The use of tissue fiducial markers in improving the accuracy of post-prostatectomy radiotherapy

Michael Chao,Huong Ho,Daryl Lim Joon,Yee Chan,Sandra Spencer,Michael Ng,Jason Wasiak,Nathan Lawrentschuk,Kevin McMillan,Shomik Sengupta,Alwin Tan,George Koufogiannis,Margaret Cokelek,Farshad Foroudi,T 대한방사선종양학회 2019 Radiation Oncology Journal Vol.37 No.1

Purpose: The aim of this retrospective study was to investigate the use of a radiopaque tissue fiducial marker (TFM) in the treatment of prostate cancer patients who undergo post-prostatectomy radiotherapy (PPRT). TFM safety, its role and benefit in quantifying the set-up uncertainties in patients undergoing PPRT image-guided radiotherapy were assessed. Materials and Methods: A total of 45 consecutive PPRT patients underwent transperineal implantation of TFM at the level of vesicourethral anastomosis in the retrovesical tissue prior to intensity-modulated radiotherapy. Prostate bed motion was calculated by measuring the position of the TFM relative to the pelvic bony anatomy on daily cone-beam computed tomography. The stability and visibility of the TFM were assessed in the initial 10 patients. Results: No postoperative complications were recorded. A total of 3,500 images were analysed. The calculated prostate bed motion for bony landmark matching relative to TFM were 2.25 mm in the left-right, 5.89 mm in the superior-inferior, and 6.59 mm in the anterior-posterior directions. A significant 36% reduction in the mean volume of rectum receiving 70 Gy (rV70) was achieved for a uniform planning target volume (PTV) margin of 7 mm compared with the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recommended PTV margin of 10 mm. Conclusion: The use of TFM was safe and can potentially eliminate set-up errors associated with bony landmark matching, thereby allowing for tighter PTV margins and a consequent favourable reduction in dose delivered to the bladder and rectum, with potential improvements in toxicities.

The use of tissue fiducial markers in improving the accuracy of post-prostatectomy radiotherapy

Chao, Michael,Ho, Huong,Joon, Daryl Lim,Chan, Yee,Spencer, Sandra,Ng, Michael,Wasiak, Jason,Lawrentschuk, Nathan,McMillan, Kevin,Sengupta, Shomik,Tan, Alwin,Koufogiannis, George,Cokelek, Margaret,Foro The Korean Society for Radiation Oncology 2019 Radiation Oncology Journal Vol.37 No.1

Purpose: The aim of this retrospective study was to investigate the use of a radiopaque tissue fiducial marker (TFM) in the treatment of prostate cancer patients who undergo post-prostatectomy radiotherapy (PPRT). TFM safety, its role and benefit in quantifying the set-up uncertainties in patients undergoing PPRT image-guided radiotherapy were assessed. Materials and Methods: A total of 45 consecutive PPRT patients underwent transperineal implantation of TFM at the level of vesicourethral anastomosis in the retrovesical tissue prior to intensity-modulated radiotherapy. Prostate bed motion was calculated by measuring the position of the TFM relative to the pelvic bony anatomy on daily cone-beam computed tomography. The stability and visibility of the TFM were assessed in the initial 10 patients. Results: No postoperative complications were recorded. A total of 3,500 images were analysed. The calculated prostate bed motion for bony landmark matching relative to TFM were 2.25 mm in the left-right, 5.89 mm in the superior-inferior, and 6.59 mm in the anterior-posterior directions. A significant 36% reduction in the mean volume of rectum receiving 70 Gy (rV₇₀) was achieved for a uniform planning target volume (PTV) margin of 7 mm compared with the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recommended PTV margin of 10 mm. Conclusion: The use of TFM was safe and can potentially eliminate set-up errors associated with bony landmark matching, thereby allowing for tighter PTV margins and a consequent favourable reduction in dose delivered to the bladder and rectum, with potential improvements in toxicities.

No difference in long-term functional outcomes or survivorship after total knee arthroplasty with or without computer navigation: a 17-year survivorship analysis

( Ng Jonathan Patrick ),( Lau Lawrence Chun Man ),( Chau Wai-wang ),( Ong Michael Tim-yun ),( Cheung Kin Wing ),( Chiu Kwok Hing ),( Chung Kwong Yin ),( Ho Kevin Ki-wai ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Background: The literature comparing the long-term outcomes and survivorship of computer navigation-assisted and conventional total knee replacement (TKR) is sparse. Moreover, of the available comparative studies with followup duration of more than 10 years, the results seem to be conflicting. The purpose of this long-term study was to compare the clinical and radiological outcomes, and implant survivorship, of TKR performed with and without computer navigation. Methods: We retrospectively compared the results of 49 computer-navigated TKRs and 139 conventional TKRs. The mean age of the patients was 67.9 (range 52-81) years for the navigation group and 67.1 (range 50-80) years for the conventional TKR group. The mean duration of follow-up for the conventional and navigation TKR groups was 12.9 and 13.2 years, respectively. Clinical and radiographic follow-up examinations of the patients were performed at 2 weeks, 1 month, 3 months and 6 months post-operatively, and at 1-year intervals thereafter. Results: There were no significant differences in the post-operative Knee Society knee and function score between the two groups. The mean overall deviation from neutral alignment and the radiological outliers were significantly higher in the conventional TKR group. The overall survival rates at 17 years were 92.9% for the navigation group and 95.6% for the conventional TKR group (p = 0.62). Conclusions: Navigated TKR resulted in fewer radiological outliers; however, this did not translate to better long-term functional outcomes or implant survival.

Ultrasonography Findings of the Carpal Tunnel after Endoscopic Carpal Tunnel Release for Carpal Tunnel Syndrome

Ng Alex Wing Hung,Griffith James Francis,Tsoi Carita,Fong Raymond Chun Wing,Mak Michael Chu Kay,Tse Wing Lim,Ho Pak Cheong 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.7

Objective: To investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR). Materials and Methods: This prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0–3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared. Results: All patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals post- ECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months. Conclusion: Postoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet. Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year post- ECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR.

Atypical Antipsychotics for Bipolar Disorder: Overblown or Blown Over?

Felicity Ng,Seetal Dodd,Michael Berk 대한정신약물학회 2007 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.5 No.2

Objective:Developments in the pharmacological treatment of bipolar disorder are of much interest, as the chronicity and disability of the disorder become better understood, and as treatment goals have shifted to emphasise early control of illness course and maintenance of euthymia in addition to acute episodic remission. Atypical antipsychotics have emerged as treatment options, and this paper aims to review the evidence for their role in bipolar disorder. Methods:A MEDLINE search was conducted for publications up till October 2006. Results:The search yielded a number of randomised, controlled clinical trials of various atypical antipsychotics as monotherapy or adjunctive therapy in bipolar disorder. The majority of such trials have investigated their efficacy in acute mania, with fewer studies devoted to acute bipolar depression or maintenance treatment. There are no specific trials on mixed states, which have mainly been studied together with bipolar mania. The most robust evidence supports a class effect of atypical agents in the treatment of mania. Conclusions:There are placebo-controlled trials that support the efficacy of olanzapine and quetiapine in bipolar depression, and of olanzapine and aripiprazole as maintenance treatment. There is strong support for the role of atypical antipsychotics in bipolar disorder management despite a relatively narrow literature base, chiefly for the treatment of mania. However, these findings need to be replicated, and further investigation is warranted to clarify their spectrum of efficacy in bipolar disorder. Objective:Developments in the pharmacological treatment of bipolar disorder are of much interest, as the chronicity and disability of the disorder become better understood, and as treatment goals have shifted to emphasise early control of illness course and maintenance of euthymia in addition to acute episodic remission. Atypical antipsychotics have emerged as treatment options, and this paper aims to review the evidence for their role in bipolar disorder. Methods:A MEDLINE search was conducted for publications up till October 2006. Results:The search yielded a number of randomised, controlled clinical trials of various atypical antipsychotics as monotherapy or adjunctive therapy in bipolar disorder. The majority of such trials have investigated their efficacy in acute mania, with fewer studies devoted to acute bipolar depression or maintenance treatment. There are no specific trials on mixed states, which have mainly been studied together with bipolar mania. The most robust evidence supports a class effect of atypical agents in the treatment of mania. Conclusions:There are placebo-controlled trials that support the efficacy of olanzapine and quetiapine in bipolar depression, and of olanzapine and aripiprazole as maintenance treatment. There is strong support for the role of atypical antipsychotics in bipolar disorder management despite a relatively narrow literature base, chiefly for the treatment of mania. However, these findings need to be replicated, and further investigation is warranted to clarify their spectrum of efficacy in bipolar disorder.

Children’s Misinterpretation of Today’s Designs: A Case Study of How Children Interpret Registered Safety Signs

Kin Wai Michael Siu,Yi Lin Wong,Mei Seung Lam,Annie W Y Ng 대한사고개발학회 2014 The International Journal of Creativity & Problem Vol.24 No.2

Safety signs are currently created by adult designers through a designer-centered process. It is questionable whether children are able to interpret and understand these signs correctly, even if they are exposed to the signs in locations designated for children, such as playgrounds and schools. Children may be unable to understand pictograms designed by adults, as discrepancies exist between children’s and adults’ cognitive abilities, developmental levels and information needs. Consequently, a study was conducted to understand how children interpret ― understand and misunderstand ― safety sign designs created by adult designers. Sixty-five primary school children from P-2 to P-6 in three Hong Kong schools were asked to interpret 12 safety signs. The children were not able to understand some of the signs and interpreted them incorrectly. Based on the children’s responses, this paper advocates that participatory design with children is important for adult designers to develop better designs.

Tone mapping for high-dynamic-range images using localized gamma correction

Qiao, Motong,Ng, Michael K. INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING (SPI 2015 JOURNAL OF ELECTRONIC IMAGING Vol.24 No.1

Stand-Alone Cervical Cages in 2-Level Anterior Interbody Fusion in Cervical Spondylotic Myelopathy: Results from a Minimum 2-Year Follow-up

Eugene Pak-Lin Ng,Andrew Siu-Leung Yip,Keith Hay-Man Wan,Michael Siu Hei Tse,Kam Kwong Wong,Tik-Koon Kwok,Wing Cheung Wong 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.2

Study Design: A retrospective review of patients who underwent 2-level anterior cervical discectomy and fusion (ACDF) with stand-alone polyetheretherketone (PEEK) cages for cervical spondylotic myelopathy (CSM). Purpose: To evaluate the efficacy of stand-alone PEEK cage in 2-level cervical interbody fusion for CSM. Overview of Literature: ACDF is a standard surgical procedure to treat degenerative disc disease. However, the use of additional anterior plating for 2-level ACDF remains controversial. Methods: We reviewed outcomes of patients who underwent 2-level ACDF with stand-alone PEEK cages for CSM over a 7-year period (2007–2015) in a regional hospital. Japanese Orthopaedic Association (JOA) score, fusion rate, subsidence rate, cage migration, and cervical alignment by the C2–7 angle as well as the local segmental angle (LSA) of the cervical spine were assessed. Results: In total, 31 patients (mean age, 59 years; range, 36–87 years) underwent 2-level ACDF with a cage-only construct procedure between 2007 and 2015. The minimum follow-up was 24 months; mean follow-up was 51 months. C3–5 fusion was performed in 45%, C4–6 fusion in 32%, and C5–7 fusion in 23%. Mean JOA score improved from 10.1±2.2 to 13.9±2.1 (p<0.01) at the 24-month follow-up. Fusion was achieved in all patients. Subsidence occurred in 22.5% of the cages but was not associated with differences in JOA scores, age, sex, or levels fused. Lordosis of the C2–7 angle and LSA increased after surgery, which were maintained for up to 1 year but subsequently disappeared after 2 years, yet the difference was not statistically significant. No cage migration was noted; two patients developed adjacent segment disease requiring posterior laminoplasty 3 years after ACDF. Conclusions: The use of a stand-alone PEEK cage in a 2-level cervical interbody fusion achieves satisfactory improvements in both clinical outcomes and fusion.

Postural Rehabilitation for Adolescent Idiopathic Scoliosis during Growth

Hans-Rudolf Weiss,Marc Michael Moramarco,Maksym Borysov,Shu Yan Ng,Sang Gil Lee,Xiaofeng Nan,Kathryn Ann Moramarco 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.3

Long-term follow-up of untreated patients with adolescent idiopathic scoliosis (AIS) indicates that, with the exception of some extremely severe cases, AIS does not have a significant impact on quality of life and does not result in dire consequences. In view of the relatively benign nature of AIS and the long-term complications of surgery, the indications for treatment should be reviewed. Furthermore, recent studies have shown that scoliosis-specific exercises focusing on postural rehabilitation can positively influence the spinal curvatures in growing adolescents. Experiential postural re-education is a conservative, non-invasive approach, and its role in the management of AIS warrants further study. This article reviews current evidence for the inclusion of various forms of postural reeducation in the management of AIS. Recent comprehensive reviews have been researched including a manual and PubMed search for evidence regarding the effectiveness of physical/postural re-education/physiotherapy programs in growing AIS patients. This search revealed that there were few studies on the application of postural re-education in the management of AIS. These studies revealed that postural re-education in the form of exercise rehabilitation programs may have a positive influence on scoliosis; however, the various programs were difficult to compare. More research is necessary. There is at present Level 1 evidence for the effectiveness of Schroth scoliosis exercises in the management of AIS. Whether this evidence can be extrapolated to include other forms of scoliosis- pattern-specific exercises requires further investigation. Because corrective postures theoretically reduce the asymmetric loading of the spinal deformities and reverse the vicious cycle of spinal curvature progression, their integration into AIS programs may be beneficial and should be further examined.

Protocol and Rationale-The Efficacy of Minocycline as an Adjunctive Treatment for Major Depressive Disorder: A Double Blind, Randomised, Placebo Controlled Trial

Olivia May Dean,Michael Maes,Melanie Ashton,Lesley Berk,Buranee Kanchanatawan,Atapol Sughondhabirom,Sookjareon Tangwongchai,Chee Ng,Nathan Dowling,Gin S. Malhi,MIchael Berk 대한정신약물학회 2014 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.12 No.3

While current pharmacotherapies are efficacious, there remain a clear shortfall between symptom remission and functionalrecovery. With the explosion in our understanding of the biology of these disorders, the time is ripe for the investigation ofnovel therapies. Recently depression is conceptualized as an immune-inflammatory and nitro-oxidative stress related disorder. Minocycline is a tetracycline antibiotic that has anti-inflammatory, pro-oxidant, glutamatergic, neurotrophic and neuroprotectiveproperties that make it a viable target to explore as a new therapy. This double blind, randomised, placebo controlled adjunctivetrial will investigate the benefits of 200 mg/day of minocycline treatment, in addition to any usual treatment, as an adjunctivetreatment for moderate-severe major depressive disorder. Sixty adults are being randomised to 12 weeks of treatment (witha 4 week follow-up post-discontinuation). The primary outcome measure for the study is mean change on the Montgomery-Asberg Depression Rating Scale (MADRS), with secondary outcomes including the Social and Occupational FunctioningAssessment Scale (SOFAS), Clinical Global Impressions (CGI), Hamilton Rating Scale for Anxiety (HAM-A), Patient GlobalImpression (PGI), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and Range of Impaired Functioning Tool(LIFE-RIFT). Biomarker analyses will also be conducted at baseline and week 12. The study has the potential to provide newtreatment targets, both by showing efficacy with a new class of ‘antidepressant’ but also through the analysis of biomarkersthat may further inform our understanding of the pathophysiology of unipolar depression.