1.Correspondence on Editorial regarding “Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients”
Yu Jun WONG ; Sanchit SHARMA ; Giulia TOSETTI ; Xiaolong QI ; Massimo PRIMIGNANI
Clinical and Molecular Hepatology 2023;29(1):188-190
2.KaKs_Calculator: Calculating Ka and Ks Through Model Selection and Model Averaging
Zhang ZHANG ; Li JUN ; Zhao XIAO-QIAN ; Wang JUN ; Wong Ka-Shu GANE ; Yu JUN
Genomics, Proteomics & Bioinformatics 2006;4(4):259-263
KaKs_Calculator is a software package that calculates nonsynonymous (Ka) and synonymous (Ks) substitution rates through model selection and model averaging. Since existing methods for this estimation adopt their specific mutation (substitution) models that consider different evolutionary features, leading to diverse estimates, KaKs_Calculator implements a set of candidate models in a maximum likelihood framework and adopts the Akaike information criterion to measure fitness between models and data, aiming to include as many features as needed for accurately capturing evolutionary information in protein-coding sequences. In addition, several existing methods for calculating Ka and Ks are also incorporated into this software. KaKs_Calculator, including source codes,compiled executables, and documentation, is freely available for academic use at http://evolution.genomics.org.cn/software.htm.
3.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.
4.Individual allergens as risk factors for asthma and bronchial hyperresponsiveness in Chinese children.
Yu-zhi CHEN ; Yu MA ; Hong-yu WANG ; Hai-jun WANG ; Jing ZHAO ; Ling CAO ; Shuo LI ; G W K WONG ; Nan-shan ZHONG ; T F FOK ; C K W LAI
Chinese Journal of Pediatrics 2003;41(7):538-541
OBJECTIVE This study aimed to determine the relationship between individual allergens with current wheezing and bronchial hyperresponsiveness (BHR) in schoolchildren from three chinese cities: Beijing, Guangzhou and Hong Kong. METHODS Community-based random samples of 10-yr-old schoolchildren from the 3 cities were recruited for study using the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. The subjects were studied by parental questionnaires (n = 10,902), skin-prick tests (n = 3478), and methacholine challenge tests (n = 608). RESULTS The highest prevalence rates of wheezing in the past 12 months (Beijing, 3.8%; Guangzhou, 3.4%; Hong Kong, 5.8%) and atopy (Beijing, 23.9%; Guangzhou, 30.8%; Hong Kong, 41.2%, defined as having
5.Non-alcoholic fatty liver disease screening in type 2 diabetes mellitus: A cost-effectiveness and price threshold analysis.
Bryan Peide CHOO ; George Boon Bee GOH ; Sing Yi CHIA ; Hong Choon OH ; Ngiap Chuan TAN ; Jessica Yi Lyn TAN ; Tiing Leong ANG ; Yong Mong BEE ; Yu Jun WONG
Annals of the Academy of Medicine, Singapore 2022;51(11):686-694
INTRODUCTION:
The cost-effectiveness of screening asymptomatic non-alcoholic fatty liver disease (NAFLD) patients remains debatable, with current studies assuming lifelong benefits of NAFLD screening while neglecting cardiovascular outcomes. This study aims to assess the cost-effectiveness of NAFLD screening among type 2 diabetes mellitus (T2DM) patients, and to establish a price threshold for NAFLD treatment, when it becomes available.
METHOD:
A Markov model was constructed comparing 4 screening strategies (versus no screening) to identify NAFLD with advanced fibrosis among T2DM patients: fibrosis-4 (FIB-4), vibration-controlled transient elastography (VCTE), FIB-4 and VCTE (simultaneous), and FIB-4 and VCTE (sequential). Sensitivity analyses and price threshold analyses were performed to assess parameter uncertainties in the results.
RESULTS:
VCTE was the most cost-effective NAFLD screening strategy (USD24,727/quality-adjusted life year [QALY]), followed by FIB-4 (USD36,800/QALY), when compared to no screening. Probabilistic sensitivity analysis revealed a higher degree of certainty for VCTE as a cost-effective strategy compared to FIB-4 (90.7% versus 73.2%). The duration of expected screening benefit is the most influential variable based on incremental cost-effectiveness ratio tornado analysis. The minimum duration of screening benefit for NAFLD screening to be cost-effective was at least 2.6 years. The annual cost of NAFLD treatment should be less than USD751 for NAFLD screening to be cost-effective.
CONCLUSION
Both VCTE and FIB-4 are cost-effective NAFLD screening strategies among T2DM patients in Singapore. However, given the lack of access to VCTE at primacy care and potential budget constraints, FIB-4 can also be considered for NAFLD screening among T2DM patients in Singapore.
Humans
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Non-alcoholic Fatty Liver Disease/diagnosis*
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Cost-Benefit Analysis
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Diabetes Mellitus, Type 2/diagnosis*
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Research
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Fibrosis
6.VIEKIRA PAK associated drug-induced interstitial lung disease: Case series with systematic review of literature
Yu Jun WONG ; Si Yuan CHEW ; John Chen HSIANG ; Prem Harichander THURAIRAJAH ; Rahul KUMAR ; Eng Kiong TEO ; Roshni Sadashiv GOKHALE ; Imran Bin Mohamed NOOR ; Jessica TAN
Clinical and Molecular Hepatology 2019;25(2):218-222
No abstract available.
Lung Diseases, Interstitial
7.The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients
Yu Jun WONG ; Prem Harichander THURAIRAJAH ; Rahul KUMAR ; Kwong Ming FOCK ; Ngai Moh LAW ; Sin-Yoong CHONG ; Fria Gloriba MANEJERO ; Tiing-Leong ANG ; Eng Kiong TEO ; Jessica TAN
Clinical and Molecular Hepatology 2021;27(3):474-485
Background/Aims:
Despite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore.
Methods:
In this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013–2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types.
Results:
A total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P<0.001) and lower treatment default rate (1% vs. 9%, P<0.001).
Conclusion
In this large cohort of incarcerated HCV-infected patients, we demonstrated that unrestricted access to DAA is an impactful strategy to allow rapid treatment up-scale in HCV micro-elimination.
8.Clinical Features and Predictors of Dysplasia in Proximal Sessile Serrated Lesions
Yi Yuan TAN ; Gary Sei Kiat TAY ; Yu Jun WONG ; James Weiquan LI ; Andrew Boon Eu KWEK ; Tiing Leong ANG ; Lai Mun WANG ; Malcolm Teck Kiang TAN
Clinical Endoscopy 2021;54(4):578-588
Background/Aims:
Proximal colorectal cancers (CRCs) account for up to half of CRCs. Sessile serrated lesions (SSLs) are precursors to CRC. Proximal location and presence of dysplasia in SSLs predict higher risks of progression to cancer. The prevalence of dysplasia in proximal SSLs (pSSLs) and clinical characteristics of dysplastic pSSLs are not well studied.
Methods:
Endoscopically resected colonic polyps at our center between January 2016 and December 2017 were screened for pSSLs. Data of patients with at least one pSSL were retrieved and clinicopathological features of pSSLs were analysed. pSSLs with and without dysplasia were compared for associations.
Results:
Ninety pSSLs were identified, 45 of which had dysplasia giving a prevalence of 50.0%. Older age (65.9 years vs. 60.1 years, p=0.034) was associated with the presence of dysplasia. Twelve pSSLs were 10 mm or larger. After adjusting for age, pSSLs ≥10 mm had an adjusted odds ratio of 5.98 (95% confidence interval, 1.21–29.6) of having dysplasia compared with smaller pSSLs.
Conclusions
In our cohort of pSSLs, the prevalence of dysplasia is high at 50.0% and is associated with lesion size ≥10 mm. Endoscopic resection for all proximal serrated lesions should be en-bloc to facilitate accurate histopathological examination for dysplasia as its presence warrants shorter surveillance intervals.
9.The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients
Yu Jun WONG ; Prem Harichander THURAIRAJAH ; Rahul KUMAR ; Kwong Ming FOCK ; Ngai Moh LAW ; Sin-Yoong CHONG ; Fria Gloriba MANEJERO ; Tiing-Leong ANG ; Eng Kiong TEO ; Jessica TAN
Clinical and Molecular Hepatology 2021;27(3):474-485
Background/Aims:
Despite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore.
Methods:
In this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013–2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types.
Results:
A total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P<0.001) and lower treatment default rate (1% vs. 9%, P<0.001).
Conclusion
In this large cohort of incarcerated HCV-infected patients, we demonstrated that unrestricted access to DAA is an impactful strategy to allow rapid treatment up-scale in HCV micro-elimination.
10.Clinical Features and Predictors of Dysplasia in Proximal Sessile Serrated Lesions
Yi Yuan TAN ; Gary Sei Kiat TAY ; Yu Jun WONG ; James Weiquan LI ; Andrew Boon Eu KWEK ; Tiing Leong ANG ; Lai Mun WANG ; Malcolm Teck Kiang TAN
Clinical Endoscopy 2021;54(4):578-588
Background/Aims:
Proximal colorectal cancers (CRCs) account for up to half of CRCs. Sessile serrated lesions (SSLs) are precursors to CRC. Proximal location and presence of dysplasia in SSLs predict higher risks of progression to cancer. The prevalence of dysplasia in proximal SSLs (pSSLs) and clinical characteristics of dysplastic pSSLs are not well studied.
Methods:
Endoscopically resected colonic polyps at our center between January 2016 and December 2017 were screened for pSSLs. Data of patients with at least one pSSL were retrieved and clinicopathological features of pSSLs were analysed. pSSLs with and without dysplasia were compared for associations.
Results:
Ninety pSSLs were identified, 45 of which had dysplasia giving a prevalence of 50.0%. Older age (65.9 years vs. 60.1 years, p=0.034) was associated with the presence of dysplasia. Twelve pSSLs were 10 mm or larger. After adjusting for age, pSSLs ≥10 mm had an adjusted odds ratio of 5.98 (95% confidence interval, 1.21–29.6) of having dysplasia compared with smaller pSSLs.
Conclusions
In our cohort of pSSLs, the prevalence of dysplasia is high at 50.0% and is associated with lesion size ≥10 mm. Endoscopic resection for all proximal serrated lesions should be en-bloc to facilitate accurate histopathological examination for dysplasia as its presence warrants shorter surveillance intervals.