1.Assessment of the American Joint Committee on Cancer 7th edition staging for localised prostate cancer in Asia treated with external beam radiotherapy.
Meihua WONG ; Connie YIP ; Huihua LI ; Terence TAN ; Ravindran KANESVARAN ; Balram CHOWBAY ; Puay Hoon TAN ; Min Han TAN ; Fuh Yong WONG
Annals of the Academy of Medicine, Singapore 2014;43(10):484-491
INTRODUCTIONMost international clinical practice guidelines for prostate cancer (PCa) are driven by data derived in a Western setting. However, tumour biology and clinical disease progression are likely to differ in the Asian population. We compare the performance of the revised American Joint Committee on Cancer (AJCC) prognostic groups with the commonly used D'Amico Risk Classification and conventional predictors for PCa, in a large cohort of Asian patients.
MATERIALS AND METHODSWe retrospectively reviewed data for 404 consecutive Singaporean patients receiving definitive radiotherapy at our centre between December 1996 and October 2006. The primary outcome was biochemical relapse-free survival (BRFS), defined using the Phoenix definition. The secondary outcome was overall survival (OS). Prognostic risk groups were defined using AJCC 7th edition (AJCC7) and 6th edition (AJCC6). Univariate analysis (UVA) and multivariate analysis (MVA) were performed for the following putative risk factors: age, Gleason score, prognostic grouping, tumour classification, radiation delivery technique, radiotherapy dose, hormonal therapy and initial PSA value.
RESULTSFor the cohort, median age was 69 years. Median follow-up was 66.3 months. Five-year BRFS rate was 84.3% with 71 biochemical relapses and 5-year OS rate was 89.1% with 54 deaths. The concordance-indices for BRFS prediction were 0.588, 0.550 and 0.567 for AJCC7, AJCC6 and D'Amico respectively. Initial PSA, T-stage and AJCC7 were prognostic for BRFS on UVA. Comparison of AJCC7 vs. D'Amico showed no statistical additional value of either classification system although D'Amico was superior when compared to AJCC6 in predicting BRFS. T-stage ≥3 and D'Amico were significant prognostic factors for BRFS on MVA.
CONCLUSIONIn our local, predominantly Chinese population, neither AJCC6 nor AJCC7 demonstrated a high predictive accuracy for BRFS although AJCC7 has a slightly better predictive ability than AJCC6.
Aged ; Aged, 80 and over ; Asia ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Practice Guidelines as Topic ; Prognosis ; Prostatic Neoplasms ; pathology ; radiotherapy ; Radiotherapy ; methods ; Retrospective Studies ; United States
2.Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis
Yu Jun WONG ; Vy H. NGUYEN ; Hwai-I YANG ; Jie LI ; Michael Huan LE ; Wan-Jung WU ; Nicole Xinrong HAN ; Khi Yung FONG ; Elizebeth CHEN ; Connie WONG ; Fajuan RUI ; Xiaoming XU ; Qi XUE ; Xin Yu HU ; Wei Qiang LEOW ; George Boon-Bee GOH ; Ramsey CHEUNG ; Grace WONG ; Vincent Wai-Sun WONG ; Ming-Whei YU ; Mindie H. NGUYEN
Clinical and Molecular Hepatology 2023;29(3):705-720
Background/Aims:
Chronic hepatitis B (CHB) and fatty liver (FL) often co-exist, but natural history data of this dual condition (CHB-FL) are sparse. Via a systematic review, conventional meta-analysis (MA) and individual patient-level data MA (IPDMA), we compared liver-related outcomes and mortality between CHB-FL and CHB-no FL patients.
Methods:
We searched 4 databases from inception to December 2021 and pooled study-level estimates using a random- effects model for conventional MA. For IPDMA, we evaluated outcomes after balancing the two study groups with inverse probability treatment weighting (IPTW) on age, sex, cirrhosis, diabetes, ALT, HBeAg, HBV DNA, and antiviral treatment.
Results:
We screened 2,157 articles and included 19 eligible studies (17,955 patients: 11,908 CHB-no FL; 6,047 CHB-FL) in conventional MA, which found severe heterogeneity (I2=88–95%) and no significant differences in HCC, cirrhosis, mortality, or HBsAg seroclearance incidence (P=0.27–0.93). IPDMA included 13,262 patients: 8,625 CHB-no FL and 4,637 CHB-FL patients who differed in several characteristics. The IPTW cohort included 6,955 CHB-no FL and 3,346 CHB-FL well-matched patients. CHB-FL patients (vs. CHB-no FL) had significantly lower HCC, cirrhosis, mortality and higher HBsAg seroclearance incidence (all p≤0.002), with consistent results in subgroups. CHB-FL diagnosed by liver biopsy had a higher 10-year cumulative HCC incidence than CHB-FL diagnosed with non-invasive methods (63.6% vs. 4.3%, p<0.0001).
Conclusions
IPDMA data with well-matched CHB patient groups showed that FL (vs. no FL) was associated with significantly lower HCC, cirrhosis, and mortality risk and higher HBsAg seroclearance probability.
3.THE IMPACT OF COVID-19 PANDEMIC ON THE MENTAL HEALTH OF COLLEGE AND UNIVERSITY STUDENTS
Fazlollah Keshavarzi ; Chia Megan ; Chon Kar Sin ; Chong Chua Wei ; Chong Chun Ming ; Connie Wong Yin Yin
ASEAN Journal of Psychiatry 2021;22(8):1-7
Objectives:
To evaluate the impact of COVID-19 pandemic on the mental health of Malaysian university and pre-university students, especially after the shift to online academic activities, following almost one year of experiencing the pandemic
Methods:
A cross-sectional online survey was conducted among Malaysian pre-university and university students, nationwide, using perceived stress scale-10 questionnaire and another validated 11-construct questionnaire.
Key findings: :
The online questionnaires were filled out by 383 Malaysian pre-university and university students. About 40% of the respondents reported moderate to severe level of loneliness and social isolation. There was a significant correlation between suicidal thoughts and the social isolation. The prevalence of moderate to severe suicidal thoughts (14% of the respondents) was more than the reported prevalence before COVID-19 pandemic. The residential state, gender and ethnicity of the respondents did not show an association with depressive and suicidal thoughts of the respondents.
Conclusion
Loneliness and feeling social isolation were the most prevalent problems, as reported by the students. Suicidal Thoughts are more prevalent, compared to pre-COVID-19 reports. The educators and institution
managers must seek for appropriate methods to address the critical condition.
4.Characteristics of dietary intakes including NOVA foods among pre-adolescents living in urban Kuala Lumpur – Findings from the PREBONE-Kids study
Wai Yew Yang ; Soon Yee Wong ; Shu Hwa Ong ; Kanimolli Arasu ; Chung Yuan Chang ; Megan Hueh Zan Chong ; Meenal Mavinkurve ; Erwin Jiayuan Khoo ; Karuthan Chinna ; Connie M. Weaver ; Winnie Siew Swee Chee
Malaysian Journal of Nutrition 2023;29(No.3):401-414
Introduction: Evidence showed considerable variability of health risk factors within different socioeconomic groups. This study aimed to characterise dietary intakes by total household income among a sample of Malaysian pre-adolescents in urban Kuala Lumpur. Methods: Baseline data of 243 healthy, pre-adolescent children between 9 and 11 years old including socio-demographic background (gender, ethnicity, and total household monthly income), anthropometry (body weight and height), and
7-day diet histories were collected. Secondary analysis was performed on dietary intakes to quantify food groups based on the Malaysian Dietary Guidelines and NOVA classification systems besides nutrients. Differences and associations between total monthly household income categories with anthropometry and dietary intakes were tested using independent t-test/Mann-Whitney U (depending on normality) and chi-square tests, respectively. Results: Most children in this study population
had dietary intakes below the recommended serving sizes for five food groups, except meat/poultry (195.2±107.2%) and fish (110.1±106.3%) and consumed about 32% of energy from ultra-processed foods (NOVA food group 4). While there was no difference in dietary intake between the bottom 40% with the middle 40% and high 20% household income groups, the percentage of energy contributed by NOVA food group 4 (processed fats/oils, condiments, and sauces) was higher in the bottom 40% households (p=0.024). Conclusion: Most pre-adolescent children in this study, regardless of household income, did not meet dietary recommendations and ate diets comprised of less nutritious foods. Comprehensive approaches that aim to improve dietary patterns and reduce the risk of diet-related chronic diseases are warranted.