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Ong PW, Lim CJ, Pereira MJ, Kwek EB, Tan BY. Achieving satisfactory functional outcomes in conservatively treated proximal humerus fractures: relationship between shoulder range of motion and patient-reported clinical outcome scores. JSES Int 2024; 8:440-445. [PMID: 38707550 PMCID: PMC11064704 DOI: 10.1016/j.jseint.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Proximal humerus fractures are common osteoporotic fractures. Postinjury outcome measures include objective clinician-measured range of motion (ROM) and subjective patient-reported outcome measures (PROMs), but the relationship between both has not been established. This study aimed to determine the relationship between shoulder ROM and PROMs and establish which ROMs correlated most with PROMs. Methods A prospective cohort study was conducted on patients with acute proximal humerus fractures. Surgical intervention, open or pathological fractures, neurovascular compromise, polytrauma, or delayed presentations were excluded. Correlation and regression analyses between active ROM and PROMs (Quick Disabilities of Arm, Shoulder and Hand [QuickDASH] and Oxford Shoulder Score [OSS]) at 1-year postinjury were explored. ROM cutoffs predicting satisfactory PROM scores were established. Results Fifty-five patients were recruited. Moderate correlations were observed between PROMs and flexion, extension, and abduction, but not internal and external rotation. Multivariate analysis showed significant relationships between PROMs and flexion [QuickDASH: adjusted coefficient (AC): -0.135, P = .013, OSS: AC: 0.072, P = .002], abduction [QuickDASH: AC: -0.115, P = .021, OSS: AC: 0.059, P = .005], and extension [QuickDASH: AC: -0.304, P = .020] adjusting for age, gender, Neer classification, injury on dominant side, and employment. Achieving 130° flexion, 59° extension, and 124° abduction were correlated with satisfactory OSS/QuickDASH scores, respectively. Conclusion Overall, holistic assessment of outcomes with both subjective and objective outcomes are necessary, as shoulder flexion, extension, and abduction are only moderately correlated with PROMs. Attaining 130° flexion, 59° extension, and 124° abduction corresponded with satisfactory functional outcomes measured by OSS/QuickDASH and can guide rehabilitation.
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Affiliation(s)
- Pei Wen Ong
- Department of Emergency Medicine, National Healthcare Group, Singapore, Singapore
| | - Chien Joo Lim
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore, Singapore
| | - Michelle J. Pereira
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Ernest B.K. Kwek
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore, Singapore
| | - Bryan Yijia Tan
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore, Singapore
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Shaari MK, Tan YW, Abdullah MY, Sharudin MF, Osman M, Teoh THQ, Lim CJ, Nah SA. Comparing Consistency and Usability of Common Bowel Function Scoring Systems in Anorectal Malformation Patients. J Pediatr Surg 2024; 59:571-576. [PMID: 38160189 DOI: 10.1016/j.jpedsurg.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Assessment of postoperative bowel function in anorectal malformation (ARM) patients is crucial for benchmarking outcomes. We compared existing bowel function scoring systems in various aspects in patients with ARM. METHODS With ethical approval, this was a cross-sectional study involving 5 paediatric surgery referral centres in Malaysia, comparing the Kelly, Japanese Study Group of Anorectal Anomalies (JSGA), Holschneider and Krickenbeck bowel function questionnaires. We recruited patients aged 4-17 years, who had completed definitive surgery & stoma closure (where relevant) > 12 months prior to participation. We standardised outcomes of each scoring system into categories ('good', 'fair', 'poor' and 'very poor') to facilitate comparison. Parents & patients were surveyed and asked to rate the ease of understanding of each questionnaire. The difference in protocol scores rated between parents and patients were compared. Association of each bowel function scoring protocol with type of anomaly was assessed. Statistical significance was p < 0.05. RESULTS Thirty-nine parents (21 mothers, 18 fathers) and 23 patients were included in this study. Fair agreement was found between Kelly and Krickenbeck protocols (κ = 0.343; p < 0.001), between JSGA constipation and Holschneider protocols (κ = 0.276; p = 0.002); JSGA constipation and Krickenbeck protocols (κ = 0.256; p = 0.004); and between Holschneider and Krickenbeck protocols (κ = 0.273; p = 0.003). Only the Kelly protocol showed significant correlation between parents and patients' answers (ρ = 0.459, p = 0.028). Krickenbeck demonstrated the best negative correlation of patients' scores with ARM types (ρ = -0.401, p = 0.001). The Kelly protocol ranked highest when comparing ease of understanding. CONCLUSION All the questionnaires appeared comparable in assessing postoperative faecal continence in ARM patients. The Kelly questionnaire performed best in 3 key areas of assessment. LEVEL OF EVIDENCE Level III Cross-Sectional Study.
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Affiliation(s)
- Mohd Khairulanuar Shaari
- Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yew-Wei Tan
- Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Division of Paediatric Surgery, Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Yusof Abdullah
- Department of Paediatric Surgery, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Mohd Fauzi Sharudin
- Division of Paediatric Surgery, Department of Surgery, Hospital Sultanah Aminah, Johor, Malaysia
| | - Marjmin Osman
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Tammy Han Qi Teoh
- Division of Paediatric Surgery, Department of Surgery, Hospital Pulau Pinang, Pulau Pinang, Malaysia
| | - Chien Joo Lim
- Department of Orthopaedic Surgery, Woodlands Health, Singapore
| | - Shireen Anne Nah
- Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Division of Paediatric Surgery, Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Jong SC, Fuentes JA, Seow AEQ, Lim CJ, Chandran G, Chua KSG. Effect of body mass index on inpatient rehabilitation outcome after stroke in a Southeast Asian cohort: a prospective study. Singapore Med J 2024; 65:223-228. [PMID: 34717300 DOI: 10.11622/smedj.2021190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We examined the association between admission body mass index (BMI) and discharge rehabilitation functional outcome using the functional independence measure (FIM) in a Southeast Asian cohort of stroke patients during inpatient rehabilitation. METHODS A prospective, observational cohort study of stroke patients admitted to a single inpatient rehabilitation unit was conducted. Using the World Health Organization Asian standards, BMI was classified as underweight (<18.5 kg/m 2 ), normal (18.5-22.9 kg/m 2 ) and overweight (≥23 kg/m 2 ). The primary outcome measure was discharge FIM, and secondary outcomes included FIM gain, FIM efficiency and FIM effectiveness. RESULTS Two hundred and forty-seven stroke subjects were enrolled. The mean age of the cohort was 59.48 (standard deviation [SD] 12.35) years; 64.4% ( n = 159) were male and 52.6% ( n = 130) had ischaemic stroke. The distributions of underweight, normal and overweight based on BMI on admission were 10.9% ( n = 27), 33.2% ( n = 82) and 55.9% ( n = 138), respectively, and the distributions upon discharge were 11.7% ( n = 29), 38.1% ( n = 94) and 50.2% (n = 124), respectively. Significant small decreases in BMI from admission to discharge were found (median [interquartile range] 23.58 [23.40-24.70] vs. 23.12 [22.99-24.21]; P < 0.001). Similarly, clinically significant FIM gains (mean ΔFIM 26.71; 95% confidence interval 24.73, 28.69, P < 0.001) were noted after a median length of stay of 36 days. No significant relationships were found between BMI and discharge FIM ( P = 0.600), FIM gain ( P = 0.254), FIM efficiency ( P = 0.412) or FIM effectiveness ( P = 0.796). CONCLUSION Findings from this study unequivocally support the benefits of acute inpatient stroke rehabilitation. Patients in the obese BMI range tended to normalise during rehabilitation. Body mass index, whether underweight, normal or overweight, did not correlate with discharge FIM.
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Affiliation(s)
- Sze Chin Jong
- Division of Rehabilitation Medicine, University Medicine Cluster, National University Hospital, Singapore
| | | | | | - Chien Joo Lim
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore
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Goff AJ, Jones LE, Lim CJ, Tan BY. A cross sectional study exploring the relationship of self-reported physical activity with function, kinesiophobia, self-efficacy and quality of life in an Asian population seeking care for knee osteoarthritis. BMC Musculoskelet Disord 2024; 25:74. [PMID: 38238654 PMCID: PMC10795260 DOI: 10.1186/s12891-024-07181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Physical activity is a guideline-recommended first-line intervention for people with knee osteoarthritis. Physical activity levels, and its potential correlates, is underexplored in Asian populations with knee osteoarthritis. METHODS Participants enrolled in a longitudinal study in Singapore self-reported physical activity (UCLA activity score), function (Knee Osteoarthritis Outcome Score [KOOS-12]), kinesiophobia (Brief fear of movement [BFOM]), self-efficacy (ASES-8), and quality of life (EQ-5D-5 L). One-Way ANOVA was used to test the difference in outcomes between UCLA categories, while ordinal logistic regression was used to identify the associated factors to physical activity level. RESULTS Seventy-three percent of all enrolled participants (n = 311/425) reported either inactivity or low physical activity (median 4, IQR 3-5). Significant, weak, positive correlations were observed be-tween UCLA activity score and either KOOS-12 (Spearman's rho: 0.1961; p < 0.001), ASES-8 (0.1983; p = 0.004), or EQ-5D-5 L (0.2078; p < 0.001). A significant, weak, negative correlation was observed between physical activity and BFOM (-0.2183; p < 0.001). Significant differences in function between groups (moderate vs. inactive or low physical activity) were not clinically important. Participants with obesity, from the eldest age category (i.e. ≥75), or who identified as Malay or female, were less physically active than those with a healthy BMI, below the age of 54, or who identified as Chinese or male, respectively. CONCLUSION Healthcare professionals in Asia should be aware of the large proportion of people with knee osteoarthritis who are either inactive or have low physical activity levels. Screening for, and offering interventions to promote, physical activity and its correlates should be prioritised.
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Affiliation(s)
- Anthony J Goff
- Singapore Institute of Technology, Health and Social Sciences, 10 Dover Drive, Singapore, 138683, Singapore
| | - Lester E Jones
- Singapore Institute of Technology, Health and Social Sciences, 10 Dover Drive, Singapore, 138683, Singapore
- Judith Lumley Centre, La Trobe University, Plenty Rd & Kingsbury Dr, Bundoora, Vic, 3086, Australia
| | - Chien Joo Lim
- Orthopaedic Surgery, Woodlands Health, Yishun Community Hospital, 2 Yishun Central 2 Tower E, Singapore, 768024, Singapore
| | - Bryan Yijia Tan
- Orthopaedic Surgery, Woodlands Health, Yishun Community Hospital, 2 Yishun Central 2 Tower E, Singapore, 768024, Singapore.
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Ratha Krishnan R, Ting SWX, Teo WS, Lim CJ, Chua KSG. Rehabilitation of Older Asian Traumatic Brain Injury Inpatients: A Retrospective Study Comparing Functional Independence between Age Groups. Life (Basel) 2023; 13:2047. [PMID: 37895429 PMCID: PMC10608274 DOI: 10.3390/life13102047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/18/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Across traumatic brain injury (TBI) severities, a geriatric TBI tsunami has emerged. Mixed outcomes are reported for elderly TBI with positive functional improvements with acute inpatient rehabilitation. We studied the effect of age at TBI on discharge functional outcomes, levels of independence and length of stay. A retrospective analysis of Asian TBI patients during inpatient rehabilitation over a 4-year period was conducted. Independent variables included admission GCS, post-traumatic amnesia (PTA) duration and injury subtypes. Primary outcomes were discharge Functional Independence Measure (Td-FIM) and FIM gain. In total, 203 datasets were analysed; 60.1% (122) were aged ≥65 years (older), while 39.9% (81) were <65 years (younger). At discharge, older TBI had a significantly lower Td-FIM by 15 points compared to younger (older 90/126 vs. younger 105/126, p < 0.001). Median FIM gains (younger 27 vs. older 23, p = 0.83) and rehabilitation LOS (older 29.5 days vs. younger 27.5 days, p = 0.79) were similar for both age groups. Older TBIs had significantly lower independence (Td-FIM category ≥ 91) levels (49.4% older vs. 63.9% younger, p = 0.04), higher institutionalisation rates (23.5% older vs. 10.7% younger, p = 0.014) and need for carers (81.5% older vs. 66.4% younger, p = 0.019) on discharge. Although 77% of older TBI patients returned home, a significantly higher proportion needed care. This study supports the functional benefits of TBI rehabilitation in increasing independence regardless of age without incurring longer inpatient rehabilitation days.
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Affiliation(s)
- Rathi Ratha Krishnan
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore 307382, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Institute of Rehabilitation Excellence, Tan Tock Seng Hospital Rehabilitation Centre, Singapore 307382, Singapore
| | - Samuel Wen Xuan Ting
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Wee Shen Teo
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore 307382, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Institute of Rehabilitation Excellence, Tan Tock Seng Hospital Rehabilitation Centre, Singapore 307382, Singapore
| | - Chien Joo Lim
- Department of Orthopaedic Surgery, Woodlands Health, Singapore 737628, Singapore
| | - Karen Sui Geok Chua
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore 307382, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Institute of Rehabilitation Excellence, Tan Tock Seng Hospital Rehabilitation Centre, Singapore 307382, Singapore
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Nah MFK, Pereira MJ, Hemaavathi M, Wong SW, Lim CJ, Tan BY. Study on proximal humerus evaluation of effective treatment (SPHEER) - what is the effect of rehabilitation compliance on clinical outcomes of proximal humerus fractures. BMC Musculoskelet Disord 2023; 24:778. [PMID: 37784126 PMCID: PMC10544385 DOI: 10.1186/s12891-023-06894-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Proximal humeral fractures (PHFs) are 3rd commonest fragility fractures and cause significant functional impairment. This paper sought to determine impact of rehabilitation compliance on the clinical outcomes for non-surgically managed PHFs, while ascertaining reasons for non-compliance which can be addressed to improve compliance. METHODS Prospective cohort study of patients undergoing non-surgical treatment for PHFs from August 2017 to April 2020 in a tertiary trauma centre was performed. Data was collected via questionnaire: patient demographic data, PHF injury details, clinical outcome measures, therapist-reported (Sport Injury Rehabilitation Adherence Scale [SIRAS]) and patient-reported (subjective compliance, frequency of exercise) rehabilitation compliance measures. Data was analysed using multiple linear regression model to account for confounding variables. RESULTS 107 participants attended physical therapy follow-up for mean 137.8 days. 6-week SIRAS strongly predicted 3-month Constant score (p = 0.023; 95%CI = 0.265,3.423), OSS (p = 0.038; 95%CI = 0.049,1.634), flexion ROM (p < 0.001; 95%CI = 2.872,8.982), extension ROM (p = 0.035; 95%CI = 0.097,2.614), abduction ROM (p = 0.002;95%CI = 1.995,8.466) and achievement of functional active ROM at 3-months (p = 0.049; 95%CI = 1.001,1.638). Pain was the top reason impairing rehabilitation compliance from therapist (43.9% at 6-weeks and 20.6% at 3-months) and patient-perspective (33.6% at 6-weeks, 24.3% at 3-months). Author-developed patient-reported compliance measures had good correlation with validated SIRAS score (subjective compliance: p < 0.001 frequency of exercise: p = 0.001). CONCLUSION Rehabilitation compliance predicts short-term clinical outcomes up to 3-months and potentially 1-year outcomes. Pain control should be optimised to maximise rehabilitation compliance and improve PHF outcomes. There is lack of consensus definition for rehabilitation compliance measures; patient-reported measures used have good correlation to existing validated measures and could serve as a steppingstone for further research. LEVEL OF EVIDENCE II, cohort study.
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Affiliation(s)
- Ming Foo Kenneth Nah
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | | | | | - Shiyun Winnie Wong
- Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chien Joo Lim
- Medical Statistician (Research), Woodlands Health, Singapore, Singapore
| | - Bryan Yijia Tan
- Department of Orthopedic Surgery, Woodlands Health, Singapore, Singapore
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Chua SKK, Soh QY, Lim CJ, Ring D, Chua ITH, Kwek EBK, Tan BY. Social determinants of outcomes in nonoperatively treated proximal humerus fractures. JSES Int 2023; 7:743-750. [PMID: 37719821 PMCID: PMC10499851 DOI: 10.1016/j.jseint.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Proximal humerus fractures (PHFs) are common fractures especially in the elderly, with most fractures being managed nonoperatively. Traditional biomedical factors such as radiological alignment have not been able to meaningfully predict comfort and capability after PHFs. Conversely, recent literature has increasingly recognized the role of psychological factors in determining comfort and capability after PHFs. Nonetheless, less is known about the impact of social factors. Additional study of these potentially modifiable social factors as targets for enhancing recovery from injury is merited. Among people recovering from a nonoperatively- treated proximal humerus fracture (PHF) we studied the social factors associated with patient-reported outcomes at 6 months and 1 year. Methods One hundred seventy-one patients who received nonoperative management of a PHF completed baseline measures of sociodemographic characteristics (age, gender, race, employment status, household income, educational level, presence of domestic workers, housing type, and smoking status). Six and 12 months after fracture, participants completed the Oxford Shoulder Score (OSS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and EuroQol-5-Dimensions (EQ5D) measures of comfort and capability. The relationship between capability and social factors was assessed using linear regression modelling, accounting for potential confounding from age, fracture severity assessed using Neer classification, premorbid comorbidities measured by Charlson Comorbidity Index, and premorbid functional status measured by Parker Mobility Index and Barthel Index. Results Lower capability (higher QuickDASH scores) 6 months and 1 year after fracture were associated with being unemployed (coef: -5.02 [95% CI: -9.96 to -0.07]; P = .047) and having domestic workers at home (coef: 8.63 [95% CI: 1.39 to 15.86]; P = .020), but not with Neer classification. Both greater shoulder discomfort and magnitude of incapability (lower OSS scores) and worse general quality of life (lower EQ5D scores) were associated with having domestic workers (coef: -4.07 [95% CI: -6.62 to -1.53]; P = .002 and coef: -0.18 [95% CI: -0.29 to -0.07]; P = .001 respectively) or living in an assisted care facility (coef: -14.82 [95% CI: -22.24 to -7.39]; P < .001 and coef: -0.59 [95% CI: -0.90 to -0.29] P < .001). Conclusions The finding that people recovering from PHF experience less incapability in proportion to their social independence (employment, absence of a caregiver such as domestic workers at home and living outside care facilities) emphasizes the important associations of social factors to musculoskeletal health, and the utility of accounting for social factors in the development and assessment of care strategies.
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Affiliation(s)
- Shaun Kai Kiat Chua
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Qian Ying Soh
- Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Chien Joo Lim
- Department of Orthopedic Surgery, Woodlands Health, National Healthcare Group, Singapore, Singapore
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX, USA
| | - Ivan Tjun Huat Chua
- Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ernest Beng Kee Kwek
- Department of Orthopedic Surgery, Woodlands Health, National Healthcare Group, Singapore, Singapore
| | - Bryan Yijia Tan
- Department of Orthopedic Surgery, Woodlands Health, National Healthcare Group, Singapore, Singapore
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Yeo JY, Lim CJ, Tan BY. Adaptation and validation of the chronic illness-related shame scale among patients with knee osteoarthritis in Singapore. BMC Musculoskelet Disord 2023; 24:633. [PMID: 37542211 PMCID: PMC10401795 DOI: 10.1186/s12891-023-06707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/07/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) of the knee is one of the most common and disabling conditions worldwide. A neglected aspect of knee OA is its psychosocial impact, such as shame. However, assessment tools to measure shame among patients diagnosed with knee OA are lacking. In this study, the psychometric properties of the Chronic Illness-related Shame Scale (CISS) were evaluated among knee OA patients in Singapore. METHODS Adaptations were made to CISS for use among the knee OA population. An exploratory factor analysis (EFA) was performed to analyze the factor structure. Cronbach's Alpha and corrected item-total correlations were used to evaluate the internal consistency. Spearman correlation coefficient was used to test the correlation between CISS and Patient Health Questionnaire-4 (PHQ-4) to determine the validity of the instrument. RESULTS The EFA yielded a one-factor structure, with an eigenvalue of 4.78 explaining 68.25% of variance. Cronbach Alpha was 0.92, which indicated good internal consistency. The Spearman correlation revealed a significant correlation between CISS and PHQ-4. CONCLUSIONS The adapted CISS is a valid and reliable instrument to measure shame for knee OA patients. Both research and clinical settings can benefit from the use of the adapted CISS for assessing shame among knee OA patients.
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Affiliation(s)
- Jia Ying Yeo
- Department of Rehabilitation Services, Yishun Health, National Healthcare Group, 90 Yishun Central, 768828, Singapore
| | - Chien Joo Lim
- Department of Orthopedic Surgery, Woodlands Health, National Healthcare Group, 2 Yishun Central 2, 768024, Singapore
| | - Bryan Yijia Tan
- Department of Orthopedic Surgery, Woodlands Health, National Healthcare Group, 11 Jalan Tan Tock Seng, 308433, Singapore.
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Tan BY, Goh ZZS, Lim CJ, Pereira MJ, Yang SY, Tan KG, Tan ACK, Liang P, Abbott JH, Briggs AM, Hunter DJ, Skou ST, Thumboo J, Car J. Singapore KneE osTeoarthritis CoHort (SKETCH): protocol for a multi-centre prospective cohort study. BMC Musculoskelet Disord 2023; 24:104. [PMID: 36750930 PMCID: PMC9903549 DOI: 10.1186/s12891-023-06207-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a leading cause of global disability. The understanding of the role of psychosocial factors in knee OA outcomes is still evolving particularly in an Asian context. The primary aim of this study is to explore psychosocial factors that prognosticate short and long-term clinical outcomes, productivity, and healthcare utilization in patients with knee OA. Secondary aims are to explore the mediation and directional relationships and the role it plays in predicting the discordance between self-reported measures (SRM), physical-performance measures (PPMs) and objective clinical parameters. METHODS A multi-centre prospective cohort study of community ambulant knee OA patients seeking treatment in the tertiary healthcare institutions in Singapore will be conducted. Patients with secondary arthritis, significant cognitive impairment, severe medical comorbidities or previous knee arthroplasty will be excluded. Primary clinical outcome measure is the Knee injury and OA Outcome Score-12 (KOOS-12). Baseline characteristics include sociodemographic status, arthritis status including symptom duration and radiographic severity, comorbidities and functional status through Charlson Comorbidities Index (CCI), Barthel Index (BI) and Parker Mobility Score (PMS). Psychosocial variables include social support, kinesiophobia, negative affect, self-efficacy, injustice, chronic illness shame and the built environment. Clinical outcomes include quality of life, physical performance, global assessment, satisfaction and physical activity levels. Productivity and healthcare utilization will be assessed by a modified OA Cost and Consequences Questionnaire (OCC-Q) and the Work Productivity and Activity Impairment Questionnaire (WPAI). Variables will be collected at baseline, 4, 12 months and yearly thereafter. Regression, mediation and structural equation modelling will be used for analysis. DISCUSSION Results will allow contextualization, identification, and phenotyping of the critical (and potentially modifiable) psychosocial parameters that predict positive clinical outcomes in the OA population to guide optimization and refinement of healthcare and community. This will facilitate: 1. identification of high-risk knee OA subpopulations that will likely experience poor outcomes and 2. formulation of targeted multidisciplinary comprehensive approaches to address these psychosocial factors to optimize non-surgical treatment care, maximize functional outcomes and create more value-based care model for knee OA. ETHICS AND DISSEMINATION The study has been registered under clinicaltrials.gov registry (Identifier: NCT04942236).
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Affiliation(s)
- Bryan Yijia Tan
- Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, Singapore, Singapore.
| | | | - Chien Joo Lim
- Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore
| | - Michelle Jessica Pereira
- grid.466910.c0000 0004 0451 6215Health Services Outcome Research, National Healthcare Group, Singapore, Singapore
| | - Su-Yin Yang
- Psychology Service, Woodlands Health, Singapore, Singapore
| | - Kelvin Guoping Tan
- grid.240988.f0000 0001 0298 8161Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Alvin Chin Kwong Tan
- grid.415203.10000 0004 0451 6370Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Phyllis Liang
- grid.59025.3b0000 0001 2224 0361Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - J. Haxby Abbott
- grid.29980.3a0000 0004 1936 7830Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew M. Briggs
- grid.1032.00000 0004 0375 4078Faculty of Health Sciences, Curtin School of Allied Health and Curtin enAble Institute, Curtin University, Perth, WA Australia
| | - David J. Hunter
- grid.412703.30000 0004 0587 9093Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Soren T. Skou
- grid.10825.3e0000 0001 0728 0170Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark ,grid.512922.fThe Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Julian Thumboo
- grid.163555.10000 0000 9486 5048Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Singapore, Singapore
| | - Josip Car
- grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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10
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Ratha Krishnan R, Yeo EQY, Lim CJ, Chua KSG. The Impact of Stroke Subtype on Recovery and Functional Outcome after Inpatient Rehabilitation: A Retrospective Analysis of Factors. Life (Basel) 2022; 12:life12091295. [PMID: 36143332 PMCID: PMC9502826 DOI: 10.3390/life12091295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
The aims of this study were to compare inpatient rehabilitation outcomes between acute stroke subtypes of Cerebral Infarction (CI) and Intracerebral Hemorrhage (ICH), and to determine the predictors of discharge outcomes. A retrospective study of stroke inpatients was carried out using the discharge Functional Independence Measure (FIM) as the primary outcome measure. Relationships between stroke subtype, rehabilitation impairments, and medical complications on FIM -gain were analyzed. Altogether, 280 datasets including 211 (75.4%) CI and 69 (24.6%) ICH were analyzed. ICH patients were significantly younger than CI patients (55 years ICH vs. 64.0 years CI years, p < 0.001), had a 10-fold higher proportion needing ICU admission (ICH 82.6% vs. CI 7.6%, p < 0.001), and had significantly lower total admission FIM scores (67 points ICH vs. 74 CI points, p = 0.006), with lower motor-FIM scores in particular (38 points ICH vs. 48 points CI, p = 0.003). Significant functional improvements after inpatient rehabilitation, i.e., FIM gain, occurred regardless of stroke subtype (FIM-ICH Δ 27 vs. FIM-CI Δ 21, p = 0.05). Despite significantly worse initial stroke severity, ICH patients achieved similar functional gains, independence levels, and return-home rates compared with their CI counterparts after inpatient rehabilitation.
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Affiliation(s)
- Rathi Ratha Krishnan
- Centre of Rehabilitation Excellence (CORE), Tan Tock Seng Hospital Rehabilitation Centre, Singapore 569766, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Correspondence:
| | - Edgar Quan Yi Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- MOH Holdings, Singapore 099253, Singapore
| | - Chien Joo Lim
- Department of Orthopaedic Surgery, Woodlands Health, Singapore 768024, Singapore
| | - Karen Sui Geok Chua
- Centre of Rehabilitation Excellence (CORE), Tan Tock Seng Hospital Rehabilitation Centre, Singapore 569766, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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11
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Tam A, Kulkarni J, An K, Li L, Dorscheid DR, Singhera GK, Bernatchez P, Reid G, Chan K, Witzigmann D, Cullis PR, Sin DD, Lim CJ. Lipid nanoparticle formulations for optimal RNA-based topical delivery to murine airways. Eur J Pharm Sci 2022; 176:106234. [PMID: 35688311 DOI: 10.1016/j.ejps.2022.106234] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Lipid nanoparticles (LNP) have been successfully used as a platform technology for delivering nucleic acids to the liver. To broaden the application of LNPs in targeting non-hepatic tissues, we developed LNP-based RNA therapies (siRNA or mRNA) for the respiratory tract. Such optimized LNP systems could offer an early treatment strategy for viral respiratory tract infections such as COVID-19. METHODS We generated a small library of six LNP formulations with varying helper lipid compositions and characterized their hydrodynamic diameter, size distribution and cargo entrapment properties. Next, we screened these LNP formulations for particle uptake and evaluated their potential for transfecting mRNA encoding green fluorescence protein (GFP) or SARS-CoV2 nucleocapsid-GFP fusion reporter gene in a human airway epithelial cell line in vitro. Following LNP-siGFP delivery, GFP protein knockdown efficiency was assessed by flow cytometry to determine %GFP+ cells and median fluorescence intensity (MFI) for GFP. Finally, lead LNP candidates were validated in Friend leukemia virus B (FVB) male mice via intranasal delivery of an mRNA encoding luciferase, using in vivo bioluminescence imaging. RESULTS Dynamic light scattering revealed that all LNP formulations contained particles with an average diameter of <100 nm and a polydispersity index of <0.2. Human airway epithelial cell lines in culture internalized LNPs with differential GFP transfection efficiencies (73-97%). The lead formulation LNP6 entrapping GFP or Nuc-GFP mRNA demonstrated the highest transfection efficiency (97%). Administration of LNP-GFP siRNA resulted in a significant reduction of GFP protein expression. For in vivo studies, intranasal delivery of LNPs containing helper lipids (DSPC, DOPC, ESM or DOPS) with luciferase mRNA showed significant increase in luminescence expression in nasal cavity and lungs by at least 10 times above baseline control. CONCLUSION LNP formulations enable the delivery of RNA payloads into human airway epithelial cells, and in the murine respiratory system; they can be delivered to nasal mucosa and lower respiratory tract via intranasal delivery. The composition of helper lipids in LNPs crucially modulates transfection efficiencies in airway epithelia, highlighting their importance in effective delivery of therapeutic products for airways diseases.
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Affiliation(s)
- A Tam
- NanoVation Therapeutics Inc. Vancouver, British Columbia, Canada; Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital Research Institute, University of British Columbia Vancouver, British Columbia, Canada; University of British Columbia (UBC) Center for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - J Kulkarni
- NanoVation Therapeutics Inc. Vancouver, British Columbia, Canada; NanoMedicines Innovation Network, Vancouver, British Columbia, Canada; University of British Columbia (UBC), Department of Biochemistry and Molecular Biology, Vancouver, British Columbia, Canada
| | - K An
- NanoVation Therapeutics Inc. Vancouver, British Columbia, Canada; University of British Columbia (UBC), Department of Biochemistry and Molecular Biology, Vancouver, British Columbia, Canada
| | - L Li
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital Research Institute, University of British Columbia Vancouver, British Columbia, Canada
| | - D R Dorscheid
- University of British Columbia (UBC) Center for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - G K Singhera
- University of British Columbia (UBC) Center for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Medicine (Division of Respirology), UBC, Vancouver, British Columbia, Canada
| | - P Bernatchez
- University of British Columbia (UBC) Center for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Medicine (Division of Respirology), UBC, Vancouver, British Columbia, Canada; Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 217-2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Gsd Reid
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital Research Institute, University of British Columbia Vancouver, British Columbia, Canada
| | - Kyt Chan
- NanoMedicines Innovation Network, Vancouver, British Columbia, Canada; University of British Columbia (UBC), Department of Biochemistry and Molecular Biology, Vancouver, British Columbia, Canada
| | - D Witzigmann
- NanoVation Therapeutics Inc. Vancouver, British Columbia, Canada; NanoMedicines Innovation Network, Vancouver, British Columbia, Canada; University of British Columbia (UBC), Department of Biochemistry and Molecular Biology, Vancouver, British Columbia, Canada
| | - P R Cullis
- NanoVation Therapeutics Inc. Vancouver, British Columbia, Canada; NanoMedicines Innovation Network, Vancouver, British Columbia, Canada; University of British Columbia (UBC), Department of Biochemistry and Molecular Biology, Vancouver, British Columbia, Canada
| | - D D Sin
- University of British Columbia (UBC) Center for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - C J Lim
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital Research Institute, University of British Columbia Vancouver, British Columbia, Canada.
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12
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Chung KKI, Lim CJ. Gender, ethnic difference in arrhythmic risks and prognosis in patients with non-ischaemic cardiomyopathy. Europace 2022. [DOI: 10.1093/europace/euac053.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The mortality benefits of Automatic Intracardiac Defibrillator (AICD) in non-ischaemic cardiomyopathy patients is less clear. Subgroup analysis of Definite trial showed that female patients favoured medical treatment. Ethnic difference in arrhythmic risk also not known.
Method
447 patients with heart failure and reduced left ventricular ejection fraction (LVEF <40%) due to non-ischemic cardiomyopathy, all have coronary angiogram to exclude significant coronary artery disease (>70% stenosis).
Continuous variables were compared by Student t tests and categorical variables compared by use of the Fisher exact test. Composite endpoints include death, sudden cardiac death (SCD), ventricular arrhythmias (VA ) and hospitalisations for heart failure. P<0.05 was denoted as statistical significant.
Results
Mean age 63.07 ± 14.19 years, male patients 314 (70%), 360 Chinese and 87 non-chinese. Mean age of male and female patients were 61.21 ± 13.65 and 67.46 ± 14.52 years old respectively. Patients with diabetes mellitus 38%, hypertension 76%, atrial fibrillation 38%, stroke 9%. LDL 2.78 ± 1.04 mmol/l, HbA1c 6.56 ± 1.62%, baseline creatinine 98.43 ± 37.27umol/l. Patients taking ivabradine 9%, b-blocker 88%, Angiotensin inhibitors/Angiotensin Receptor Blocker 66%, Sacubitrial/ Valsartan 26%, spironolactone 57%, SGLT-2 inhibitor 9%.
Mean follow-up duration of 6.18 ± 4.16 years. There were 61 deaths (13%, 2.20% death/ year, 20 females and 41 males). 38 SCD, 22 VA, 218 hospitalisation for heart failure
There was a significant increase in LVEF from 24.88 ± 8.17 to 39.92 ± 13.88% and 22.05 ± 8.52 to 36.14 ± 8.17 % in female and male patients respectively (p=0.023). 190 patients (43%) have LVEF increased to or more than 35%.
40 patients (9%) received device therapy (AICD and Cardiac resynchronization therapy), 19% secondary prevention, 81% for primary prevention. The median time from diagnosis of NICMP to appropriate device therapy for VT/ VT storms was 85.5 months (interquartile range 35-131). 18/21 patients (86%) noted to have appropriate therapy for VT/ VT storms were males. HR for males 8, 95% CI (1.06, 60.34, p=0.044). All the device therapy occurred in patients with LVEF< 35%. There is also gender difference in composite endpoints (p=0.0022)
LVEF improved from 23.31± 8.67 to 38.10 ±15.20 and 21.63 ±7.57 to 33.74 ±12.92% respectively (p=0.014) in Chinese and non-Chinese patients respectively. There are no significant difference in the VA or primary composite endpoints.
Conclusions
The study showed progressive improvement of the therapeutic regimens improve mortality by improving LVEF regardless of gender or ethnicity. The ventricular tachyarrhythmic risk, composite endpoints are significantly higher in male than female patients with non-ischaemic cardiomyopathy. There is no ethnic difference in clinical endpoints.
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Affiliation(s)
- KKI Chung
- Tan Tock Seng Hospital, Singapore, Singapore
| | - CJ Lim
- Tan Tock Seng Hospital, Singapore, Singapore
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13
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Kanesen D, Kandasamy R, Wong ASH, Tharakan J, Lim CJ, Abdullah JM. Clinical Outcome of Tuberculous Meningitis with Hydrocephalus - A Retrospective Study. Malays J Med Sci 2022; 28:82-93. [PMID: 35115890 PMCID: PMC8793966 DOI: 10.21315/mjms2021.28.5.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/15/2021] [Indexed: 10/27/2022] Open
Abstract
Background To study the clinical outcome of tuberculous meningitis with hydrocephalus (TBMH) and the factors contributing to its poor clinical outcome. Methods Clinical data of 143 adult patients diagnosed with TBM over a 6-year period in two tertiary hospitals in Malaysia were retrospectively reviewed. Relevant clinical and radiological data were studied. Patients with TBMH were further analysed based on their clinical grade and rendered treatment to identify associated factors and outcome of this subgroup of patients. The functional outcome of patients was assessed at 12 months from treatment. Results The mean age of patients was 35.6 (12.4) years old, with a male gender predominance of 67.1%. Forty-four percent had TBMH, of which 42.9% had surgical intervention. In the good modified Vellore grade, 76.5% was managed medically with concurrent anti-tuberculosis treatment (ATT), steroids and osmotic agents. Four patients had surgery early in the disease as they did not respond to medical therapy and reported a good outcome subsequently. Poor outcome (65.2%) was seen in the poor modified Vellore grade despite medical and surgical intervention. Multivariate model multiple Cox regression showed significant results for seizure (adjusted hazard ratio [aHR]: 15.05; 95% CI: 3.73, 60.78), Glasgow coma scale (GCS) (aHR: 0.79; 95% CI: 0.70, 0.89) and cerebrospinal fluid (CSF) cell count (aHR: 1.11; 95% CI: 1.05, 1.17). Conclusion Hydrocephalus was seen in 44% of patients in this study. GCS score, seizure and high CSF cell count were factors associated with a poor prognosis in TBM. Patients with TBMH treated medically (TBMHM) had better survival function compared to TBMH patients undergoing surgical intervention (TBMHS) (P-value < 0.001). This retrospective study emphasises that TBMH is still a serious illness as 47.6% of the patients had poor outcome despite adequate treatment.
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Affiliation(s)
- Davendran Kanesen
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Neurosurgery, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Regunath Kandasamy
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | - John Tharakan
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Chien Joo Lim
- Clinical Research Centre, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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14
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Tay MRJ, Lim CJ, Chua KSG. Functional and ambulatory benefits of robotic-assisted gait training during early subacute inpatient rehabilitation following severe stroke. Singapore Med J 2021. [PMID: 34823332 DOI: 10.11622/smedj.2021219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Chien Joo Lim
- Clinical Research & Innovation Office, Tan Tock Seng Hospital, Singapore
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15
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Chua KSG, Loke JJY, Lim CJ, Thio JML, Krishnan RR. Rehabilitation outcome after acute subarachnoid haemorrhage: the role of early functional predictors and complications. Singapore Med J 2021. [PMID: 34808738 DOI: 10.11622/smedj.2021198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Karen Sui Geok Chua
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore
| | | | - Chien Joo Lim
- Clinical Research & Innovation Office, Tan Tock Seng Hospital, Singapore
| | - Jocelyn Mei Lin Thio
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore
| | - Rathi Ratha Krishnan
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore
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16
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Chua KSG, Krishnan RR, Yen JM, Plunkett TK, Soh YM, Lim CJ, Chia CM, Looi JC, Ng SG, Rao J. 3D-printed external cranial protection following decompressive craniectomy after brain injury: A pilot feasibility cohort study. PLoS One 2021; 16:e0258296. [PMID: 34710123 PMCID: PMC8553164 DOI: 10.1371/journal.pone.0258296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 09/20/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES 3D-printed (3DP) customized temporary cranial protection solutions following decompressive craniectomy (DC) are currently not widely practiced. A pilot trial of a 3DP customized head protection prototype device (HPPD) on 10 subjects was conducted during the subacute rehabilitation phase. MATERIALS AND METHODS Subjects > 30 days post-DC with stable cranial flaps and healed wounds were enrolled. HPPD were uniquely designed based on individuals' CT scan, where the base conformed to the surface of the individual's skin covering the cranial defect, and the lateral surface three-dimensionally mirrored, the contralateral healthy head. Each HPPD was fabricated using the fused deposition modeling method. These HPPD were then fitted on subjects using a progressive wearing schedule and monitored over 1, 2, 4, 6 and 8 follow-up (FU) weeks. Outcomes during FU included; reported wearing time/day (hours), subjective pain, discomfort, pruritus, dislodgment, cosmesis ratings; and observed wound changes. The primary outcome was safety and tolerability without pain or wound changes within 30 minutes of HPPD fitting. RESULTS In all, 10 enrolled subjects received 12 HPPDs [5/10 male, mean (SD) age 46 (14) years, mean (SD) duration post-DC 110 days (76)] and all subjects tolerated 30 minutes of initial HPPD fitting without wound changes. The mean (SD) HPPD mass was 61.2 g (SD 19.88). During 8 weeks of FU, no HPPD-related skin dehiscence was observed, while 20% (2/10) had transient skin imprints, and 80% (8/10) reported self-limiting pressure and pruritis. DISCUSSION Findings from this exploratory study demonstrated preliminary feasibility and safety for a customized 3DP HPPD for temporary post-DC head protection over 8 weeks of follow-up. Monitoring and regular rest breaks during HPPD wear were important to prevent skin complications. CONCLUSION This study suggests the potential for wider 3DP technology applications to provide cranial protection for this vulnerable population.
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Affiliation(s)
- Karen Sui Geok Chua
- Tan Tock Seng Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
- * E-mail:
| | - Rathi Ratha Krishnan
- Tan Tock Seng Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jia Min Yen
- Tan Tock Seng Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tegan Kate Plunkett
- Tan Tock Seng Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yan Ming Soh
- Tan Tock Seng Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chien Joo Lim
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | | | | | - Suan Gek Ng
- Department of Neurosurgery, National Neuroscience Institute, TTSH Campus, Singapore, Singapore
| | - Jai Rao
- Department of Neurosurgery, National Neuroscience Institute, TTSH Campus, Singapore, Singapore
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17
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Drakeford PA, Tham SQ, Kwek JL, Lim V, Lim CJ, How KY, Ljungqvist O. Acute Kidney Injury within an Enhanced Recovery after Surgery (ERAS) Program for Colorectal Surgery. World J Surg 2021; 46:19-33. [PMID: 34665309 DOI: 10.1007/s00268-021-06343-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We aimed to determine the prevalence, risk factors, and outcomes of acute kidney injury (AKI) within an ERAS program for colorectal surgery (CRS). METHODS This is a retrospective case-control study conducted from March 2016 to September 2018 at a single tertiary hospital in Singapore. All adult patients requiring CRS within our ERAS program were considered eligible. Exclusions were stage 5 chronic kidney disease or patients requiring a synchronous liver resection. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. Secondary outcomes included mortality, major complications, and hospital length of stay. Patient, surgical, and anaesthesia-related data were analysed to determine factors associated with AKI. RESULTS A total of 575 patients were eligible for the study. Twenty patients were excluded from the study leaving 555 patients for analysis. Mean age was 67.8 (SD 11.4) years. Seventy-four patients met the criteria for AKI (13.4%: stage 1-11.2%, stage 2-2.0%, stage 3-0.2%). One patient required renal replacement therapy (RRT). Patients with AKI had a longer length of stay (median [IQR], 11.0 [5.0-17.0] days vs 6.0 [4.0-8.0] days; P < .001), more major complications (OR, 6.55; 95% CI, 3.00-14.35, P < .001), and a trend towards higher mortality at one year (OR, 1.44; 95% CI 0.48-4.30; p = 0.511. After multivariable regression analysis, factors associated with AKI were preoperative creatinine (OR, 1.01 per 10 µmol/l; 95% CI, 1.03-1.22; P = 0.01), robotic surgery vs open surgery (OR, 0.15; 95% CI, 0.06-0.39; P < 0.001), anaesthesia duration (OR, 1.38 per hour; 95% CI, 1.22-1.55; P < 0.001), and major complications (OR, 5.55; 95% CI, 2.63-11.70; P < 0.001). CONCLUSIONS Within the present cohort, the implementation of an ERAS program for CRS was associated with a low prevalence of moderate to severe AKI despite a balanced intravenous fluid regimen. Patients having open surgery, longer procedures, and major complications are at increased risk of AKI.
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Affiliation(s)
- Paul Andrew Drakeford
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Novena, 308433, Singapore.
| | - Shu Qi Tham
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Novena, 308433, Singapore
| | - Jia Li Kwek
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Novena, 308433, Singapore
| | - Vera Lim
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Novena, 308433, Singapore
| | - Chien Joo Lim
- Clinical Research & Innovation Office, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Novena, 308433, Singapore
| | - Kwang Yeong How
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Novena, 308433, Singapore
| | - Olle Ljungqvist
- Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
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Chee Y, Toh GL, Lim CJ, Goh LL, Dalan R. Sex Modifies the Association of Fibroblast Growth Factor 21 With Subclinical Carotid Atherosclerosis. Front Cardiovasc Med 2021; 8:627691. [PMID: 33996935 PMCID: PMC8116496 DOI: 10.3389/fcvm.2021.627691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background and Aims: Fibroblast growth factor 21 (FGF21), an emerging metabolic hepatokine, is associated with atherosclerosis. An interaction with sex has been described in various populations. We aimed to study whether sex modulates the relationship between FGF21 and subclinical carotid atherosclerosis in a diabetes-enriched multiethnic population of Singapore. We explore differences in intermediary mechanisms, in terms of hypertension, lipids, and inflammation, between FGF21 and atherosclerosis. Methods: We recruited 425 individuals from a single diabetes center in Singapore, and demographics, anthropometry, metabolic profile, FGF21, and carotid ultrasonography were performed. Multivariable logistic regression models were used to study the association between subclinical atherosclerosis and FGF21 adjusting for age, ethnicity, body mass index (BMI), hemoglobin A1c (HbA1c), systolic and diastolic blood pressures, and low-density lipoprotein (LDL)-cholesterol separately for males and females as two groups after an interaction test. Results: An interaction test assessing interaction by sex on the relationship between subclinical atherosclerosis and FGF21 showed a significant interaction with sex (Pinteraction = 0.033). In the female subgroup, significant independent associations of standardized lnFGF21 with subclinical atherosclerosis were seen, with 1 SD increment in lnFGF21 being associated with 1.48-fold (95% CI: 1.03, 2.12; p = 0.036) increase in risk. In the male subgroup, the association of subclinical atherosclerosis with standardized lnFGF21 was not significant [odds ratio (OR) (95% CI): 0.90 (0.63, 1.28); p = 0.553]. We found sex interactions with pulse pressure being significantly associated in females only and triglycerides and C-reactive protein being associated with males only. Conclusion: FGF21 is positively associated with subclinical carotid atherosclerosis in women, but not in men. The sex–racial patterns in the mechanisms by which FGF21 causes subclinical atherosclerosis needs to be explored in larger population-based studies and mechanistically studied in greater detail.
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Affiliation(s)
| | | | | | | | - Rinkoo Dalan
- Tan Tock Seng Hospital, Singapore, Singapore.,Department of Metabolic Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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19
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Ting CY, Lee YF, Lim CJ, Ting RSK, Md Zahrin MM, Ahmad AS, Wong JSY, Arip M, Zakaria Z, Ahmad Zaidi Adruce S, Tnay JKS, Wong YS. Factors Associated with Intention to Donate Hematopoietic Stem Cells among Blood Donors. Transfus Med Hemother 2020; 48:188-195. [PMID: 34177425 DOI: 10.1159/000512197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Past studies pay little attention to the intention to donate hematopoietic stem cells (HSC) among blood donors. This study investigated the level of and the influence of socio-demographic characteristics, knowledge, attitude, subjective norm and self-efficacy on the intention to donate HSC among blood donors. Methods This cross-sectional study recruited blood donors at selected public hospitals in the Malaysian State of Sarawak in 2019. A structured questionnaire was developed based on the review of relevant literature. It gathered information on socio-demographic characteristics, knowledge, attitude, subjective norm and self-efficacy on the intention to donate HSC. Variables with a p value <0.200 in bivariate analysis were included in the variable selection for regression modeling to examine their associations with the intention to donate HSC. Results A total of 569 blood donors participated (94.5% response rate). Overall, 87.1% reported a positive intention to donate HSC. In the regression model, the factor with the greatest association with intention to donate HSC was subjective norms about HSC donation (β = 0.35, 95% CI 0.27-0.42), followed by attitude about regulations of HSC donation (β= 0.21, 95% CI 0.13-0.35), self-efficacy on HSC donation (β = 0.15, 95% CI 0.09-0.32), attitude about the potential side effects of HSC donation (β = 0.14, 95% CI 0.02-0.10) and highest education level (β = 0.10, 95% CI 0.03-0.44). Conclusions The findings can be used to formulate a better strategy in promoting HSC donation among blood donors in the region.
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Affiliation(s)
- Chuo Yew Ting
- Pharmacy Practice and Development Division, Sarawak State Health Department, Ministry of Health, Kuching, Malaysia.,Institute of Borneo Studies, Universiti Malalysia Sarawak, Kota Samarahan, Malaysia
| | - Yew Fong Lee
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Ministry of Health, Putrajaya, Malaysia
| | - Chien Joo Lim
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rachel Sing Kiat Ting
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia
| | - Mohammad Masrin Md Zahrin
- Blood Transfusion Services and Blood Bank Department, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | - Abu Sufian Ahmad
- Blood Transfusion Services and Blood Bank Unit, Sibu Hospital, Ministry of Health, Sibu, Malaysia
| | | | - Masita Arip
- Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia
| | - Zubaidah Zakaria
- Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia
| | - Shahren Ahmad Zaidi Adruce
- Faculty of Cognitive Sciences and Human Development, Universiti Malalysia Sarawak, Kota Samarahan, Malaysia
| | - Jessie Koh Sing Tnay
- Institute of Borneo Studies, Universiti Malalysia Sarawak, Kota Samarahan, Malaysia
| | - Yi Shen Wong
- Blood Transfusion Services and Blood Bank Department, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
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20
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Chua K, Lim WS, Lim PH, Lim CJ, Hoo CM, Chua KC, Chee J, Ong WS, Liu W, Wong CJ. An Exploratory Clinical Study on an Automated, Speed-Sensing Treadmill Prototype With Partial Body Weight Support for Hemiparetic Gait Rehabilitation in Subacute and Chronic Stroke Patients. Front Neurol 2020; 11:747. [PMID: 32793109 PMCID: PMC7394021 DOI: 10.3389/fneur.2020.00747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022] Open
Abstract
Impairments in walking speed, capacity, and endurance are commonly seen after stroke. Treadmill training improves endurance and gait speed. However, the lack of variable training speed and automated speed progression increases the risk of backward displacement and falling. An automated, speed-sensing treadmill prototype with partial body weight support, the Variable Automated Speed and Sensing Treadmill II (VASST II), was tested in an outpatient rehabilitation setting. Eleven subacute or chronic hemiplegics who could ambulate at > 0.2 m/s for >50 m participated in the study. All subjects underwent physiotherapist-supervised training on VASST II for 60 min daily, 3 times per week, for 5 weeks (total 15 h). Outcome measures at Week 3 (mid-VASST II training), Week 6 (post-VASST II training), Week 12 (first follow-up), and Week 24 (second follow-up) included the 6 minute walk test (6 MWT), 10 meter walk test (10 MWT), Berg Balance Scale (BBS) score, and Functional Ambulation category (FAC) score. User acceptability of VASST II for both study subjects and physiotherapists were also assessed. All subjects [median (IQR) age: 53.0 (22) years; median (IQR) duration post-stroke: 524 (811) days] completed VASST II training. At baseline, mean ± SD 6 MWT was 114 ± 50.9 m; mean ± SD 10 MWT was 0.37 ± 0.18 m/s; mean ± SD BBS score was 40 ± 10; and, mean ± SD FAC score was 4 ± 1. At Week 6, there were significant improvements in the 6 MWT [158.91 ± 88.69 m; P = 0.003], 10 MWT [0.49 ± 0.30 m/s; P = 0.016], and BBS score [42 ± 10; P = 0.003]. Improvements in 6 MWT and BBS scores were sustained at Week 24, but not in the 10 MWT. No VASST II-training related falls were reported. All subjects rated their VASST II training positively and indicated that it improved their current walking ability. VASST II training was effective, feasible, and safe in patients with subacute or chronic post-stroke hemiparetic gait, with sustained gains in distance walked (6 MWT) and functional balance (BBS score) up to 19 weeks post-intervention.
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Affiliation(s)
- Karen Chua
- Department of Rehabilitation Medicine, Centre of Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Wei Sheong Lim
- Department of Rehabilitation Medicine, Centre of Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Pang Hung Lim
- Department of Rehabilitation Medicine, Centre of Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Chien Joo Lim
- Clinical Research & Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chuan Mien Hoo
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Kuang Chua Chua
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Johnny Chee
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Wai Sing Ong
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Weidong Liu
- School of Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Chin Jung Wong
- Department of Rehabilitation Medicine, Centre of Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
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21
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Hui TCH, Khoo HW, Young BE, Haja Mohideen SM, Lee YS, Lim CJ, Leo YS, Kaw GJL, Lye DC, Tan CH. Clinical utility of chest radiography for severe COVID-19. Quant Imaging Med Surg 2020; 10:1540-1550. [PMID: 32676371 PMCID: PMC7358410 DOI: 10.21037/qims-20-642] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/29/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chest radiography (CXR) is performed more widely and readily than CT for the management of coronavirus disease (COVID-19), but there remains little data on its clinical utility. This study aims to assess the diagnostic performance of CXR, with emphasis on its predictive value, for severe COVID-19 disease. METHODS A retrospective cohort study was conducted, 358 chest radiographs were performed on 109 COVID-19 patients (median age 44.4 years, 58 males and 30 with comorbidities) admitted between 22 January 2020 and 15 March 2020. Each CXR was reviewed and scored by three radiologists in consensus using a 72-point COVID-19 Radiographic Score (CRS). Disease severity was determined by the need for supplemental oxygen and mechanical ventilation. RESULTS Patients who needed supplemental oxygen (n=19, 17.4%) were significantly older (P<0.001) and significantly more of them had co-morbidities (P=0.011). They also had higher C-reactive protein (CRP) (P<0.001), higher lactate dehydrogenase (LDH) (P<0.001), lower lymphocyte count (P<0.001) and lower hemoglobin (Hb) (P=0.001). Their initial (CRSinitial) and maximal CRS (CRSmax) were higher (P<0.001). Adjusting for age and baseline hemoglobin, the AUROC of CRSmax (0.983) was as high as CRPmax (0.987) and higher than the AUROC for lymphocyte countmin (0.897), and LDHmax (0.900). The AUROC for CRSinitial was slightly lower (0.930). CRSinitial ≥5 had a sensitivity of 63% and specificity of 92% in predicting the need for oxygen, and 73% sensitivity and 88% specificity in predicting the need for mechanical ventilation. CRS between the 6th and 10th day from the onset of symptoms (CRSD6-10) ≥5 had a sensitivity of 89% and specificity of 95% in predicting the need for oxygen, and 100% sensitivity and 86% specificity in predicting the need for mechanical ventilation. CONCLUSIONS Adjusting for key confounders of age and baseline Hb, CRSmax performed comparable to or better than laboratory markers in the diagnosis of severe disease. CXR performed between the 6th and 10th days from symptom onset was a better predictor of severe disease than CXR performed earlier at presentation. A benign clinical course was seen in CXR that were normal or had very mild abnormalities.
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Affiliation(s)
- Terrence C. H. Hui
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hau Wei Khoo
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Barnaby E. Young
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | | | - Yeong Shyan Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chien Joo Lim
- Clinical Research & Innovations Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gregory J. L. Kaw
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - David C. Lye
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
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22
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Dalan R, Goh LL, Lim CJ, Seneviratna A, Liew H, Seow CJ, Xia L, Chew DEK, Leow MKS, Boehm BO. Impact of Vitamin E supplementation on vascular function in haptoglobin genotype stratified diabetes patients (EVAS Trial): a randomised controlled trial. Nutr Diabetes 2020; 10:13. [PMID: 32341356 PMCID: PMC7186220 DOI: 10.1038/s41387-020-0116-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/09/2022] Open
Abstract
AIMS Vitamin E (Vit-E) may preferentially improve cardiovascular risk in haptoglobin 2-2 (Hp2-2) genotype diabetes individuals. We studied the impact of Vit-E supplementation on vascular function in diabetes individuals stratified by haptoglobin genotype in Singapore. METHODS In this 24-week, double blind, placebo-controlled RCT, we recruited 187 subjects (101 Hp2-2, 86 non-Hp2-2). INTERVENTION alpha-tocopherol-400 IU. PRIMARY OUTCOME Change in EndoPAT-derived reactive-hyperaemia index (RHI) and augmentation index (AIx); Secondary Outcomes: Pulse-Wave velocity (Sphygmocor-PWV), carotid intima media thickness (CIMT), inflammation (hsCRP), derivatives of reactive-oxygen metabolites (dROMs), biological antioxidant-potential (BAPs), HbA1c, LDL-C, HDL-C and oxidised LDL-C (ox-LDL). RESULTS Overall, with Vit-E supplementation no significant change in RHI, PWV, CIMT, hsCRP, dROMS, BAPs, HDL-C and HbA1c was observed (p > 0.05); an increase in LDL-C with concomitant decrease in ox-LDL, and incidentally increase in eGFR was observed (p < 0.05). No interaction effect with haptoglobin genotype was seen for all outcomes (p > 0.05). Subgroup analysis: In the non-Hp-2-2 group, Vit-E supplementation led to a higher EndoPAT-derived AIx, accompanied by higher LDL and ox-LDL concentrations (p < 0.05); Hp2-2 group: Vit-E supplementation led to higher eGFR when compared to the non-Hp2-2 group (exploratory) (p < 0.05). We observed an interaction effect for baseline haptoglobin concentration (threshold > 119 mg/dl) with intervention in terms of increased EndoPAT-derived AIx in the Hp > 119 mg/dl group whereas no change in the group with Hp ≤ 119 mg/dl. CONCLUSION Vit-E supplementation did not show any preferential benefit or deleterious effect on vascular function in Hp2-2 diabetes subjects in Singapore. A possible deleterious effect of an increase in arterial stiffness in individuals with Hp > 119 mg/dl was observed. Future studies should consider personalisation based on baseline Hp concentrations in patients with T2DM rather than just Hp2-2 genotype to evaluate impact on the detailed lipid pathways, cardiac and renal physiology. The impact of ethnic differences needs to be explored in greater details.
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Affiliation(s)
- Rinkoo Dalan
- Tan Tock Seng Hospital, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
| | | | | | | | | | - Cherng Jye Seow
- Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Lian Xia
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Daniel E K Chew
- Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Melvin K S Leow
- Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Bernhard O Boehm
- Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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23
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Ting CY, Ahmad Zaidi Adruce S, Lim CJ, Abd Jabar AHA, Ting RSK, Ting H, Osman NA, Ngau E, Talin BA, Muhammad M, Loo SC, Lim SE, Hassali MA. Effectiveness of a pharmacist-led structured group-based intervention in improving medication adherence and glycaemic control among type 2 diabetes mellitus patients: A randomized controlled trial. Res Social Adm Pharm 2020; 17:344-355. [PMID: 32327398 DOI: 10.1016/j.sapharm.2020.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A pharmacist-led structured group-based intervention (MEDIHEALTH) was formulated to improve medication adherence among Malay type 2 diabetes mellitus (T2DM) patients in the Malaysian state of Sarawak. OBJECTIVES The objective of this study was to examine the effectiveness of MEDIHEALTH and its mechanism of impact for improving medication adherence and the glycated haemoglobin (HbA1c) level. METHODS A two group and parallel randomised controlled trial with a twelve months follow-up period was conducted at two primary health clinics in Malaysia that were surrounded by Malay communities. Malay T2DM patients whose HbA1c was >7% and total score on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was <26 were recruited and parallelly randomised to the MEDIHEALTH or usual care (control) groups. The extended theory of planned behaviour was employed to test the mechanism of impact. Repeated measure analysis of variance was used to assess the difference in the estimated marginal mean of the SEAMS scores and HbA1c level between the intervention and control groups at different times. RESULTS A total of 142 participants were recruited and randomised; three from the intervention group and eight from the control group withdrew before receiving any treatment. Hence, 68 participants in the intervention group and 63 in the control group were included for analyses. The MEDIHEALTH group had a significantly greater increase in the SEAMS score compared to the control group (p < 0.001) at one, three, six and twelve months post-intervention. There was also a significantly greater reduction in HbA1c in the MEDIHEALTH compared to the control group at one, three, six and twelve months post-intervention (p < 0.001). These improvements were mediated by enhancements in perceived behavioural control and knowledge about medications. CONCLUSIONS The MEDIHEALTH may improve medication adherence and glycaemic control among Malay T2DM patients.
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Affiliation(s)
- Chuo Yew Ting
- Institute of Borneo Studies, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia; Pharmacy Practice and Development Division, Sarawak State Health Department Sarawak, Minitry of Health, Malaysia.
| | - Shahren Ahmad Zaidi Adruce
- Institute of Borneo Studies, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia; Faculty of Cognitive Science and Human Development, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Chien Joo Lim
- Clinical Research & Innovation Office, Tan Tock Seng Hospital, Singapore.
| | | | - Rachel Sing-Kiat Ting
- Monash University, Jeffrey Cheah School of Medicine and Health Sciences, Selangor, Malaysia.
| | - Hiram Ting
- Sarawak Research Society, Sarawak, Malaysia; Faculty of Hospitality and Tourism Management, UCSI University, Malaysia.
| | - Nor Anizah Osman
- Pharmacy Practice and Development Division, Sarawak State Health Department Sarawak, Minitry of Health, Malaysia.
| | - Esther Ngau
- Pharmacy Department, Petra Jaya Health Clinic, Petra Jaya, Kuching, Ministry of Health, Malaysia.
| | - Benodict Apok Talin
- Pharmacy Enforcement Division, Sarawak State Health Department Sarawak, Ministry of Health, Malaysia.
| | - Munira Muhammad
- Pharmaceutical Services Division, Ministry of Health, Malaysia.
| | - Shing Chyi Loo
- Pharmacy Enforcement Division, Sarawak State Health Department Sarawak, Ministry of Health, Malaysia.
| | - Su Ee Lim
- Pharmacy Practice and Development Division, Sarawak State Health Department Sarawak, Minitry of Health, Malaysia.
| | - Mohamed Azmi Hassali
- Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
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24
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Jie Chee Y, Seneviratna A, Joo Lim C, Chiong CX, Peh DS, Hawkins R, Chew DE, Dalan R. Red cell distribution width is associated with mortality and cardiovascular complications in diabetes mellitus in Singapore. Eur J Prev Cardiol 2019; 27:216-219. [PMID: 31130002 DOI: 10.1177/2047487319836854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ying Jie Chee
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Aruni Seneviratna
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore
| | - Chien Joo Lim
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore
| | - Cleo Xy Chiong
- Department of Family Medicine, National University Health System, Singapore
| | - Daryl Sl Peh
- Department of Metabolic Medicine, Lee Kong Chian School of Medicine, Singapore
| | - Robert Hawkins
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
| | - Daniel Ek Chew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore.,Department of Metabolic Medicine, Lee Kong Chian School of Medicine, Singapore.,Department of General Medicine, Yong Loo Lin School of Medicine, Singapore
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore.,Department of Metabolic Medicine, Lee Kong Chian School of Medicine, Singapore.,Department of General Medicine, Yong Loo Lin School of Medicine, Singapore
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25
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Ting CY, Adruce SAZ, Hassali MA, Ting H, Lim CJ, Ting RSK, Jabar AHAA, Osman NA, Shuib IS, Loo SC, Sim ST, Lim SE. Correction to: Effectiveness and sustainability of a structured group-based educational program (MEDIHEALTH) in improving medication adherence among Malay patients with underlying type 2 diabetes mellitus in Sarawak State of Malaysia: study protocol of a randomized controlled trial. Trials 2019; 20:267. [PMID: 31077233 PMCID: PMC6511171 DOI: 10.1186/s13063-019-3348-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Chuo Yew Ting
- Institute of Borneo Studies, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | | | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Hiram Ting
- Sarawak Research Society, Sarawak, Malaysia
| | - Chien Joo Lim
- Clinical Research Center, Sarawak General Hospital, Sarawak, Malaysia
| | - Rachel Sing-Kiat Ting
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | | | - Nor Anizah Osman
- Pharmacy Practice and Development Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Izzul Syazwan Shuib
- Pharmacy Enforcement Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Shing Chyi Loo
- Pharmacy Enforcement Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Sui Theng Sim
- Pharmacy Enforcement Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Su Ee Lim
- Pharmacy Practice and Development Division, Sarawak State Health Department, Sarawak, Malaysia
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26
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Ting CY, Ting RSK, Lim CJ, King TL, Ting H, Gerofi J. Pilot study on functional performance and acceptability of two new synthetic adhesive male condoms (Wondaleaf): a randomized cross-over trial. Contraception 2019; 100:65-71. [PMID: 30871936 DOI: 10.1016/j.contraception.2019.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study compared the condom failure rate, safety and acceptability of two new synthetic adhesive male condoms, Wondaleaf-Cap® (WLC) and Wondaleaf-On-Man® (WLM), with a marketed latex external condom Durex®-Together (DT). STUDY DESIGN We enrolled healthy married, monogamous, heterosexual condom users in a randomized controlled, cross-over, pilot trial in Malaysia. We randomized participants to six groups with different condom use-orders of the experimental WLC and WLM and control latex condom for four episodes for vaginal sex over 1 month for each condom type. We summarized the clinical and non-clinical failure rate, safety and acceptability of each condom type using descriptive statistics. We tested differences in condom failure and acceptability using generalized estimating equations and repeated measure ANOVA respectively. RESULTS We screened 75 couples and randomized 50 eligible couples. Two couples withdrew before receiving any condom. The remaining used 576 condoms with 192 uses for each condom variant. Clinical failure rates of WLC, WLM and DT were 1.04%, 0% and 0.52%, respectively. Non-clinical failure rates of WLC, WLM and DT were 2.08%, 3.12% and 1.04%, respectively. Removal was found more painful with Wondaleaf products than the DT. Preferences of participants for WLC, WLM and DT were 33.3%, 29.2% and 25%, respectively. Overall, WLC and DT had greater acceptances among male participants than WLM. CONCLUSION Results of this pilot study support that use of synthetic adhesive male condoms is associated with failure rates similar to those seen with existing latex, and with greater acceptability. A larger study to ascertain non-inferiority is underway. IMPLICATIONS The availability of synthetic adhesive male condoms may increase the acceptability of condom use. However, removal pain and clinical performance requires further study.
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Affiliation(s)
- Chuo Yew Ting
- Sarawak Research Society, Lot 56, Phase 5, Lorong Greenwood 21, Greenwood Park Batu 9 ½ Jalan Kuching-Serian, 94200 Kuching, Sarawak, Malaysia; Institute of Borneo Studies, Universiti Malaysia Sarawak, Jalan Datuk Mohammad Musa, 94300 Kota Samarahan, Sarawak, Malaysia.
| | - Rachel Sing-Kiat Ting
- Monash University Malaysia, Jeffrey Cheah School of Medicine and Health Sciences, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia.
| | - Chien Joo Lim
- Clinical Research Center, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia.
| | - Teck Long King
- Clinical Research Center, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia; Pharmacy Department, Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia.
| | - Hiram Ting
- Sarawak Research Society, Lot 56, Phase 5, Lorong Greenwood 21, Greenwood Park Batu 9 ½ Jalan Kuching-Serian, 94200 Kuching, Sarawak, Malaysia; Faculty of Hospitality and Tourism Management, UCSI University, Muara Tebas Land District, Sejingkat, 93450 Kuching, Sarawak, Malaysia.
| | - John Gerofi
- Enersol Pty Ltd, 235 Nelson St, Annandale, NSW, 2038, Australia.
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27
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Hoeppli RE, MacDonald KN, Leclair P, Fung VCW, Mojibian M, Gillies J, Rahavi SMR, Campbell AIM, Gandhi SK, Pesenacker AM, Reid G, Lim CJ, Levings MK. Tailoring the homing capacity of human Tregs for directed migration to sites of Th1-inflammation or intestinal regions. Am J Transplant 2019; 19:62-76. [PMID: 29766641 DOI: 10.1111/ajt.14936] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/17/2018] [Accepted: 05/06/2018] [Indexed: 01/25/2023]
Abstract
Cell-based therapy with CD4+ FOXP3+ regulatory T cells (Tregs) is a promising strategy to limit organ rejection and graft-vs-host disease. Ongoing clinical applications have yet to consider how human Tregs could be modified to direct their migration to specific inflammation sites and/or tissues for more targeted immunosuppression. We show here that stable, homing-receptor-tailored human Tregs can be generated from thymic Tregs isolated from pediatric thymus or adult blood. To direct migration to Th1-inflammatory sites, addition of interferon-γ and IL-12 during Treg expansion produced suppressive, epigenetically stable CXCR3+ TBET+ FOXP3+ T helper (Th)1-Tregs. CXCR3 remained expressed after injection in vivo and Th1-Tregs migrated efficiently towards CXCL10 in vitro. To induce tissue-specific migration, addition of retinoic acid (RA) during Treg expansion induced expression of the gut-homing receptors α4β7-integrin and CCR9. FOXP3+ RA-Tregs had elevated expression of the functional markers latency-associated peptide and glycoprotein A repetitions predominant, increased suppressive capacity in vitro and migrated efficiently to healthy and inflamed intestine after injection into mice. Homing-receptor-tailored Tregs were epigenetically stable even after long-term exposure to inflammatory conditions, suppressive in vivo and characterized by Th1- or gut-homing-specific transcriptomes. Tailoring human thymic Treg homing during in vitro expansion offers a new and clinically applicable approach to improving the potency and specificity of Treg therapy.
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Affiliation(s)
- R E Hoeppli
- Department of Surgery, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - K N MacDonald
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada.,Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - P Leclair
- Department of Pediatrics, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - V C W Fung
- Department of Surgery, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - M Mojibian
- Department of Surgery, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - J Gillies
- Department of Surgery, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - S M R Rahavi
- Department of Pediatrics, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - A I M Campbell
- Department of Surgery, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - S K Gandhi
- Department of Surgery, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - A M Pesenacker
- Department of Surgery, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - G Reid
- Department of Pediatrics, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - C J Lim
- Department of Pediatrics, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - M K Levings
- Department of Surgery, University of British Columbia & British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
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Ting CY, Ahmad Zaidi Adruce S, Hassali MA, Ting H, Lim CJ, Ting RSK, Abd Jabar AHA, Osman NA, Shuib IS, Loo SC, Sim ST, Lim SE, Morisky DE. Effectiveness and sustainability of a structured group-based educational program (MEDIHEALTH) in improving medication adherence among Malay patients with underlying type 2 diabetes mellitus in Sarawak State of Malaysia: study protocol of a randomized controlled trial. Trials 2018; 19:310. [PMID: 29871651 PMCID: PMC5989376 DOI: 10.1186/s13063-018-2649-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/13/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Amidst the high disease burden, non-adherence to medications among patients with type 2 diabetes mellitus (T2DM) has been reported to be common and devastating. Sarawak Pharmaceutical Services Division has formulated a pharmacist-led, multiple-theoretical-grounding, culturally sensitive and structured group-based program, namely "Know Your Medicine - Take if for Health" (MEDIHEALTH), to improve medication adherence among Malay patients with T2DM. However, to date, little is known about the effectiveness and sustainability of the Program. METHODS/DESIGN This is a prospective, parallel-design, two-treatment-group randomized controlled trial to evaluate the effectiveness and sustainability of MEDIHEALTH in improving medication adherence. Malay patients who have underlying T2DM, who obtain medication therapy at Petra Jaya Health Clinic and Kota Samarahan Health Clinic, and who have a moderate to low adherence level (8-item Morisky Medication Adherence Scale, Malaysian specific, score <6) were randomly assigned to the treatment group (MEDIHEALTH) or the control group. The primary outcome of this study is medication adherence level at baseline and 1, 3, 6 and 12 months post-intervention. The secondary outcomes are attitude, subjective norms, perceived behavioural control, intention and knowledge related to medication adherence measured at baseline and 1, 6 and 12 months post-intervention. The effectiveness and sustainability of the Program will be triangulated by findings from semi-structured interviews with five selected participants conducted 1 month after the intervention and in-depth interviews with two main facilitators and two managerial officers in charge of the Program 12 months after the intervention. Statistical analyses of quantitative data were conducted using SPSS version 22 and Stata version 14. Thematic analysis for qualitative data were conducted with the assistance of ATLAS.ti 8. DISCUSSION This study provides evidence on the effectiveness and sustainability of a structured group-based educational program that employs multiple theoretical grounding and a culturally sensitive approach in promoting medication adherence among Malays with underlying T2DM. Both the quantitative and qualitative findings of this study could assist in the future development of the Program. TRIAL REGISTRATION National Medical Research Register, NMRR-17-925-35875 (IIR). Registered on 19 May 2017. ClinicalTrials.gov, NCT03228706 . Registered on 25 July 2017.
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Affiliation(s)
- Chuo Yew Ting
- Institute of Borneo Studies, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | | | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Hiram Ting
- Sarawak Research Society, Sarawak, Malaysia
| | - Chien Joo Lim
- Clinical Research Center, Sarawak General Hospital, Sarawak, Malaysia
| | - Rachel Sing-Kiat Ting
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | | | - Nor Anizah Osman
- Pharmacy Practice and Development Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Izzul Syazwan Shuib
- Pharmacy Enforcement Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Shing Chyi Loo
- Pharmacy Enforcement Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Sui Theng Sim
- Pharmacy Enforcement Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Su Ee Lim
- Pharmacy Practice and Development Division, Sarawak State Health Department, Sarawak, Malaysia
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Bujang MA, Adnan TH, Mohd Hatta NKB, Ismail M, Lim CJ. A Revised Version of Diabetes Quality of Life Instrument Maintaining Domains for Satisfaction, Impact, and Worry. J Diabetes Res 2018; 2018:5804687. [PMID: 30327784 PMCID: PMC6169225 DOI: 10.1155/2018/5804687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/12/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Diabetes quality of life (DQoL) instrument has been widely used to measure quality of life among diabetes patients. This study aimed to develop a revised version of DQoL instrument that incorporated issues of redundancies in the items and strengthen the basis of validity of the instrument. METHODS This was a cross-sectional study where diabetes patients were recruited from December 1, 2014, until end of March 2015 at a public health clinic in Peninsular Malaysia. A questionnaire that included patients' information and DQoL instrument was distributed to patients. Item selection of DQoL instrument was conducted to screen and finalize the items based on issues of missing values and redundancy. Validity testing was conducted for the revised DQoL instrument based on exploratory factor analysis, confirmatory factor analysis, and Rasch analysis. RESULTS The pattern structure matrix yielded three domains similar to the original version with 18 items. The minimum factor loading from the structure matrix was 0.358. The item's and person's reliability was excellent with 0.92 and 0.84 for "satisfaction" domain, 0.98 and 0.60 for "impact" domain, and 0.99 and 0.57 for "worry" domain, respectively. Confirmatory factor analysis has dropped 5 items and the revised version of DQoL contained 13 items. Composite reliability of the revised version was computed for "satisfaction" domain (0.922; 95% CI: 0.909-0.936), "impact" domain (0.781; 95% CI: 0.745-0.818), and "worry" domain (0.794; 95% CI: 0.755-0.832). CONCLUSION A revised version of DQoL that maintains the conceptualization of "satisfaction," "impact," and "worry" with 13 items was successfully developed.
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Affiliation(s)
- Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
| | - Tassha Hilda Adnan
- National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Mastura Ismail
- Health Clinic Seremban 2, Ministry of Health Malaysia, Seremban Negeri Sembilan, Malaysia
| | - Chien Joo Lim
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
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Khademolhosseini F, Liu CC, Lim CJ, Chiao M. A magnetically actuated cellular strain assessment tool for quantitative analysis of strain induced cellular reorientation and actin alignment. Rev Sci Instrum 2016; 87:085004. [PMID: 27587150 DOI: 10.1063/1.4960567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Commercially available cell strain tools, such as pneumatically actuated elastomer substrates, require special culture plates, pumps, and incubator setups. In this work, we present a magnetically actuated cellular strain assessment tool (MACSAT) that can be implemented using off-the-shelf components and conventional incubators. We determine the strain field on the MACSAT elastomer substrate using numerical models and experimental measurements and show that a specific region of the elastomer substrate undergoes a quasi-uniaxial 2D stretch, and that cells confined to this region of the MACSAT elastomer substrate undergo tensile, compressive, or zero axial strain depending on their angle of orientation. Using the MACSAT to apply cyclic strain on endothelial cells, we demonstrate that actin filaments within the cells reorient away from the stretching direction, towards the directions of minimum axial strain. We show that the final actin orientation angles in strained cells are spread over a region of compressive axial strain, confirming previous findings on the existence of a varied pre-tension in the actin filaments of the cytoskeleton. We also demonstrate that strained cells exhibit distinctly different values of actin alignment coherency compared to unstrained cells and therefore propose that this parameter, i.e., the coherency of actin alignment, can be used as a new readout to determine the occurrence/extent of actin alignment in cell strain experiments. The tools and methods demonstrated in this study are simple and accessible and can be easily replicated by other researchers to study the strain response of other adherent cells.
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Affiliation(s)
- F Khademolhosseini
- Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia V6T-1Z4, Canada
| | - C-C Liu
- Department of Medicine, University of British Columbia, Vancouver, British Columbia V5Z-1M9, Canada
| | - C J Lim
- Child and Family Research Institute, BC Children's Hospital, Vancouver, British Columbia V5Z-4H4, Canada
| | - M Chiao
- Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia V6T-1Z4, Canada
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Liu CC, Leclair P, Monajemi M, Sly LM, Reid GS, Lim CJ. α-Integrin expression and function modulates presentation of cell surface calreticulin. Cell Death Dis 2016; 7:e2268. [PMID: 27310876 PMCID: PMC5143402 DOI: 10.1038/cddis.2016.176] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/10/2016] [Accepted: 05/26/2016] [Indexed: 12/22/2022]
Abstract
Calreticulin presentation on the cell surface is an important hallmark of immunogenic cell death (ICD), serving as the prophagocytic signal for macrophages. Cell adhesion is a physiologically relevant stimulus previously shown to increase calreticulin interaction with α-integrins via the juxtamembrane, cytosolic GFFKR motif. This study assessed whether integrin function can regulate surface calreticulin levels in ICD. We generated calreticulin-null T-lymphoblasts and confirmed the loss of surface calreticulin expression on cells treated with doxorubicin, an ICD inducer. Reconstituted expression with full-length calreticulin targeted to the endoplasmic reticulum (ER) successfully rescued doxorubicin-induced surface calreticulin. Reconstitution with a truncation mutant calreticulin targeted to the cytosol led to constitutively high surface calreticulin that was not further elevated by doxorubicin, suggesting calreticulin released from the stressed ER transits the cytosol before its translocation to the cell surface. When stimulated to engage integrin substrates, doxorubicin-treated wild-type T-lymphoblasts exhibited decreased surface calreticulin compared with cells under non-adherent conditions. The inhibitory effect on surface calreticulin was recapitulated for cells in suspension treated with a β1-integrin-activating antibody, 9EG7. Similarly, cells expressing a truncated α-integrin cytosolic tail, bearing only the juxtamembrane GFFKR calreticulin-binding motif, exhibited low surface calreticulin with doxorubicin treatment under non-adherent conditions. Using partial permeabilization techniques to distinguish between cytosolic and ER staining, we found that ICD inducers promoted the accumulation of cytosolic calreticulin with negligible change in total calreticulin, suggesting that integrin-mediated inhibition of surface calreticulin was due to reduced cytosolic to surface translocation. T-lymphoblasts co-treated with an ICD inducer and 9EG7 exhibited reduced phagocytosis by macrophages when compared with treatment with only ICD inducer. This study reveals a previously uncharacterized function of integrins as negative regulators of ICD by suppressing presentation of cell surface calreticulin.
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Affiliation(s)
- C-C Liu
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V5Z 4H4.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 4H4
| | - P Leclair
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V5Z 4H4
| | - M Monajemi
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 4H4
| | - L M Sly
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V5Z 4H4
| | - G S Reid
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V5Z 4H4.,Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital, Vancouver, BC, Canada V5Z 4H4
| | - C J Lim
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V5Z 4H4.,Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital, Vancouver, BC, Canada V5Z 4H4
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Chan HK, Hassali MA, Lim CJ, Saleem F, Tan WL. Using pictograms to assist caregivers in liquid medication administration: a systematic review. J Clin Pharm Ther 2015; 40:266-72. [PMID: 25865563 DOI: 10.1111/jcpt.12272] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/18/2015] [Indexed: 01/20/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE It has been reported that more than 80% of out-of-hospital medication errors among the young children involve liquid formulations. The usefulness of pictorial aids to improve communication of medication instructions has not been extensively investigated for child health. The objective of this study was to determine the effectiveness of pictorial aids used to assist caregivers in the administration of liquid medications. METHODS MEDLINE, CINAHL, PsycINFO, ScienceDirect, Scopus and the Cochrane Library were searched for articles published up to February 2015. Studies that used pictorial aids with liquid medications and measured at least one of the following outcomes were included: dosing accuracy, comprehension of medication instructions, recall of information and adherence of caregivers. Two authors independently selected studies, extracted data and assessed methodological quality of studies using the Cochrane Collaboration's tool. RESULTS AND DISCUSSION Five experimental studies (four hospital based and one community based) with a total of 962 participants were included. A wide range of liquid formulations were studied, including both prescription and over-the-counter medications. The existing findings suggest that pictographic interventions reduced dosing errors, enhanced comprehension and recall of medication instructions and improved adherence of caregivers. Incorporating pictorial aids into verbal medication counselling or text-based instructions was more beneficial than using the single approach alone. Mixed results were identified for the relationship between health literacy of caregivers and effectiveness of pictorial aids. WHAT IS NEW AND CONCLUSION The evidence remains limited due to the small number of studies found and variations in methodological quality. This review suggests that pictorial aids might be potential interventions, but more high-quality studies are needed to support the routine use of any pictogram-based materials with liquid medications in the clinical settings.
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Affiliation(s)
- H K Chan
- Department of Pharmacy, Hospital Sultanah Bahiyah, Kedah, Malaysia
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Oh KS, Lee JH, Yi KY, Lim CJ, Lee S, Park CH, Seo HW, Lee BH. The orally active urotensin receptor antagonist, KR36676, attenuates cellular and cardiac hypertrophy. Br J Pharmacol 2015; 172:2618-33. [PMID: 25597918 DOI: 10.1111/bph.13082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/11/2014] [Accepted: 01/13/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Blockade of the actions of urotensin-II (U-II) mediated by the urotensin (UT) receptor should improve cardiac function and prevent cardiac remodelling in cardiovascular disease. Here, we have evaluated the pharmacological properties of the recently identified UT receptor antagonist, 2-(6,7-dichloro-3-oxo-2H-benzo[b][1,4]oxazin-4(3H)-yl)-N-methyl-N-(2-(pyrrolidin-1-yl)-1-(4-(thiophen-3-yl)phenyl) ethyl)acetamide (KR36676). EXPERIMENTAL APPROACH Pharmacological properties of KR36676 were studied in a range of in vitro assays (receptor binding, calcium mobilization, stress fibre formation, cellular hypertrophy) and in vivo animal models such as cardiac hypertrophy induced by transverse aortic constriction (TAC) or myocardial infarction (MI). KEY RESULTS KR36676 displayed high binding affinity for the UT receptor (Ki : 0.7 nM), similar to that of U-II (0.4 nM), and was a potent antagonist at that receptor (IC50 : 4.0 nM). U-II-induced stress fibre formation and cellular hypertrophy were significantly inhibited with low concentrations of KR36676 (≥0.01 μM). Oral administration of KR36676 (30 mg·kg(-1) ) in a TAC model in mice attenuated cardiac hypertrophy and myocardial fibrosis. Moreover, KR36676 restored cardiac function and myocyte size in rats with MI-induced cardiac hypertrophy. CONCLUSIONS AND IMPLICATIONS A highly potent UT receptor antagonist exerted anti-hypertrophic effects not only in infarcted rat hearts but also in pressure-overloaded mouse hearts. KR36676 could be a valuable pharmacological tool in elucidating the complicated physiological role of U-II and UT receptors in cardiac hypertrophy.
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Affiliation(s)
- K S Oh
- Research Center for Drug Discovery Technology, Korea Research Institute of Chemical Technology, Daejeon, Korea; Department of Medicinal and Pharmaceutical Chemistry, University of Science and Technology, Daejeon, Korea
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Wang C, Peng J, Li H, Bi XT, Legros R, Lim CJ, Sokhansanj S. Oxidative torrefaction of biomass residues and densification of torrefied sawdust to pellets. Bioresour Technol 2013; 127:318-325. [PMID: 23131655 DOI: 10.1016/j.biortech.2012.09.092] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 09/25/2012] [Accepted: 09/25/2012] [Indexed: 06/01/2023]
Abstract
Oxidative torrefaction of sawdust with a carrier gas containing 3-6% O(2) was investigated in a TG and a fluidized bed reactor, with the properties of the torrefied sawdust and pellets compared with traditional torrefaction without any O(2), as well as the dry raw material. It is found that the oxidative torrefaction process produced torrefied sawdust and pellets of similar properties as normally torrefied sawdust and corresponding pellets, especially on the density, energy consumption for pelletization, higher heating value and energy yield. For moisture absorption and hardness of the torrefied pellets, the oxidative torrefaction process showed slightly poor but negligible performance. Therefore, it is feasible to use oxygen laden combustion flue gases as the carrier gas for torrefaction of biomass. Besides, torrefied sawdust can be made into dense and strong pellets of high hydrophobicity at a higher die temperature than normally used in the production of traditional control pellets.
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Affiliation(s)
- Congwei Wang
- Key Laboratory of Renewable Energy and Gas Hydrate, Guangzhou Institute of Energy Conversion, Chinese Academy of Sciences, Guangzhou 510640, PR China
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Rydin Y, Bleahu A, Davies M, Dávila JD, Friel S, De Grandis G, Groce N, Hallal PC, Hamilton I, Howden-Chapman P, Lai KM, Lim CJ, Martins J, Osrin D, Ridley I, Scott I, Taylor M, Wilkinson P, Wilson J. Shaping cities for health: complexity and the planning of urban environments in the 21st century. Lancet 2012; 379:2079-108. [PMID: 22651973 PMCID: PMC3428861 DOI: 10.1016/s0140-6736(12)60435-8] [Citation(s) in RCA: 473] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Li H, Liu X, Legros R, Bi XT, Lim CJ, Sokhansanj S. Torrefaction of sawdust in a fluidized bed reactor. Bioresour Technol 2012; 103:453-458. [PMID: 22055091 DOI: 10.1016/j.biortech.2011.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 10/01/2011] [Accepted: 10/02/2011] [Indexed: 05/31/2023]
Abstract
In the present work, stable fluidization of sawdust was achieved in a bench fluidized bed with an inclined orifice distributor without inert bed materials. A solids circulation pattern was established in the bed without the presence of slugging and channeling. The effects of treatment severity and weight loss on the solid product properties were identified. The decomposition of hemicelluloses was found to be responsible for the significant changes of chemical, physical and mechanical properties of the torrefied sawdust, including energy content, particle size distribution and moisture absorption capacity. The hydrophobicity of the torrefied sawdust was improved over the raw sawdust with a reduction of around 40 wt.% in saturated water uptake rate, and enhanced with increasing the treatment severity due to the decomposition of hemicelluloses which are rich in hydroxyl groups. The results in this study provided the basis for torrefaction in fluidized bed reactors.
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Affiliation(s)
- Hui Li
- Clean Energy Research Centre & Department of Chemical & Biological Engineering, University of British Columbia, Vancouver, Canada
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Chan SW, Lim CJ, Huang C, Chong YF, Gunaratne HJ, Hogue KA, Blackstock WP, Harvey KF, Hong W. WW domain-mediated interaction with Wbp2 is important for the oncogenic property of TAZ. Oncogene 2010; 30:600-10. [PMID: 20972459 PMCID: PMC3033532 DOI: 10.1038/onc.2010.438] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The transcriptional co-activators YAP and TAZ are downstream targets inhibited by the Hippo tumor suppressor pathway. YAP and TAZ both possess WW domains, which are important protein–protein interaction modules that mediate interaction with proline-rich motifs, most commonly PPXY. The WW domains of YAP have complex regulatory roles as exemplified by recent reports showing that they can positively or negatively influence YAP activity in a cell and context-specific manner. In this study, we show that the WW domain of TAZ is important for it to transform both MCF10A and NIH3T3 cells and to activate transcription of ITGB2 but not CTGF, as introducing point mutations into the WW domain of TAZ (WWm) abolished its transforming and transcription-promoting ability. Using a proteomic approach, we discovered potential regulatory proteins that interact with TAZ WW domain and identified Wbp2. The interaction of Wbp2 with TAZ is dependent on the WW domain of TAZ and the PPXY-containing C-terminal region of Wbp2. Knockdown of endogenous Wbp2 suppresses, whereas overexpression of Wbp2 enhances, TAZ-driven transformation. Forced interaction of WWm with Wbp2 by direct C-terminal fusion of full-length Wbp2 or its TAZ-interacting C-terminal domain restored the transforming and transcription-promoting ability of TAZ. These results suggest that the WW domain-mediated interaction with Wbp2 promotes the transforming ability of TAZ.
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Affiliation(s)
- S W Chan
- Cancer and Developmental Cell Biology Division, Institute of Molecular and Cell Biology, Singapore
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Igathinathane C, Tumuluru JS, Sokhansanj S, Bi X, Lim CJ, Melin S, Mohammad E. Simple and inexpensive method of wood pellets macro-porosity measurement. Bioresour Technol 2010; 101:6528-6537. [PMID: 20371174 DOI: 10.1016/j.biortech.2010.03.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 03/06/2010] [Accepted: 03/11/2010] [Indexed: 05/29/2023]
Abstract
A novel simplified stereometric measurement method for determining the macro-porosity of wood pellets through geometrical approach was successfully developed and tested. The irregular ends of pellets of circular cross-section were sanded flat so that their geometry becomes cylinder and their volumes evaluated using mensuration formula. Such formed cylindrical pellets were loose or tap filled to selected volumes to evaluate the macro-porosity and the constant specific weight. The method was extended to evaluate actual wood pellets properties. Overall macro-porosity of actual wood pellets was determined as 41.0+/-2.5% and 35.5+/-2.7%, mean bulk density as 670+/-29 kg m(-3) and 731+/-31 kg m(-3), and classified as "Class-3:Medium" and "Class-3&4:Medium to Low" for loose and tapped fills, respectively. Hausner ratio and Carr's compressibility index classify wood pellets as "freely flowing." The developed stereometric method can be used as a handy inexpensive laboratory procedure to estimate the macro-porosity of different types and makes of wood pellets and other similar packaged materials.
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Affiliation(s)
- C Igathinathane
- Department of Agricultural and Biosystems Engineering, North Dakota State University, Fargo, ND 58102, USA.
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Yazdanpanah F, Sokhansanj S, Lau AK, Lim CJ, Bi X, Melin S, Afzal M. Permeability of wood pellets in the presence of fines. Bioresour Technol 2010; 101:5565-5570. [PMID: 20223658 DOI: 10.1016/j.biortech.2010.01.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 01/14/2010] [Accepted: 01/21/2010] [Indexed: 05/28/2023]
Abstract
Broken pellets and fines are produced when pellets are handled. The resistance to air flow was measured for clean pellets and for pellets mixed with 1-20% broken pellets (fines). A pellet diameter was 6mm. The lengths ranged from 6 to 12 mm. Clean pellets were defined as particles that remained on a 4mm screen. A typical sieve analysis showed 30% of the mass of particles that passed through the 4mm screen was smaller than 1mm. The airflow rates used in the experiment ranged from 0.004 to 0.357 ms(-1). The corresponding pressure drop ranged from 1.9 to 271 Pam(-1) for clean pellets, from 4.8 to 1100 Pam(-1) for 10% fines content, and from 7.9 to 1800 Pam(-1) for 20% fines content. Coefficients of Hukill and Ives' equation were estimated for clean pellets and a multiplier was defined to calculate pressure drop for pellets mixed with fines.
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Affiliation(s)
- F Yazdanpanah
- Chemical and Biological Engineering Department, University of British Columbia, 2360 East Mall, Vancouver, BC, Canada V6T 1Z3
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Nor Shazwani MN, Suzana S, Hanis Mastura Y, Lim CJ, Teh SC, Mohd Fauzee MZ, Lim HC, Dahlia S, Norliza M. Assessment of Physical Activity Level among Individuals with Type 2 Diabetes Mellitus at Cheras Health Clinic, Kuala Lumpur. Malays J Nutr 2010; 16:101-112. [PMID: 22691857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A cross-sectional study was carried out to assess the physical activity levels among patients with type 2 diabetes mellitus (DM) at Cheras Health Clinic in Kuala Lumpur. A total of 132 subjects (62 men and 70 women) aged 30 years and above participated in this study. Data was collected using an interview based questionnaire to obtain socio-demographic and health profile information. Physical activity was assessed using a shortened version of the International Physical Activity Questionnaire (IPAQ). Anthropometric measurements and body fat were also taken. Glycaemic status, that is, HbA1c, fasting blood sugar (FBS) and 2 hours post-prandial (2-HPP) were obtained from medical records. Results showed that the mean age of the patients was 51.9 + 5.8 years. The majority of patients had poor glycaemic control based on HbA1c (70.7%), FBS (71.9%) and 2HPP (85.4%). Patients who were unmarried and aged(60 years and above had a lower physical activity level (p< 0.05). In the older age group, low physical activity was associated with poor glycaemic control (p< 0.05). Patients in the moderate and high physical activity level were motivated to perform physical activity so as to be healthy (68.1%). Low physical activity level among patients was due to lack of time (54.5%) and lack of energy (21.2%). In conclusion, physical activity levels of the patients were unsatisfactory and associated with poor glycaemic control, especially in the elderly. There is a need to encourage diabetic patients to undertake regular physical activity in order to achieve optimal glycaemic control.
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Affiliation(s)
- M N Nor Shazwani
- Department of Nutrition and Dietetics of Allied Health Sciences, Universiti Kebangsaan Malaysia
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Laursen K, Grace JR, Lim CJ. Enhancement of the sulfur capture capacity of limestones by the addition of Na2CO3 and NaCl. Environ Sci Technol 2001; 35:4384-4389. [PMID: 11718362 DOI: 10.1021/es0108279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The ability of Na2CO3 and NaCl to enhance the sulfur capture capacity of three limestones was evaluated via fixed-bed calcination and sulfation experiments. The tested limestones represent three different sulfation morphologies: unreacted-core, network, and uniformly sulfated. Treatment with aqueous or powdered Na2CO3 significantly increased the Ca-utilization for two stones which normally sulfate in an unreacted-core pattern (20% to 45%) and network pattern (33% to 49%). The increase was lower for the uniformly sulfated stone (44% to 48%). Na2CO3 treatment increased the number of macropores leading to uniform sulfation of all particles, nearly eliminating the normal strong dependence of utilization on limestone type and particle size. The effect of Na2CO3 is believed to be associated with formation of a eutectic melt which enhances ionic diffusion and accelerates molecular rearrangement of the CaO. Treatment with aqueous NaCl solution caused a decrease in utilization, probably due to formation of large grains and plugging of pores caused by formation of a large amount of eutectic melt. The effect of Na2CO3 is less sensitive than that of NaCl to the amount added and the combustion environment (temperature and gas composition). In addition, Na2CO3 neither promotes corrosion nor forms chlorinated byproducts, which are main concerns associated with NaCl. Thus, Na2CO3 appears to have significant advantages over NaCl for enhancement of limestone sulfur capture capacity in fluidized-bed combustors.
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Affiliation(s)
- K Laursen
- Environmental Technology Institute, Innovation Centre (NTU), Singapore.
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Kim HG, Park KN, Cho YW, Park EH, Fuchs JA, Lim CJ. Characterization and regulation of glutathione S-transferase gene from Schizosaccharomyces pombe. Biochim Biophys Acta 2001; 1520:179-85. [PMID: 11513961 DOI: 10.1016/s0167-4781(01)00265-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A glutathione S-transferase (GST) gene has been cloned from Schizosaccharomyces pombe for the first time. The nucleotide sequence determined was found to contain 2030 base pairs including an open reading frame of 229 amino acids that would encode a protein of a molecular mass of 27017 Da. The cloned GST gene was expressed and was found to function in S. pombe, Saccharomyces cerevisiae, and Escherichia coli. The plasmid pGT207 encoding the S. pombe GST gene appeared to be able to accelerate the growth of a wild type S. pombe culture. In a culture of S. pombe containing plasmid pGT207, the growth was inhibited less by mercuric chloride than in a culture with vector alone. The 1088 bp region upstream from the GST gene as well as the region encoding the N-terminal 14 amino acids was transferred into the promoterless beta-galactosidase gene of plasmid YEp357R to yield the fusion plasmid pYSH2000. beta-Galactosidase synthesis was induced by cadmium chloride, mercuric chloride, hydrogen peroxide, and menadione. It was also induced by high temperature. These results suggest that the cloned S. pombe GST gene is involved in the oxidative stress response.
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Affiliation(s)
- H G Kim
- Division of Life Sciences, College of Natural Sciences, Kangwon National University, Chuncheon, South Korea
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Wang J, Yao H, Lim CJ, Zhao Y, Yeo TJ, Hwang NH. Computational fluid dynamics study of a protruded-hinge bileaflet mechanical heart valve. J Heart Valve Dis 2001; 10:254-262; discussion 263. [PMID: 11297213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Following clinical experience with the Medtronic Parallel bileaflet mechanical heart valve, considerable interest has been shown in investigating fluid mechanics inside the hinge socket. Most of these studies involved hinges that are recessed into the valve housing, such as the St. Jude Medical (SJM), CarboMedics, Sorin and On-X bileaflet mechanical heart valves. The aim of this study was to investigate the flow fields of a protruded hinge under steady flow conditions, with the occluder in its fully open position. Computational fluid dynamics (CFD) simulation using the Fluent 4.4.7 commercial solver was applied in this investigation. This protruded hinge mechanism for pivoting the occluder is an in-house design from the Cardiovascular Dynamics Laboratory, Nanyang Technological University. METHODS The Fluent 4.4.7 code was run on a Silicon Graphic Inc. computer (4-CPUx185 MHz) in the CFD simulation. A body-fitted coordinates (BFC) grid was generated to cover the entire valvular flow domain, including the interior of the hinge and leaflet. Clearance between the leaflet and pivot housing was 50-70 microm. In the vicinity of the protruded hinge, mesh cells were small compared with hinge dimensions. A power law distribution of grid points was applied to optimize the number of cells used to cluster the entire flow field. The overall computational flow domain of the valve channel, including the floating leaflet and immersed hinge, was approximately 170,000 cells in total. Inside the hinge socket, approximately 10,000 cells were generated. A comparative model with recessed hinge that resembled the SJM valve hinge design was modeled. Due to geometric difficulties, an unstructured grid scheme was applied. Great attention was focused within the hinge pocket, in particular to the clearance between the hinge pivot and leaflet. A total of 2 million cells was generated for the whole computational flow domain. RESULTS Under steady flow conditions, with the leaflet fixed in an open position, the protruded hinge design yielded a pair of small vortices that formed behind the stoppers. A low-magnitude velocity was observed inside the hinge clearance. Vortices developed behind the protruded stopper. Migrating flow was noted beneath the leaflet clearance as a result of pressure difference across the leaflet. For the recessed hinge design, reverse flow dominated the inside of the hinge socket, and developed into a pair of vortices at high Reynolds number. CONCLUSION The protruded hinge mechanism was designed to expose the overall hinge region to the mainstream flow for a positive washing effect. Flow in this protruded hinge design is, in general, found to be three-dimensional. Initial results under steady flow conditions showed low laminar and turbulent shear stress, while the hinge clearance was well washed.
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Affiliation(s)
- J Wang
- Cardiovascular Dynamics Laboratory, School of Mechanical and Production Engineering, Nanyang Technological University, Singapore
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Cho YW, Kim HG, Park EH, Fuchs JA, Lim CJ. Cloning, expression and regulation of Schizosaccharomyces pombe gene encoding thioltransferase. Biochim Biophys Acta 2000; 1517:171-5. [PMID: 11118633 DOI: 10.1016/s0167-4781(00)00242-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The genomic DNA encoding thioltransferase was isolated from Schizosaccharomyces pombe using the polymerase chain reaction. The amplified DNA fragment was confirmed by Southern hybridization, completely digested with HindIII and BamHI, and then ligated into the yeast-Escherichia coli shuttle vector pRS316, which resulted in plasmid pEH1. The insert of plasmid pEH1 was transferred into the multi-copy vector YEp357 to generate plasmid pYEH1. The determined nucleotide sequence harbors an open reading frame consisting of four exons and three introns, which encodes a polypeptide of 101 amino acids with a molecular mass of 11261 Da. Thioltransferase activity was increased 1.6-fold in Saccharomyces cerevisiae containing plasmid pYEH1, and 1.8- and 2.7-fold in S. pombe containing plasmid pEH1 and pYEH1, respectively. The upstream sequence and the region encoding the N-terminal six amino acids were fused into promoterless beta-galactosidase gene of the shuttle vector YEp357R to generate the fusion plasmid pYEHR1. Synthesis of beta-galactosidase from the fusion plasmid was found to be enhanced by zinc and NO-generating S-nitroso-N-acetylpenicillamine.
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Affiliation(s)
- Y W Cho
- Division of Life Sciences, College of Natural Sciences, Kangwon National University, Chuncheon, South Korea
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Hwang DY, Chae KR, Shin DH, Jang IS, Hwang JH, Kim YJ, Cho JY, Kim BJ, Goo JS, Lim CJ, Kim CK, Cho YY, Paik SG, Kim YK, Cho JS. Mammary gland tumor in transgenic mice expressing targeted beta-casein/HPV16E6 fusion gene. Int J Oncol 2000; 17:1093-8. [PMID: 11078793 DOI: 10.3892/ijo.17.6.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The human papillomaviruses (HPV)-16 and HPV-18 referred to as high-risk HPVs are strongly associated with anogenital malignancies as well as benign epithelial cysts. It has been demonstrated that transgenic mice carrying HPV-16 E6-E7 under the control of the MMTV LTR developed malignant tumors including salivary gland carcinoma, lymphoma, skin histiocytomas and testicular tumors in a non-mammary gland specific manner. Another regulatory unit of rat beta-casein gene can confer the expression of fusion gene preferentially in the mammary glands of transgenic mice in a developmentally regulated manner. In order to generate mammary tumor formation in transgenic mice directing HPV16E6 gene alone into the mammary gland, this regulatory unit was fused to the E6 gene of HPV-16 type to constructing fusion gene. By screening 51 newborn founder transgenic mice, three mice carrying transgenes were identified. One line termed TG32 developed in a mammary gland tumor with large subcutaneous mass in the left rib region at 17 months of age. The levels of E6 transcript in the mass-tumor of TG32 line were lower than those in non-tumor mammary gland of identical TG32 and of TG250. In each tissue of TG32 line, high expression of E6 transcript was detected both in the mammary gland and brain. Histological analysis showed that cells from mammary gland tumor of the TG32 line had also hyperplasia appearance, with irregular or increased total number of mitotic rate. These observations suggest that developing phenotype and the level of E6 transcripts in the process of malignant transformation may have different mechanisms involving the capacity to bind and destabilize p53, although for confirmation it is necessary to investigate many more transgenic mice.
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MESH Headings
- Animals
- Caseins/genetics
- Caseins/metabolism
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Viral/genetics
- Female
- Genes, Synthetic
- Mammary Glands, Animal/metabolism
- Mammary Neoplasms, Experimental/genetics
- Mammary Neoplasms, Experimental/metabolism
- Mice
- Mice, Inbred C57BL
- Mice, Inbred ICR
- Mice, Transgenic
- Oncogene Proteins, Viral/genetics
- Oncogene Proteins, Viral/physiology
- Organ Specificity
- Papillomaviridae/genetics
- Promoter Regions, Genetic
- Rats
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/physiology
- Repressor Proteins
- Transgenes
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- D Y Hwang
- Division of Laboratory Animal Resources, Korea Food and Drug Administration, National Institute of Toxicological Research, Seoul 122-704, Korea
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Abstract
The two promoters of Escherichia coli trxA gene were separately cloned into pKO100 as well as pJEL170. Galactokinase expression in cells containing the pKO100 derivatives was found to be negatively correlated with growth rate and was 6- to 20-fold higher in stationary cultures than in exponential cultures. The expression of trxA-galK was induced by amino acid starvation in a RelA(+) strain but not in an isogenic Rel(-) strain indicating that the control involves guanosine 3',5'-bispyrophosphate (ppGpp). RpoS, which appears to be essential for expression of most stationary phase expressed genes, is not required for trxA expression. Increased expression of relA, which increases ppGpp concentration, increases trxA expression.
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Affiliation(s)
- C J Lim
- Division of Life Sciences, Kangwon National University, Chuncheon, South Korea.
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Kim HG, Cho YW, Park EH, Park SS, Ahn KS, Lim CJ. Cloning, nucleotide sequence and expression of thioltransferase (glutaredoxin) cDNA from Schizosaccharomyces pombe. Mol Cells 1999; 9:668-72. [PMID: 10672936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Thioltransferase (TTase), also known as glutaredoxin (Grx), is an enzyme that catalyzes the reduction of a variety of disulfide compounds, including protein disulfides, in the presence of reduced glutathione. TTase acts as a cofactor for various enzymes such as ribonucleotide reductase. We previously purified a TTase from Schizosaccharomyces pombe and its molecular size was determined. In the present study, a cDNA coding TTase was isolated from a cDNA library of Schizosaccharomyces pombe by colony hybridization, which was constructed in a plasmid vector pGAD GH, and its corresponding insert was confirmed by Southern hybridization. The nucleotide sequence of the 375 bp long cDNA clone reveals an open reading frame, which encodes a protein of 101 amino acids. The coding region of the original clone was transferred after the lac promoter of pUC13 vector for expression in E. coli, and simultaneously, a suitable Shine-Dalgarno (SD) sequence was added in front of the coding region by PCR. The two primers used for PCR also separately contained BamHI and HindIII restriction sites. The E. coli strain (A434) harboring the pUC13 derivative pKU10 showed a 17.3-fold increase in TTase activity compared to the strain with only the vector plasmid.
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Affiliation(s)
- H G Kim
- Division of Life Sciences, College of Natural Sciences, Kangwon National University, Chuncheon, Korea
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Cho YW, Kim JC, Jin CD, Han TJ, Lim CJ. Thioltransferase from Arabidopsis thaliana seed: purification to homogeneity and characterization. Mol Cells 1998; 8:550-5. [PMID: 9856342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Thioltransferase is a general GSH-disulfide reductase of importance for redox regulation. The protein thioltransferase has been purified to apparent homogeneity on SDS-PAGE from the Arabidopsis thaliana seed. The purification procedures included DEAE-cellulose ion exchange chromatography, Sephadex G-75 gel filtration, Q-Sepharose ion exchange chromatography, and DEAE-Sephadex A-25 ion exchange chromatography. The enzyme has a molecular mass of 22 kDa and a pI of 4.8, and it is heatstable. The protein had broad specificities for substrates ranging from low-molecular disulfides (S-sulfocysteine and cystine) to protein disulfides (trypsin and insulin). However, it could not reduce the disulfide linkages of ribonuclease A and bovine serum albumin. It could utilize non-disulfide substrates such as dehydroascorbic acid and alloxan. The protein can reduce the disulfide bond in 2-hydroxyethyl disulfide with an optimum pH of 8.5. Its activity was greatly activated by monothiol compounds such as reduced glutathione and L-cysteine.
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Affiliation(s)
- Y W Cho
- Division of Life Sciences, Kangwon National University, Chuncheon, Korea
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Kim HG, Park EH, Lim CJ. Thioltransferase from Schizosaccharomyces pombe: purification to homogeneity and some properties. Mol Cells 1998; 8:431-7. [PMID: 9749530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Two types of thioltransferase were identified in the cytosolic extract of Schizosaccharomyces pombe, a fission yeast. In the present study, the major one of them was purified to homogeneity using chromatography processes such as ion-exchange chromatography and gel filtration. Purification was monitored by the transhydrogenase activity of thioltransferase with 2-hydroxyethyl disulfide as a substrate. Its molecular weight was estimated to be about 14,000 on SDS-polyacrylamide gel electrophoresis. The purified enzyme catalyzes the reduction of various disulfide compounds such as S-sulfocysteine, L-cystine, and insulin. It was also found to contain the reducing activity on non-disulfide substrates such as dehydroascorbic acid and alloxan. Its activity was greatly activated by high concentrations of reduced glutathione. It was found to be very heat-stable as like other thioltransferases. It was characterized on other aspects such as kinetic parameters and optimal reaction conditions.
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Affiliation(s)
- H G Kim
- Division of Life Sciences, College of Natural Sciences, Kangwon National University, Chuncheon, Korea
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Lim HW, Sa JH, Park SS, Lim CJ. A second form of phenylalanine ammonia-lyase from leaf mustard. Mol Cells 1998; 8:343-9. [PMID: 9666473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Phenylalanine ammonia-lyase (PAL, EC 4.3.1.5) catalyzes the elimination of ammonium ion from L-phenylalanine in a variety of plants and fungal species. PAL was previously purified and characterized from leaf mustard in our laboratory. In the present study, we purified a second phenylalanine ammonia-lyase (PAL II) from leaf mustard by a combination of ion exchange chromatography and gel filtration. PAL I and PAL II migrate at a different rate on native polyacrylamide gel electrophoresis. It consists of four subunits, each having the molecular mass of about 37,000 Da. Its isoelectric point and Km value for L-phenylalanine were found to be 5.4 and 3.8 x 10(-5)M, respectively. The purified enzyme has an optimum pH and temperature of 8 and 45 degree C, respectively. It is activated about 2-fold by caffeic acid (1 mM), whereas it is inhibited to 15% by Zn2+ (1 mM). However, the physiological role of PAL II remains unknown.
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Affiliation(s)
- H W Lim
- Division of Life Sciences, College of Natural Sciences, Kangwon National University, Chuncheon, Korea
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