10.12809/hkmj219771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION Threatened miscarriage is a common complication of pregnancy. This study aimed to assess psychological morbidity in women with threatened miscarriage, with the goal of identifying early interventions for women at risk of anxiety or depression. METHODS Women in their first trimester attending an Early Pregnancy Assessment Clinic were recruited between July 2013 and June 2015. They were asked to complete the 12-item General Health Questionnaire (GHQ-12), the Beck Depression Inventory (BDI), Spielberger's State Anxiety Inventory State form (STAI-S), the Fatigue Scale-14 (FS-14), and the Profile of Mood States (POMS) before consultation. They were also asked to rate anxiety levels before and after consultation using a visual analogue scale (VAS). RESULTS In total, 1390 women completed the study. The mean ± standard deviation of GHQ-12 (bi-modal) and GHQ-12 (Likert) scores were 4.04 ± 3.17 and 15.19 ± 5.30, respectively. Among these women, 48.4% had a GHQ-12 (bi-modal) score ≥4 and 76.7% had a GHQ-12 (Likert) score >12, indicating distress. The mean ± standard deviation of BDI, STAI-S, and FS-14 scores were 9.35 ± 7.19, 53.81 ± 10.95, and 2.40 ± 0.51, respectively. The VAS score significantly decreased after consultation (P<0.001). Compared with women without a history of miscarriage, women with a previous miscarriage had higher GHQ-12, BDI, and POMS scores (except for fatigue-inertia and vigour-activity subscales). A higher bleeding score was strongly positively correlated with GHQ-12 (Likert) score. There were weak correlations between pain score and the GHQ-12 (bi-modal) ≥4, BDI >12, and POMS scores (except for confusion-bewilderment subscale which showed a strong positive correlation). CONCLUSION Women with threatened miscarriage experience a considerable psychological burden, emphasising the importance of early recognition for timely management.
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Affiliation(s)
- P N P Ip
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K Ng
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - O Y K Wan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J W K Kwok
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J P W Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - S S C Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Teh WT, Chung J, Holdsworth-Carson SJ, Donoghue JF, Healey M, Rees HC, Bittinger S, Obers V, Sloggett C, Kendarsari R, Fung JN, Mortlock S, Montgomery GW, Girling JE, Rogers PAW. A molecular staging model for accurately dating the endometrial biopsy. Nat Commun 2023; 14:6222. [PMID: 37798294 PMCID: PMC10556104 DOI: 10.1038/s41467-023-41979-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
Natural variability in menstrual cycle length, coupled with rapid changes in endometrial gene expression, makes it difficult to accurately define and compare different stages of the endometrial cycle. Here we develop and validate a method for precisely determining endometrial cycle stage based on global gene expression. Our 'molecular staging model' reveals significant and remarkably synchronised daily changes in expression for over 3400 endometrial genes throughout the cycle, with the most dramatic changes occurring during the secretory phase. Our study significantly extends existing data on the endometrial transcriptome, and for the first time enables identification of differentially expressed endometrial genes with increasing age and different ethnicities. It also allows reinterpretation of all endometrial RNA-seq and array data that has been published to date. Our molecular staging model will significantly advance understanding of endometrial-related disorders that affect nearly all women at some stage of their lives, such as heavy menstrual bleeding, endometriosis, adenomyosis, and recurrent implantation failure.
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Affiliation(s)
- W T Teh
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
- Melbourne IVF, Melbourne, Victoria, Australia
| | - J Chung
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Melbourne Bioinformatics, University of Melbourne, Melbourne, Victoria, Australia
| | - S J Holdsworth-Carson
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
- Julia Argyrou Endometriosis Centre, Epworth HealthCare, Richmond, Victoria, Australia
| | - J F Donoghue
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - M Healey
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - H C Rees
- Royal Women's Hospital, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - S Bittinger
- Royal Women's Hospital, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - V Obers
- Melbourne Pathology, Collingwood, Victoria, Australia
| | - C Sloggett
- Melbourne Bioinformatics, University of Melbourne, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - R Kendarsari
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia
- Illumina Inc. 11 Biopolis Way, Singapore, 138667, Singapore
| | - J N Fung
- School of Biomedical Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - S Mortlock
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia
| | - G W Montgomery
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia
| | - J E Girling
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Aotearoa, New Zealand
| | - P A W Rogers
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia.
- Royal Women's Hospital, Melbourne, Victoria, Australia.
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Chau OSY, Law TSM, Ng K, Li TC, Chung JPW. Five-year retrospective review of ultrasoundguided manual vacuum aspiration for first-trimester miscarriage. Hong Kong Med J 2023. [PMID: 37226490 DOI: 10.12809/hkmj2210127] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Manual vacuum aspiration is increasingly accepted as an alternative to medical or surgical evacuation of the uterus after first-trimester miscarriage. This study aimed to assess the efficacy of ultrasound-guided manual vacuum aspiration (USG-MVA) in the management of first-trimester miscarriage. METHODS This retrospective analysis included adult women with first-trimester miscarriage who underwent USG-MVA in Hong Kong between July 2015 and February 2021. The primary outcome was the efficacy of USG-MVA in terms of complete evacuation of the uterus, without the need for further medical or surgical intervention. Secondary outcomes included tolerance of the entire procedure, the success rate of karyotyping using chorionic villi, and procedural safety (ie, any clinically significant complications). RESULTS In total, 331 patients were scheduled to undergo USG-MVA for first-trimester miscarriage or incomplete miscarriage. The procedure was completed in 314 patients and well-tolerated in all of those patients. The complete evacuation rate was 94.6% (297/314), which is similar to the rate (98.1%) achieved by conventional surgical evacuation in a previous randomised controlled trial in our unit. There were no major complications. Samples from 95.2% of patients were suitable for karyotyping, which is considerably higher than the rate of suitable samples (82.9%) obtained via conventional surgical evacuation in our previous randomised controlled trial. CONCLUSION Ultrasound-guided manual vacuum aspiration is a safe and effective method to manage first-trimester miscarriage. Although it currently is not extensively used in Hong Kong, its broader clinical application could avoid general anaesthesia and shorten hospital stay.
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Affiliation(s)
- O S Y Chau
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong SAR, China
| | - T S M Law
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong SAR, China
| | - K Ng
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong SAR, China
| | - T C Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J P W Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Chung JPW, Chan DYL, Song Y, Ng EYL, Law TSM, Ng K, Leung MBW, Wang S, Wan HM, Li JJX, Wang CC. Implementation of ovarian tissue cryopreservation in Hong Kong. Hong Kong Med J 2023; 29:121-131. [PMID: 36822598 DOI: 10.12809/hkmj2210220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Worldwide, >130 babies have been born from ovarian tissue cryopreservation (OTC) and ovarian tissue transplantation (OTT). Ovarian tissue cryopreservation can improve quality of life among young female cancer survivors. Here, we assessed the feasibility of OTC and subsequent OTT in Hong Kong via xenografts in nude mice. METHODS This pilot study was conducted in a university-affiliated tertiary hospital. Fifty-two ovarian tissues were collected from 12 patients aged 29 to 41 years during ovarian surgery, then engrafted into 34 nude mice. The efficacies of slow freezing and vitrification were directly compared. In Phase I, non-ovariectomised nude mice underwent ovarian tissue engraftment. In Phase II, ovariectomised nude mice underwent ovarian tissue engraftment, followed by gonadotrophin administration to promote folliculogenesis. Ovarian tissue viability was assessed by gross anatomical, histological, and immunohistochemical examinations before and after OTC. Follicular density and morphological integrity were also assessed. RESULTS After OTC and OTT, grafted ovarian tissues remained viable in nude mice. Primordial follicles were observed in thawed and grafted ovarian tissues, indicating that the cryopreservation and transplantation protocols were both effective. The results were unaffected by gonadotrophin stimulation. CONCLUSION This study demonstrated the feasibility of OTC in Hong Kong as well as primordial follicle viability after OTC and OTT in nude mice. Ovarian tissue cryopreservation is ideal for patients who cannot undergo the ovarian stimulation necessary for oocyte or embryo freezing as well as prepubertal girls (all ineligible for oocyte freezing). Our findings support the clinical implementation of OTC and subsequent OTT in Hong Kong.
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Affiliation(s)
- J P W Chung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.,Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - D Y L Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.,Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Y Song
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - E Y L Ng
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - T S M Law
- Department of Obstetrics and Gynaecology, Union Hospital, Hong Kong
| | - K Ng
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - M B W Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - S Wang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - H M Wan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - J J X Li
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
| | - C C Wang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.,Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.,Li Ka Shing Institute of Health Science, School of Biomedical Sciences; and Chinese University of Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong
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Chung J, Luo H, Tolsma J, Bista P, Nichols A. MODELING AND SIMULATION PREDICTS ROBUST HAE ATTACK SUPPRESSION WITH EVERY 3 MONTH DOSING OF STAR-0215. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Macy M, Cash T, Pinto N, Pressey J, Szalontay L, Furman W, Bukowinski A, Foster J, Friedman G, HaDuong J, Fox E, Weigel B, Grevel J, Huang F, Phelps C, Childs B, Chung J, Chaturvedi S, Schulz A, DuBois S. Phase I dose-escalation study of the pan-PI3 K inhibitor copanlisib in children and adolescents with relapsed/refractory solid tumors. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00878-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Witkowski A, Ludzik J, Chung J, White K, Leitenberger J, Lee C, Berry E, Samatham R, Esener S, Pellacani G, Leachman S. LB997 Detecting the world’s smallest solid malignant tumor: The role of reflectance confocal microscopy in the diagnosis and management of a micro-melanoma. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.1023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chung J, Bartolome L, Gruben D, Ray M, Masters E, Mitra D, Mostaghimi A. 208 The burden of alopecia areata (AA) vs psoriasis (PsO) in the United States. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chiu CPH, Feng Q, Chaemsaithong P, Sahota DS, Lau YY, Yeung YK, Yim LW, Chung JPW, Poon LC. Prediction of spontaneous preterm birth and preterm prelabor rupture of membranes using maternal factors, obstetric history and biomarkers of placental function at 11-13 weeks. Ultrasound Obstet Gynecol 2022; 60:192-199. [PMID: 35445767 DOI: 10.1002/uog.24917] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/25/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To determine whether first-trimester biomarkers of placental function can be used to screen for spontaneous preterm birth (sPTB), and to develop prediction models using maternal factors, obstetric history and biomarkers of placental function at 11-13 weeks for the calculation of patient-specific risk for sPTB. METHODS This was a retrospective secondary analysis of data derived from a prospective cohort study on first-trimester screening for pre-eclampsia in singleton pregnancies attending for routine Down syndrome screening at 11 + 0 to 13 + 6 weeks' gestation at a tertiary obstetric unit between December 2016 and September 2019. A split-sample internal validation method was used to explore and develop prediction models for all sPTB at < 37 weeks and for PTB at < 37 weeks after preterm prelabor rupture of membranes (PPROM) using maternal risk factors, uterine artery Doppler indices, serum placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A) and β-human chorionic gonadotropin (β-hCG). Screening performance was assessed using receiver-operating-characteristics (ROC)-curve analysis, with calculation of the areas under the ROC curves (AUCs). RESULTS A total of 9298 singleton pregnancies were included in this study. sPTB at < 37 weeks occurred in 362 (3.89%) cases, including 231 (2.48%) cases of PPROM. sPTB at < 34 weeks occurred in 87 (0.94%) cases, including 39 (0.42%) cases of PPROM. Identified maternal risk factors for sPTB at < 37 weeks included chronic hypertension, conception using in-vitro fertilization and history of PTB. Maternal risk factors for PPROM at < 37 weeks included conception using in-vitro fertilization and history of PTB. Median PlGF multiples of the median (MoM) and PAPP-A MoM were significantly reduced in women with sPTB at < 37 weeks, as well as in those who had PPROM, compared to those who delivered at term. Screening by a combination of maternal risk factors, PAPP-A and PlGF achieved better performance in predicting sPTB at < 37 weeks (AUC, 0.630 vs 0.555; detection rate (DR), 24.8% vs 16.6% at a false-positive rate (FPR) of 10%; P ≤ 0.0001) and PPROM at < 37 weeks (AUC, 0.643 vs 0.558; DR, 28.1% vs 17.0% at a FPR of 10%; P ≤ 0.0001) than using maternal risk factors alone. Both models were successfully applied to the internal validation dataset, with AUCs of 0.628 and 0.650, respectively. CONCLUSIONS We demonstrated that low levels of maternal serum PAPP-A and PlGF in the first trimester are associated with increased risks of sPTB and PPROM at < 37 weeks. However, further research is needed to identify additional biomarkers to improve the screening performance of the combined model that includes maternal risk factors, PAPP-A and PlGF before clinical application. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C P H Chiu
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Q Feng
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - P Chaemsaithong
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - D S Sahota
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Y Y Lau
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Y K Yeung
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - L W Yim
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - J P W Chung
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - L C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Chung J, Ramani V, Cruz P, Ariizumi K. 626 Targeting a novel carbohydrate that serves as an immune checkpoint and angiogenic regulator for treatment of melanoma. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Park M, Jang S, Chung J, Kim K, Kwon O, Jo S. 702 Inhibition of class I HDACs preserves hair follicle inductivity in postnatal dermal cells. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shin H, Zouboulis C, Kim M, Lee D, Chung J. 750 Minocycline suppresses lipogenesis via inhibition of p300 histone acetyltransferase activity in human SZ95 sebocytes. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee T, Chung H, Chung J, Hur M, Hwang S, Song Y, Lee D. M168 Automation of harboe method for the measurement of plasma free hemoglobin. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim S, Lim J, Chung J, Chang J, Lim H. M201 Is it reliable to establish the critical difference for laboratory tests based on the opinion of the clinician? Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jeong T, Kim S, Kim S, Lim C, Chung J. M132 Comparison between polynomial regression and weighted least squares regression analysis for verification of linearity of quantitative measurements. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Parker Z, Shasti B, Chung J, Taylor K. Changing Geographic Distributions of Coccidioides spp. in the United States: A Narrative Review of Climate Change Implications. Int J Infect Dis 2022. [DOI: 10.1016/j.ijid.2021.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chee L, Ritchie D, Ludford-Menting M, Ripley J, Chung J, Park D, Norton S, Kenealy M, Koldej R. Dysregulation of immune cell and cytokine signaling correlates with clinical outcomes in myelodysplastic syndrome (MDS). Eur J Haematol 2021; 108:342-353. [PMID: 34963023 DOI: 10.1111/ejh.13742] [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] [Received: 09/22/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis. Although hypomethylating agents (HMA) have improved survival in higher-risk MDS, most patients eventually succumb to progressive disease. Utilizing samples collected prospectively from three MDS clinical trials, we analyzed genetic and immunological biomarkers and correlated them with clinical outcomes. METHODS 154 samples were analyzed from 133 de novo MDS patients for T-cell and myeloid cell immunophenotyping and gene expression analysis. Treatments were with HMA or immunomodulatory drug (IMiD) alone or in combination. RESULTS We observed differences in immune cell subsets between lower and higher risk IPSS groups with NKT cells, MDSCs, intermediate-proinflammatory and non-classical monocytes being higher in the latter group while naïve CD4+ T-cells were reduced. Intermediate-proinflammatory monocytes were increased in non-responders and those failing to achieve at least a hematological improvement. Pro-inflammatory NKT cells were increased at diagnosis for patients failing to derive clinical benefit after 12 months of treatment. Gene expression analysis of paired bone marrow (BM) colony-forming units (CFUs) from diagnosis and 4 cycles post-treatment confirmed that genes involved in cytokine signaling were downregulated in C4 normal colonies. CONCLUSIONS These findings support the central roles of dysregulation in innate immunity and inflammatory signaling in the pathogenesis of MDS which correlated with clinical outcomes post-treatment.
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Affiliation(s)
- L Chee
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, The Royal Melbourne Hospital, Melbourne, VIC, 3000, Australia.,Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC, 3050, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, 3050, Australia.,The Australasian Leukaemia and Lymphoma Group, Richmond, VIC, 3121, Australia
| | - D Ritchie
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, The Royal Melbourne Hospital, Melbourne, VIC, 3000, Australia.,Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC, 3050, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, 3050, Australia.,The Australasian Leukaemia and Lymphoma Group, Richmond, VIC, 3121, Australia
| | - M Ludford-Menting
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, The Royal Melbourne Hospital, Melbourne, VIC, 3000, Australia
| | - J Ripley
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, The Royal Melbourne Hospital, Melbourne, VIC, 3000, Australia.,Liverpool Hospital, Liverpool, NSW, 2170, Australia
| | - J Chung
- Melbourne Bioinformatics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - D Park
- Melbourne Bioinformatics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - S Norton
- Nanix Limited, Dunedin, New Zealand
| | - M Kenealy
- The Australasian Leukaemia and Lymphoma Group, Richmond, VIC, 3121, Australia.,Cabrini Hospital, Malvern, VIC, 3144, Australia.,Monash University, Clayton, VIC, 3800, Australia
| | - R Koldej
- Australian Cancer Research Foundation (ACRF) Translational Laboratory, The Royal Melbourne Hospital, Melbourne, VIC, 3000, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, 3050, Australia
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Palma D, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Eskander A, Higgins K, Karam I, Poon I, Husain Z, Enepekides D, Hier M, Sultanem K, Richardson K, Mlynarek A, Johnson-Obaseki S, Eapen L, Odell M, Bayley A, Dowthwaite S, Jackson J, Dzienis M, O'Neil J, Chandarana S, Banerjee R, Hart R, Chung J, Tenenholz T, Krishnan S, Le H, Yoo J, Mendez A, Winquist E, Kuruvilla S, Stewart P, Warner A, Mitchell S, Chen J, Parker C, Wehrli B, Kwan K, Theurer J, Sathya J, Hammond J, Read N, Venkatesan V, MacNeil D, Fung K, Nichols A. A Randomized Trial of Radiotherapy vs. Trans-Oral Surgery for Treatment De-Escalation in HPV-Associated Oropharyngeal Squamous Cell Carcinoma (ORATOR2). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Polkoff K, Gupta N, Chung J, Gleason K, Marquez Y, Piedrahita J. 4 Transgenic porcine model reveals two roles for LGR5 in lung development and homeostasis. Reprod Fertil Dev 2021; 34:235-236. [PMID: 35231293 DOI: 10.1071/rdv34n2ab4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- K Polkoff
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | - N Gupta
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - J Chung
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | - K Gleason
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Y Marquez
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - J Piedrahita
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
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21
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An K, De Mestral C, Tam D, Qiu F, Ouzounian M, Lindsay T, Wijeysundera H, Chung J. IMAGING SURVEILLANCE FOLLOWING ACUTE TYPE A AORTIC DISSECTION: A POPULATION-BASED COHORT STUDY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Ibrahim M, Stevens L, Ouzounian M, Hage A, Dagenais F, Peterson M, El-Hamamsy I, Boodhwani M, Bozinovski J, Moon M, Yamashita MH, Atoui R, Bittira B, Payne D, Lachapelle K, Chu M, Chung J. EVOLVING SURGICAL TECHNIQUES AND IMPROVING OUTCOMES FOR AORTIC ARCH SURGERY IN CANADA. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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23
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Lagan C, Huckle JE, Katz JM, Khorsand B, Daurio D, Andrews GP, Chung J, Alvarez-Nunez F. Solvent-Assisted Hot Melt Extrusion of a Thermally Labile, High Melting Point Compound. AAPS PharmSciTech 2021; 22:235. [PMID: 34498147 DOI: 10.1208/s12249-021-02122-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/18/2021] [Indexed: 11/30/2022] Open
Abstract
Molecular dispersions are a highly effective method of increasing bioavailability for a poorly soluble active pharmaceutical ingredient (API) and can be prepared on a large scale by hot melt extrusion (HME). Processing thermally labile active pharmaceutical ingredients (APIs) via HME is generally more difficult, with operating temperatures limited to below that of the API melting point. API melting is considered essential to facilitate the formation of a fully homogeneous amorphous system. Processing below the melting point renders the system much more susceptible to residual crystalline content; hence, HME is not suitable for APIs which degrade upon melting. In the following work, meloxicam (MEL) was used as a model API, possessing properties of high melting temperature and thermal lability. In this proof of concept work, a modified HME method, termed solvent-assisted HME, was used to overcome this issue and prepare an amorphous solid dispersion using HME, wherein a solvent was incorporated in the formulation blend during extrusion and removed post-processing. Formulations containing 10%wt meloxicam (MEL) and 90%wt polyvinylpyrrolidone vinyl acetate (PVPVA) copolymer were extruded using a twin-screw extruder at temperatures below the melting point of MEL. Dimethylformamide (DMF) solvent was added directly into the extruder barrel through a liquid addition port, resulting in extrudate products having a higher conversion of API to the amorphous form. The incorporation of solvent allowed a significant reduction in processing temperatures due to its increased mobility, while also driving the conversion of the API to its amorphous form. The solvent was successfully reduced through a secondary drying step using a vacuum oven. This advancement has demonstrated the potential for thermally labile APIs to be processed via HME expanding the applications of this technology.
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Kim J, Han HJ, Lee W, Park SK, Chung J, Kim YB, Park KY. Safety and Efficacy of Stent-Assisted Coiling of Unruptured Intracranial Aneurysms Using Low-Profile Stents in Small Parent Arteries. AJNR Am J Neuroradiol 2021; 42:1621-1626. [PMID: 34210666 DOI: 10.3174/ajnr.a7196] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Stent-assisted coiling of intracranial aneurysms arising from small vessels (≤ 2.0 mm) is a common procedure. However, data regarding its treatment outcomes are scarce. This study evaluated the clinical and radiologic outcomes of stent-assisted coiling using low-profile stents for aneurysms of small parent arteries. MATERIALS AND METHODS From November 2015 to October 2020, sixty-four patients with 66 aneurysms arising from parent arteries of ≤2.0 mm were treated with stent-assisted coiling using a Low-Profile Visualized Intraluminal Support Junior (LVIS Jr) or the Neuroform Atlas stent in a single institution. The clinical and radiologic data were retrospectively reviewed, and the risk factors for procedure-related complications were evaluated. RESULTS The LVIS Jr and Neuroform Atlas stents were used in 22 (33.3%) and 44 (66.7%) cases, respectively. Technical success was achieved in 66 cases (100%). Immediate postprocedural aneurysm occlusion grades assessed by the Raymond-Roy occlusion classification were I (57.6%), II (19.7%), and III (22.7%), respectively. Procedure-related complications occurred in 10 cases (15.2%), with 8 thromboembolic complications (12.1%) and 2 hemorrhagic complications (3.0%). Procedure-related morbidity was 4.5% without mortality. On multivariate analysis, current smoking (odds ratio = 7.1, P = .021) had a statistically significant effect on procedure-related complications. CONCLUSIONS Stent-assisted coiling of intracranial aneurysms with low-profile stents in small vessels (≤ 2.0 mm) had a 100% success rate and a 15.2% overall complication rate with 4.5% morbidity. Current smoking was a significant risk factor associated with procedure-related complications.
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Affiliation(s)
- J Kim
- From the Department of Neurosurgery (J.K., H.J.H., J.C., Y.B.K., K.Y.P.)
| | - H J Han
- From the Department of Neurosurgery (J.K., H.J.H., J.C., Y.B.K., K.Y.P.)
| | - W Lee
- Severance Stroke Center, and Department of Neurosurgery (W.L., S.K.P.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S K Park
- Severance Stroke Center, and Department of Neurosurgery (W.L., S.K.P.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Chung
- From the Department of Neurosurgery (J.K., H.J.H., J.C., Y.B.K., K.Y.P.)
| | - Y B Kim
- From the Department of Neurosurgery (J.K., H.J.H., J.C., Y.B.K., K.Y.P.)
| | - K Y Park
- From the Department of Neurosurgery (J.K., H.J.H., J.C., Y.B.K., K.Y.P.)
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Chung JPW, Law T, Sahota D, Mak J, Li TC. P-745 The efficacy of Buscopan® in reducing pain during ultrasound-guided manual vacuum aspiration (USG-MVA): A double-blind randomised placebo-controlled trial. Hum Reprod 2021. [DOI: 10.1093/humrep/deab128.033] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Does Buscopan® reduce abdominal pain experienced by women undergoing ultrasound-guided manual vacuum aspiration (USG-MVA)?
Summary answer
The addition of 20mg Buscopan® intravenous injection was not associated with a statistical reduction in pain score but leads to a higher patient satisfaction score.
What is known already
Ultrasound-guided Manual Vacuum aspiration is a feasible and effective out-patient treatment option for treating early pregnancy loss. However, it is associated with a moderate amount of pain due to uterine contraction.
Study design, size, duration
This randomised, double-blinded, placebo-controlled trial was conducted in a university-affiliated tertiary hospital. The study assessed whether 1 ml of 20mg Buscopan® intravenous injection 5 minutes before the USG-MVA will reduce the abdominal pain experienced by the women immediately and 2 hours after the procedure. Participants were randomised between June 2018 to January 2020 using a computer-generated number series in a 1:1 ratio.
Participants/materials, setting, methods
Women aged 18 years or older with first-trimester miscarriage undergoing the USG-MVA procedure were eligible. In total, 122 participants out of 128 eligible were included. Of whom, 111 underwent the USG-MVA procedure, 60 randomised to the Buscopan® group, and 62 to the placebo group.
Main results and the role of chance
The median abdominal pain scores in the Buscopan® group were 16.0% and 21.2% lower than the placebo group immediately post-procedure and 2 hours after the procedure in the Buscopan® group. Repeated measures ANOVA indicated that the both vaginal and abdominal pain scores improved significantly with the time (Vaginal F(1,108)= 180.1,p<0.0001;
Abdominal
F(1,108)=83.41,p<0.001) but not with group. No difference was noted in the complications and side effects profile. The physiological stress measured by Log10 sAA levels reduced significantly with time (F(2.8,286.1)= 6.3, p < 0.001) but not with group (F = 0.1, p = 0.96). Women randomised to Buscopan® had a significantly higher (p = 0.032) mean VAS satisfaction scores compared to those receiving placebo (79.0±17.3 vs 73.4±24.1).
Limitations, reasons for caution
This study was a single-centre study, thus one should be cautious in the overall generalisability of the results.
Wider implications of the findings
Few studies have evaluated the use of anti-spasmodic agents to minimise uterine contraction pain in women undergoing outpatient uterine evacuation. We consider Buscopan® a useful adjunct in the pain control of USG-MVA to specifically reduce uterine cramps. Further larger studies are required to evaluate its efficacy
Trial registration number
ChiCTR1800014590
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Affiliation(s)
- J P W Chung
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T Law
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - D Sahota
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - J Mak
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T C Li
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
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26
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Chung JPW, Law T, Sahota D, Mak J, Li TC. P–745 The efficacy of Buscopan® in reducing pain during ultrasound-guided manual vacuum aspiration (USG-MVA): A double-blind randomised placebo-controlled trial. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.744] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Does Buscopan® reduce abdominal pain experienced by women undergoing ultrasound-guided manual vacuum aspiration (USG-MVA)?
Summary answer
The addition of 20mg Buscopan® intravenous injection was not associated with a statistical reduction in pain score but leads to a higher patient satisfaction score.
What is known already
Ultrasound-guided Manual Vacuum aspiration is a feasible and effective out-patient treatment option for treating early pregnancy loss. However, it is associated with a moderate amount of pain due to uterine contraction.
Study design, size, duration
This randomised, double-blinded, placebo-controlled trial was conducted in a university-affiliated tertiary hospital. The study assessed whether 1 ml of 20mg Buscopan® intravenous injection 5 minutes before the USG-MVA will reduce the abdominal pain experienced by the women immediately and 2 hours after the procedure. Participants were randomised between June 2018 to January 2020 using a computer-generated number series in a 1:1 ratio.
Participants/materials, setting, methods
Women aged 18 years or older with first-trimester miscarriage undergoing the USG-MVA procedure were eligible. In total, 122 participants out of 128 eligible were included. Of whom, 111 underwent the USG-MVA procedure, 60 randomised to the Buscopan® group, and 62 to the placebo group.
Main results and the role of chance
The median abdominal pain scores in the Buscopan® group were 16.0% and 21.2% lower than the placebo group immediately post-procedure and 2 hours after the procedure in the Buscopan® group. Repeated measures ANOVA indicated that the both vaginal and abdominal pain scores improved significantly with the time (Vaginal F(1,108)=180.1,p<0.0001; Abdominal: F(1,108)=83.41,p<0.001) but not with group. No difference was noted in the complications and side effects profile. The physiological stress measured by Log10 sAA levels reduced significantly with time (F(2.8,286.1)= 6.3, p < 0.001) but not with group (F = 0.1, p = 0.96). Women randomised to Buscopan® had a significantly higher (p = 0.032) mean VAS satisfaction scores compared to those receiving placebo (79.0±17.3 vs 73.4±24.1).
Limitations, reasons for caution
This study was a single-centre study, thus one should be cautious in the overall generalisability of the results.
Wider implications of the findings: Few studies have evaluated the use of anti-spasmodic agents to minimise uterine contraction pain in women undergoing outpatient uterine evacuation. We consider Buscopan® a useful adjunct in the pain control of USG-MVA to specifically reduce uterine cramps. Further larger studies are required to evaluate its efficacy.
Trial registration number
ChiCTR1800014590
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Affiliation(s)
- J P W Chung
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T Law
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - D Sahota
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - J Mak
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
| | - T C Li
- The Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Hong Kong, Hong Kong
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Zhao M, Li H, Wang S, Alqawasmeh O, Xu M, Chung J, Chan DYL. P–134 Zygote morphokinetic parameters (ZMP) differs between fertilized and non-fertilized (in vitro maturation) oocytes. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.133] [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: 11/14/2022] Open
Abstract
Abstract
Study question
Is there any difference on the ZMP between the fertilized and the non-fertilized oocytes in an IVM cohort?
Summary answer
The zona pellucida (zp_g) , cytoplasm greyscale(cm_g),the cytoplasm size (cm_size), radius (cm_r) and deviation (cm_d) showed different patterns from the two groups.
What is known already
We developed a convolutional neural network (CNN) based algorithm that provides instant and bias-free analytical outcomes of oocyte morphological segmentation. The mature but not-fertilized oocytes tend to be static while the fertilized oocytes are more dynamic for preparing its following biological events.
Study design, size, duration
This was a case-control study on oocytes including 631 normal fertilized oocytes and 100 IVM oocytes from 01/08/2017 to 31/12/2019 conducted in the Prince of Wales Hospital, The Chinese University of Hong Kong.
Participants/materials, setting, methods
We used the convolutional neural network (CNN) algorithm to segment the ZMPs of the cytoplasm and zona pellucida of the oocytes. The ZMPs include cm_g, cm_size, cm_r, cm_d, zp_g, thickness of zona pellucida and the area of perivitelline space. For the ZMPs that did not change with time, we used t-test to test the significance and for the parameters changed with time we used dynamic warp timing and similarity test to find the difference.
Main results and the role of chance
The IVM group had a higher intensity of zp_g of 142.03 (128.52–158.70) compared with the fertilized group of 137.04 (121.69–154.37). The cm_g of IVM group was higher than fertilized group [122.55 (114.87–137.62) vs 119.37(108.88–132.87)]. The cm_size, cm_r and cm_d as parameters changed with time and showed a different pattern in two groups. The IVM group decreased the cm_size faster than the fertilized group but the fertilized group had a more dynamic change in the shape of cytoplasm (cm_d) during the development. The cm_r changed with the same pattern of cm_size provided evidence supporting the finding above.
Limitations, reasons for caution
The ZMPs in the IVM group was captured for 21 hours from the first polar body extrusion. Though the duration was similar to the one from fertilized to the first cleavage. The morphology change during that period may not represent the holistic one of IVM oocytes.
Wider implications of the findings: The IVM oocytes have different morphokinetic performance from fertilized oocytes. We used a novel method based on CNN to confirm the differences between the two groups showing that our algorithm was able to describe the morphokinetic changes in a quantitative way and corresponded with embryologist’s experience.
Trial registration number
The Hong Kong Obstetrical & Gynaecological Trust Fund
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Affiliation(s)
- M Zhao
- The Chinese University of Hong Kong, ART Unit- Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
| | - H Li
- Guilin University of Electronic Technology, School of Computer Science and Information Security, Guilin, China
| | - S Wang
- The Chinese University of Hong Kong, ART Unit- Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
| | - O Alqawasmeh
- The Chinese University of Hong Kong, ART Unit- Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
| | - M Xu
- The Chinese University of Hong Kong, ART Unit- Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
| | - J Chung
- The Chinese University of Hong Kong, ART Unit- Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
| | - D Y L Chan
- The Chinese University of Hong Kong, ART Unit- Department of Obstetrics and Gynaecology- Faculty of Medicine, Shatin, Hong Kong
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Lee T, Kim I, Kim J, Song C, Kim Y, Kim K, No J, Suh D, Chung J, Eom K. PO-1295 Stereotactic ablative body radiotherapy boost for cervical cancer when brachytherapy is not feasible. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07746-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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29
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Mao S, Li D, Ahmad K, Gao Y, Flores F, Hosseini H, Bakhsheshi H, Bakhsheshi H, Chung J, Yusin N, Chehrzadeh S, Budoff M. Both Vertebral Bone Mineral Density And Present Or Growth Of Schmorl’S Node Are Important Predictors For Future Vertebral Fracture. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Brown F, Hwang I, Sloan S, Hinterschied C, Helmig‐Mason J, Long M, Youssef Y, Chan W, Prouty A, Chung J, Zhang Y, Chen‐Kiang S, DiLiberto M, Elemento O, Sehgal L, Alinari L, Scherle P, Vaddi K, Lapalombella R, Paik J, Baiocchi RA. PRMT5 INHIBITION RESTARTS A PRO‐APOPTOTIC PROGRAM AND CREATES VULNERABILITY TO COMBINATION TREATMENT WITH BCL‐2 INHIBITOR VENETOCLAX IN MANTLE CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.143_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- F Brown
- The Ohio State University Department of Hematology Columbus USA
| | - I Hwang
- Weil Cornell Medicine Department of Pathology and Laboratory Medicine New York USA
| | - S Sloan
- The Ohio State University Department of Hematology Columbus USA
| | - C Hinterschied
- The Ohio State University Department of Hematology Columbus USA
| | - J Helmig‐Mason
- The Ohio State University Department of Hematology Columbus USA
| | - M Long
- The Ohio State University Department of Hematology Columbus USA
| | - Y Youssef
- The Ohio State University Department of Hematology Columbus USA
| | - W Chan
- The Ohio State University Department of Hematology Columbus USA
| | - A Prouty
- The Ohio State University Department of Hematology Columbus USA
| | - J Chung
- The Ohio State University Department of Hematology Columbus USA
| | - Y Zhang
- Prelude Therapeutics, R&D, Wilmington Delaware USA
| | - S Chen‐Kiang
- Weil Cornell Medicine Department of Pathology and Laboratory Medicine New York USA
| | - M DiLiberto
- Weil Cornell Medicine Department of Pathology and Laboratory Medicine New York USA
| | - O Elemento
- Weil Cornell Medicine Department of Physiology & Biophysics, New York New York USA
| | - L Sehgal
- The Ohio State University Department of Hematology Columbus USA
| | - L Alinari
- The Ohio State University Department of Hematology Columbus USA
| | - P Scherle
- Prelude Therapeutics, R&D, Wilmington Delaware USA
| | - K Vaddi
- Prelude Therapeutics, R&D, Wilmington Delaware USA
| | - R Lapalombella
- The Ohio State University Department of Hematology Columbus USA
| | - J Paik
- Weil Cornell Medicine Department of Pathology and Laboratory Medicine New York USA
| | - R. A Baiocchi
- The Ohio State University Department of Hematology Columbus USA
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31
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Cho S, Lee D, Han B, Lee J, Hong J, Chung J, Lee D, Na J. 463 Automated atopic dermatitis severity assessment based on convolutional neural networks. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lee WY, Mok A, Chung JPW. Potential effects of COVID-19 on reproductive systems and fertility; assisted reproductive technology guidelines and considerations: a review. Hong Kong Med J 2021; 27:118-126. [PMID: 33853972 DOI: 10.12809/hkmj209078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) employs the angiotensin-converting enzyme 2 (ACE2) receptor in the renin-angiotensin system for viral entry. The ACE2 receptor is present in both female and male reproductive systems, and reports of multi-organ involvement have led to uncertainty regarding its effects on the reproductive system and fertility. We review the existing literature regarding the function of ACE2 and the renin-angiotensin system in the female and male reproductive systems to postulate the possible implications of SARS-CoV-2 regarding fertility. Because of the presence of ACE2 in the ovaries, SARS-CoV-2 infection may disrupt ovarian function and hence oocyte quality. Higher expression of ACE2 in the endometrium with age and during the secretory phase raises concern about increased susceptibility to infection during periods of high ACE2 expression. The possibility of vertical transmission and the presence of ACE2 in the placenta and during pregnancy are also discussed. The presence of SARS-CoV-2 RNA in semen is controversial, but impaired semen quality has been found in men with moderate coronavirus disease 2019 infection. Evidence of orchitis and hormonal changes seen in male coronavirus disease 2019 infection may lead to infertility. The implications of these effects on assisted reproductive technology (ART) outcomes are also explored. The ART guidelines from different fertility societies for the management of patients treated with ART are provided. The importance of prioritising 'time-sensitive' patients for ART, counselling patients about the uncertainty and risks of ART, and pregnancy during the pandemic is discussed. Recommendations are also provided for infection control and safe regulation of ART centres and laboratories.
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Affiliation(s)
- W Y Lee
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - A Mok
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - J P W Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
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Chung J, Yeung WS. Webinar to Promote Mental Wellness Among Healthcare Staff During the COVID-19 Pandemic. East Asian Arch Psychiatry 2021; 31:21-22. [PMID: 33753574 DOI: 10.12809/eaap2072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J Chung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - W S Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
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Kwon S, Kwon H, Kim E, Suh K, Kim S, Kim Y, Lee J, Chung J, Kim H. P14.11 Optimal Combination of Biomarkers to Improve the Predictive Value of Immunotherapeutic Response in Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chan OYM, Leung TY, Cao Y, Shi MM, Kwan AHW, Chung JPW, Choy KW, Chong SC. Expanded carrier screening using next-generation sequencing of 123 Hong Kong Chinese families: a pilot study. Hong Kong Med J 2021; 27:177-183. [PMID: 33602879 DOI: 10.12809/hkmj208486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION To determine the carrier frequency and common mutations of Mendelian variants in Chinese couples using next-generation sequencing (NGS). METHODS Preconception expanded carrier testing using NGS was offered to women who attended the subfertility clinic. The test was then offered to the partners of women who had positive screening results. Carrier frequency was calculated, and the results of the NGS panel were compared with those of a target panel. RESULTS One hundred twenty-three women and 20 of their partners were screened. Overall, 84 (58.7%) individuals were identified to be carriers of at least one disease, and 68 (47.6%) were carriers after excluding thalassaemias. The most common diseases found were GJB2-related DFNB1 nonsyndromic hearing loss and deafness (1 in 4), alpha-thalassaemia (1 in 7), beta-thalassaemia (1 in 14), 21-hydroxylase deficient congenital adrenal hyperplasia (1 in 13), Pendred's syndrome (1 in 36), Krabbe's disease (1 in 48), and spinal muscular atrophy (1 in 48). Of the 43 identified variants, 29 (67.4%) were not included in the American College of Medical Genetics and Genomics or American College of Obstetrics and Gynecology guidelines. Excluding three couples with alpha-thalassaemia, six at-risk couples were identified. CONCLUSION The carrier frequency of the investigated members of the Chinese population was 58.7% overall and 47.6% after excluding thalassaemias. This frequency is higher than previously reported. Expanded carrier screening using NGS should be provided to Chinese people to improve the detection rate of carrier status and allow optimal pregnancy planning.
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Affiliation(s)
- O Y M Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.,Adept Medical Centre, Hong Kong
| | - T Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.,The Chinese University of Hong Kong-Baylor College of Medicine Joint Center of Medical Genetics, Hong Kong
| | - Y Cao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.,The Chinese University of Hong Kong-Baylor College of Medicine Joint Center of Medical Genetics, Hong Kong.,Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - M M Shi
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - A H W Kwan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - J P W Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - K W Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.,The Chinese University of Hong Kong-Baylor College of Medicine Joint Center of Medical Genetics, Hong Kong
| | - S C Chong
- The Chinese University of Hong Kong-Baylor College of Medicine Joint Center of Medical Genetics, Hong Kong.,Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
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Kim S, Chung J. The associations of epicardial adipose tissue with coronary atherosclerosis. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mohamed W, Hirji S, Mohamed M, Percy E, Braidley P, Chung J, Aranki S, Mamas M. Incidence and predictors of postoperative ischaemic stroke after coronary artery bypass grafting in the United States. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2666] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Postoperative acute ischemic stroke (AIS) is a catastrophic complication of coronary artery bypass grafting (CABG). There is limited data on the incidence and outcomes of AIS complicating CABG in the contemporary era, and whether these have changed over the years.
Purpose
To study the incidence and outcomes of postoperative AIS in a nationally representative cohort of CABG procedures over a 12-year period and examine predictors of AIS in patients undergoing CABG.
Methods
The National Inpatient Sample was used to identify all adult patients (>18 years old) who underwent CABG in the United States between January 2004 and September 2015. Multivariable logistic regression was performed to examine the associations between postoperative AIS and in-hospital mortality and identify predictors of AIS after CABG, expressed as odds ratios (OR) with corresponding 95% confidence intervals (CI).
Results
A total of 2,569,597 CABG operations were analysed. The incidence of postoperative AIS was 1.8% (n=47,279) in the overall cohort increasing from 1.2% in 2004 to 2.3% in 2015 (p<0.001). Significantly higher rates of AIS were observed amongst patients with atrial fibrillation (AF) and those undergoing non-elective or concomitant valve operations over the study period (see Figure). Patient risk profiles increased over time in both AIS and no-AIS cohorts, with higher Charlson comorbidity scores observed amongst AIS patients. AIS was independently associated with increased odds of in-hospital mortality (OR 3.03, 95% CI 2.93, 3.13) and prolonged hospital stay (∼6 more days) and a higher hospitalisation cost (∼$80,000 more) (p<0.001 for all). Several factors were predictors of AIS including age>60 years (61–70 years: OR 1.33, 95% CI 1.29, 1.37; 71–80 years: OR 1.49, 95% CI 1.44, 1.54; >80 years: OR 1.42, 95% CI 1.37, 1.48), female sex (OR 1.33, 95% CI 1.31, 1.36) and AF (OR 1.14 95% CI 1.12, 1.16) (p<0.001 for all). In contrast, on-pump CABG was not an independent predictor of stroke (OR 1.01, 95% CI 0.94, 1.09) (p=0.784).
Conclusion
In this nationally representative study, we have shown that the rates of postoperative stroke following CABG have increased over time in line with complexity of patient risk profiles. The present findings emphasise the need for further work on strategies to reduce the risk of postoperative stroke after CABG.
Trends of postoperative AIS (2004-2015)
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- W Mohamed
- Glenfield Hospital, Leicester, United Kingdom
| | - S Hirji
- Brigham and Women's Hospital, Division of Cardiac Surgery, Boston, United States of America
| | - M Mohamed
- Keele University, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele, United Kingdom
| | - E Percy
- Brigham and Women's Hospital, Division of Cardiac Surgery, Boston, United States of America
| | - P Braidley
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - J Chung
- Loma Linda University Medical Center, Department of Cardiac Surgery, Loma Linda, United States of America
| | - S Aranki
- Brigham and Women's Hospital, Division of Cardiac Surgery, Boston, United States of America
| | - M.A Mamas
- Keele University, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele, United Kingdom
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Cardarelli-Leite L, Hadjivassiliou A, Klass D, Chung J, Ho SGF, Lim HJ, Kim PTW, Mujoomdar A, Liu DM. Current locoregional therapies and treatment strategies in hepatocellular carcinoma. ACTA ACUST UNITED AC 2020; 27:S144-S151. [PMID: 33343208 DOI: 10.3747/co.27.7171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Locoregional therapies (lrts) play an important role in the treatment of hepatocellular carcinoma (hcc), with the aim of increasing overall survival while preserving liver function. Various forms of lrt are available, and choosing the best one depends on technical aspects, liver morphology, tumour biology, and the patient's symptoms. The purpose of the present review article is to provide an overview of the current evidence relating to the use of percutaneous ablation, transarterial chemoembolization, and transarterial radioembolization for the curative or palliative treatment of hcc. Special situations are also reviewed, including the combined use of systemic therapy and lrt, indications and techniques for bridging to transplant and downstaging, and the use of lrt to treat patients with hcc and macrovascular invasion.
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Affiliation(s)
| | - A Hadjivassiliou
- Department of Radiology, University of British Columbia, Vancouver, BC
| | - D Klass
- Department of Radiology, University of British Columbia, Vancouver, BC
| | - J Chung
- Department of Radiology, University of British Columbia, Vancouver, BC
| | - S G F Ho
- Department of Radiology, University of British Columbia, Vancouver, BC
| | - H J Lim
- Department of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC
| | - P T W Kim
- Department of Surgery, University of British Columbia, Vancouver, BC
| | - A Mujoomdar
- Department of Medical Imaging, Western University, London, ON
| | - D M Liu
- Department of Radiology, University of British Columbia, Vancouver, BC
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Ng K, Ip PNP, Yiu KW, Chung JPW, Chan SSC. Treatment of patients with Mayer-Rokitansky- Küster-Hauser syndrome in a tertiary hospital. Hong Kong Med J 2020; 26:397-403. [PMID: 33060366 DOI: 10.12809/hkmj208467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is an uncommon congenital malformation characterised by agenesis or hypoplasia of the vagina and uterus. Here, we describe the treatment of patients with MRKH syndrome in a tertiary hospital. METHODS This retrospective study included patients with MRKH syndrome attending the Paediatric and Adolescent Gynaecology Clinic in a tertiary hospital. Their clinical manifestations, examinations, and methods for neovagina creation were recorded. Among patients who underwent vaginal dilation (VD), therapy duration, vaginal width and length at baseline and after VD, complications, and sexual activity and dyspareunia outcomes were evaluated. RESULTS Forty nine patients with MRKH syndrome were identified. Their mean age at presentation was 17.9 years; 69.4% and 24.5% of patients presented for primary amenorrhoea treatment and vaginoplasty, respectively. Forty eight patients had normal renal imaging findings and 46 XX karyotypes. Seventeen (34.7%) patients underwent VD as first-line therapy; three did not complete the therapy. Two had surgical vaginoplasty, whereas five achieved adequate vaginal length by sexual intercourse alone; 25 had not yet requested VD. The mean duration of VD was 16±10.2 (range, 4-35) weeks. The widths and lengths of the vagina at baseline and after VD were 1.1±0.28 cm and 1.3±0.7 cm, and 3.1±0.5 cm and 6.9±0.9 cm, respectively. The overall success rate of VD was 92.3%. Vaginal spotting was the most common complication (21%); only one patient reported dyspareunia. CONCLUSIONS Mayer-Rokitansky-Küster-Hauser syndrome is an uncommon condition that requires multidisciplinary specialist care. Vaginal dilation is an effective first-line approach for neovagina creation.
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Affiliation(s)
- K Ng
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - P N P Ip
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - K W Yiu
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - J P W Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - S S C Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Elbatarny M, David C, Chung J, Lafreniere-Roula M, David T, Ouzounian M. IMPROVED OUTCOMES FOLLOWING REIMPLANTATION OF THE AORTIC VALVE COMPARED TO REMODELING IN MARFAN SYNDROME: A PROPENSITY-MATCHED STUDY. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Weig EA, Chung J, Wilbur J, Levy BT, Wanat KA. Provider comfort, knowledge and attitudes in treating psychocutaneous diseases in dermatology, psychiatry and family medicine. Clin Exp Dermatol 2020; 45:765-767. [DOI: 10.1111/ced.14283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
- E. A. Weig
- University of Iowa Carver College of Medicine Iowa City IA USA
| | - J. Chung
- Department of Dermatology Thomas Jefferson University Philadelphia PA USA
| | - J. Wilbur
- Department of Family Medicine University of Iowa Hospitals and Clinics Iowa City IA USA
| | - B. T. Levy
- Departments of Family Medicine and Epidemiology University of Iowa Hospitals and Clinics Iowa City IA USA
| | - K. A. Wanat
- Department of Dermatology Medical College of Wisconsin Milwaukee WI USA
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Mao S, Li D, Gao Y, Flores F, Hosseini H, Bakhsheshi H, Chung J, Yusin N, Chehrzadeh S, Fu G, Kim K, Budoff M. Thoracic Qct From Heart Scan Can Monitor Age-related Bone Loss Sensitively: A Comparing With Dxa And Qct Study. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hahn SH, Han H, Woo M, Bak J, Chung J, Jeon Y, Jeong J, Joung M, Juhn J, Kim H, Kim H, Lee M, Shin G, Tak T, Yoon S, Barr J, Eidietis N, Humphreys D, Hyatt A, Penaflor B, Piglowski D, Walker M, Welander A, Boyer M, Erickson K, Mueller D. Advances and challenges in KSTAR plasma control toward long-pulse, high-performance experiments. Fusion Engineering and Design 2020. [DOI: 10.1016/j.fusengdes.2020.111622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ha Y, Park K, Park D, Chung J, Choi S, Lee J, Kim B, Kim H, Kim T, Yoo E, Kwon T. Outcomes of topical steroid therapy depending on steroid potency for boys with symptomatic phimosis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Montenegro S, Oh J, Mun J, Chung J. 231 Analysis of corneodesmosomal proteins in nummular eczema skin. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ha Y, Park K, Park D, Chung J, Choi S, Lee J, Kim B, Kim H, Kim T, Yoo E, Kwon T. Comparison of recurrence rate of urolithiasis according to the stone composition in patients without dietary modification. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chung J, Ramani V, Cruz P, Savory S, Ariizumi K. 701 Dysplastic nevi (DN) patients have high DC-HIL-expressing myeloid-derived suppressor cells (MDSC) that may confer increased risk for melanoma. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lee C, Chung J, Kwak C, Jeong C, Seo S, Kang M, Hong S, Song C, Park J, Hwang E, Hakmin L, Ja Yoon K, Won Ik S, Choi S, Ha H. Late recurrence of renal cell carcinoma after surgical therapy and responses to targeted therapy: Results from the Korean Renal Cancer Study Group (KRoCS). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
INTRODUCTION The fertility preservation (FP) services offered in Hong Kong are underutilised. There have been no previous studies on Chinese medical students to investigate the underlying reasons for this underutilisation in terms of awareness, knowledge, and attitudes towards FP and age-related fertility. METHODS This was a cross-sectional survey among Chinese medical students in Hong Kong. RESULTS The majority of participants (77.8%) were not familiar with any clinics or specialists who provide FP services. The vast majority (88.1%) underestimated female infertility at age 45 years, and 89.8% overestimated the age of male fertility decline. The students' FP knowledge was mainly acquired from electronic media (58.4%) and medical school (57.6%). Medical students showed overwhelming support towards FP for medical reasons (97.9%) but had mixed responses about FP for elective reasons related to career development in women (58.8%). Of the participants, 80.2% agreed that the government should subsidise FP services for patients with medical reasons. CONCLUSION This study highlights the limited awareness and knowledge of FP among Chinese medical students. There is a strong worldwide need to increase education about and exposure to FP in the medical curriculum and improve medical students' knowledge.
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Affiliation(s)
- E Y L Ng
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - J K H Ip
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - D R Mak
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - A Y W Chan
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - J P W Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
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Abstract
INTRODUCTION Cancer survivorship is increasingly important with advances in cancer therapeutics. Minimisation of treatment-related morbidity is an area that requires attention. This situation is most pressing in premenopausal patients with breast cancer, in whom advances in hormonal and targeted therapies have improved mortality rates. However, treatment-related infertility is still poorly addressed, and in East Asia, there is limited discussion regarding management of treatment-related infertility. METHODS A search of the literature was conducted using PubMed, Google Scholar, and Science Direct using the terms "breast cancer", "fertility preservation", "oocyte and embryonic cryopreservation", "GnRH-a co-administration", "ovarian tissue cryopreservation and transplantation", "Japan", "China", "Korea", and 'Singapore". Only studies published in English from 1980-2019 were included. The focus of the review was on identifying the current fertility preservation methods available to premenopausal women with breast cancer and the barriers that impede access. RESULTS Fertility preservation options include GnRH-a co-administration to minimise treatment-associated infertility, oocyte and embryonic cryopreservation, and emerging treatments such as ovarian tissue cryopreservation and transplantation. In East Asia, the uptake of fertility preservation options has been limited despite it being a major patient concern. A lack of awareness of fertility preservation treatments hinders discussion between patients and clinicians about fertility preservation. CONCLUSION Despite progress in fertility preservation technologies, their impact for patients will be minimal if there is a lack of awareness/use of the technology. This review aims to raise awareness of such technologies among clinicians, enabling discussion between patients and clinicians about fertility preservation options.
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Affiliation(s)
- S S Y Wang
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - H Loong
- Faculty of Medicine, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - J P W Chung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - W Yeo
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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