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1. Frailty, cognitive impairment, and chronic limb-threatening ischaemia

Author

Houghton, John S. M.

Subjects
Frailty, Cognitive Impairment, Chronic limb-threatening ischaemia, medicine, thesis, CLTI, Cardiovascular science
Abstract

Chronic limb-threatening ischaemia (CLTI) is the end-stage of peripheral artery disease and is characterised by lower limb rest pain, ulceration, or gangrene. Frailty is increasingly recognised as an important factor in health outcomes in older adults, and is frequently associated with cognitive impairment. Those with CLTI are likely to have high rates of both frailty and cognitive impairment due to their age, multi-morbidity and functional performance status. This thesis aimed to investigate the prevalence of frailty and cognitive impairment among individuals with CLTI, their associations with outcomes, and trajectories following intervention. Two systematic reviews, a retrospective cohort study, and a prospective cohort study were undertaken to answer several key research questions. Results from this thesis demonstrate that both frailty and cognitive impairment are highly prevalent among patients with CLTI. Both are strongly associated with each other, and frailty has a complex interrelationship with CLTI. Frailty is related to severity of limb threat, and those with frailty have a greater degree of impaired lower limb function. Frailty is strongly associated with increased perioperative morbidity and mortality, and both frailty and cognitive impairment are likely to have an impact on shared decision making. Successful revascularisation may improve frailty status in a small subset of individuals with CLTI and frailty, although a greater proportion of non-frail patients will transition to frailty at 3 months. Those with frailty may also have a more limited improvement in quality of life following intervention for CLTI. This thesis provides a comprehensive investigation of frailty and cognitive impairment in the context of CLTI, and its results have implications for both clinical practice and future research. Screening for frailty and cognitive impairment are likely to be beneficial for patients, supporting shared decision making and the identification of those most likely to benefit from specialist geriatrician input in the perioperative period.

Published
2022
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2. Lateral membrane organization as target of an antimicrobial peptidomimetic compound

Author

Adéla Melcrová, Sourav Maity, Josef Melcr, Niels A. W. de Kok, Mariella Gabler, Jonne van der Eyden, Wenche Stensen, John S. M. Svendsen, Arnold J. M. Driessen, Siewert J. Marrink, and Wouter H. Roos

Subjects
Science
Abstract

Abstract Antimicrobial resistance is one of the leading concerns in medical care. Here we study the mechanism of action of an antimicrobial cationic tripeptide, AMC-109, by combining high speed-atomic force microscopy, molecular dynamics, fluorescence assays, and lipidomic analysis. We show that AMC-109 activity on negatively charged membranes derived from Staphylococcus aureus consists of two crucial steps. First, AMC-109 self-assembles into stable aggregates consisting of a hydrophobic core and a cationic surface, with specificity for negatively charged membranes. Second, upon incorporation into the membrane, individual peptides insert into the outer monolayer, affecting lateral membrane organization and dissolving membrane nanodomains, without forming pores. We propose that membrane domain dissolution triggered by AMC-109 may affect crucial functions such as protein sorting and cell wall synthesis. Our results indicate that the AMC-109 mode of action resembles that of the disinfectant benzalkonium chloride (BAK), but with enhanced selectivity for bacterial membranes.

Published
2023
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4. Femtosecond laser-assisted astigmatic keratotomy: a review

Author

John S. M. Chang

Subjects
Femtosecond laser-assisted astigmatic keratotomy, Post-keratoplasty astigmatism, Astigmatism correction, Refractive surgery, Ophthalmology, RE1-994
Abstract

Abstract Background Astigmatic keratotomy (AK) remains an accessible means to correct surgically induced or naturally occurring astigmatism. The advantages of femtosecond laser-assisted astigmatic keratotomy (FSAK) over conventional methods have been recognized recently. Main text This review evaluates the efficacy, complications, and different methods of FSAK for correction of astigmatism in native eyes and those that underwent previous penetrating keratoplasty (PKP). The penetrating and intrastromal FSAK (IFSAK) techniques can reduce post-keratoplasty astigmatism by 35.4% to 84.77% and 23.53% to 89.42%, respectively. In native eyes, the penetrating and IFSAK techniques reduce astigmatism by 26.8% to 58.62% and 36.3% to 58% respectively, implying that the magnitude of the astigmatic reduction is comparable between the two FSAK procedures. Nonetheless, IFSAK offers the additional advantages of almost no risk of infection, wound gape, and epithelial ingrowth. The use of nomograms, anterior-segment optical coherence tomography, and consideration of posterior cornea and corneal biomechanics are helpful to enhance the efficacy and safety of FSAK. The complications of FSAK in eyes that underwent PKP include overcorrection, visual loss, microperforations, infectious keratitis, allograft rejection, and endophthalmitis. The reported difficulties in native eyes include overcorrection, anterior gas breakthrough, and suction loss. Conclusions In eyes that underwent PKP, FSAK effectively reduces high regular or irregular astigmatism, with rare and manageable complications. Nevertheless, the drawbacks of the procedure include the potential loss of visual acuity and low predictability. For native eyes undergoing femtosecond laser-assisted cataract surgery, IFSAK is a good choice to correct low astigmatism (

Published
2018
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6. Chronic hand eczema in Europe:Patient experiences and perspectives (CHEPEP) in qualitative interviews

Author

Rönsch, H., Schiffers, F., Ofenloch, R., Weisshaar, E., Buse, A. S., Hansen, A., John, S. M., Giménez Arnau, A. M., Pesqué, D., Agner, T., Nørreslet, L. B., Loman, L., Romeijn, G. L. E., Schuttellaar, M. L. A., Košćec Bjelajac, A., Macan, J., Apfelbacher, C., Bauer, A., Rönsch, H., Schiffers, F., Ofenloch, R., Weisshaar, E., Buse, A. S., Hansen, A., John, S. M., Giménez Arnau, A. M., Pesqué, D., Agner, T., Nørreslet, L. B., Loman, L., Romeijn, G. L. E., Schuttellaar, M. L. A., Košćec Bjelajac, A., Macan, J., Apfelbacher, C., and Bauer, A.

Abstract

Background: Chronic hand eczema (CHE) is a very common skin disease among the European population. It causes itch and pain and, in more severe cases, seriously impairs hand functioning at work and in private life. Objectives: To explore perspectives of people with lived experience on CHE-related problems, wishes and goals. Methods: Following a qualitative approach, we conducted topic-guided interviews in five European countries and applied template analysis to identify recurrent themes among patients with CHE. Results: We interviewed 60 patients in seven outpatient dermatological and occupational medicine clinics in Croatia, Denmark, Germany, the Netherlands and Spain. Five main themes were identified: (1) knowledge about the disease and its course, (2) preventive behaviour, (3) hand eczema therapy, (4) impact on everyday life and (5) attitudes towards CHE and healthcare. Participants did not feel well informed about CHE, especially about causes, triggers and treatment options. Preventive measures were experienced as more or less effective but also cumbersome. Experiences with therapy were diverse. Treatment satisfaction depended on the results and on the perceived support from the treatment teams. Participants found it important to be taken seriously, to receive practical advice, to try out additional treatments or examinations, find new hope and have occupational perspectives. They wished that others could better understand the physical and emotional burden of CHE. Patient support groups were not mentioned. Participants found it important to learn to take care of themselves and accept life with CHE. Conclusions: Due to its annoying symptoms, high visibility and impaired functioning at work and in private life, CHE has a high emotional and social impact. Some people may require support to learn coping with CHE and its prevention. Patients wish for information about causes and triggers. They value physicians who listen to them and keep looking for solutions.

Published
2023

7. Effect of Level and Downhill Running on Breathing Efficiency

Author

Matthew D. Cook, Stephen D. Myers, John S. M. Kelly, and Mark E. T. Willems

Subjects
eccentric exercise, muscle damage, ventilatory equivalent, metabolic equivalent, moderate intensity, treadmill running, Sports, GV557-1198.995
Abstract

Ventilatory equivalents for oxygen and carbon dioxide are physiological measures of breathing efficiency, and are known to be affected by the intensity and mode of exercise. We examined the effect of level running (gradient 0%) and muscle-damaging downhill running (−12%), matched for oxygen uptake, on the ventilatory equivalents for oxygen () and carbon dioxide (). Nine men (27 ± 9 years, 179 ± 7 cm, 75 ± 12 kg, : 52.0 ± 7.7 mL·kg−1·min−1) completed two 40-min running bouts (5 × 8-min with 2-min inter-bout rest), one level and one downhill. Running intensity was matched at 60% of maximal metabolic equivalent. Maximal isometric force of m.quadriceps femoris was measured before and after the running bouts. Data was analyzed with 2-way ANOVA or paired samples t-tests. Running speed (downhill: 13.5 ± 3.2, level: 9.6 ± 2.2 km·h−1) and isometric force deficits (downhill: 17.2 ± 7.6%, level: 2.0 ± 6.9%) were higher for downhill running. Running bouts for level and downhill gradients had , heart rates and respiratory exchange ratio values that were not different indicating matched intensity and metabolic demands. During downhill running, the , (downhill: 29.7 ± 3.3, level: 27.2 ± 1.6) and (downhill: 33.3 ± 2.7, level: 30.4 ± 1.9) were 7.1% and 8.3% higher (p < 0.05) than level running. In conclusion, breathing efficiency appears lower during downhill running (i.e., muscle-damaging exercise) compared to level running at a similar moderate intensity.

Published
2015
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10. Visual Outcomes, Quality of Vision, and Quality of Life of Diffractive Multifocal Intraocular Lens Implantation after Myopic Laser In Situ Keratomileusis: A Prospective, Observational Case Series

Author

John S. M. Chang, Jack C. M. Ng, Vincent K. C. Chan, and Antony K. P. Law

Subjects
Ophthalmology, RE1-994
Abstract

Purpose. To report visual performance and quality of life after implantation of a bifocal diffractive multifocal intraocular lens (MIOL) in postmyopic laser in situ keratomileusis (LASIK) patients. Methods. Prospective, observational case series. Patients with prior myopic LASIK who had implantation of Tecnis ZMA00/ZMB00 MIOL (Abbott Medical Optics) at Hong Kong Sanatorium and Hospital were included. Postoperative examinations included monocular and binocular distance, intermediate and near visual acuity (VA), and contrast sensitivity; visual symptoms (0–5); satisfaction (1–5); spectacle independence rate; and quality of life. Results. Twenty-three patients (27 eyes) were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate, and near were 0.13±0.15 (standard deviation), 0.22±0.15, and 0.16±0.15, respectively. Corresponding mean values for binocular uncorrected VA were 0.00±0.10, 0.08±0.13, and 0.13±0.10, respectively. No eyes lost >1 line of corrected distance VA. Contrast sensitivity at different spatial frequencies between operated and unoperated eyes did not differ significantly (all P>0.05). Mean score for halos, night glare, starbursts, and satisfaction were 1.46±1.62, 1.85±1.69, 0.78±1.31, and 3.50±1.02, respectively. Eighteen patients (78%) reported complete spectacle independence. Mean composite score of the quality-of-life questionnaire was 90.31±8.50 out of 100. Conclusions. Implantation of the MIOL after myopic LASIK was safe and achieved good visual performance.

Published
2017
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11. Interaction between gut microbiota and COVID-19 and its vaccines

Author

John S M Leung

Subjects
Vaccines, COVID-19 Vaccines, Virus Diseases, Gastroenterology, Humans, COVID-19, General Medicine, Gastrointestinal Microbiome
Abstract

The whole world has been continuously afflicted by the coronavirus disease 2019 (COVID-19) pandemic for the past 3 years. Many countries have tried many methods to control this virus infection with varying successes and failures. The gut microbiota is a biosystem spanning the entire length of the digestive tract and playing important roles in health and disease. It is much affected by COVID-19. In return it also substantially impacts infection. In particular, the gut microbiota has established a bidirectional interaction with the COVID-19 vaccines, enhancing or reducing vaccine efficacy by virtue of its varying components. Conversely, COVID-19 vaccines also make a substantial impact on the gut microbiota, re-ducing its overall population and biodiversity. It is hoped that by exploring and harnessing this bidirectional interaction we may break new ground and develop new methods to prevent and treat this formidable virus infection.

Published
2022

14. Guidelines for diagnosis, prevention, and treatment of hand eczema

Author

Thyssen, J. P., Schuttelaar, M. L. A., Alfonso, J. H., Andersen, K. E., Angelova-Fischer, I., Arents, B. W. M., Bauer, A., Brans, R., Cannavo, A., Christoffers, W. A., Crépy, M. N., Elsner, P., Fartasch, M., Filon, F. L., Giménez-Arnau, A. M., Gonçalo, M., Guzmán-Perera, M. G., Hamann, C. R., Hoetzenecker, W., Johansen, J. D., John, S. M., Kunkeler, A. C. M., Hadzavdic, S. L., Molin, S., Nixon, R., Oosterhaven, J. A. F., Rustemeyer, T., Serra-Baldrich, E., Shah, M., Simon, D., Skudlik, C., Spiewak, R., Valiukevičienė, S., Voorberg, A. N., Weisshaar, E., Agner, T., Thyssen, J. P., Schuttelaar, M. L. A., Alfonso, J. H., Andersen, K. E., Angelova-Fischer, I., Arents, B. W. M., Bauer, A., Brans, R., Cannavo, A., Christoffers, W. A., Crépy, M. N., Elsner, P., Fartasch, M., Filon, F. L., Giménez-Arnau, A. M., Gonçalo, M., Guzmán-Perera, M. G., Hamann, C. R., Hoetzenecker, W., Johansen, J. D., John, S. M., Kunkeler, A. C. M., Hadzavdic, S. L., Molin, S., Nixon, R., Oosterhaven, J. A. F., Rustemeyer, T., Serra-Baldrich, E., Shah, M., Simon, D., Skudlik, C., Spiewak, R., Valiukevičienė, S., Voorberg, A. N., Weisshaar, E., and Agner, T.

Abstract

Background: Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. Objectives: To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. Method: The Guideline Development Group (GDG) was established on behalf of the ESCD. A call for interest was launched via the ESCD website and via the ESCD members' mailing list. Appraisal of the evidence for therapeutic and preventive interventions was applied and a structured method of developing consensus was used and moderated by an external methodologist. The final guideline was approved by the ESCD executive committee and was in external review on the ESCD webpage for 1 month. Results: Consensus was achieved for several statements and management strategies. Conclusion: The updated guideline should improve management of hand eczema.

Published
2022

15. Visual Performance after Bilateral Implantation of a Four-Haptic Diffractive Toric Multifocal Intraocular Lens in High Myopes

Author

John S. M. Chang, Vincent K. C. Chan, Jack C. M. Ng, and Antony K. P. Law

Subjects
Ophthalmology, RE1-994
Abstract

Background. The vision with diffractive toric multifocal intraocular lenses after cataract surgery in long eyes has not been studied previously. Objectives. To report visual performance after bilateral implantation of a diffractive toric multifocal intraocular lens in high myopes. Methods. Prospective, observational case series to include patients with axial length of ≥26 mm and corneal astigmatism of >1 dioptre who underwent bilateral AT LISA 909M implantation. Postoperative examinations included photopic and mesopic distance, intermediate, and near visual acuity; photopic contrast sensitivity; visual symptoms (0–5); satisfaction (1–5); and spectacle independence rate. Results. Twenty-eight eyes (14 patients) were included. Postoperatively, mean photopic monocular uncorrected distance, intermediate, and near visual acuities (logMAR) were 0.12±0.20 (standard deviation), 0.24±0.16, and 0.29±0.21, respectively. Corresponding binocular values were -0.01±0.14, 0.13±0.12, and 0.20±0.19, respectively. One eye (4%) had one-line loss in vision. Under mesopic condition, intermediate vision and near vision decreased significantly (all P≤0.001). Contrast sensitivity at all spatial frequencies did not improve significantly under binocular condition (all P>0.05). Median scores for halos, night glare, starbursts, and satisfaction were 0.50, 0.00, 0.00, and 4.25, respectively. Ten patients (71%) reported complete spectacle independence. Conclusions. Bilateral implantation of the intraocular lens in high myopes appeared to be safe and achieved good visual performance and high satisfaction.

Published
2016
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16. Effect of high-pain versus low-pain structured exercise on walking ability in people with intermittent claudication: meta-analysis

Author

Jemma Perks, Francesco Zaccardi, Craig Paterson, John S. M. Houghton, Andrew T. O. Nickinson, Coral J. Pepper, Harjeet Rayt, Thomas Yates, and Robert Sayers

Subjects
RC1200, Adult, Exercise Test, Humans, Pain, Surgery, Walking, Intermittent Claudication, Exercise, Exercise Therapy
Abstract

Background The aim was to determine the comparative benefits of structured high-pain exercise, structured low-pain exercise, and usual-care control, to identify which has the largest effect on walking ability in people with intermittent claudication (IC). Methods A network meta-analysis was undertaken to assess two outcomes: pain-free walking ability (PFWA) and maximal walking ability (MWA). Nine electronic databases were searched. Trials were included if they were: RCTS; involved adults with IC; had at least two of the following arms—structured low-pain exercise, structured high­-pain exercise or usual-care control; and a maximal or pain-free treadmill walking outcome. Results Some 14 trials were included; results were pooled using the standardized mean difference (MD). Structured low-pain exercise had a significant large positive effect on MWA (MD 2.23, 95 percent c.i. 1.11 to 3.35) and PFWA (MD 2.26, 1.26 to 3.26) compared with usual-care control. Structured high-pain exercise had a significant large positive effect on MWA (MD 0.95, 0.20 to 1.70) and a moderate positive effect on PFWA (0.77, 0.01 to 1.53) compared with usual-care control. In an analysis of structured low- versus high pain exercise, there was a large positive effect in favour of low-pain exercise on MWA (MD 1.28, −0.07 to 2.62) and PFWA (1.50, 0.24 to 2.75); however, this was significant only for PFWA. Conclusion There is strong evidence in support of use of structured high-pain exercise, and some evidence in support of structured low-pain exercise, to improve walking ability in people with IC compared with usual-care control (unstructured exercise advice).

Published
2021

17. Acceptance of skin products in healthcare workers: an empirical investigation.

Author

Symanzik, C, Skudlik, C, and John, S M

Subjects
MEDICAL personnel, PRODUCT acceptance, HAND washing, COVID-19, SATISFACTION
Abstract

Background Healthcare workers (HCWs) are at high risk of developing hand eczema (HE). This can be exacerbated by hygiene measures related to the coronavirus disease (COVID - 19). Using mild skin cleansers and emollients or moisturizers is central in the prevention of HE—especially with increased COVID-19 hygiene regimes. Aims This study aimed to assess parameters important for the acceptance of a skincare concept in HCWs. Methods In this proof-of-concept user trial, HCWs were provided ad libitum with hand wash oil and hand cream during the 6-month period, when occupationally acquired COVID-19 infections among HCWs were peaking in Germany and then surveyed about acceptance of the products using questionnaires. Results Of 135 HCWs, 115 (85%) responded. Skin tolerance of the hand wash oil and the hand cream was rated very good by 63% and 52% of the 115 participants, respectively. Of the 115 participants, 58% and 57% were very satisfied with the hand wash oil and the hand cream, respectively. Conclusions Acceptance of skin cleansing and skincare products in HCWs seems influenced by parameters such as self-assessed skin tolerance and self-reported overall satisfaction. It must be assumed that products are only used as recommended if they are well-accepted. Employers might survey employees about acceptance of products using the parameters identified to adjust concepts if necessary to sustainably contribute to the prevention of HE. [ABSTRACT FROM AUTHOR]

Published
2023
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21. Visual Outcomes and Patient Satisfaction after Refractive Lens Exchange with a Single-Piece Diffractive Multifocal Intraocular Lens

Author

John S. M. Chang, Jack C. M. Ng, Vincent K. C. Chan, and Antony K. P. Law

Subjects
Ophthalmology, RE1-994
Abstract

Purpose. To report visual outcomes and patient satisfaction after unilateral or bilateral refractive lens exchange (RLE) with a single-piece bifocal diffractive multifocal intraocular lens (MIOL). Methods. All patients underwent RLE with the ZMB00 MIOL (Abbott Medical Optics). Patient charts were reviewed to evaluate the distance, intermediate, and near visual acuity (VA), contrast sensitivity, extent of visual symptoms (0–5), satisfaction (1–5), and rate of spectacle independence between unilateral and bilateral RLE group. Results. Forty-seven eyes of 28 patients were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were 0.01±0.12 (standard deviation), 0.27±0.18, and 0.15±0.11, respectively. No eyes lost >1 line of corrected distance VA. Monocular contrast sensitivity remained at normal level. Median scores of halos, night glare, and starbursts for 27 patients were 2.0, 3.0, and 0.0, respectively. Median score of satisfaction was 4.0. There were no differences in visual symptom scores or satisfaction between unilateral and bilateral group (P>0.05). Eighty percent of 25 patients reported total spectacle freedom, with similar rate between bilateral (82%) and unilateral group (75%) (P=1.000). Conclusions. RLE with the bifocal diffractive MIOL was safe in presbyopic patients and resulted in a high rate of spectacle independence.

Published
2014
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23. Patch test informed consent form:position statement by European Academy of Dermatology and Venereology Task Force on Contact Dermatitis

Author

Balato, A., Scala, E., Ayala, F., Bauer, A., Crépy, M. N., Gonçalo, M., Duus Johansen, J., John, S. M., Rustemeyer, T., Wagner, N., Wilkinson, M., Giménez-Arnau, A., Balato, A., Scala, E., Ayala, F., Bauer, A., Crépy, M. N., Gonçalo, M., Duus Johansen, J., John, S. M., Rustemeyer, T., Wagner, N., Wilkinson, M., and Giménez-Arnau, A.

Abstract

Background: To our knowledge, an international consensus is lacking regarding the development of an adequate informed consent form for a patch test (PT) and the information that should be included in such document. Objectives: The aim of the study was to reach a consensus on the specific points that need to be addressed in a PT consent form. Methods: A Delphi survey, comprising 2 rounds and 1 final discussion, was used to gather and analyse data, which was conducted over the Internet. Each statement that reached a consensus with the respondents (9 expert dermatologists from Europe) was defined as a median consensus score (MED) of ≥7 and agreement among panelists as an interquartile range (IQR) of ≤3. All study participants were members of the EADV task force on contact dermatitis. Results: The expert panel addressed several topics that should be included in an informed consent form for a PT: introduction, preparation for PT, testing procedure, allowed activities, adverse events and additional authorizations. Conclusions: Our results assess recommendations regarding points to be contained in an informed consent form for a PR. Future actions towards standardization and harmonization of this specific consent form are needed.

Published
2021

29. Impact of COVID-19 as a vertical infection in late pregnancy

Author

John S M Leung

Subjects
Pregnancy, 2019-20 coronavirus outbreak, biology, Coronavirus disease 2019 (COVID-19), business.industry, SARS-CoV-2, Pneumonia, Viral, COVID-19, medicine.disease, biology.organism_classification, Late pregnancy, Virology, Pneumonia, Betacoronavirus, Pandemic, medicine, Hong Kong, Humans, Female, business, Coronavirus Infections, Pandemics
Published
2020

30. Basal cell carcinoma risk and solar UV exposure in occupationally relevant anatomic sites: do histological subtype, tumor localization and Fitzpatrick phototype play a role? A population-based case-control study

Author

Bauer, A., Haufe, E., Heinrich, L., Seidler, A., Schulze, H. J., Elsner, P., Drexler, H., Letzel, S., John, S. M., Fartasch, M., Brüning, T., Dugas-Breit, S., Gina, M., Weistenhöfer, W., Bachmann, K., Bruhn, I., Lang, B. M., Brans, R., Allam, J. P., Grobe, W., Westerhausen, S., Knuschke, P., Wittlich, M., Diepgen, T. L., and Schmitt, J.

Subjects
ddc:610
Abstract

Background A two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. However, there is an ongoing discussion whether histopathological subtype, tumor localization and Fitzpatrick phototype may influence the risk estimates. Objectives To evaluate the influence of histological subtype, tumor localization and Fitzpatrick phototype on the risk to develop basal cell carcinoma in highly UV-exposed cases and controls compared to those with moderate or low solar UV exposure. Methods Six hundred forty-three participants suffering from incident basal cell carcinoma in commonly sun-exposed anatomic sites (capillitium, face, lip, neck, dorsum of the hands, forearms outside, décolleté) of a population-based, case-control, multicenter study performed from 2013 to 2015 in Germany were matched to controls without skin cancer. Multivariate logistic regression analysis was conducted stratified for histological subtype, phototype 1/2 and 3/4. Dose-response curves adjusted for age, age2, sex, phototype and non-occupational UV exposure were calculated. Results Participants with high versus no (OR 2.08; 95% CI 1.24–3.50; p = 0.006) or versus moderate (OR 2.05; 95% CI 1.15–3.65; p = 0.015) occupational UV exposure showed a more than two-fold significantly increased risk to develop BCC in commonly UV-exposed body sites. Multivariate regression analysis did not show an influence of phototype or histological subtype on risk estimates. The restriction of the analysis to BCC cases in commonly sun-exposed body sites did not influence the risk estimates. The occupational UV dosage leading to a 2-fold increased basal cell carcinoma risk was 6126 standard erythema doses. Conclusion The risk to develop basal cell carcinoma in highly occupationally UV-exposed skin was doubled consistently, independent of histological subtype, tumor localization and Fitzpatrick phototype.

Published
2020

31. The evolving field of Dermato-oncology and the role of dermatologists: Position Paper of the EADO, EADV and Task Forces, EDF, IDS, EBDV–UEMS and EORTC Cutaneous Lymphoma Task Force

Author

Garbe, C., Peris, Ketty, Soura, E., Forsea, A. M., Hauschild, A., Arenbergerova, M., Bylaite, M., del Marmol, V., Bataille, V., Samimi, M., Gandini, S., Saiag, P., Eigentler, T. K., Lallas, A., Zalaudek, Iri, Lebbe, C., Grob, J. -J., Hoeller, C., Robert, C., Dreno, B., Arenberger, P., Kandolf-Sekulovic, L., Kaufmann, R., Malvehy, J., Puig, S., Leiter, U., Ribero, S., Papadavid, E., Quaglino, P., Bagot, M., John, S. M., Richard, M. -A., Trakatelli, M., Salavastru, C., Borradori, L., Marinovic, B., Enk, A., Pincelli, C., Ioannides, D., Paul, C., Stratigos, A. J., Peris K. (ORCID:0000-0002-5237-0463), Zalaudek I., Garbe, C., Peris, Ketty, Soura, E., Forsea, A. M., Hauschild, A., Arenbergerova, M., Bylaite, M., del Marmol, V., Bataille, V., Samimi, M., Gandini, S., Saiag, P., Eigentler, T. K., Lallas, A., Zalaudek, Iri, Lebbe, C., Grob, J. -J., Hoeller, C., Robert, C., Dreno, B., Arenberger, P., Kandolf-Sekulovic, L., Kaufmann, R., Malvehy, J., Puig, S., Leiter, U., Ribero, S., Papadavid, E., Quaglino, P., Bagot, M., John, S. M., Richard, M. -A., Trakatelli, M., Salavastru, C., Borradori, L., Marinovic, B., Enk, A., Pincelli, C., Ioannides, D., Paul, C., Stratigos, A. J., Peris K. (ORCID:0000-0002-5237-0463), and Zalaudek I.

Abstract

Background: The incidence of skin cancers has been increasing steadily over the last decades. Although there have been significant breakthroughs in the management of skin cancers with the introduction of novel diagnostic tools and innovative therapies, skin cancer mortality, morbidity and costs heavily burden the society. Objective: Members of the European Association of Dermato-Oncology, European Academy of Dermatology and Venereology, International Dermoscopy Society, European Dermatology Forum, European Board of Dermatovenereology of the European Union of Medical Specialists and EORTC Cutaneous Lymphoma Task Force have joined this effort to emphasize the fundamental role that the specialist in Dermatology–Venereology has in the diagnosis and management of different types of skin cancer. We review the role of dermatologists in the prevention, diagnosis, treatment and follow-up of patients with melanoma, non-melanoma skin cancers and cutaneous lymphomas, and discuss approaches to optimize their involvement in effectively addressing the current needs and priorities of dermato-oncology. Discussion: Dermatologists play a crucial role in virtually all aspects of skin cancer management including the implementation of primary and secondary prevention, the formation of standardized pathways of care for patients, the establishment of specialized skin cancer treatment centres, the coordination of an efficient multidisciplinary team and the setting up of specific follow-up plans for patients. Conclusion: Skin cancers represent an important health issue for modern societies. The role of dermatologists is central to improving patient care and outcomes. In view of the emerging diagnostic methods and treatments for early and advanced skin cancer, and considering the increasingly diverse skills, knowledge and expertise needed for managing this heterogeneous group of diseases, dermato-oncology should be considered as a specific subspecialty of Dermatology–Venereology.

Published
2020

33. Femtosecond Laser in situ Keratomileusis Flap Creation in Narrow Palpebral Fissure Eyes without Suction

Author

May S Y Cheng, John S M Chang, Antony K. P. Law, and Jack C.M. Ng

Subjects
Suction (medicine), medicine.medical_specialty, genetic structures, Suction loss, medicine.medical_treatment, Femtosecond, Case Report, Keratomileusis, law.invention, 03 medical and health sciences, 0302 clinical medicine, lcsh:Ophthalmology, law, medicine, Narrow palpebral fissure, Fixation (histology), business.industry, Significant difference, LASIK, 030208 emergency & critical care medicine, Laser, Laser in situ keratomileusis, eye diseases, Surgery, Ophthalmology, lcsh:RE1-994, 030221 ophthalmology & optometry, sense organs, business, Flap creation
Abstract

Purpose: To evaluate a surgical technique used in eyes with narrow palpebral fissure undergoing femtosecond laser flap creation without suction during laser in situ keratomileusis (LASIK). Methods: All data of 2 patient groups were collected through chart review. Group 1 consisted of 6 eyes with narrow palpebral fissure in which the suction ring was manually fixated and femtosecond laser was applied accordingly. Thirty comparison cases were randomly drawn from among eyes that underwent a standard LASIK procedure matched for age and preoperative refraction (group 2). Only 1 eye of each patient was selected to compare the refractive and visual outcomes between groups. Results: In all group 1 eyes, the flaps were created successfully with manual fixation of the suction ring without suction. No eyes lost 2 or more lines of vision. No significant difference was found in the safety and refractive outcomes between groups. Conclusion: Manual fixation of the suction ring in eyes with narrow palpebral fissure without suction was feasible for flap creation during LASIK.

Published
2017

34. The structure and molecular size of the polysaccharide components of the seeds of Hevea brasiliensis

Author

Robertson, John S. M.

Subjects
547.78
Abstract

Seeds contain a wide variety of polysaccharides. hese polymers may vary in function from skeletal omponents of the cellulose and hemicellulose type to starch-like food storage materials. In addition, here may be present complex mucilages and pectins. Some of these polysaccharides are relatively simple in structure, whilst others are extremely complicated. The constituents depend on the species of the plant, although it would appear that seeds of I the same family usually contain polysaccharides of similar structure. Seed-materials provide, in fact, a very extensive and attractive field for investigation, although the problems involved are difficult and entail (1) the extraction and separation of the polysaccharide mixture, (2) the determination of the nature and configuration of the structural units in the components, and (3) the determination of the molecular size of the components. Few studies on these lines have been reported. In the investigations outlined below, the endosperm of the seeds of the rubber tree (Hevea brasiliensis), has been separated into its polysaccharide components and the constitution and size of two of these studied.

Published
1954

35. Bilateral Implantation of a Single-Piece Bifocal Diffractive Intraocular Lens in Presbyopic Patients: A Prospective Case Series

Author

John S M Chang

Subjects
Adult, Male, medicine.medical_specialty, genetic structures, Mesopic vision, media_common.quotation_subject, medicine.medical_treatment, Visual Acuity, Intraocular lens, Contrast Sensitivity, 03 medical and health sciences, 0302 clinical medicine, Lens Implantation, Intraocular, Ophthalmology, medicine, Humans, Contrast (vision), Prospective Studies, Aged, media_common, Lenses, Intraocular, business.industry, Glare (vision), Presbyopia, General Medicine, Phacoemulsification, Middle Aged, Multifocal intraocular lens, medicine.disease, eye diseases, 030221 ophthalmology & optometry, Female, business, 030217 neurology & neurosurgery, Photopic vision
Abstract

PURPOSE To report visual outcomes and quality after bilateral implantation of a single-piece diffractive multifocal intraocular lens (MIOL) with a bifocal design. DESIGN Prospective, observational case series. METHODS All presbyopic subjects were implanted with the ZMB00 MIOL (Abbott Medical Optics) at the Hong Kong Sanatorium and Hospital. We evaluated the distance, intermediate, and near visual acuity (VA) under photopic and mesopic conditions; contrast sensitivity with and without glare under photopic and mesopic conditions; quality of vision; and rate of spectacle independence. RESULTS A total of 36 subjects were included. No intraoperative complications developed. At the 6-month visit, the mean (± standard deviation) monocular uncorrected VAs at distance, intermediate, and near were 0.01 ± 0.12, 0.26 ± 0.17, and 0.09 ± 0.08, respectively. The respective mean binocular uncorrected VAs were -0.05 ± 0.09, 0.12 ± 0.13, and 0.04 ± 0.06. No eyes lost any corrected distance VA. The binocular contrast sensitivity was significantly better without glare than with glare under photopic and mesopic conditions (P < 0.05 for all spatial frequencies under both conditions). A total of 21 (58%) and 21 subjects (58%) reported halo and glare, respectively. Thirty subjects (83%) reported complete spectacle independence. CONCLUSIONS Bilateral implantation of the bifocal MIOL in presbyopic patients with or without cataract was safe and resulted in satisfactory vision and a high rate of spectacle independence. Halos and glare were common.

Published
2019

37. The role of the dermatologist in the immune-mediated/allergic diseases – position statement of the EADV task force on contact dermatitis, EADV task force on occupational skin diseases, UEMS-EBDV subcommission allergology and European Dermatology Forum

Author

Balato, A., Raimondo, A., Arenberger, P., Bruze, M., Czarnecka-Operacz, M., Johanssen, J. D., Gonçalo, M., Ranki, A., Uter, W., Wilkinson, M., Ayala, F., John, S. M., Giménez-Arnau, A., Gollnick, H., Balato, A., Raimondo, A., Arenberger, P., Bruze, M., Czarnecka-Operacz, M., Johanssen, J. D., Gonçalo, M., Ranki, A., Uter, W., Wilkinson, M., Ayala, F., John, S. M., Giménez-Arnau, A., and Gollnick, H.

Abstract

Background: The members of the Task Force on Contact Dermatitis and the Task Force on Occupational Dermatoses of the European Academy of Dermatology and Venereology (EADV), of the European Dermatology Forum (EDF), and the members of the UEMS Section of Dermatology-Venereology (UEMS-EBDV) we want to vindicate the fundamental role that the specialist in Dermatology has in the diagnosis and management of Immuno-mediated /allergic Diseases. Objective: In disagreement with the blueprint paper of the UEMS section of Allergology (2013), in which dermatologists are excluded from one of their core activities it was decided to write this consensus paper. Discussion: The skin occupies a crucial place in the broad spectrum of allergic diseases; there is no other organ with such a multitude of different clinical conditions mediated by so many pathogenetic immune mechanisms. Subsequently, dermatologists play a fundamental role in the management of immune-mediated diseases including among others contact dermatitis, atopic dermatitis, urticaria and angioedema or cutaneous adverse drug, food and arthropod reactions. The essential role of dermatology in the diagnostic, therapeutic and preventive management of immune mediated /allergic diseases which is crucial for patient management is justified from both the academic and professional point of view. Conclusion: Based on the best care of the patient with cutaneous immune allergic disease a multidisciplinary approach is desirable and the dermatologist has a pivotal role in patient management. Be so good and no one will not ignore you, dermatologist. Ideally Dermatology should be governed according the following Henry Ford statement: “Arriving together is the beginning; keeping together is progress; working together is success.”.

Published
2019

38. Cataract Surgery with a New Fluidics Control Phacoemulsification System in Nanophthalmic Eyes

Author

Jack C.M. Ng, Antony K. P. Law, Vincent K. C. Chan, and John S M Chang

Subjects
genetic structures, medicine.medical_treatment, Case Report, After cataract, Intraocular lenses, Cataract extraction, 03 medical and health sciences, 0302 clinical medicine, lcsh:Ophthalmology, medicine, Microphthalmos, Axial length, eye, Phacoemulsification, business.industry, Cataract surgery, eye diseases, Ophthalmology, lcsh:RE1-994, 030221 ophthalmology & optometry, Optometry, sense organs, business, 030217 neurology & neurosurgery
Abstract

Purpose: To report visual outcomes and complications after cataract surgery in nanophthalmic eyes with a phacoemulsification system using the active fluidics control strategy. Methods: This is a retrospective case series. All eyes with an axial length of less than 20 mm that underwent cataract surgery or refractive lens exchange using the Centurion Vision System (Alcon Laboratories Inc.) in Hong Kong Sanatorium and Hospital were evaluated. The visual acuity and intraoperative and postoperative complications were reported. Prior approval from the Hospital Research Committee has been granted. Results: Five eyes of 3 patients were included. The mean follow-up period was 10.2 ± 5.3 months (range, 4–18). Two eyes (40%) had a one-line loss of corrected distance visual acuity. No uveal effusion and posterior capsular tear developed. An optic crack and haptic breakage in the intraocular lens developed in 1 eye (20%) and 2 eyes (40%), respectively. Additional surgeries to treat high postoperative intraocular pressure were required in 1 eye (20%). Conclusion: The use of a new phacoemulsification system, which actively monitors and maintains the intraoperative pressure, facilitated anterior chamber stability during cataract surgery in nanophthalmic eyes. This minimized the risk of major complications related to unstable anterior chambers such as uveal effusion and posterior capsular tear. Development of intraoperative crack/breakage in a high-power intraocular lens was common.

Published
2016

42. Leg ischaemia management collaboration (LIMb): study protocol for a prospective cohort study at a single UK centre

Author

Houghton, John S M, primary, Nduwayo, Sarah, additional, Nickinson, Andrew T O, additional, Payne, Tanya J, additional, Sterland, Sue, additional, Nath, Mintu, additional, Gray, Laura J, additional, McMahon, Greg S, additional, Rayt, Harjeet S, additional, Singh, Sally J, additional, Robinson, Thompson G, additional, Conroy, Simon P, additional, Haunton, Victoria J, additional, McCann, Gerry P, additional, Bown, Matthew J, additional, Davies, Robert S M, additional, and Sayers, Rob D, additional

Published
2019
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48. Visual Outcomes, Quality of Vision, and Quality of Life of Diffractive Multifocal Intraocular Lens Implantation after Myopic Laser In Situ Keratomileusis: A Prospective, Observational Case Series

Author

Vincent K. C. Chan, Jack C.M. Ng, Antony K. P. Law, and John S M Chang

Subjects
medicine.medical_specialty, Article Subject, genetic structures, media_common.quotation_subject, medicine.medical_treatment, Keratomileusis, 03 medical and health sciences, 0302 clinical medicine, Quality of life, lcsh:Ophthalmology, Ophthalmology, Medicine, Contrast (vision), media_common, Series (stratigraphy), business.industry, LASIK, Glare (vision), Multifocal intraocular lens, eye diseases, Surgery, lcsh:RE1-994, 030221 ophthalmology & optometry, Clinical Study, Observational study, sense organs, business, 030217 neurology & neurosurgery
Abstract

Purpose. To report visual performance and quality of life after implantation of a bifocal diffractive multifocal intraocular lens (MIOL) in postmyopic laser in situ keratomileusis (LASIK) patients.Methods. Prospective, observational case series. Patients with prior myopic LASIK who had implantation of Tecnis ZMA00/ZMB00 MIOL (Abbott Medical Optics) at Hong Kong Sanatorium and Hospital were included. Postoperative examinations included monocular and binocular distance, intermediate and near visual acuity (VA), and contrast sensitivity; visual symptoms (0–5); satisfaction (1–5); spectacle independence rate; and quality of life.Results. Twenty-three patients (27 eyes) were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate, and near were0.13±0.15(standard deviation),0.22±0.15, and0.16±0.15, respectively. Corresponding mean values for binocular uncorrected VA were0.00±0.10,0.08±0.13, and0.13±0.10, respectively. No eyes lost >1 line of corrected distance VA. Contrast sensitivity at different spatial frequencies between operated and unoperated eyes did not differ significantly (allP>0.05). Mean score for halos, night glare, starbursts, and satisfaction were1.46±1.62,1.85±1.69,0.78±1.31, and3.50±1.02, respectively. Eighteen patients (78%) reported complete spectacle independence. Mean composite score of the quality-of-life questionnaire was90.31±8.50out of 100.Conclusions. Implantation of the MIOL after myopic LASIK was safe and achieved good visual performance.

Published
2017

49. Epikutantest-ergebnisse mit der Europäischen standardreihe bei patienten mit berufsbedingtem kontaktekzem in Europa: Ergebnisse des ESSCA netzwerks 2002 - 2010. [Patch test results with the European baseline series among patients with occupational dermatitis across Europe: Analyses of the ESSCA network, 2002 - 2010]

Author

Uter, W., Jolanki, R., Larese Filon, F., Wilkinson, M., Krecisz, B., Kiec-͆wierczynska, M., Bauer, A., Mahler, V., John, S. M., Schnuch, A., Pesonen, M., Namen des ESSCA Netzwerks, Uter, W., Jolanki, R., Larese Filon, F., Wilkinson, M., Krecisz, B., Kiec-͆wierczynska, M., Bauer, A., Mahler, V., John, S. M., Schnuch, A., Pesonen, M., and Namen des ESSCA, Netzwerks

Subjects
Chromium, Epoxy resins, Clinical epidemiology, Contact allergy, Chloromethylisothiazolinone/methylisothiazolinone, Cobalt, Formaldehyde, Methyldibromo glutaronitrile, Occupational dermatitis, P-phenylene diamine, Patch testing, Thiurams, Epoxy resin, Occupational dermatiti
Abstract

Background: Occupational contact dermatitis is one of the most common occupational diseases in Europe. In order to develop efficient preventive measures, detailed and up-to-date data on the incidence, main causes and professions at risk of occupational contact dermatitis are needed. Objectives: To describe the pattern of patch test reactivity to allergens in the European baseline series in patients with occupational dermatitis in different occupations. Methods: We analyzed data collected by the European Surveillance System on Contact Allergy network (ESSCA) from 2002 to 2010, from 11 European countries. Results: Allergens in the European Baseline Series associated with an at least doubled risk of occupational dermatitis include thiuram rubber chemicals, epoxy resin, and the antimicrobial chloromethylisothiazolinone/methylisothiazolinone. Conclusions: When planning and implementing measures aiming to prevent occupational contact dermatitis, the focus should be on high-risk occupational groups and particularly the most common occupational allergies. Patch testing solely with the baseline series is not adequate in diagnostic work-up of occupational contact dermatitis. Special series and, as appropriate, materials from the workplace must be included in the test programme.

Published
2015

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