Publications by authors named "Alfred Wong"

34 Publications

Using an economic evaluation approach to support specialist nursing services for people with Parkinson's in a regional community.

J Adv Nurs 2021 Jun 12. Epub 2021 Jun 12.

Charles Sturt University, School of Nursing, Midwifery and Indigenous Health, Orange, New South Wales, Australia.

Aim: This study aims to provide economic evidence of the cost-effectiveness of employing specialist Parkinson's nurses in a regional community in Australia.

Study Design: This retrospective study utilized hospital service usage data to compare outcomes for people with Parkinson's disease before and after the employment of a specialist Parkinson's nurse in a regional community.

Methods: A representative sample was drawn from the target population of people with a diagnosis of Parkinson's admitted to a regional hospital over a 4-year period (2013-2014 and 2016-2017). A multiple regression approach and cost-benefit analysis were used to examine hospital costs related to length of stay based on hospital records. All costs were attributed to resource allocation according to service category and the national funding system. Quantitative data were analysed using Strata Analytics.

Results: Statistical findings demonstrated a reduction in hospital length of stay ranging from 0.37 (AUD$1924) to 0.755 day (AUD$3926) after the establishment of the specialist Parkinson's nurse. The cost-benefit analysis showed a net dollar benefit, or savings in hospital costs, of up to $8600.00 per person over a 3-year period, as a result of the specialist Parkinson's nurse intervention.

Conclusion: The statistical results show significant cost benefits associated with reduced length of hospital stay following introduction of the specialist Parkinson's nurse. These findings support advocacy for sustainable specialist Parkinson's nurse positions and have the potential to inform and influence policy and systemic changes within the health care system.

Impact: The benefits of embedding specialist nursing services for people with Parkinson's disease in primary health settings include the direct impact on the potential to avoid hospital admissions due to worsening symptoms, improving quality of life for the person with Parkinson's and slowing the trajectory of the disease. Additional benefits are increased access to specialist services and reduced family caregiver burden.
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http://dx.doi.org/10.1111/jan.14920DOI Listing
June 2021

Short-term mechanical circulatory support (intra-aortic balloon pump, Impella, extracorporeal membrane oxygenation, TandemHeart): a review.

Ann Transl Med 2020 Jul;8(13):829

Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China.

Cardiogenic shock remains a major cause of morbidity and mortality for patients with acute myocardial infarction and advanced heart failure. Intra-aortic balloon pump has been the most widely used short-term mechanical circulatory support device to rapidly stabilize hemodynamics. However, it provides modest support, current evidence does not show a decrease in mortality, and the latest guidelines no longer recommend its routine use. Several percutaneous mechanical circulatory support devices have been introduced into clinical practice (Impella, extracorporeal membrane oxygen, TandemHeart), providing a greater level of hemodynamic support. These resource-intensive devices demand a careful selection of patients that stand to benefit the most. Premature initiation of mechanical circulatory support exposes the patient to unnecessary risk, whereas delaying therapy leads to irreversible end-organ injury, rendering any intervention medically futile. Cannulation methods, pump designs, and circuit configurations differ between devices, as do the adverse effects and physiological impact on the myocardium, which needs to be factored into consideration before deployment on the patient in cardiogenic shock. This article will review the commonly used percutaneous mechanical circulatory support devices in the setting of cardiogenic shock, compare their advantages and disadvantages, evaluate key clinical trials, and discuss a practical approach to guide clinicians' decision and management.
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http://dx.doi.org/10.21037/atm-20-2171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396256PMC
July 2020

The kinase IRAK4 promotes endosomal TLR and immune complex signaling in B cells and plasmacytoid dendritic cells.

Sci Signal 2020 06 2;13(634). Epub 2020 Jun 2.

Research, Genentech, 1 DNA Way, South San Francisco, CA 94080, USA.

The dysregulation of multiple signaling pathways, including those through endosomal Toll-like receptors (TLRs), Fc gamma receptors (FcγR), and antigen receptors in B cells (BCR), promote an autoinflammatory loop in systemic lupus erythematosus (SLE). Here, we used selective small-molecule inhibitors to assess the regulatory roles of interleukin-1 receptor (IL-1R)-associated kinase 4 (IRAK4) and Bruton's tyrosine kinase (BTK) in these pathways. The inhibition of IRAK4 repressed SLE immune complex- and TLR7-mediated activation of human plasmacytoid dendritic cells (pDCs). Correspondingly, the expression of interferon (IFN)-responsive genes (IRGs) in cells and in mice was positively regulated by the kinase activity of IRAK4. Both IRAK4 and BTK inhibition reduced the TLR7-mediated differentiation of human memory B cells into plasmablasts. TLR7-dependent inflammatory responses were differentially regulated by IRAK4 and BTK by cell type: In pDCs, IRAK4 positively regulated NF-κB and MAPK signaling, whereas in B cells, NF-κB and MAPK pathways were regulated by both BTK and IRAK4. In the pristane-induced lupus mouse model, inhibition of IRAK4 reduced the expression of IRGs during disease onset. Mice engineered to express kinase-deficient IRAK4 were protected from both chemical (pristane-induced) and genetic (NZB/W_F1 hybrid) models of lupus development. Our findings suggest that kinase inhibitors of IRAK4 might be a therapeutic in patients with SLE.
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http://dx.doi.org/10.1126/scisignal.aaz1053DOI Listing
June 2020

Complexities and Challenges of Singapore Nurses Providing Postacute Home Care in Multicultural Communities: A Grounded Theory Study.

J Transcult Nurs 2018 Sep 23;29(5):402-409. Epub 2017 Oct 23.

2 Khoo Teck Puat Hospital, Alexandra Health System, Singapore, Singapore.

Introduction: Studies are needed to inform the preparation of community nurses to address patient behavioral and social factors contributing to unnecessary readmissions to hospital. This study uses nurses' input to understand challenges faced during home care, to derive a framework to address the challenges.

Methods: Semistructured interviews were conducted to saturation with 16 community nurses in Singapore. Interviews were transcribed verbatim and transcripts independently coded for emergent themes. Themes were interpreted using grounded theory.

Results: Seven major themes emerged from 16 interviews: Strained social relationships, complex care decision-making processes within families, communication barriers, patient's or caregiver neglect of health issues, building and maintaining trust, trial-and-error nature of work, and dealing with uncertainty.

Discussion: Community nurses identified uncertainty arising from complexities in social-relational, personal, and organizational factors as a central challenge. Nursing education should focus on navigating and managing uncertainty at the personal, patient, and family levels.
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http://dx.doi.org/10.1177/1043659617736884DOI Listing
September 2018

An anti-CD3/anti-CLL-1 bispecific antibody for the treatment of acute myeloid leukemia.

Blood 2017 02 1;129(5):609-618. Epub 2016 Dec 1.

Research and Early Development, Genentech, South San Francisco, CA.

Acute myeloid leukemia (AML) is a major unmet medical need. Most patients have poor long-term survival, and treatment has not significantly changed in 40 years. Recently, bispecific antibodies that redirect the cytotoxic activity of effector T cells by binding to CD3, the signaling component of the T-cell receptor, and a tumor target have shown clinical activity. Notably, blinatumomab is approved to treat relapsed/refractory acute lymphoid leukemia. Here we describe the design, discovery, pharmacologic activity, pharmacokinetics, and safety of a CD3 T cell-dependent bispecific (TDB) full-length human IgG1 therapeutic antibody targeting CLL-1 that could potentially be used in humans to treat AML. CLL-1 is prevalent in AML and, unlike other targets such as CD33 and CD123, is not expressed on hematopoietic stem cells providing potential hematopoietic recovery. We selected a high-affinity monkey cross-reactive anti-CLL-1 arm and tested several anti-CD3 arms that varied in affinity, and determined that the high-affinity CD3 arms were up to 100-fold more potent in vitro. However, in mouse models, the efficacy differences were less pronounced, probably because of prolonged exposure to TDB found with lower-affinity CD3 TDBs. In monkeys, assessment of safety and target cell depletion by the high- and low-affinity TDBs revealed that only the low-affinity CD3/CLL1 TDB was well tolerated and able to deplete target cells. Our data suggest that an appropriately engineered CLL-1 TDB could be effective in the treatment of AML.
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http://dx.doi.org/10.1182/blood-2016-08-735365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290988PMC
February 2017

Depressive Symptoms and Orthostatic Hypotension Are Risk Factors for Unexplained Falls in Community-Living Older People.

J Am Geriatr Soc 2016 05;64(5):1073-8

Neuroscience Research Australia, University of New South Wales, Sydney, Australia.

Objectives: To investigate risk factors for unexplained falls in older community-dwelling individuals.

Design: Prospective cohort study.

Setting: Community population, Sydney, Australia.

Participants: Older adults (N = 529; mean age 79.8 ± 4.4, 52.2% female).

Measurements: Participants provided information demographic, medical, and medication characteristics and completed cardiovascular (tilt table test, pulse wave velocity), cognitive, and sensorimotor assessments at baseline. Falls were then recorded in monthly fall diaries for 12 months. Unexplained fallers (UFs) were those who reported falls due to a blackout, dizziness, feeling faint, or "found themselves suddenly on the ground."

Results: Of the 523 participants available at follow-up, 238 (45.5%) reported one or more falls; 35 participants fulfilled the definition of UFs. UFs were more likely than balance-related fallers (BFs) (n = 203) and nonfallers (n = 291) to have orthostatic hypotension (39.4%, 20.5% and 22.4%, respectively) and depressive symptoms (24.2%, 10.1%, and 7.9% respectively). More UFs (88.6%) than BFs (70.9%) had injurious falls. A multivariate logistic regression model revealed that depressive symptoms and orthostatic hypotension were significant and independent determinants of UF status.

Conclusion: Approximately 15% of fallers had unexplained falls, which were more likely to result in injuries. Depressive symptoms and orthostatic hypotension increased the risk of unexplained falls, whereas cognitive deficits and sensorimotor and balance impairments did not. Future research should investigate whether psychotherapy and physical exercise to improve mood and medication reviews and nonpharmacological therapies for the treatment of orthostatic hypotension and depression are effective at reducing the risk of unexplained falls in older people.
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http://dx.doi.org/10.1111/jgs.14104DOI Listing
May 2016

The colorectal surgeon's liposarcoma.

ANZ J Surg 2018 Jul-Aug;88(7-8):E621-E622. Epub 2016 Mar 8.

Colorectal Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia.

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http://dx.doi.org/10.1111/ans.13530DOI Listing
March 2016

High arterial pulse wave velocity is a risk factor for falls in community-dwelling older people.

J Am Geriatr Soc 2014 Aug 15;62(8):1534-9. Epub 2014 Jul 15.

Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia.

Objectives: To examine whether arterial stiffness is a risk factor for falls in community-dwelling older people.

Design: Prospective cohort study.

Setting: Community population, Sydney, Australia.

Participants: Community-dwelling older adults (mean age 79.8±4.4, 52.2% female; N=481).

Measurements: Carotid-femoral pulse wave velocity (PWV) was measured in the supine position after lying for 10 minutes. Demographic, medical, and medication characteristics and levels of physical activity were obtained in clinical interviews and questionnaires, and falls were recorded with monthly falls diaries for 12 months.

Results: Participants in the top quintile of PWV (high PWV) were more likely to have higher seated systolic blood pressure (SBP) and heart rate, unsatisfactory control of blood pressure, diabetes mellitus, and lower physical activity levels. These participants were also more likely to be male and taking cardiovascular medications. Of the 473 participants available for follow-up, 212 (44.8%) reported one or more falls. In modified Poisson regression analyses, high PWV was a risk factor for falls (relative risk=1.37, 95% confidence interval=1.06-1.78) after adjusting for use of psychotropic and cardiovascular medications, age, sex, body mass index, seated SBP, heart rate, and diabetes status.

Conclusion: In community-dwelling older people, high PWV (as a measure of arterial stiffness) was a risk factor for falls after adjusting for potential demographic, anthropometric, disease, and medication confounders. Further research is required to investigate mediators for this association and the effect of lowering arterial stiffness on falls in older people.
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http://dx.doi.org/10.1111/jgs.12931DOI Listing
August 2014

Angiotensin system-blocking medications are associated with fewer falls over 12 months in community-dwelling older people.

J Am Geriatr Soc 2013 May 30;61(5):776-81. Epub 2013 Apr 30.

Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.

Objectives: To investigate relationships between the use of cardiovascular medications, including angiotensin system-blocking medications (ASBMs), orthostatic hypotension (OH), fall risk, and falls in community-dwelling older people.

Design: Prospective cohort study.

Setting: Sydney, Australia.

Participants: Five hundred twenty community-dwelling older adults.

Measurements: Medical, medication and falls history were obtained from a standardized questionnaire in all participants. Blood pressure was measured in supine, seated, and tilted positions. Fall risk was assessed using the Physiological Profile Assessment (PPA). Falls data were collected prospectively for 12 months using monthly fall calendars. Participants were defined as nonfallers (no falls) and fallers (≥ 1 falls) at the end of the 12-month follow-up.

Results: Participants taking medications affecting the angiotensin system had greater quadriceps strength, but after adjusting for sex, this difference became insignificant. People taking ASBMs were less likely to fall (odds ratio = 0.68, 95% confidence interval = 0.48-0.97), and the association between ASBMs and falls remained significant after adjusting for sex, body mass index, PPA score, and psychotropic medication and 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitor (statin) use. OH was more frequently observed in participants taking alpha adrenergic receptor blockers (α-blockers), but the presence of OH did not increase fall risk.

Conclusion: The use of cardiovascular medications in older people did not increase the risk of falls, and the use of ASBMs was associated with lower fall risk. The mechanisms for this apparent protective effect are unclear and appear not to be directly related to muscle strength. More research is required to elucidate the possible protective effects of certain cardiovascular medications in relation to falls in older people.
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http://dx.doi.org/10.1111/jgs.12205DOI Listing
May 2013

Pain and anxiety mediate the relationship between dizziness and falls in older people.

J Am Geriatr Soc 2013 Mar 25;61(3):423-8. Epub 2013 Jan 25.

Falls and Balance Research Group, Neuroscience Research Australia, Randwick, New South Wales, Australia.

Objectives: To identify medical, psychological, and physiological mediators of the relationship between dizziness and falls in older adults.

Design: Secondary analysis of a prospective cohort study.

Setting: Community.

Participants: Five hundred sixteen community-dwelling adults aged 73 to 92.

Measurements: Participants completed questionnaires related to health and psychological well-being and underwent a tilt table blood pressure test, the Physiological Profile Assessment (PPA; vision, reaction time, proprioception, postural sway, and quadriceps strength), and leaning balance tests. Prospective falls data were collected using monthly calendars for 12 months. Participants were categorized into dizzy and nondizzy groups based on self-report of dizziness, vertigo, and light-headedness.

Results: Two hundred seventeen (42%) participants reported vertigo or dizziness (10%), light-headedness (16%), or both (16%). The dizzy participants were significantly more likely to report neck and back pain, past transient ischemic attacks, and feeling dizzy upon upright tilting. They also had poorer balance and less strength and scored higher on measures of depression and anxiety (P < .05). There were no blood pressure measurement-related differences between the groups. Dizziness increased the risk of multiple falls in an unadjusted analysis (relative risk (RR) = 1.55, 95% confidence interval = 1.08-2.23). After controlling for PPA scores, neck and back pain and anxiety were mediators that reduced the RR of the relationship between dizziness and faller status the most (14%) in a modified Poisson regression model.

Conclusion: Suffering from neck and back pain and anxiety were mediators of the relationship between dizziness and falls after controlling for poor sensorimotor function and balance. Older people with dizziness might benefit from interventions targeting these mediators such as pain management and cognitive behavioral therapy.
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http://dx.doi.org/10.1111/jgs.12131DOI Listing
March 2013

Falls incidence, risk factors, and consequences in Chinese older people: a systematic review.

J Am Geriatr Soc 2011 Mar 1;59(3):536-43. Epub 2011 Mar 1.

Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, Australia.

Falls incidence in Chinese older people has been reported to be approximately half that of Caucasian populations. It is possible that the falls risk factor profile may differ significantly between Caucasian and Chinese populations, and a better understanding of this reported difference in incidence and associated risk factors may influence potential approaches to future intervention. A systematic literature review was conducted using the EMBase, Medline, Chinese Electronic Periodical Services, and WanFangdata databases to collate and evaluate the studies that have addressed the incidence and risk factors for falls in Chinese older people. Twenty-one studies conducted in China, Hong Kong, Macao, Singapore, and Taiwan met the inclusion criteria. Fall rates ranged between 14.7% and 34% per annum (median 18%). In the four prospective studies, injuries were reported by 60% to 75% of those reporting falls, with fractures constituting 6% to 8% of all injuries. One hundred thirty-two variables were identified as fall risk factors, with commonly reported factors being female sex, older age, use of multiple medications, gait instability, fear of falling, and decline in activities of daily living. The findings reveal a consistently lower incidence of self-reported falls in Chinese older people than in Caucasian older people, although the types and prevalence of risk factors were not dissimilar from those found in studies of Caucasian older people. A greater understanding of the health, behavioral, and lifestyle factors that influence fall rates in Chinese populations is required for elucidating fall prevention strategies in Chinese and non-Chinese older people.
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http://dx.doi.org/10.1111/j.1532-5415.2010.03286.xDOI Listing
March 2011

Preoperative capecitabine and pelvic radiation in locally advanced rectal cancer--is it equivalent to 5-FU infusion plus leucovorin and radiotherapy?

Int J Radiat Oncol Biol Phys 2010 Apr;76(5):1413-9

Department of Radiation Oncology, Tom Baker Cancer Centre, Alberta, Canada.

Purpose: The aim of this retrospective case-matching study was to compare the treatment outcomes and acute toxicity of preoperative radiotherapy (RT) with capecitabine vs. preoperative RT with intermittent 5-fluorouracil (5-FU) infusion, leucovorin, and mitomycin C in rectal cancer.

Methods And Materials: We matched 34 patients who were treated with preoperative concurrent capecitabine and 50 Gy of RT by their clinical T stage (T3 or T4) and the tumor location (7 cm from the anal verge) with another 68 patients who were treated with preoperative intermittent 5-FU infusion, leucovorin, mitomycin C, and 50 Gy of RT for a comparison of the pathologic tumor response, local control, distant failure, and survival rates.

Results: The pathologic complete response rate was 21% with capecitabine and 18% with 5-FU and leucovorin (p = 0.72). The rate of T downstaging after chemoradiation was 59% for both groups. The rate of sphincter-sparing resection was 38% after capecitabine plus RT and 43% after 5-FU plus RT (p = 0.67). At 3 years, there was no significant difference in the local control rate (93% for capecitabine and 92% for 5-FU and leucovorin), relapse-free rate (74% for capecitabine and 73% for 5-FU and leucovorin), or disease-specific survival rate (86% for capecitabine and 77% for 5-FU and leucovorin). The acute toxicity profile was comparable, with little Grade 3 and 4 toxicity.

Conclusions: When administered with concurrent preoperative RT, both capecitabine and intermittent 5-FU infusion with leucovorin modulation provided comparable pathologic tumor response, local control, relapse-free survival, and disease-specific survival rates in rectal cancer.
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http://dx.doi.org/10.1016/j.ijrobp.2009.03.048DOI Listing
April 2010

Bioactive properties of wood knot extracts on cultured human cells.

J Med Food 2009 Dec;12(6):1245-51

Department of Food and Nutritional Sciences, University College Cork, Cork, Ireland.

Not all felled wood is converted to timber or pulp, with the remaining material being a rich source of relatively unexplored and unexploited potentially novel bioactive compounds. Therefore the potential bioactive effects of two softwood knot (the part of the branch encased in the tree stem) extracts--namely, Pinus banksiana Lamb. (Jack pine) and Picea sitchensis (Bong.) Carr. (Sitka spruce)--were investigated by (1) determining their effects on the viability and antioxidant status of human Jurkat T cells, (2) investigating potential cytoprotective and genoprotective effects against oxidative stress in cultured cells, and (3) assessing their effects on concanavalin A (ConA)-induced interleukin-2 (IL-2) production. Initially, both Jack pine knot and Sitka spruce knot extracts were shown to possess strong antioxidant activity as determined by the ferric reducing antioxidant power assay. When added to Jurkat cells, Jack pine knot extract was more toxic compared with Sitka spruce knot extract, with concentrations that resulted in 50% cell death of 153.0 microg/mL and 376.1 microg/mL, respectively. Supplementation of Jurkat cells with wood knot extracts did not affect their glutathione content or catalase activity. Pretreatment of Jurkat cells with Sitka spruce or Jack pine knot extracts protected against H(2)O(2)-induced cell injury. However, none of the extracts protected against H(2)O(2)-induced DNA damage. Jack pine knots, at a concentration of 30 microg/mL, significantly suppressed ConA-induced IL-2 production. Although total phenol content did not differ between the two extracts, gas chromatography analysis did show variation in the types of constituents present. Further research is warranted to elucidate the selective bioactive properties of these softwood knot extracts.
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http://dx.doi.org/10.1089/jmf.2008.0125DOI Listing
December 2009

Computation lithography: virtual reality and virtual virtuality.

Opt Express 2009 Jul;17(15):12259-68

Imaging Systems Laboratory, Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong.

Computation lithography is enabled by a combination of physical understanding, mathematical abstraction, and implementation simplification. An application in the virtual world of computation lithography can be a virtual reality or a virtual virtuality depending on its engineering sensibleness and technical feasibility. Examples under consideration include design-for-manufacturability and inverse lithography.
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http://dx.doi.org/10.1364/oe.17.012259DOI Listing
July 2009

Oxaliplatin plus irinotecan compared with irinotecan alone as second-line treatment after single-agent fluoropyrimidine therapy for metastatic colorectal carcinoma.

J Clin Oncol 2008 Oct;26(28):4544-50

Abramson Cancer Center at the University of Pennsylvania, 16 Penn Tower, 3400 Spruce St, Philadelphia, PA 19014-4283, USA.

Unlabelled: PURPOSE To determine whether irinotecan plus oxaliplatin (IROX) is superior to irinotecan alone in patients with metastatic colorectal cancer (CRC) previously treated with single-agent fluoropyrimidines. PATIENTS AND METHODS A phase III, randomized, open-label, multicenter study of patients with metastatic or recurrent CRC that had progressed or recurred during or after adjuvant or first-line fluoropyrimidines (fluorouracil/leucovorin or capecitabine, the latter only for metastatic CRC). Patients received IROX (irinotecan 200 mg/m(2) plus oxaliplatin 85 mg/m(2)) or irinotecan alone (350 mg/m(2)) every 3 weeks.

Results: At the data cutoff (when 447 of 628 randomly assigned patients had died), median overall survival was 13.4 months (95% CI, 12.4 to 14.7 months) and 11.1 month (95% CI, 10.0 to 12.7 months) in the IROX and irinotecan groups, respectively (hazard ratio = 0.78; 95% CI, 0.65 to 0.94; P = .0072). Overall response rate (22% v 7%, respectively; P < .0001), median time to progression (5.3 v 2.8 months, respectively; P < .0001), and improvement in tumor-related symptoms (32% v 19%, respectively; P = .0072) were also improved with IROX as compared with irinotecan. With the exception of granulocytopenia (25% v 13%), diarrhea (28% v 23%), and sensory disturbances (5% v 0%), grade 3 to 4 toxicities were comparable between the IROX and irinotecan groups, respectively. CONCLUSION IROX is an effective treatment for metastatic CRC that has progressed after first-line fluoropyrimidine therapy. IROX improves efficacy compared with irinotecan alone, providing an additional option in the postadjuvant or second-line treatment setting for patients who experience treatment failure with single-agent fluoropyrimidine therapy.
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http://dx.doi.org/10.1200/JCO.2008.17.1249DOI Listing
October 2008

Initialization for robust inverse synthesis of phase-shifting masks in optical projection lithography.

Opt Express 2008 Sep;16(19):14746-60

Department of Electrical and Electronic Engineering, Imaging Systems Laboratory, The University of Hong Kong, Pokfulam Road, Hong Kong.

The continuous shrinkage of minimum feature size in integrated circuit (IC) fabrication incurs more and more serious distortion in the optical projection lithography process, generating circuit patterns that deviate significantly from the desired ones. Conventional resolution enhancement techniques (RETs) are facing critical challenges in compensating such increasingly severe distortion. In this paper, we adopt the approach of inverse lithography in the mask design, which is a branch of design methodology to treat it as an inverse mathematical problem. We focus on using pixel-based algorithms to design alternating phase-shifting masks with minimally distorted output, with the goal that the patterns generated should have high contrast and low dose sensitivity. This is achieved with a dynamic-programming-based initialization scheme to pre-assign phases to the layout when alternating phase-shifting masks are used. Pattern fidelity and worst case slopes are shown to improve with this initialization scheme, which are important for robustness considerations.
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http://dx.doi.org/10.1364/oe.16.014746DOI Listing
September 2008

Incident solar radiation and coronary heart disease mortality rates in Europe.

Authors:
Alfred Wong

Eur J Epidemiol 2008 14;23(9):609-14. Epub 2008 Aug 14.

Xymega Corporation, Post Office Box 34173, Vancouver, Canada V6J 4N1.

The reported low mortality rate from coronary heart disease in Portugal, Spain, Italy, Greece, and France, to a lesser extent, has been attributed in numerous nutritional studies to the consumption of a Mediterranean-type diet. There are still many unresolved issues about the direct causal effect of the Mediterranean dietary regime on low incidence of coronary heart disease. An analysis of coronary heart disease mortality rates in Europe from a latitudinal gradient perspective has shown to have a close correlation to incident solar radiation. It is surmised that the resulting increased in situ biosynthesis of Vitamin D(3) could be the critical missing confounder in the analysis of the beneficial health outcome of the Mediterranean diet.
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http://dx.doi.org/10.1007/s10654-008-9274-yDOI Listing
January 2009

GLP-1 and appetite responses to a meal in lean and overweight adolescents following exercise.

Obesity (Silver Spring) 2008 Jan;16(1):202-4

Endocrinology and Diabetes Unit, British Columbia's Children's Hospital, University of British Columbia, Vancouver, Canada.

Objective: Increased physical activity is an integral part of weight loss programs in adolescents. We prospectively investigated the effects of exercise on glucagon-like peptide-1 (GLP-1) concentrations and on appetite markers.

Methods And Procedures: Normal weight (NW) and at risk of overweight/overweight (OW) male adolescents (n = 17/gr) underwent five consecutive days of aerobic exercise (1 h/day). A test meal was administered prior to the first exercise session and 36 hours following the last exercise session. GLP-1 and markers of appetite were assessed.

Results: GLP-1 concentrations over the course of the test meal were lower in OW compared to NW boys (P < 0.05), while fasting GLP-1 concentrations tended to be lower in OW boys (0.05 < P < 0.1). Exercise caused an increase in the acute GLP-1 response to the liquid meal (from 52 to 78%, P = 0.02) that was similar in NW and OW adolescents. OW adolescents expressed greater restraint compared to NW adolescents (three-factor eating questionnaire, TFEQ) and there was a significant correlation between TFEQ for restraint score and BMI s.d. both before and after exercise intervention (P < 0.015). There was no significant correlation between markers of appetite and GLP-1 concentrations.

Discussion: Lower concentrations of GLP-1, a satiety hormone, in OW compared to NW male adolescents support the theory that GLP-1 plays a role in the etiology of overweight. Whether the greater meal-induced, 0-30 min GLP-1 response following exercise is associated with increased satiety, a potentially beneficial effect of exercise, needs to be evaluated in larger studies. Obesity (2008) 16, 202-204. doi:10.1038/oby.2007.39.
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http://dx.doi.org/10.1038/oby.2007.39DOI Listing
January 2008

Regulation of appetite in lean and obese adolescents after exercise: role of acylated and desacyl ghrelin.

J Clin Endocrinol Metab 2007 Feb 21;92(2):648-54. Epub 2006 Nov 21.

Endocrinology and Diabetes Unit, Room K4-212, British Columbia's Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, Canada V6H 3V4.

Context: Increased physical activity is an integral part of weight loss programs in adolescents. We hypothesized that exercise could affect appetite-regulating hormones and the subjective desire to eat, which could partly explain the poor success rate of the existing interventions.

Objective: The objective of this study was to investigate prospectively the effects of exercise on acylated ghrelin (AG) and desacyl ghrelin (DG) concentrations and on appetite.

Setting: The setting for this study was a tertiary care center.

Participants: Normal-weight [NW; body mass index (mean +/- se), 20.7 +/- 0.5 kg/m2] and overweight (OW; body mass index, 32.4 +/- 1.7) male adolescents (n = 17/group, age 15.3 +/- 0.2 yr) were studied.

Intervention: Those studied participated in 5 consecutive days of aerobic exercise (1 h/d).

Main Outcome: Changes in AG and DG concentrations and in appetite during a test meal were studied.

Results: Exercise did not significantly affect insulin sensitivity or body weight. Fasting total (AG and DG) ghrelin concentrations were lower in OW (600 +/- 33 pg/ml) compared with NW (764 +/- 33 pg/ml, P < 0.05) boys and were not affected by exercise. In contrast, there was a differential effect of exercise on both AG and DG (P
Conclusion: Exercise differentially affects AG and DG in NW and OW male adolescents. Our data suggest that total ghrelin does not adequately reflect AG and DG concentrations and that the influence of exercise-induced hormonal changes should be considered to ensure success in weight management.
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http://dx.doi.org/10.1210/jc.2006-1028DOI Listing
February 2007

Obestatin, acylated and total ghrelin concentrations in the perinatal rat pancreas.

Horm Res 2006 29;66(2):81-8. Epub 2006 May 29.

Endocrinology and Diabetes Unit, British Columbia's Children's Hospital, University of British Columbia, Vancouver, Canada.

Background: Ghrelin and obestatin are encoded by the preproghrelin gene and originate from posttranslational processing of the preproghrelin peptide. The fetal rat pancreas contains acylated and desacylated ghrelin peptides, as well as growth hormone secretagogue receptor -1a mRNA. Acylated ghrelin inhibits insulin secretion. We investigated the plasma and tissue ontogeny of ghrelin and obestatin in the rat.

Methods: We measured obestatin and acylated and total ghrelin concentrations in plasma, pancreas and stomach from rat fetuses (F20) and neonates at postnatal day (PN) 1, 6, 12 and 21).

Results: Overall, obestatin concentrations were markedly lower than total ghrelin concentrations. In plasma, total ghrelin concentrations decreased abruptly after birth (p < 0.05), contrasting with a 3 times increase in the concentration of acylated ghrelin between F20 and PN1 (p < 0.05). In pancreas, total ghrelin and obestatin concentrations decreased progressively from PN1 to PN21 but acylated ghrelin concentrations increased 6-7 times from F20 (18 [6] pg/ml) to PN6 (122 [59] pg/ml). The percent of acylated ghrelin increased from 1.8 (0.6) at F20 to 39.7 (13.0) % of total ghrelin immunoreactivity at PN12 (p < 0.05). There were significant positive correlations between postnatal obestatin, acylated or total ghrelin and insulin concentrations in the pancreas (all p < 0.02, r(2) > 0.21) and between postnatal total ghrelin and obestatin (in pancreas, r(2) = 0.37) or acylated ghrelin (in stomach, r(2) = 0.27) (p < 0.001).

Conclusion: Ghrelin and obestatin are present in the perinatal pancreas where they could potentially affect insulin secretion.
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http://dx.doi.org/10.1159/000093585DOI Listing
September 2006

Organizational partnerships in China: self-interest, goal interdependence, and opportunism.

J Appl Psychol 2005 Jul;90(4):782-91

Department of Management, Lingnan University, Hong Kong, China.

Opportunism in organizational partnerships may be understood in terms of how partners conclude that their self-interests are related to each other. When partners believe that their goals are competitively but not cooperatively related, they are tempted to pursue their self-interests opportunistically. Cognitive understandings and values of a shared vision may help partners believe their goals are cooperatively related. Results from 103 pairs of customer and supplier organizations support the argument that partnerships are not inevitably threatened by opportunism. Using structural equation analysis, the authors suggested that shared vision can help partners develop cooperative goals that lead to low levels of opportunism. These results suggest that a shared vision and cooperative goals are important foundations for effective organizational partnerships.
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http://dx.doi.org/10.1037/0021-9010.90.4.782DOI Listing
July 2005

Capecitabine as adjuvant treatment for stage III colon cancer.

N Engl J Med 2005 Jun;352(26):2696-704

University of Leeds and Bradford NHS Hospitals' Trust, Leeds, United Kingdom.

Background: Intravenous bolus fluorouracil plus leucovorin is the standard adjuvant treatment for colon cancer. The oral fluoropyrimidine capecitabine is an established alternative to bolus fluorouracil plus leucovorin as first-line treatment for metastatic colorectal cancer. We evaluated capecitabine in the adjuvant setting.

Methods: We randomly assigned a total of 1987 patients with resected stage III colon cancer to receive either oral capecitabine (1004 patients) or bolus fluorouracil plus leucovorin (Mayo Clinic regimen; 983 patients) over a period of 24 weeks. The primary efficacy end point was at least equivalence in disease-free survival; the primary safety end point was the incidence of grade 3 or 4 toxic effects due to fluoropyrimidines.

Results: Disease-free survival in the capecitabine group was at least equivalent to that in the fluorouracil-plus-leucovorin group (in the intention-to-treat analysis, P<0.001 for the comparison of the upper limit of the hazard ratio with the noninferiority margin of 1.20). Capecitabine improved relapse-free survival (hazard ratio, 0.86; 95 percent confidence interval, 0.74 to 0.99; P=0.04) and was associated with significantly fewer adverse events than fluorouracil plus leucovorin (P<0.001).

Conclusions: Oral capecitabine is an effective alternative to intravenous fluorouracil plus leucovorin in the adjuvant treatment of colon cancer.
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http://dx.doi.org/10.1056/NEJMoa043116DOI Listing
June 2005

Ghrelin is suppressed by glucagon and does not mediate glucagon-related growth hormone release.

Horm Res 2005 17;63(3):111-8. Epub 2005 Mar 17.

Endocrinology and Diabetes Unit, British Columbia's Children's Hospital, University of British Columbia, Vancouver, Canada.

Background: Glucagon stimulation is routinely used as a provocative test to assess growth hormone (GH) sufficiency in pediatrics. Ghrelin also markedly stimulates GH secretion. Because glucagon stimulates the promoter of the ghrelin gene in vitro as well as ghrelin secretion by the perfused rat stomach, we sought to determine whether ghrelin mediates glucagon-induced GH secretion.

Methods: We compared ghrelin, GH, insulin and glucose responses following administration of 0.03 mg/kg intravenously (iv; max. 1 mg) and 0.1 mg/kg intramuscularly (im; max. 2 mg) of glucagon in two groups (n = 10-11/group) of GH-sufficient children. We also measured ghrelin before and 6 min after iv administration of 1 mg glucagon in 21 adult subjects.

Results: In children, glucagon caused a 26% decrease in ghrelin and a 72% increase in glucose concentrations that were independent of the dose or administration route of glucagon. In contrast, the insulin response was 2-3 times higher following administration of 0.1 mg/kg im compared to 0.03 mg/kg of glucagon iv. There was a significant correlation between the maximum decrease in ghrelin and increases in glucose (p = 0.03) but not in insulin. There was a significant correlation between ghrelin and GH area under the curve after controlling for the dose of glucagon (p = 0.03) but not for the maximum increase in glucose.In normal adults, glucagon administration caused a 7% decrease in ghrelin concentrations after 6 min (p = 0.0002).

Conclusion: Ghrelin does not play a causal role in the GH response to pharmacological glucagon administration, which suppresses ghrelin levels starting a few minutes after injection.
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http://dx.doi.org/10.1159/000084569DOI Listing
August 2005

Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy.

Int J Radiat Oncol Biol Phys 2005 Mar;61(3):665-77

Department of Radiation Oncology, Tom Baker Cancer Center, 1331 29th Street NW, Calgary, Alberta T2N 4N2, Canada.

Purpose: To evaluate the prognostic value of the posttreatment TNM stage as a predictor of outcome in locally advanced rectal cancers treated with preoperative chemotherapy and radiotherapy.

Methods And Materials: Between 1993 and 2000, 128 patients with tethered (103) or fixed (25) rectal cancers were treated with 50 Gy preoperative pelvic radiotherapy and two cycles of concurrent 5-fluorouracil infusion (20 mg/kg/d) and leucovorin (200 mg/m(2)/d) chemotherapy on Days 1-4 and 22-25 and a single bolus mitomycin C injection (8 mg/m(2)) on Day 1. Of the 128 patients, 111 had Stage T3 and 17 Stage T4 according to the rectal ultrasound or CT findings and clinical evaluation. All 128 patients underwent surgery 8 weeks after chemoradiotherapy. Postoperatively, the disease stage was determined according to the surgical and pathologic findings using the American Joint Committee on Cancer TNM staging system.

Results: Of the 128 patients, 32 had postchemoradiotherapy (pCR) Stage 0 (T0N0M0), 37 pCR Stage I, 26 pCR Stage II, 28 pCR Stage III, and 5 pCR Stage IV disease. Of the 128 patients, 79 had pCR Stage T0-T2, 35 pCR Stage T3, and 14 pCR Stage T4. The rate of T stage downstaging was 66% (84 of 128). Of the 128 patients, 25% achieved a pathologic complete response, and 31 (24%) had positive nodal disease. Lymphovascular or perineural invasion was found in 13 patients (10%). The 5-year disease-specific survival rate was 97% for pCR Stage 0, 88% for pCR Stage I, 74% for pCR Stage II, 44% for pCR Stage III, and 0% for pCR Stage IV (p = 0.0000059). The 5-year relapse-free survival rate was 97% for pCR Stage 0, 80% for pCR Stage I, 72% for pCR Stage II, 42% for pCR Stage III, and 0% for pCR Stage IV (p < 0.000001). In univariate analysis, the pretreatment tumor status (fixed vs. tethered tumors), the pCR TNM stage, T stage downstaging, pathologic T4 tumors, node-positive disease after chemoradiotherapy, and lymphovascular or perineural invasion were statistically significant prognosticators of disease-specific survival and relapse-free survival. pCR Stage T4 disease was a strong predictor of local recurrence. The 5-year local control rate was 98% for pCR T0-T2, 89% for pCR T3, and 65% for pCR T4 disease (p = 0.00044). In multivariate analysis, the pCR TNM stage was the most statistically significant independent predictor of survival (p = 0.003) and relapse-free survival (p < 0.001).

Conclusion: For patients who underwent preoperative chemoradiotherapy for locally advanced rectal cancer, the pCR TNM stage was a strong prognosticator of recurrence and survival. It can be used to identify high-risk patients for additional postoperative therapy.
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http://dx.doi.org/10.1016/j.ijrobp.2004.06.206DOI Listing
March 2005

Ghrelin, peptide YY, glucose-dependent insulinotropic polypeptide, and hunger responses to a mixed meal in anorexic, obese, and control female adolescents.

J Clin Endocrinol Metab 2005 Apr 18;90(4):2161-8. Epub 2005 Jan 18.

Endocrinology and Diabetes Unit, Room K4-212, British Columbia's Children's Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada.

To determine whether peptide YY (PYY), ghrelin, glucose-dependent insulinotropic polypeptide (GIP), and satiety responses to food intake are impaired in anorexia or obesity, we studied 30 female adolescents with anorexia nervosa [body mass index (BMI) 16.3 kg/m2], obesity (BMI 34.3 kg/m2), or normal weight (BMI 20.2 kg/m2). PYY, ghrelin, GIP, insulin, and glucose concentrations and four markers of satiety were measured for 240 min after a mixed meal. The area under the curve for glucose was similar in obese (OB) and normal-weight control (C) subjects but was 15% lower in anorexic (AN) subjects. The area under the curve for insulin was 47% lower in AN and 87% higher in OB subjects, compared with C subjects. After the meal, PYY increased significantly in C (+41%, P < 0.05) but not in AN or OB adolescents. Ghrelin concentrations were highest in AN subjects and lowest in the OB group, compared with C subjects and fell significantly by 25% in all three groups. GIP concentrations were lower in AN subjects throughout the test and increased in all three groups after the mixed meal. AN adolescents reported being less hungry than OB and C adolescents. There was a negative correlation between fasting ghrelin (but not PYY or GIP) and BMI and insulin (r2= 0.33) and a positive correlation between the decrease in hunger 15 min after the meal and PYY concentrations at 15 min (r2= 0.20). In conclusion, the blunted PYY response to a meal in OB adolescents suggests that PYY plays a role in the pathophysiology of obesity. Ghrelin is unlikely to play a causal role in anorexia nervosa or obesity. The lower GIP observed in AN subjects despite a similar caloric intake may appropriately prevent an excessive insulin response in these patients.
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http://dx.doi.org/10.1210/jc.2004-1251DOI Listing
April 2005

Selenium deficiency impairs corticosterone and leptin responses to adrenocorticotropin in the rat.

Biofactors 2004 ;20(2):109-18

Endocrinology and Diabetes Unit, British Columbia's Children's Hospital, University of British Columbia, Vancouver, BC, Canada.

Selenium deficiency causes oxidative stress and impairs steroidogenesis in vitro. Leptin is closely related to the hypothalamo-pituitary-adrenal (HPA) axis. Leptin inhibits the HPA axis at the central level while corticosteroids have been shown to stimulate leptin secretion in most studies. We hypothesized that oxidative stress impairs adrenal steroidogenesis and decreases leptin production in vivo. The goal of this study was to investigate in rats the effects of selenium deficiency and oxidative stress on adrenal function and on leptin concentrations. Weanling rats were fed a selenium-deficient (Se-) or selenium-sufficient (Se+) diet for 4-10 weeks. Selenium deficiency caused a marked decrease in liver (> or = 99%) and adrenal (> or = 81%) glutathione peroxidase (GPx) activities. Selenium deficiency did not affect basal and short-term adrenocorticotropin (ACTH) stimulated corticosterone or leptin concentrations. In contrast, after long-term ACTH stimulation, selenium deficiency caused a doubling in adrenal isoprostane content and blunted the increase in corticosterone and leptin concentrations observed in Se+ animals. Plasma leptin concentrations were 50% lower in Se- compared to Se+ animals following long-term ACTH. Our results suggest that oxidative stress causes a decrease in circulating corticosterone in response to ACTH, and, as a consequence, a decrease in plasma leptin concentrations.
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http://dx.doi.org/10.1002/biof.5520200205DOI Listing
February 2005

Ghrelin gene expression is markedly higher in fetal pancreas compared with fetal stomach: effect of maternal fasting.

Endocrinology 2004 Aug 13;145(8):3813-20. Epub 2004 May 13.

Endocrinology and Diabetes Unit, British Columbia's Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada V6H 3V4.

Ghrelin is an orexigenic peptide secreted mainly by the stomach in adult rats. Ghrelin concentrations increase with fasting and decrease after food intake. Ghrelin is also present in the placenta and in the fetal stomach, but the role of fetal ghrelin remains unclear. In this study, we compared changes in plasma ghrelin, insulin, and glucose concentrations and in ghrelin gene expression in stomach, pancreas, and placenta in response to fasting and feeding in adult nonpregnant rats and in 20-d pregnant dams and their fetuses. Plasma total ghrelin concentrations were three times higher in the fetus than in the dam but did not increase in response to fasting. In contrast to total ghrelin, plasma active ghrelin concentrations wee 50% lower in the fetus compared with the adult pregnant rat. Ghrelin mRNA and total ghrelin were markedly elevated in the fetal pancreas and six to seven times greater than in the fetal stomach but were not affected by fasting. In contrast, fetal pancreas and stomach active ghrelin concentrations increased two to three times after maternal fasting. Ghrelin receptor mRNA was present in all fetal pancreas samples. Placenta ghrelin gene expression was detectable but low. These data raise the possibility that in the fetus, in contrast to the adult, the pancreas and not the stomach is a major source of circulating immunoreactive ghrelin. Furthermore, the presence of a strong ghrelin gene expression and of ghrelin receptor mRNA in the fetal pancreas is intriguing and suggests that ghrelin may play an important role in beta-cell development.
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http://dx.doi.org/10.1210/en.2004-0053DOI Listing
August 2004

Elevated umbilical cord ghrelin concentrations in small for gestational age neonates.

J Clin Endocrinol Metab 2003 Sep;88(9):4324-7

Special Care Nursery, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada V6H 3V4.

Ghrelin has orexigenic effects. It is present in umbilical cord plasma in full-term neonates, raising the prospect that ghrelin plays a role in fetal and neonatal energy balance. We measured ghrelin in small (SGA), appropriate (AGA), and large (LGA) for gestational age neonates and evaluated whether ghrelin levels are modulated by neonatal insulin and glucose concentrations. Plasma concentrations of ghrelin, insulin, and glucose were measured in cord blood sampled at birth in 123 SGA, AGA, and LGA neonates (gestational age, 24-41 wk) born to mothers with and without diabetes. Ghrelin was detected in samples from all infants. Its concentration was 40% higher in SGA neonates (mean +/- SD, 2436 +/- 657 pg/ml) compared with AGA (1738 +/- 380) and LGA (1723 +/- 269) neonates. There was a positive correlation between ghrelin and gestational age in AGA/LGA (r = 0.23; P < 0.05) and a negative correlation in SGA (r = -0.67; P < 0.005) neonates. Therefore, the difference in ghrelin between SGA and AGA/LGA neonates decreases with advancing gestational age. Birth weight z-score, maternal hypertension, and glucose concentrations were significant determinants of ghrelin concentrations. In conclusion, SGA neonates present with higher umbilical cord ghrelin plasma concentrations than AGA/LGA neonates. Ghrelin may play a physiological role in fetal adaptation to intrauterine malnutrition.
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http://dx.doi.org/10.1210/jc.2003-030265DOI Listing
September 2003

Umbilical cord ghrelin concentrations in Asian and Caucasian neonates.

Horm Res 2003 ;60(3):116-20

Endocrinology and Diabetes Unit, British Columbia's Children's Hospital, Vancouver, Canada.

Objectives: To compare the relationship between cord plasma ghrelin and growth hormone (GH) concentrations and birth weight in Asian and Caucasian neonates.

Methods: We measured umbilical cord ghrelin and GH concentrations in 180 full-term newborns [4 groups of 45 according to ethnicity (Caucasian/Asian) and sex].

Results: Ghrelin was detectable in all umbilical cord samples (mean +/- SD: 611 +/- 267, range 193-2,010 pg/ml). There was no significant difference in ghrelin concentrations between Asian and Caucasian male or female neonates. In contrast, GH values were significantly affected by sex (p = 0.001) and ethnicity (p = 0.006). Except for a weak (r = -0.33, p < 0.03) negative correlation between ghrelin and GH in male Caucasian neonates, ghrelin and GH concentrations were independent.

Conclusions: Umbilical cord concentrations of ghrelin, a potent orexigenic and GH stimulatory agent, are similar in Caucasian and Asian newborns, suggesting that ghrelin does not play a causal role in the differences in body composition and GH metabolism observed in these neonates.
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http://dx.doi.org/10.1159/000072522DOI Listing
March 2004

Influence of the route of reconstruction on morbidity, mortality and local recurrence after esophagectomy for cancer.

Dig Surg 2003 ;20(3):209-14

Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.

Background: A choice of retrosternal or orthotopic route for reconstruction exists after three-phase esophagectomy with cervical anastomosis. Whether the route of reconstruction affects postoperative morbidity, mortality and recurrence patterns remains controversial.

Study Design: Patients with cancer of the thoracic esophagus who underwent three-phase esophagectomy between 1990 and 1999 were studied. Postoperative outcome, recurrence patterns and survival were analyzed from a prospectively collected database.

Results: Seventy-five patients underwent three-phase esophagectomy. There were 46 patients in the retrosternal group and 29 in the orthotopic group. The mean age of the retrosternal group was younger than the orthotopic group, 60 and 66 years, respectively (p = 0.004). The retrosternal group also had more advanced disease; 24% of patients had curative resection compared with 59% in the orthotopic group (p = 0.003). There was no significant difference in postoperative complications except that the retrosternal group had more blood loss, median 800 ml compared with 700 ml (p = 0.04). Hospital mortality was 13% in the retrosternal group and 3.4% in the orthotopic group (p = 0.24). Multivariate analysis showed that age (odds ratio 1.16, p = 0.035) and pulmonary risk (odds ratio 10, p = 0.01) were predictive of hospital mortality, but not the route of reconstruction. No patient in the retrosternal group developed recurrence in the gastric conduit compared to 4 of 28 patients (14%) in the orthotopic group (p = 0.03). Two of these patients were symptomatic with bleeding from the intragastric recurrence. Survival was worse in the retrosternal group, 5-year survival was 29.8 vs. 8.2% (p < 0.01), reflecting the more advanced disease and higher prevalence of palliative resections.

Conclusions: Cardiopulmonary complications and hospital mortality were not significantly different in the two groups. Recurrent tumor infiltration of the gastric conduit occurred in 14% of patients when the orthotopic route was used.
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http://dx.doi.org/10.1159/000070387DOI Listing
October 2003
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