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Tan K, Chow WS, Leung J, Ho A, Ozaki R, Kam G, Li J, Choi CH, Tsang MW, Chan N, Lee KK, Chan KW. Clinical considerations when adding a sodium-glucose co-transporter-2 inhibitor to insulin therapy in patients with diabetes mellitus. Hong Kong Med J 2019; 25:312-319. [PMID: 31416990 DOI: 10.12809/hkmj197802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- K Tan
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - W S Chow
- Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
| | - J Leung
- Department of Integrated Medical Service, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong
| | - A Ho
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - R Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - G Kam
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
| | - J Li
- Department of Medicine, Yan Chai Hospital, Tsuen Wan, Hong Kong
| | - C H Choi
- Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - M W Tsang
- Specialist in Endocrinology, Private Practice
| | - N Chan
- Specialist in Endocrinology, Private Practice
| | - K K Lee
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - K W Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong
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Xiu D, Fung YL, Lau BHP, Wong DFK, Chan CHY, Ho RTH, So TH, Lam TC, Lee VHF, Lee AWM, Chow SF, Lim FM, Tsang MW, Chan CLW, Chow AYM. Comparing dyadic cognitive behavioral therapy (CBT) with dyadic integrative body-mind-spirit intervention (I-BMS) for Chinese family caregivers of lung cancer patients: a randomized controlled trial. Support Care Cancer 2019; 28:1523-1533. [PMID: 31280363 DOI: 10.1007/s00520-019-04974-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/14/2019] [Accepted: 06/28/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The study adopted a randomized controlled trial to compare the effect of culturally compatible psychosocial interventions on multiple aspects of quality of life (QoL) for family caregivers of lung cancer patients. METHODS 157 Chinese informal caregivers of lung cancer patients were recruited together with the family members for whom they were providing care, and randomly assigned to either integrative body-mind-spirit intervention (I-BMS) or cognitive behavioral therapy (CBT). Patient-caregiver dyads attended the same arm of intervention in separate groups for 8 weeks. Assessments of generic QoL, anxiety, depression, perceived stress, insomnia, and caregiving burden were measured before intervention (T0), within 1-week (T1), 8-week (T2), and 16-week (T3) post-intervention. RESULTS Adopting the intention-to-treat analysis, family caregivers in receipt of both I-BMS and CBT exhibited a statistically significant improvement in generic QoL immediately following intervention and at follow-up assessments, with moderate effect size. Improvement of insomnia was found at T1 for both modes, which deteriorated at follow-up; both modes reduced anxiety and perceived stress at follow-up. No intervention effect was observed in depression and domains of caregiving burden. There was no significant interaction effect between intervention type and time. No main or interaction effect between sample background variables and intervention type was found to predict symptomatic changes at T1 and T3. CONCLUSIONS Culturally attuned I-BMS and CBT exhibited equivalent effectiveness in improving psychological distress and generic QoL for family caregivers of lung cancer patients. To improve the evaluation of outcomes, future study could benefit from incorporating a usual care control.
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Affiliation(s)
- Daiming Xiu
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yat-Lui Fung
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Bobo Hi-Po Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Daniel F K Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Celia H Y Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Rainbow T H Ho
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz-Him So
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tai-Chung Lam
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Victor Ho-Fun Lee
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Anne W M Lee
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | - Cecilia L W Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong.
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Ko GTC, Yeung CY, Leung WYS, Chan KW, Chung CH, Fung LM, Ip TP, Kum G, Lau KP, Lau IT, Li JKY, Siu SC, Tsang MW, Yeung VTF, Tong PCY, So WY, Chan JCN. Cost implication of team-based structured versus usual care for type 2 diabetic patients with chronic renal disease. Hong Kong Med J 2011; 17 Suppl 6:9-12. [PMID: 22147352] [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: 05/31/2023] Open
Affiliation(s)
- G T C Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Abstract
OBJECTIVE Hong Kong (HK) is a special administrative region of China as well as being a metropolitan city. In HK, like in many developed countries, Diabetes mellitus, with over 97% of diabetic patients having Type 2 Diabetes mellitus (Type 2 DM), is a growing public health problem but the local financial burden has never been investigated. The primary objectives of this study were to evaluate from the social perspective the costs of Type 2 DM, to identify the major cost drivers, and the proportion of the burden shared by the government, patient and the society. The study was carried out in a group of Hong Kong Chinese patients attending a government hospital. The economic impact of Type 2 DM on local and governmental healthcare expenditure was also examined. METHODS A retrospective cohort observational study was conducted in Type 2 DM patients attending the Diabetes Mellitus Outpatient Clinic at a public hospital in the period January 2004 to May 2004, in which 204 patients were randomly selected and invited to join this study. A total of 147 patients were subsequently enrolled giving an inclusion rate of 72%. RESULTS Annual total cost of Type 2 DM in a patient was US$ 1,725 +/- 2,044 (HK$ 13,457 +/- 15,943) with direct costs accounting for > 87.9%. The government was the major payer with over 78.4% of the total costs. Annual total direct medical costs per patient were US$ 1,492 +/- 1,716 (HK$ 11,638 +/- 13,386) of which the government paid 90.6%. Direct medical costs increased markedly if complications were present. In patients with microvascular or macrovascular complications only, the costs increased 1.1-fold compared to those for patients without complications. If both microvascular and macrovascular complications were present in the same patient, the costs were 1.3-fold higher than in patients without complications. CONCLUSION Costs of Type 2 DM have a significant impact on the local healthcare budget. It contributed in 2004 up to 3.9% of the total HK healthcare expenditure and 6.4% of the HK Hospital Authority's (public sector) expenditures on health.
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Affiliation(s)
- B S W Chan
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Tsang MW, Chu CL, Kam YW, Kwong KH, Lam CK, Ngan SY, Yu YK. Characterising atherothrombosis in Hong Kong: results of the Hong Kong data from a global atherothrombosis epidemiological survey. Hong Kong Med J 2005; 11:36-41. [PMID: 15687514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVES To describe the characteristics of patients in Hong Kong with or at risk of atherothrombosis, to determine the proportion of symptomatic patients with more than one vascular bed affected, and to assess the relationship between ankle brachial index and disease severity. DESIGN Local participation in an international prevalence study. SETTING Five centres in Hong Kong. PARTICIPANTS A total of 210 subjects were recruited (105 women and 105 men). Patients were divided into the symptomatic group (with current or previous atherothrombotic symptoms, n=101) and at-risk group (with no current or previous symptoms, but aged over 55 years with at least two specified risk factors, n=109). MAIN OUTCOME MEASURES Patient characteristics were described, including the number of arterial beds affected, ankle brachial index, presence of risk factors, and medications taken. RESULTS Of the symptomatic patients, 30% had more than one arterial bed involved. A total of 55.4% of the symptomatic group and 18.4% of the at-risk group had abnormal ankle brachial index values. Lower ankle brachial indices were associated with a greater number of affected arterial beds. Diabetes mellitus and hypertension were the most prevalent risk factors in the at-risk group. Symptomatic patients were commonly treated with antihypertensive and antiplatelet agents, whereas at-risk patients were mostly treated with antihypertensive and antidiabetic agents. Only 20% of at-risk patients were taking antiplatelet agents. CONCLUSIONS Ankle brachial index is a useful tool for predicting those at risk of atherothrombosis. This simple measurement can be used as part of the screening process in the general practice. The role of antiplatelet agents in primary prevention of atherothrombotic events in at-risk patients deserves further attention.
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Affiliation(s)
- M W Tsang
- Diabetes Ambulatory Care Centre, Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
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Affiliation(s)
- R C W Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.
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Leung GPH, Cheung KH, Leung CT, Tsang MW, Wong PYD. Regulation of epididymal principal cell functions by basal cells: role of transient receptor potential (Trp) proteins and cyclooxygenase-1 (COX-1). Mol Cell Endocrinol 2004; 216:5-13. [PMID: 15109739 DOI: 10.1016/j.mce.2003.10.077] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The epithelia lining the epididymides of many species including the human are known to consist of several cell types. Among them, the principal cells are the most abundant and their functions most extensively studied. There are other cell types such as the narrow cells, clear cells, halo cells and basal cells which are scattered along the duct in lesser number. Although these minority cell types have not been studied to the same extent as the principal cells, it is conceivable that their presence are essential to the integrated functions of the epididymis. In the intact epididymis, basal cells can be seen adhering to the basement membrane forming close contact with the principal cells above them. Work in our laboratory has provided evidence that through local formation of prostaglandins, basal cells may regulate electrolyte and water transport by the principal cells. This regulatory process involves two proteins which are exclusively expressed by the basal cells. They are the transient receptor potential (Trp) proteins, which serve as transmembrane pathways for Ca(2+) influx, and cyclooxygenase 1 (COX-1), a key enzyme in the formation of prostaglandins. The role of the two proteins in the integrated functions of the basal cells as humoral regulators of principal cells is discussed.
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Affiliation(s)
- G P H Leung
- Department of Physiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., China
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Tsang MW, Mok M, Kam G, Jung M, Tang A, Chan U, Chu CM, Li I, Chan J. Improvement in diabetes control with a monitoring system based on a hand-held, touch-screen electronic diary. J Telemed Telecare 2001; 7:47-50. [PMID: 11265938 DOI: 10.1258/1357633011936138] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a six-month prospective interventional crossover study examining a computerized diabetes monitoring system (DMS) that conveyed dietary information. The objectives were to compare glycaemic control between intervention and control periods, and to assess patients' acceptance of the DMS. Nineteen patients were randomized into two groups, each using the DMS for three months and serving as the control group for another three months. The patients recorded information about their meal portions and blood glucose readings in a hand-held electronic diary. After transmitting the data to the DMS through a telephone modem, the patients received immediate feedback about the carbohydrate, protein and fat content of the meal, as well as the calorie content. A significant improvement in glycaemic control was achieved during intervention compared with control periods (mean HbA1C reduction of 0.825%). The DMS was also highly acceptable: 95% patients found it easy to operate while 63% found it useful. The DMS was thus a feasible model of telemedicine in diabetes care and a larger study is warranted to examine its cost-effectiveness.
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Affiliation(s)
- M W Tsang
- Diabetes Team, United Christian Hospital, Hong Kong, China.
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Lam CW, Yang T, Tsang MW, Pang CP. Homoplasmic 3316G-->A in the ND1 gene of the mitochondrial genome: a pathogenic mutation or a neutral polymorphism? J Med Genet 2001; 38:E10. [PMID: 11238687 PMCID: PMC1734818 DOI: 10.1136/jmg.38.3.e10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yang T, Lam CW, Tsang MW, Tong SF, Chan LY, Kam GY, Poon PM, Wu XQ, Pang CP. Novel single nucleotide polymorphisms (3203A>G and 3204C>T) in the 3' end of the mitochondrial 16S rRNA gene. Hum Mutat 2000; 16:375. [PMID: 11013458 DOI: 10.1002/1098-1004(200010)16:4<375::aid-humu20>3.0.co;2-f] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- T Yang
- Department of Chemical Pathology, The Chinese University of Hong Kong
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Yung BC, Loke TK, Tse TW, Tsang MW, Chan JC. Sporadic bilateral adrenal medullary hyperplasia: apparent false positive MIBG scan and expected MRI findings. Eur J Radiol 2000; 36:28-31. [PMID: 10996755 DOI: 10.1016/s0720-048x(99)00166-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adrenal medullary hyperplasia is a rare cause of clinical symptoms and biochemical findings identical to pheochromocytoma occurring mostly in multiple endocrine neoplasia patients. The scenario of positive MIBG scan, but no focal lesion found on CT and MRI led to diagnostic and management difficulties. Like pheochromocytoma, surgical excision can lead to clinical and biochemical recovery. We report this unusual case of sporadic bilateral adrenal medullary hyperplasia, with hypertension and biochemical abnormalities alleviated after surgical adrenalectomy. Based on T2 values reported in literature, high signal focal lesions may not appear on T2-weighted MRI images until development of frank pheochromocytoma. MIBG scan remains the most sensitive imaging modality for this condition.
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Affiliation(s)
- B C Yung
- Department of Radiology and Organ Imaging, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
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Jung M, Chan U, Mok M, Tsang MW. Telemedicine in diabetes: Communication of dietary data using a hand-held electronic diary to dial into a central server. J Telemed Telecare 2000. [DOI: 10.1258/1357633001934005] [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: 11/18/2022]
Affiliation(s)
- May Jung
- Dietetic Department, United Christian Hospital
| | - Una Chan
- Dietetic Department, United Christian Hospital
| | - Maisy Mok
- Diabetes Team, Department of Medicine, United Christian Hospital, Hong Kong, China
| | - M W Tsang
- Diabetes Team, Department of Medicine, United Christian Hospital, Hong Kong, China
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Abstract
OBJECTIVE To determine the efficacy of acarbose, compared with placebo, on the metabolic control of NIDDM patients inadequately controlled on maximal doses of conventional oral agents. RESEARCH DESIGN AND METHODS In this three-center double-blind study, 90 Chinese NIDDM patients with persistent poor glycemic control despite maximal doses of sulfonylurea and metformin were randomly assigned to receive additional treatment with acarbose 100 mg thrice daily or placebo for 24 weeks, after 6 weeks of dietary reinforcement. Efficacy was assessed by changes in HbA1c, fasting and 1-h postprandial plasma glucose and insulin levels, and fasting lipid levels. RESULTS Acarbose treatment was associated with significantly greater reductions in HbA1c (-0.5 +/- 0.2% vs. placebo 0.1 +/- 0.2% [means +/- SEM], P = 0.038), 1-h postprandial glucose (-2.3 +/- 0.4 mmol/l vs. placebo 0.7 +/- 0.4 mmol/l, P < 0.001) and body weight (-0.54 +/- 0.32 kg vs. placebo 0.42 +/- 0.29 kg, P < 0.05). There was no significant difference between the two groups regarding changes in fasting plasma glucose and lipids or fasting and postprandial insulin levels. Flatulence was the most common side effect (acarbose vs. placebo: 28/45 vs. 11/44, P < 0.05). One patient on acarbose had asymptomatic elevations in serum transaminases that normalized in 4 weeks after acarbose withdrawal. Another patient on acarbose developed severe hypoglycemia; glycemic control was subsequently maintained on half the baseline dosage of sulfonylurea. CONCLUSIONS In NIDDM patients inadequately controlled on conventional oral agents, acarbose in moderate doses resulted in beneficial effects on glycemic control, especially postprandial glycemia, and mean body weight. Additional use of acarbose can be considered as a useful alternative in such patients if they are reluctant to accept insulin therapy.
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Affiliation(s)
- K S Lam
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
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Tsang MW, Shader RI, Greenblatt DJ. Metabolism of haloperidol: clinical implications and unanswered questions. J Clin Psychopharmacol 1994; 14:159-62. [PMID: 8027411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Zhang G, Sato JD, Herley MT, Tsang MW, Ye H, Liu H, Ichimura T, Yan G, McKeehan WL, Stevens JL. Stable and temperature-sensitive transformation of rat kidney epithelial cells suppresses expression of acidic fibroblast growth factor 1 but activates secretion of fibroblast growth factor 3 (int-2) and vascular endothelial growth factor. Cell Growth Differ 1994; 5:349-357. [PMID: 7519042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Rat kidney proximal tubule epithelial cells (RPTE) in primary culture express acidic fibroblast growth factor 1 (FGF-1). Transformation of RPTE by SV40 (SV-RPTE) suppressed FGF-1 expression but activated secretion of FGF-like factor(s). SV-RPTE conditioned medium contained growth-promoting activity for SV-RPTE and human umbilical vein endothelial cells, indicating that both autocrine and angiogenic factors were secreted. Reverse transcriptase-polymerase chain reaction and Northern analysis for various FGFs showed that only FGF-3, also known as int-2, mRNA was expressed in SV-RPTE. In addition, expression of mRNA for the heparin-binding angiogenic factor vascular endothelial growth factor (VEGF) increased dramatically in SV-RPTE. Physical characterization of the activity in the SV-RPTE conditioned medium suggested that FGF-3 and VEGF contributed the autocrine and angiogenic activities, respectively. We also investigated FGF-3 and VEGF secretion in temperature-sensitive (ts) SV40-transformed RPTE. tsSV-RPTE had transformed properties resembling those of SV-RPTE only at the permissive temperature (33 degrees C), e.g., increased growth potential and anchorage-independent growth. FGF-1 was expressed only at the nonpermissive temperature. VEGF mRNA levels and secretion of the human umbilical vein endothelial cell growth-promoting activity were reduced by switching tsSV-RPTE cells from 33 degrees to 39 degrees C. However, FGF-3 mRNA levels were not affected significantly by the temperature switch suggesting that activation of VEGF and FGF-3 occurs through different mechanisms. These results indicate that FGF-1 expression in RPTE is suppressed by SV40 transformation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Zhang
- W. Alton Jones Cell Science Center, Lake Placid, New York 12946
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