ARDC Research Link Australia

ORCID Profile
Orcid icon. 0000-0003-4802-010X

Current Organisations
Gachon University, College of Medicine , London Health Sciences Centre , Cal Poly Humboldt College of Professional Studies , Korea Maritime and Ocean University

Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.

Publications

Publication

Run, lift, or both? Associations between concurrent aerobic–muscle strengthening exercise with adverse cardiometabolic biomarkers among Korean adults

Publisher: Oxford University Press (OUP)

Date: 06-12-2020

DOI: 10.1177/2047487318817899

Abstract: Clinical exercise interventions show that combining moderate to vigorous intensity physical activity (MVPA) and muscle strengthening exercise (MSE) has more favourable cardiometabolic health benefits than engaging in only one mode of physical activity. However, few studies have examined these associations among community-based s les and none among Asian adults. This cross-sectional analysis included 9120 participants aged 20–80 years from the 2014–2015 Korea National Health and Nutritional Examination Survey. Fasting blood s les were analysed for adverse cardiometabolic biomarkers (e.g. high glucose/glycohaemoglobin/triglycerides) and MVPA and MSE were assessed using validated questionnaires. Poisson regression models examined the association between the in idual and total number of adverse biomarkers across categories of MVPA–MSE guideline adherence (met neither (reference) met MSE only met MVPA only met both) and prevalence ratios are reported adjusted for covariates (e.g. age, education, smoking, waist circumference and sitting time). The mean ± SD age was 46.2 ± 16.3 years and 50.3% of the participants were women. Compared with meeting neither guideline, meeting both guidelines had the lowest prevalence ratios for four out of eight in idual adverse cardiometabolic biomarkers. In a sex-stratified analysis of men, only meeting both guidelines had a lower prevalence ratio for ≥4 adverse biomarkers (prevalence ratio 0.67 95% confidence interval 0.53–0.85). For women, the prevalence ratio for ≥4 adverse biomarkers was lowest among those meeting both guidelines (prevalence ratio 0.46 95% confidence interval 0.31–0.66), followed by MSE only (prevalence ratio 0.65 95% confidence interval 0.42–0.96) and MVPA only (prevalence ratio 0.78 95% confidence interval 0.65–0.92). Among a large s le of Korean adults, concurrent MVPA–MSE was independently associated with favourable cardiometabolic outcomes. This study supports public health action to promote adherence to MVPA–MSE guidelines to enhance cardiovascular health among Korean adults.

Publication

Benefits and Risks of Primary Treatments for High-risk Localized and Locally Advanced Prostate Cancer: An International Multidisciplinary Systematic Review

Publisher: Elsevier BV

Date: 05-2020

DOI: 10.1016/J.EURURO.2020.01.033

Publication

Benefits of Empiric Nutritional and Medical Therapy for Semen Parameters and Pregnancy and Live Birth Rates in Couples with Idiopathic Infertility: A Systematic Review and Meta-analysis

Publisher: Elsevier BV

Date: 04-2019

DOI: 10.1016/J.EURURO.2018.12.022

Abstract: Empiric use of medical and nutritional supplements to improve semen parameters and pregnancy rates in couples with idiopathic infertility has reached global proportions, although the evidence base for their use in this setting is controversial. We systematically reviewed evidence comparing the benefits of nutritional and medical therapy on pregnancy rates and semen parameters in men with idiopathic infertility. A literature search was performed using MEDLINE, Embase, LILACS, and the Cochrane Library (searched from January 1, 1990 to September 19, 2017). using the methods detailed in the Cochrane Handbook. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of evidence. The literature search identified 5663 citations, and after screening of abstracts and full texts, 61 studies (59 randomised controlled trials and two nonrandomised comparative studies) were included. Pooled results demonstrated that pentoxyfylline, coenzyme Q10, L-carnitine, follicle-stimulating hormone, tamoxifen, and kallikrein all resulted in improvements in semen parameters. In idual studies identified several other medical and nutritional therapies that improved semen parameters, but data were limited to in idual studies with inherent methodological flaws. There were limited data available on live birth and pregnancy rates for all interventions. The GRADE certainty of evidence for all outcomes was very low mainly owing to methodological flaws and inconsistencies in study design. Some outcomes were also downgraded owing to imprecision of results. There is some evidence that empiric medical and nutritional supplements may improve semen parameters. There is very limited evidence that empiric therapy leads to better live birth rates, spontaneous pregnancy, or pregnancy following assisted-reproductive techniques. However, the findings should be interpreted with caution as there were some methodological flaws, as a number of studies were judged to be either at high or unclear risk of bias for many domains. This review identified several medical and nutritional treatments, such as pentoxyfylline, coenzyme Q10, L-carnitine, follicle-stimulating hormone, tamoxifen, and kallikrein, that appear to improve semen parameters. However, there are limited data suggesting improvements in pregnancy and live birth rates. The lack of evidence can be attributed to methodological flaws in studies and the low number of pregnancies reported.

Publication

Systematic Review of Active Surveillance for Clinically Localised Prostate Cancer to Develop Recommendations Regarding Inclusion of Intermediate-risk Disease, Biopsy Characteristics at Inclusion and M

Publisher: Elsevier BV

Date: 04-2022

DOI: 10.1016/J.EURURO.2021.12.007

Abstract: There is uncertainty regarding the most appropriate criteria for recruitment, monitoring, and reclassification in active surveillance (AS) protocols for localised prostate cancer (PCa). To perform a qualitative systematic review (SR) to issue recommendations regarding inclusion of intermediate-risk disease, biopsy characteristics at inclusion and monitoring, and repeat biopsy strategy. A protocol-driven, Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-adhering SR incorporating AS protocols published from January 1990 to October 2020 was performed. The main outcomes were criteria for inclusion of intermediate-risk disease, monitoring, reclassification, and repeat biopsy strategies (per protocol and/or triggered). Clinical effectiveness data were not assessed. Of the 17 011 articles identified, 333 studies incorporating 375 AS protocols, recruiting 264 852 patients, were included. Only a minority of protocols included the use of magnetic resonance imaging (MRI) for recruitment (n = 17), follow-up (n = 47), and reclassification (n = 26). More than 50% of protocols included patients with intermediate or high-risk disease, whilst 44.1% of protocols excluded low-risk patients with more than three positive cores, and 39% of protocols excluded patients with core involvement (CI) >50% per core. Of the protocols, ≥80% mandated a confirmatory transrectal ultrasound biopsy 72% (n = 189) of protocols mandated per-protocol repeat biopsies, with 20% performing this annually and 25% every 2 yr. Only 27 protocols (10.3%) mandated triggered biopsies, with 74% of these protocols defining progression or changes on MRI as triggers for repeat biopsy. For AS protocols in which the use of MRI is not mandatory or absent, we recommend the following: (1) AS can be considered in patients with low-volume International Society of Urological Pathology (ISUP) grade 2 (three or fewer positive cores and cancer involvement ≤50% CI per core) or another single element of intermediate-risk disease, and patients with ISUP 3 should be excluded (2) per-protocol confirmatory prostate biopsies should be performed within 2 yr, and per-protocol surveillance repeat biopsies should be performed at least once every 3 yr for the first 10 yr and (3) for patients with low-volume, low-risk disease at recruitment, if repeat systematic biopsies reveal more than three positive cores or maximum CI >50% per core, they should be monitored closely for evidence of adverse features (eg, upgrading) patients with ISUP 2 disease with increased core positivity and/or CI to similar thresholds should be reclassified. We examined the literature to issue new recommendations on active surveillance (AS) for managing localised prostate cancer. The recommendations include setting criteria for including men with more aggressive disease (intermediate-risk disease), setting thresholds for close monitoring of men with low-risk but more extensive disease, and determining when to perform repeat biopsies (within 2 yr and 3 yearly thereafter).

Publication

A Systematic Review of Focal Ablative Therapy for Clinically Localised Prostate Cancer in Comparison with Standard Management Options: Limitations of the Available Evidence and Recommendations for Cli

Publisher: Elsevier BV

Date: 06-2021

DOI: 10.1016/J.EUO.2020.12.008

Abstract: The clinical effectiveness of focal therapy (FT) for localised prostate cancer (PCa) remains controversial. To analyse the evidence base for primary FT for localised PCa via a systematic review (SR) to formulate clinical practice recommendations. A protocol-driven, PRISMA-adhering SR comparing primary FT (sub-total, focal, hemi-gland, or partial ablation) versus standard options (active surveillance [AS], radical prostatectomy [RP], or external beam radiotherapy [EBRT]) was undertaken. Only comparative studies with ≥50 patients per arm were included. Primary outcomes included oncological, functional, and quality-of-life outcomes. Risk of bias (RoB) and confounding assessments were undertaken. Eligible SRs were reviewed and appraised (AMSTAR) and ongoing prospective comparative studies were summarised. Out of 1119 articles identified, four primary studies (1 randomised controlled trial [RCT] and 3 retrospective studies) recruiting 3961 patients and ten eligible SRs were identified. Only qualitative synthesis was possible owing to clinical heterogeneity. Overall, RoB and confounding were moderate to high. An RCT comparing vascular-targeted focal photodynamic therapy (PDT) with AS found a significantly lower rate of treatment failure at 2 yr with PDT. There were no differences in functional outcomes, although PDT was associated with worse transient adverse events. However, the external validity of the study was contentious. A retrospective study comparing focal HIFU with robotic RP found no significant differences in treatment failure at 3 yr, with focal HIFU having better continence and erectile function recovery. Two retrospective cohort studies using Surveillance, Epidemiology and End Results data compared focal laser ablation (FLA) against RP and EBRT, reporting significantly worse oncological outcomes for FLA. The overall data quality and applicability of the primary studies were limited because of clinical heterogeneity, RoB and confounding, lack of long-term data, inappropriate outcome measures, and poor external validity. Virtually all the SRs identified concluded that there was insufficient high-certainty evidence to make definitive conclusions regarding the clinical effectiveness of FT, with the majority of SRs judged to have a low or critically low confidence rating. Eight ongoing prospective comparative studies were identified. Ways of improving the evidence base are discussed. The certainty of the evidence regarding the comparative effectiveness of FT as a primary treatment for localised PCa was low, with significant uncertainties. Until higher-certainty evidence emerges from robust prospective comparative studies measuring clinically meaningful outcomes at long-term time points, FT should ideally be performed within clinical trials or well-designed prospective cohort studies. We examined the literature to determine the effectiveness of prostate-targeted treatment compared with standard treatments for untreated localised prostate cancer. There was no strong evidence showing that focal treatment compares favourably with standard treatments consequently, focal treatment is not recommended for routine standard practice.

Publication