1
|
Tan-Garcia A, Lee YT, Kuick CH, Soh SY, Chang KTE, Merchant K. Spontaneous Partial Regression of Fetal Lung Interstitial Tumor With A2M::ALK Rearrangement in a Neonate. Pediatr Dev Pathol 2024; 27:187-192. [PMID: 37818649 DOI: 10.1177/10935266231189929] [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] [Indexed: 10/12/2023]
Abstract
The differential diagnosis for neonatal primary lung masses includes developmental anomalies and congenital lung tumors. Fetal lung interstitial tumor (FLIT) is a rare benign mesenchymal lesion which presents either antenatally or within the first 3 months of age. FLIT is a circumscribed solid-cystic mass which histologically resembles the fetal lung during the canalicular stage at 20-24 weeks of gestation. It is composed of immature mesenchymal cells expanding the interstitium and irregular airspace-like structures. Of all published cases, only 1 identified an α2-macroglobulin (A2M)::anaplastic lymphoma kinase (ALK) fusion and all cases underwent surgical resection in the neonatal or infancy period. We present the second case of FLIT with an A2M::ALK fusion diagnosed postnatally in a neonate which partially regressed spontaneously during conservative management with interim resection at 39 months of age, and provide a review of the literature.
Collapse
Affiliation(s)
- Alfonso Tan-Garcia
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chik Hong Kuick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shui Yen Soh
- Haematology/Oncology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kenneth Tou-En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Khurshid Merchant
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| |
Collapse
|
2
|
Purwono G, Lee YT, Chua JH, Loh AH. Systematic Lymphatic Repair for Reduction of Postoperative Lymphatic Leak Following Neuroblastoma Resection. J Pediatr Surg 2024:S0022-3468(24)00098-8. [PMID: 38493026 DOI: 10.1016/j.jpedsurg.2024.02.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Gross total resection of neuroblastoma is associated with lymphatic leaks that can delay postoperative resumption of treatment. To prevent postoperative lymphatic leak, we introduced systematic lymphatic repair (SLR), which involved oversewing the entire edge of the disrupted lymphatic plane after neuroblastoma resection. We sought to study the impact of SLR on postoperative lymphatic leak and time to return to treatment. METHODS We reviewed 60 neuroblastoma patients who underwent gross total resection at KK Women's and Children's Hospital. Patient, disease, and operative factors were correlated with surgical drainage, treatment delay and length of stay (LOS). Among patients with sufficient records, the interaction between variables associated with drainage, delay and LOS outcomes were compared in 14 patients who had SLR versus 35 historical controls who had targeted lymphatic repair (TLR). RESULTS Postoperative drain duration and volume were significantly higher in tumors with ≥2 image-derived risk factors (IDRFs, P = 0.005 and P = 0.013, respectively) or vessel encasement (P = 0.031 and P = 0.024, respectively). Longer LOS was significantly associated with ≥2 IDRFs (P = 0.006). All forms of suture repair of lymphatics and use of Tachosil™ were associated with significantly longer postoperative drain duration (P < 0.05); the former was also associated with significantly higher total drain volume (P < 0.05) - indicating appropriate use of these adjuncts in patients at risk of chyle leak. In patients who had suture repair of lymphatics, SLR was significantly associated with reduced postoperative interval to chemotherapy resumption (P = 0.014, two-way ANOVA). CONCLUSION A systematic approach to repair of lymphatic channels following neuroblastoma resection can significantly reduce time to postoperative resumption of treatment. TYPE OF STUDY Clinical Research. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
| | - York Tien Lee
- Duke-NUS Medical School, Singapore; Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore; VIVA-KKH Paediatric Brain and Solid Tumour Programme, KKH Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore
| | - Joyce Hy Chua
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Amos Hp Loh
- Duke-NUS Medical School, Singapore; Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore; VIVA-KKH Paediatric Brain and Solid Tumour Programme, KKH Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore.
| |
Collapse
|
3
|
Zadey S, Leraas H, Gupta A, Biswas A, Hollier P, Vissoci JRN, Mugaga J, Ssekitoleko RT, Everitt JI, Loh AHP, Lee YT, Saterbak A, Mueller JL, Fitzgerald TN. KeyLoop retractor for global gasless laparoscopy: evaluation of safety and feasibility in a porcine model. Surg Endosc 2023:10.1007/s00464-023-10054-5. [PMID: 37074419 PMCID: PMC10338623 DOI: 10.1007/s00464-023-10054-5] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/26/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Many surgeons in low- and middle-income countries have described performing surgery using gasless (lift) laparoscopy due to inaccessibility of carbon dioxide and reliable electricity, but the safety and feasibility of the technique has not been well documented. We describe preclinical testing of the in vivo safety and utility of KeyLoop, a laparoscopic retractor system to enable gasless laparoscopy. METHODS Experienced laparoscopic surgeons completed a series of four laparoscopic tasks in a porcine model: laparoscopic exposure, small bowel resection, intracorporeal suturing with knot tying, and cholecystectomy. For each participating surgeon, the four tasks were completed in a practice animal using KeyLoop. Surgeons then completed these tasks using standard-of-care (SOC) gas laparoscopy and KeyLoop in block randomized order to minimize learning curve effect. Vital signs, task completion time, blood loss and surgical complications were compared between SOC and KeyLoop using paired nonparametric tests. Surgeons completed a survey on use of KeyLoop compared to gas laparoscopy. Abdominal wall tissue was evaluated for injury by a blinded pathologist. RESULTS Five surgeons performed 60 tasks in 15 pigs. There were no significant differences in times to complete the tasks between KeyLoop and SOC. For all tasks, there was a learning curve with task completion times related to learning the porcine model. There were no significant differences in blood loss, vital signs or surgical complications between KeyLoop and SOC. Eleven surgeons from the United States and Singapore felt that KeyLoop could be used to safely perform several common surgical procedures. No abdominal wall tissue injury was observed for either KeyLoop or SOC. CONCLUSIONS Procedure times, blood loss, abdominal wall tissue injury and surgical complications were similar between KeyLoop and SOC gas laparoscopy for basic surgical procedures. This data supports KeyLoop as a useful tool to increase access to laparoscopy in low- and middle-income countries.
Collapse
Affiliation(s)
- Siddhesh Zadey
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
- Association for Socially Applicable Research (ASAR), Pune, MH, India.
| | - Harold Leraas
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Aryaman Gupta
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Arushi Biswas
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | | | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Julius Mugaga
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Jeffrey I Everitt
- Department of Pathology, Duke University of School of Medicine, Durham, NC, USA
| | - Amos H P Loh
- Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ann Saterbak
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Jenna L Mueller
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| |
Collapse
|
4
|
Loh AHP, Angelina C, Wong MK, Tan SH, Sukhatme SA, Yeo T, Lim SB, Lee YT, Soh SY, Leung W, Chang KTE, Chua YW, Alkaff SMF, Lim TKH, Lim CT, Chen ZX. Pro-metastatic and mesenchymal gene expression signatures characterize circulating tumor cells of neuroblastoma patients with bone marrow metastases and relapse. Front Oncol 2022; 12:939460. [PMID: 36176417 PMCID: PMC9513238 DOI: 10.3389/fonc.2022.939460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Existing marker-based methods of minimal residual disease (MRD) determination in neuroblastoma do not effectively enrich for the circulating disease cell population. Given the relative size differential of neuroblastoma tumor cells over normal hematogenous cells, we hypothesized that cell size-based separation could enrich circulating tumor cells (CTCs) from blood samples and disseminated tumor cells (DTCs) from bone marrow aspirates (BMA) of neuroblastoma patients, and that their gene expression profiles could vary dynamically with various disease states over the course of treatment. Using a spiral microfluidic chip, peripheral blood of 17 neuroblastoma patients at 3 serial treatment timepoints (diagnosis, n=17; post-chemotherapy, n=11; and relapse, n=3), and bone marrow samples at diagnosis were enriched for large intact circulating cells. Profiling the resulting enriched samples with immunohistochemistry and mRNA expression of 1490 cancer-related genes via NanoString, 13 of 17 samples contained CTCs displaying cytologic atypia, TH and PHOX2B expression and/or upregulation of cancer-associated genes. Gene signatures reflecting pro-metastatic processes and the neuroblastoma mesenchymal super-enhancer state were consistently upregulated in 7 of 13 samples, 6 of which also had metastatic high-risk disease. Expression of 8 genes associated with PI3K and GCPR signaling were significantly upregulated in CTCs of patients with bone marrow metastases versus patients without. Correspondingly, in patients with marrow metastases, differentially-expressed gene signatures reflected upregulation of immune regulation in bone marrow DTCs versus paired CTCs samples. In patients who later developed disease relapse, 5 genes involved in immune cell regulation, JAK/STAT signaling and the neuroblastoma mesenchymal super-enhancer state (OLFML2B, STAT1, ARHGDIB, STAB1, TLR2) were upregulated in serial CTC samples over their disease course, despite urinary catecholamines and bone marrow aspirates not indicating the disease recurrences. In summary, using a label-free cell size-based separation method, we enriched and characterized intact circulating cells in peripheral blood indicative of neuroblastoma CTCs, as well as their DTC counterparts in the bone marrow. Expression profiles of pro-metastatic genes in CTCs correlated with the presence of bone marrow metastases at diagnosis, while longitudinal profiling identified persistently elevated expression of genes in CTCs that may serve as novel predictive markers of hematogenous MRD in neuroblastoma patients that subsequently relapse.
Collapse
Affiliation(s)
- Amos H. P. Loh
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
- Department of Paediatric Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
| | - Clara Angelina
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Meng Kang Wong
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Sheng Hui Tan
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Sarvesh A. Sukhatme
- Mechanobiology Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Trifanny Yeo
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Su Bin Lim
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - York Tien Lee
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
- Department of Paediatric Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
| | - Shui Yen Soh
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
- Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Wing Leung
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
- Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Kenneth T. E. Chang
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Yong Wei Chua
- Department of Anatomic Pathology, Singapore General Hospital, Singapore, Singapore
| | - Syed M. F. Alkaff
- Department of Anatomic Pathology, Singapore General Hospital, Singapore, Singapore
| | - Tony K. H. Lim
- Duke NUS Medical School, Singapore, Singapore
- Department of Anatomic Pathology, Singapore General Hospital, Singapore, Singapore
| | - Chwee Teck Lim
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Mechanobiology Institute of Singapore, National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
- Institute of Health Innovation and Technology, National University of Singapore, Singapore, Singapore
| | - Zhi Xiong Chen
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Cancer Institute, National University Health System, Singapore, Singapore
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: Zhi Xiong Chen,
| |
Collapse
|
5
|
Yu WS, Chang MH, Lee HL, Lee YT, Tsai MC, Wang CC. Recurrent umbilical varix rupture with hemoperitoneum: a case report and review of literature. BMC Gastroenterol 2022; 22:160. [PMID: 35365084 PMCID: PMC8973573 DOI: 10.1186/s12876-022-02167-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Non-traumatic hemoperitoneum was a rare event with the risk of sudden death. Spontaneous rupture of hepatocellular carcinoma is the most intuitive diagnosis when hemoperitoneum occurs in cirrhotic patients who are not regularly followed up. However, other etiologies of hemoperitoneum, such as intra-abdominal varix rupture, should be kept in mind.
Case presentation A 44-year-old man with alcoholic liver cirrhosis, Child–Pugh B was sent to our emergency department (ED) because of recurrent abdominal pain and hypovolemic shock. He had similar symptoms one month ago and was diagnosed as hepatocellular carcinoma (HCC) rupture with hemoperitoneum, therefore he underwent trans-arterial embolization (TAE). However, the follow-up magnetic resonance imaging (MRI) showed less possibility of hepatocellular carcinoma. Contrast enhanced abdominal computed tomography (CT) showed possible umbilical vein contrast agent extravasation. Exploratory laparotomy confirmed the diagnosis of rupture umbilical varix with hemoperitoneum. Conclusion Although umbilical varix rupture is a rare cause of hemoperitoneum, it should be kept in mind in cirrhotic patients with unexplained hemoperitoneum. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02167-3.
Collapse
Affiliation(s)
- W S Yu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - M H Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - H L Lee
- Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Y T Lee
- Infection Control, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - M C Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - C C Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| |
Collapse
|
6
|
Wong D, Lee YT, Tang GPY, Chan SSC. Surgical treatment of pelvic organ prolapse in women aged ≥75 years in Hong Kong: a multicentre retrospective study. Hong Kong Med J 2022; 28:107-115. [PMID: 35354666 DOI: 10.12809/hkmj219271] [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] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is common among older women. With the increasing lifespan and emphasis on quality of life worldwide, older women increasingly prefer surgical treatment for POP. We reviewed the surgical treatment of POP in older women to characterise its safety, effectiveness, and the type most often selected. METHODS This multicentre, retrospective study was conducted at four hospitals between 2013 and 2018. Included patients were aged ≥75 years and had undergone POP surgery. We compared patient demographic characteristics, POP severity, and surgical outcomes between reconstructive and obliterative surgeries; these comparisons were also made among vaginal hysterectomy plus pelvic floor repair (VHPFR), transvaginal mesh surgery (TVM), vaginal hysterectomy (VH) plus colpocleisis, and colpocleisis alone. RESULTS In total, 343 patients were included; 84.3% and 15.7% underwent reconstructive and obliterative surgeries, respectively. Overall, 246 (71.7%), 43 (12.5%), 20 (5.8%), and 34 (9.9%) patients underwent VHPFR, TVM, VH plus colpocleisis, and colpocleisis alone, respectively. Patients who were older (81.9 vs 79.6 y; P=0.001), had vault prolapse (38.9% vs 3.5%; P<0.001), and had medical co-morbidities (37% vs 4.8%; P<0.001) chose obliterative surgery more frequently than reconstructive surgery. Obliterative surgeries had shorter operative time (73.5 min vs 107 min; P<0.001) and fewer surgical complications (9.3% vs 28.0%; P=0.003). Vaginal hysterectomy plus pelvic floor repair had the highest rate of surgical complications (most were minor), while colpocleisis alone had the lowest rate (30.1% vs 8.8%; P=0.01). CONCLUSIONS Pelvic organ prolapse surgeries were safe and effective for older women. Colpocleisis may be appropriate as primary surgery for fragile older women.
Collapse
Affiliation(s)
- D Wong
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Y T Lee
- Department of Obstetrics and Gynaecology, Prince of Margaret Hospital, Hong Kong
| | - G P Y Tang
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
| | - S S C Chan
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong
| |
Collapse
|
7
|
Halepota HF, Tan JSK, Reddy SK, Tang PH, Ong LY, Lee YT, Chan MY, Soh SY, Chang KTE, Ng ASB, Loh AHP. Association of anesthetic and surgical risk factors with outcomes of initial diagnostic biopsies in a current cohort of children with anterior mediastinal masses. World Jnl Ped Surgery 2021; 4:e000303. [DOI: 10.1136/wjps-2021-000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/06/2021] [Indexed: 11/03/2022] Open
Abstract
BackgroundDiagnostic biopsies of pediatric anterior mediastinal masses (AMMs) are high-risk procedures in which general anesthesia (GA) is traditionally avoided. However, awareness of historically recognized risk factors and corresponding perioperative management have improved over time and may now no longer strictly preclude the use of GA. Therefore, in this study, we examined the association of anesthetic and surgical risk factors and modalities with resulting procedural and survival outcomes in a current patient cohort.MethodsWe retrospectively reviewed charts of 35 children with AMMs who underwent initial diagnostic biopsies between January 2001 and August 2019, and determined tracheal compression and deviation from archival CT scans and procedural and disease outcomes.ResultsTwenty-three (65%) patients underwent GA while 12 (35%) received sedation. Among patients with available CT measurements, 13 of 25 (52%) had >50% anteroposterior tracheal diameter reduction. Patients with >50% anteroposterior tracheal compression received sedation more frequently (p=0.047) and were positioned upright (p=0.015) compared with patients with ≤50% compression, although 4 of 13 and 9 of 12, respectively, still received GA. Intraoperative adverse events (AEs) occurred in four (11.4%) patients: three received GA, and all were positioned supine or lateral. AEs were not associated with radiographic airway risk factors but were significantly associated with morphine and sevoflurane use (p<0.001) and with thoracoscopic biopsies (p=0.035). There were no on-table mortalities, but four delayed deaths occurred (three related to disease and one from late procedural complications).ConclusionsIn a current cohort of pediatric AMM biopsies, patients with >50% anteroposterior tracheal compression were more frequently managed with a conservative perioperative management strategy, though not completely excluding GA. The corresponding reduction in frequency of procedural AEs in this traditionally high-risk group suggests that increased awareness of procedural risk factors and appropriate risk-guided perioperative management choices may obviate the procedural mortality historically associated with pediatric AMM biopsies.
Collapse
|
8
|
Othman MY, Halepota HF, Le Linn Y, Lee YT, Chang KTE, Ahamed SH, Lam JCM, Bhattacharyya R, Tan AM, Loh AHP. Gastrointestinal and oncologic outcomes of pediatric gastrointestinal lymphoma following upfront resection or biopsy of bowel masses. Pediatr Surg Int 2021; 37:1049-1059. [PMID: 33963920 DOI: 10.1007/s00383-021-04915-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Complete upfront resection of pediatric gastrointestinal lymphomas is recommended over biopsy whenever feasible, but either approach may have adverse sequelae. We sought to compare gastrointestinal and oncological outcomes of pediatric gastrointestinal lymphomas who underwent attempted upfront resection or biopsy of the presenting bowel mass. METHODS We retrospectively reviewed charts of children with gastrointestinal lymphomas treated on LMB89 and LMB96 protocols from 2000 to 2019 who underwent upfront gastrointestinal surgery, and compared resection and biopsy groups. RESULTS Of 33 children with abdominal lymphomas, 20 had upfront gastrointestinal surgery-10 each had resection or biopsy. Patients with attempted upfront resections had fewer postoperative gastrointestinal complications compared to biopsies (10% vs. 60%, p = 0.057), but longer time to chemotherapy initiation (median 11.5 vs. 4.5 days, p < 0.001). Three resection patients were surgically down-staged. Second surgeries were required in 30% and 40% of resected and biopsied patients, respectively, at median 4.6 months. Survival was similar in both groups, but better in patients on LMB96 protocol and stage II/III disease. CONCLUSIONS Children with upfront attempted resection had low rates of surgical down-staging, greater delay in chemotherapy initiation, but fewer gastrointestinal complications and subsequent surgeries than biopsies. Survival was similar regardless of upfront surgery, likely reflecting beneficial effects of newer protocols.
Collapse
Affiliation(s)
- Mohd Yusran Othman
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Pediatric Surgery, Hospital Tunku Azizah (Women's and Children's Hospital), Jalan Raja Muda Abdul Aziz, Kampung Baru, 50300, Kuala Lumpur, Malaysia
| | - Huma Faiz Halepota
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Pediatric General Surgery, Indus Hospital, Plot C-76, Sector 31/5, Karachi, Pakistan
| | - Yun Le Linn
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Kenneth T E Chang
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Summaiyya Hanum Ahamed
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Joyce C M Lam
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Rajat Bhattacharyya
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Ah Moy Tan
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Amos H P Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. .,Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore. .,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| |
Collapse
|
9
|
Tip SWM, Lee YT, Tang PH, Chang KTE, Soh SY, Tan AM, Loh AHP. Retroperitoneal tumors and congenital variations in vascular anatomy of retroperitoneal great vessels. J Pediatr Surg 2019; 54:2112-2116. [PMID: 30765156 DOI: 10.1016/j.jpedsurg.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/06/2018] [Revised: 11/20/2018] [Accepted: 01/03/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND/OBJECTIVES Variations in vascular anatomy (VIVAs) of the retroperitoneal great vessels are uncommon but can potentially complicate surgical procedures and negatively affect treatment outcomes, yet their incidence and clinical impact are poorly studied. We sought to assess the incidence and clinical impact of VIVAs of retroperitoneal great vessels in patients with retroperitoneal tumors. METHODS We retrospectively analyzed imaging, surgical, treatment and survival data of all pediatric patients with retroperitoneal tumors who underwent resection between January 2007 and October 2016, comparing preoperative scans with corresponding intraoperative observations, and subsequent surgical outcomes. RESULTS Among 66 children with renal, adrenal and paravertebral tumors, 6 (9%) had retroperitoneal VIVAs. Retroperitoneal VIVAs were present only with right-sided tumors and significantly associated with more frequent intraoperative complications (P = 0.013). While the presence of retroperitoneal VIVAs was not directly associated with survival outcomes, relapse was more frequent in patients with VIVAs (33%) than those without (18.3%, P = 0.378), and relapse was also associated with lower overall and event-free survival (P < 0.001). CONCLUSIONS VIVAs of retroperitoneal great vessels occurred in 9% of our patients with retroperitoneal tumors. Retroperitoneal VIVAs were associated with higher rates of intraoperative complications and disease relapse but was not directly related to survival outcomes. TYPE OF STUDY Retrospective review study. LEVEL OF EVIDENCE Level III Retrospective comparative study.
Collapse
Affiliation(s)
- Sai Woon Merng Tip
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Shui Yen Soh
- Department of Paediatric Subspecialties, Haematology and Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Ah Moy Tan
- Department of Paediatric Subspecialties, Haematology and Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| |
Collapse
|
10
|
Lin ZJ, Lee YT, Chua JHY, Wang R, Lee V, Cheah SM, Saffari SE, Lam JCM, Loh AHP. Evaluation of a Novel Bony Landmark-Based Method for Teaching Percutaneous Insertion of Subclavian Venous Catheters in Pediatric Patients. World J Surg 2019; 43:2106-2113. [PMID: 30953198 DOI: 10.1007/s00268-019-04997-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Surgical trainees performing subclavian vein (SCV) cannulation often incorrectly perceive needle trajectory and anatomical relations. As surface landmark-based methods derived from adult surgical practice may be less effective in younger patients, we developed and evaluated a novel bony landmark-based method for teaching SCV cannulation for central venous access device (CVAD) placement in children. METHODS Over 2 sequential 3-year periods, pediatric surgical trainees were taught infraclavicular SCV cannulation via surface- and bony-landmark approaches, respectively. We prospectively recorded patient, surgeon and operative details on all Hickman line and port-a-cath insertions placed by trainees as the first surgeon via percutaneous infraclavicular SCV puncture and compared procedural outcomes and complications across both periods. RESULTS Of 271 cases included in the study, trainees performed 52 (50.5%) and 92 (54.8%) procedures in the first and second periods, respectively. Patients in both periods did not differ by gender, disease, CVAD device, or prior CVAD, chemotherapy or infection status. In the second (bony landmark) period, although patients were younger (6.0 vs. 8.7 years, P = 0.003) mean procedural duration was shorter (42.5 vs. 58.3 min, P < 0.001). Also, cannulation attempts and complication rates did not differ significantly between study periods (P = 0.257 and 1.0, respectively). CONCLUSIONS With the bony landmark approach, trainees could perform the procedures faster despite operating on younger patients, without impacting complication rates and cannulation attempts. Bony landmarks may better approximate SCV position across a range of ages, thus improving the consistency of SCV cannulation in CVAD placements in children.
Collapse
Affiliation(s)
- Zhiyang Jace Lin
- Flinders University School of Medicine, Flinders University, Adelaide, Australia
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | | | - Rachel Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vanessa Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sue Mei Cheah
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Joyce Ching Mei Lam
- Department of Paediatric Subspecialties Haematology Oncology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| |
Collapse
|
11
|
Loke BN, Wong MK, Tawng KD, Kuick CH, Jain S, Lian D, Wagner E, Zou Y, Ganesan V, Sim SW, Lee YT, Chin F, Chan MY, Tan AM, Teh BT, Soh SY, Chang KT, Loh AH. Clinical, pathological and loss of heterozygosity differences in Wilms tumors between Asian and non-Asian children. Int J Cancer 2018; 144:1234-1242. [DOI: 10.1002/ijc.31946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/27/2018] [Accepted: 10/10/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Benjamin N. Loke
- Department of Biological Sciences; National University of Singapore; Singapore Singapore
| | - Meng Kang Wong
- VIVA-KKH Paediatric Solid Tumour Research Laboratory; KK Women's and Children's Hospital; Singapore Singapore
| | - Khawn D. Tawng
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Chick Hong Kuick
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Sudhanshi Jain
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Derrick Lian
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Elizabeth Wagner
- Institute for Genomic Medicine; Nationwide Children's Hospital; Columbus OH
| | - Yuhan Zou
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Visveswari Ganesan
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Siam Wee Sim
- Department of Paediatric Surgery; KK Women's and Children's Hospital; Singapore Singapore
| | - York Tien Lee
- Department of Paediatric Surgery; KK Women's and Children's Hospital; Singapore Singapore
| | - Francis Chin
- Division of Radiation Oncology, National Cancer Centre Singapore; Singapore Singapore
| | - Mei Yoke Chan
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Ah Moy Tan
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore; Singapore Singapore
| | - Shui Yen Soh
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Kenneth T.E. Chang
- VIVA-KKH Paediatric Solid Tumour Research Laboratory; KK Women's and Children's Hospital; Singapore Singapore
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Amos H.P. Loh
- VIVA-KKH Paediatric Solid Tumour Research Laboratory; KK Women's and Children's Hospital; Singapore Singapore
- Department of Paediatric Surgery; KK Women's and Children's Hospital; Singapore Singapore
| |
Collapse
|
12
|
Ferguson M, Bhinge R, Park J, Lee YT, Law KH. A Data Processing Pipeline for Prediction of Milling Machine Tool Condition from Raw Sensor Data. Smart Sustain Manuf Syst 2018; 2:10.1520/SSMS20180019 . [PMID: 31093603 PMCID: PMC6512847 DOI: 10.1520/ssms20180019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With recent advances in sensor and computing technology, it is now possible to use real-time machine learning techniques to monitor the state of manufacturing machines. However, making accurate predictions from raw sensor data is still a difficult challenge. In this work, a data processing pipeline is developed to predict the condition of a milling machine tool using raw sensor data. Acceleration and audio time series sensor data is aggregated into blocks that correspond to the individual cutting operations of the Computer Numerical Control (CNC) milling machine. Each block of data is preprocessed using well-known and computationally efficient signal processing techniques. A novel kernel function is proposed to approximate the covariance between preprocessed blocks of time series data. Several Gaussian process regression models are trained to predict tool condition, each with a different covariance kernel function. The model with the novel covariance function outperforms the models that use more common covariance functions. The trained models are expressed using the Predictive Model Markup Language (PMML), where possible, to demonstrate how the predictive model component of the pipeline can be represented in a standardized form. The tool condition model is shown to be accurate, especially when predicting the condition of lightly worn tools.
Collapse
Affiliation(s)
- M Ferguson
- Stanford University, Civil and Environmental Engineering, Stanford, CA, USA
| | - R Bhinge
- Infinite Uptime, Inc. Berkeley, CA, USA
| | - J Park
- Korea Advanced Institute of Science and Technology, Industrial and Systems Engineering, Daejeon, South Korea
| | - Y T Lee
- National Institute of Standards and Technology, Systems Integration Division, Gaithersburg, MD, USA
| | - K H Law
- Stanford University, Civil and Environmental Engineering, Stanford, CA, USA
| |
Collapse
|
13
|
Affiliation(s)
- Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shu Lin Lam
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chiou Li Ong
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| |
Collapse
|
14
|
Ziegler AD, Echaubard P, Lee YT, Chuah CJ, Wilcox BA, Grundy-Warr C, Sithithaworn P, Petney TN, Laithevewat L, Ong X, Andrews RH, Ismail T, Sripa B, Khuntikeo N, Poonpon K, Tungtang P, Tuamsuk K. Untangling the Complexity of Liver Fluke Infection and Cholangiocarcinoma in NE Thailand Through Transdisciplinary Learning. Ecohealth 2016; 13:316-327. [PMID: 26822781 DOI: 10.1007/s10393-015-1087-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/22/2015] [Accepted: 11/19/2015] [Indexed: 06/05/2023]
Abstract
This study demonstrates how a transdisciplinary learning approach provided new insights for explaining persistent Opisthorchis viverrini infection in northern Thailand, as well as elucidating problems of focusing solely on the parasite as a means of addressing high prevalence of cholangiocarcinoma. Researchers from diverse backgrounds collaborated to design an investigative homestay program for 72 Singaporean and Thai university students in five northeast Thai villages. The students explored how liver fluke infection and potential cholangiocarcinoma development are influenced by local landscape dynamics, aquatic ecology, livelihoods, food culture and health education. Qualitative fieldwork was guided daily by the researchers in a collaborative, co-learning process that led to viewing this health issue as a complex system, influenced by interlinked multidimensional factors. Our transdisciplinary experience has led us to believe that an incomplete understanding of these linkages may reduce the efficacy of interventions. Further, viewing liver fluke infection and cholangiocarcinoma as the same issue is inadvisable. Although O. viverrini infection is an established risk factor for the development of cholangiocarcinoma, multiple factors are known to influence the likelihood of acquiring either. Understanding the importance of the current livelihood transition, landscape modification and the resulting mismatch between local cultures and new socio-ecological settings on cholangiocarcinoma initiation and liver fluke transmission is of critical importance as it may help readjust our view of the respective role of O. viverrini and other socioeconomic risk factors in cholangiocarcinoma etiology and refine intervention strategies. As demonstrated in this study, transdisciplinary approaches have the potential to yield more nuanced perspectives to complex diseases than research that focuses on specific aspects of their epidemiology. They may therefore be valuable when designing effective solutions to context-sensitive diseases such as liver fluke infection and cholangiocarcinoma.
Collapse
Affiliation(s)
- A D Ziegler
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore.
| | - P Echaubard
- Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Global Health Asia, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Biology, Laurentian University, Sudbury, ON, Canada
| | - Y T Lee
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore
| | - C J Chuah
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore
| | - B A Wilcox
- Global Health Asia, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - C Grundy-Warr
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore
| | - P Sithithaworn
- Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - T N Petney
- Department of Ecology and Parasitology, Karlsruhe Institute of Technology, Kornblumenstrasse 13, Karlsruhe, Germany
- Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - L Laithevewat
- Office of Prevention and Control 8, Udonthani Province, Thailand
| | - X Ong
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore
| | - R H Andrews
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - T Ismail
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore
| | - B Sripa
- Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - N Khuntikeo
- Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - K Poonpon
- Department of English Language, Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - P Tungtang
- Department of English Language, Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - K Tuamsuk
- Department of English Language, Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand
| |
Collapse
|
15
|
Abstract
INTRODUCTION This study evaluates the demographics of paediatric pedestrian injuries with the aim of identifying the group of children who is most vulnerable and the risk factors for major trauma (MT). METHODS Data was extracted from the integrated trauma system of a regional paediatric referral hospital. All paediatric cases involving road traffic accidents from January 2011 to December 2013 were studied. Demographics, injury mechanism, treatment and outcome were evaluated. Patients were categorised as MT or non-MT (NMT) based on their Injury Severity Score, admission to the intensive care unit, type of surgery (e.g. life/limb-saving) and death. Data analysis was done using nonparametric tests and Fisher's exact test. RESULTS A total of 261 children were admitted for pedestrian injuries during the study period. The median age was ten years (range 14 months-16 years) and the median weight was 42.4 (range 8.6-93.7) kg. Half (i.e. 50.2%) of the children were primary-schoolers. The majority of the accidents occurred on roads (i.e. 83.1%), between 12 pm and 6 pm (i.e. 52.8%). Among the 261 children, 177 (67.8%) were unaccompanied by an adult at the time of the accident; 17 (6.5%) children sustained MT, while 244 (93.5%) suffered NMT. MT patients were more likely to have lost consciousness (p < 0.001) and been flung (p = 0.001). CONCLUSION Most paediatric pedestrian injuries involved primary-schoolers walking home from school unaccompanied by adults. This information should inform future road safety campaigns. Being flung and loss of consciousness predicted MT in children who sustained pedestrian injuries.
Collapse
Affiliation(s)
- Xun Yi Jasmine Feng
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Shireen Anne Nah
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Yea-Chyi Lin
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Li Wei Chiang
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
16
|
Chen PC, Chien KL, Su TC, Jeng JS, Hsu HC, Lee YT. Carotid Atherosclerosis Progression and Risk of Cardiovascular Events in a Community in Taiwan. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
17
|
Lee KH, Lee YT, Chen TC, Yeh CC, Chen JY, Liu LY, Chi CH. Effects of sheng hua tang on uterine involution and ovarian activity in postpartum dairy cows. Asian-Australas J Anim Sci 2014; 26:1247-54. [PMID: 25049906 PMCID: PMC4093405 DOI: 10.5713/ajas.2013.13042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/16/2013] [Accepted: 04/08/2013] [Indexed: 11/27/2022]
Abstract
The effects of Sheng Hua Tang (SHT) on uterine involution and ovarian activity were investigated in postpartum dairy cows. SHT (70 g) was given to dairy cows (n = 10) to evaluate its effects for five days from the first postpartum day. Postpartum cows fed with a basal diet without SHT were used as the control group (n = 10). Ultrasounds and blood tests were recorded for four weeks from postpartum day seven with a 3-d interval. The results showed that the areas and diameters of endometria were significantly (p<0.01) reduced in the group that received SHT compared to the control group on the seventh postpartum day. The group that received SHT had an intrauterine fluid volume mean of 1.2±0.6 cm(3), which was significantly lower than that of the control group, 2.3±0.8 cm(3) (p<0.01) on the 13th postpartum day. In addition, the uterine tension score was a mean of 1.0±0.0 in the group that received SHT, which was also significantly lower than that of the control group, 1.5±0.5 (p<0.01) on the 19th postpartum day. Taken together, the Chinese herbal medicine remedy, SHT, promoted uterine involution and ovarian activity in postpartum dairy cows.
Collapse
Affiliation(s)
- K H Lee
- Department of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - Y T Lee
- Department of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - T C Chen
- Department of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - C C Yeh
- Department of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - J Y Chen
- Department of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - L Y Liu
- Department of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - C H Chi
- Department of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan
| |
Collapse
|
18
|
Yang HS, Chen IC, Lee YT, Lee KC, Chuang YC, Chang CY, Wei J. Cardiac transplantation and concomitant coronary artery bypass grafting: our experiences in 11 cases. Transplant Proc 2014; 46:900-2. [PMID: 24767376 DOI: 10.1016/j.transproceed.2013.11.127] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/07/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The shortage of donor hearts for transplantation could be alleviated by including the hearts of older donors. Previous literature revealed similar early and medium-term survival outcomes compared with those of younger donors. This study presents our experience with patients who underwent orthotopic heart transplantation and concomitant coronary artery bypass grafting at our institution. METHODS We present our experience with 11 patients with end-stage cardiomyopathy (8 men and 3 women) undergoing orthotopic heart transplantation and concomitant coronary artery bypass grafting from September 2002 to November 2011 at our institute. RESULTS All 11 donor organs would otherwise have been rejected, depriving potential recipients of organ transplantation. Two patients received concurrent 2-coronary-artery bypass, and the other 9 patients received concurrent single-coronary-artery bypass during orthotopic heart transplantation. All patients had an uneventful postoperative course, with follow-up completed 3 to 128 months after cardiac transplantation and concomitant coronary artery bypass grafting surgery. CONCLUSIONS Our experiences suggest that donor hearts requiring coronary artery bypass grafting, which form a small but significant donor subgroup, can be used effectively and safely when matched to the recipients' age and medical condition.
Collapse
Affiliation(s)
- H S Yang
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, R.O.C
| | - I C Chen
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, R.O.C
| | - Y T Lee
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, R.O.C
| | - K C Lee
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, R.O.C
| | - Y C Chuang
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, R.O.C
| | - C Y Chang
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, R.O.C
| | - J Wei
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, R.O.C.
| |
Collapse
|
19
|
Abstract
INTRODUCTION A regionalized trauma system must be tailored to the trauma epidemiology and the trauma care resources of the population it serves. Pediatric trauma system in Singapore differs from others because of its geographic compactness and relatively low incidence of severe trauma. The scarcity of polytrauma highlights the need of a reliable screening system to identify injured children who necessitate urgent transport to emergency department (ED) with pediatric resuscitation capacity as well as activation of trauma team upon their arrival. In this study, the validity of Pediatric Trauma Score (PTS), Glasgow Come Scale (GCS), and respiratory rate (RR) in identifying pediatric patients with major trauma and receipt of resuscitation is evaluated. PATIENTS AND METHODS After obtaining Institutional Review Board approval, a retrospective analysis was performed using data obtained from our trauma registry between January 2011 and December 2012. Information pertaining to the demographics, causative mechanism, and injury description, resuscitation, admitting disciplines, surgical intervention, and outcome were analyzed. The sensitivity and specificity of PTS, GCS, and RR to predict outcomes of interest are calculated. RESULTS A total of 92 patients were recruited. From the 92 patients, 26 sustained major trauma, and 21 patients received ED resuscitation. The mean age was 4 years 9 months. Sensitivity and specificity of PTS ≤ 8, GCS ≤ 10, and abnormal RR for predicting major trauma were 61.5, 77.3; 26.9, 100; and 53.8, 60.6%; respectively. When the reliability to identify patients received ED resuscitation was evaluated the sensitivity and specificity of PTS ≤ 8, GCS ≤ 10, and abnormal RR were 90.5, 83.1; 28.6, 98.6; and 76.2, 66.2%; respectively. CONCLUSION The parameters of PTS need to be further refined to improve its accuracy and minimize the undertriage rate. If a combined physiologic and anatomic scoring system such as PTS is used, other physiologic parameters such as GCS and RR may become redundant. The evaluation of the validity of PTS, GCS, and RR in predicting pediatric major trauma indicated poor reliability.
Collapse
Affiliation(s)
- York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Xun Yi Jasmine Feng
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Yea-Chyi Lin
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Li Wei Chiang
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
20
|
Wei J, Sue SH, Lee YT, Chang CY. Combined heart transplantation and total replacement of thoracic aorta in Marfan's syndrome with recurrent aortic dissection: a case report. Transplant Proc 2012; 44:1174-5. [PMID: 22564657 DOI: 10.1016/j.transproceed.2012.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It is extremely rare for a patient to need simultaneous heart transplantation (HTx) and replacement of the thoracic aorta. A 23-year-old woman with Marfan's syndrome underwent Bentall's operation and replacement of the ascending aorta (AsA) due to a type A aortic dissection (AD) in August 2001. In March 2005, she began to experience dyspnea on exertion and was found to have a huge pseudoaneurysm at the aortic root, which had caused dehiscence of the aortic conduit. In July 2009, she suffered acute chest pain followed by hypotension and cold sweating. The computed tomography (CT) scan showed a recurrent dissection with a long intimal tear extending from the arch to the mid-portion of the descending thoracic aorta (DTA). Due to technical difficulties in the repair of the aortic root, she was placed on the HTx waiting list. The next day, she received a donor heart and underwent combined HTx and total replacement of the thoracic aorta. Explantation of the heart improved the exposure of the DTA. With the use of a vascular ring connector (Vasoring), the operation was successfully performed without need for a blood transfusion. The patient was still well at 2 years after the operation. Simultaneous replacement of the heart and the whole segment of the thoracic aorta is technically possible in Marfan patients who are complicated with aortic dissection.
Collapse
Affiliation(s)
- J Wei
- Heart Centre, Cheng-Hsin General Hospital, Taipei, Taiwan, R.O.C.
| | | | | | | |
Collapse
|
21
|
You JH, Kim DH, Lee DU, Yoo KH, Park CY, Park KW, Jang SJ, Lee YT, Kim TW. Effect of temperature on optical and electronic properties of InGaP/InGaAIP multiple quantum wells. J Nanosci Nanotechnol 2012; 12:5843-5846. [PMID: 22966667 DOI: 10.1166/jnn.2012.6246] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The optical and electronic properties in an InGaP/InGaAIP multiple quantum well (MQW) grown by using molecular-beam epitaxy utilizing the digital alloy technique were investigated through temperature-dependent photoluminescence (PL) measurements and numerical calculations. The high-resolution transmission electron microscopy images showed that the sample clearly displayed the InGaP wells and the InGaAIP barriers and separate confinement heterostructure layers. The PL measurements at various temperatures were performed to investigate the interband transitions of the InGaP/InGaAIP MQW. The electronic subband energies and the wavefunctions in the InGaP/InGaAIP MQW at several temperatures were determined by using a finite element method employing the standard 8-band k x p Lagrangian. The numerical results for optical interband transition energies from the ground state electron subband to the ground state heavy-hole subband of the InGaP/InGaAIP MQW at various temperatures were in reasonable agreement with the excitonic transition energies observed in the PL measurements.
Collapse
Affiliation(s)
- J H You
- Department of Electronics and Computer Engineering, Hanyang University, Seoul 133-791, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Wei YJ, Tsai KS, Lin LC, Lee YT, Chi CW, Chang MC, Tsai TH, Hung SC. Catechin stimulates osteogenesis by enhancing PP2A activity in human mesenchymal stem cells. Osteoporos Int 2011; 22:1469-79. [PMID: 20683709 DOI: 10.1007/s00198-010-1352-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 06/14/2010] [Indexed: 01/03/2023]
Abstract
SUMMARY Using human mesenchymal stem cells, we identified catechin from a panel of herbal ingredients and Chinese traditional compounds with the strongest osteogenic effects. Catechin increased alkaline phosphatase activity, calcium deposition, and mRNA expression of Runx2 and osteocalcin. We further clarified the signaling pathway that catechin mediated to stimulate osteogenesis. INTRODUCTION Human mesenchymal stem cells (hMSCs), useful as a species specific cell culture system for studying cell lineage differentiation, were examined as a tool to identify novel herbal ingredients and Chinese traditional compounds for enhancing osteogenesis. METHODS Immortalized and primary hMSCs were induced in osteogenic induction medium in the presence of a variety of herbal ingredients and Chinese traditional compounds and osteogenic differentiation was evaluated by histochemical assays and quantitative RT-PCR. RESULTS Using immortalized hMSCs, we first identified catechin, 18β-glycyrrhetinic acid, baishao, and danggui with osteogenic properties, which enhanced calcium deposition at the dose without significant cytotoxic effects. Primary hMSCs were then applied for confirming the osteogenic effects of catechin, which increased alkaline phosphatase activity, calcium deposition, and mRNA expression of Runx2 and osteocalcin. We further found the extracellular signal-regulated kinase (ERK) pathway was downregulated upon stimulation with catechin. Catechin increased the level and activity of protein phosphatases 2A (PP2A) that dephosphorylates ERK kinase (MEK) and ERK. Further, PP2A inhibitor, okadaic acid, abolished the effect of catechin-mediated inactivation of ERK and stimulation of osteogenesis. The blocking effect of okadaic acid on osteogenesis was further reversed by PD98059, a specific inhibitor of MEK. Co-immunoprecipitation revealed the association of PP2A to both MEK and ERK. CONCLUSIONS These studies propose catechin enhanced osteogenesis by increasing the PP2A level that inhibits the MEK and ERK signaling in hMSCs. These results prove the concept of using hMSCs as a convenient tool for rapid and consistent screening of the osteogenic herbal ingredients and traditional Chinese compounds.
Collapse
Affiliation(s)
- Y J Wei
- Laboratory of Pharmacokinetics, Institute of Traditional Medicine, National Yang-Ming University, 155, Sec 2, Li-Nong Street, Taipei 112, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Reid WV, Chen D, Goldfarb L, Hackmann H, Lee YT, Mokhele K, Ostrom E, Raivio K, Rockström J, Schellnhuber HJ, Whyte A. Earth System Science for Global Sustainability: Grand Challenges. Science 2010; 330:916-7. [PMID: 21071651 DOI: 10.1126/science.1196263] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- W V Reid
- David and Lucile Packard Foundation, Los Altos, CA 94022, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Noh SJ, Lee YT, Byrnes C, Miller JL. A transcriptome-based examination of blood group expression. Transfus Clin Biol 2010; 17:120-5. [PMID: 20685146 DOI: 10.1016/j.tracli.2010.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 06/08/2010] [Indexed: 11/27/2022]
Abstract
Over the last two decades, red cell biologists witnessed a vast expansion of genetic-based information pertaining to blood group antigens and their carrier molecules. Genetic progress has led to a better comprehension of the associated antigens. To assist with studies concerning the integrated regulation and function of blood groups, transcript levels for each of the 36 associated genes were studied. Profiles using mRNA from directly sampled reticulocytes and cultured primary erythroblasts are summarized in this report. Transcriptome profiles suggest a highly regulated pattern of blood group gene expression during erythroid differentiation and ontogeny. Approximately one-third of the blood group carrier genes are transcribed in an erythroid-specific fashion. Low-level and indistinct expression was noted for most of the carbohydrate-associated genes. Methods are now being developed to further explore and manipulate expression of the blood group genes at all stages of human erythropoiesis.
Collapse
Affiliation(s)
- S-J Noh
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 31 Center Drive, Bethesda, Building 10, Room 9N311, MD 20892, USA
| | | | | | | |
Collapse
|
25
|
Lee YT, Hwang S, Lee SG, Kim KW, Choi NK, Park GC, Yu YD, Yoo JW, Kim WS, Shim TS. Living-donor liver transplantation in patients with concurrent active tuberculosis at transplantation. Int J Tuberc Lung Dis 2010; 14:1039-1044. [PMID: 20626950] [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: 05/29/2023] Open
Abstract
SETTING Although active tuberculosis (TB) is a contraindication for liver transplantation (LT), LT may be the only possible treatment option in patients with irreversible liver failure and concurrent TB. OBJECTIVES To assess the outcome of LT in patients with concurrent TB and liver failure. METHODS We retrospectively evaluated the clinical outcomes of nine LT recipients with concurrent TB in Korea, an intermediate TB burden country. RESULTS The primary causes of living-donor LT (LDLT) in nine patients were anti-tuberculosis drug-induced fulminant hepatic failure (n = 4) and end-stage liver disease (n = 5). The sites of active TB were the lungs (n = 5), lymph nodes (n = 3) and pleura (n = 1). After LDLT, most patients were treated with less hepatotoxic drugs, including fluoroquinolones, ethambutol and cycloserine; none was treated with pyrazinamide. One patient experienced acute rejection, probably attributable to an interaction between rifampicin and cyclosporine. All nine patients, including one taking rifabutin, successfully completed anti-tuberculosis treatment and have been followed up for a median of 926 days after LDLT, without relapse of TB. CONCLUSION When properly managed, the prognosis of LDLT recipients with concurrently active TB at transplantation is very favourable. The current protocol, which considers active TB an absolute contraindication for LT, should be modified or relaxed, particularly for patients with LDLT.
Collapse
Affiliation(s)
- Y T Lee
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Lee YT, Lai LH, Sung JJY, Ko FWS, Hui DSC. Endoscopic ultrasonography-guided fine-needle aspiration in the management of mediastinal diseases: local experience of a novel investigation. Hong Kong Med J 2010; 16:121-125. [PMID: 20354246] [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: 05/29/2023] Open
Abstract
OBJECTIVE To study the efficacy and safety of endoscopic ultrasonography-guided fine-needle aspiration in the management of mediastinal diseases in Hong Kong. DESIGN Retrospective review of prospectively collected data. SETTING University teaching hospital, Hong Kong. PATIENTS A total of 125 consecutive patients with various mediastinal and pulmonary lesions that underwent trans-oesophageal endoscopic ultrasonography-guided fine-needle aspiration from July 1998 to June 2007. MAIN OUTCOME MEASURES The diagnostic accuracy and safety of the procedure and its influence in patient management. RESULTS Malignancy was confirmed in 62 (50%) of the patients and excluded in 42 (34%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopic ultrasonography-guided fine-needle aspiration in diagnosing mediastinal malignancies were 75% (95% confidence interval, 64-83%), 100% (90-100%), 100% (93-100%), 67% (54-78%), and 83%, respectively. Eighty-six (69%) of the patients had their initial plan of invasive investigations changed. Only one (0.8%) patient developed a septic complication in a mediastinal cyst after puncturing, and was treated surgically. CONCLUSIONS Trans-oesophageal endoscopic ultrasonography-guided fine-needle aspiration is a minimally invasive, effective, and safe method of diagnosing malignant mediastinal disease. It may reduce the need for other invasive investigations.
Collapse
Affiliation(s)
- Y T Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | | | | | | | | |
Collapse
|
27
|
Song YM, Choi ES, Yu JS, Lee YT. Light-extraction enhancement of red AlGaInP light-emitting diodes with antireflective subwavelength structures. Opt Express 2009; 17:20991-20997. [PMID: 19997337 DOI: 10.1364/oe.17.020991] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We demonstrate the enhancement of light extraction in 633 nm AlGaInP light-emitting diodes (LEDs) with antireflective subwavelength structures (SWS). From the contour plots by the rigorous coupled wave analysis method, it is found that the reduction of the internal reflection strongly depends on the period of SWS. The Ag nanoparticles formed by thermal dewetting were used as an etch mask for dry etch process to fabricate antireflective SWS on the LED surface. The tapered pillars on the GaP were fabricated, on average, with distances below 200 nm, satisfying the required antireflection condition at the emission wavelength. The improvement in light output power by approximately 26.4% was achieved for the fabricated AlGaInP LEDs with SWS compared to the conventional LEDs due to a strongly reduced Fresnel internal reflection at the GaP/air interface. The improved directionality in the far-field pattern was also obtained due to the directional light extraction enhancement.
Collapse
Affiliation(s)
- Y M Song
- Department of Information and Communications, Gwangju Institute of Science and Technology, 1 Oryong-dong, Buk-gu, Gwangju 500-712, Republic of Korea
| | | | | | | |
Collapse
|
28
|
Song YM, Jeong BK, Na BH, Chang KS, Yu JS, Lee YT. High-speed characteristics of vertical cavity surface emitting lasers and resonant-cavity-enhanced photodetectors based on intracavity-contacted structure. Appl Opt 2009; 48:F11-F17. [PMID: 19724307 DOI: 10.1364/ao.48.000f11] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We fabricated vertical cavity surface emitting lasers (VCSELs) and resonant-cavity-enhanced photodetectors (RCE-PDs) with GaAs/AlGaAs distributed Bragg reflectors (DBRs), operating at lambda approximately 980 nm, based on an intracavity-contacted structure. The top-DBR mesa diameter of the VCSELs was optimized to 18 microm in terms of slope efficiency, differential series resistance, and 3 dB bandwidth. For VCSELs with an oxide aperture of 4.5 microm and a top-DBR mesa diameter of 18 microm, the threshold current was about 1.2 mA, exhibiting maximum output power of approximately 3.49 mW (at 20 degrees C) with good uniformity. The effect of the overetching in the outermost layer of RCE-PDs on the device performance was also investigated. For RCE-PDs based on the VCSEL structure, a peak responsivity of 0.44 A/W (at lambda approximately 979.7 nm) with a spectral width of approximately 3 nm and a dark current of 68 pA under a bias voltage of -5 V at 20 degrees C was obtained. The maximum 3 dB bandwidths of approximately 11.5 GHz with a modulation current efficiency factor of 5.6 GHz/mA(1/2) at -7 mA and 9 GHz at -7 V were achieved for VCSELs and RCE-PDs, respectively.
Collapse
Affiliation(s)
- Y M Song
- Department of Information and Communications, Gwangju Institute of Science and Technology, Gwangju 500-712, South Korea
| | | | | | | | | | | |
Collapse
|
29
|
Chang CH, Chang SR, Lin JS, Lee YT, Yeh SR, Chen H. A CMOS neuroelectronic interface based on two-dimensional transistor arrays with monolithically-integrated circuitry. Biosens Bioelectron 2009; 24:1757-64. [PMID: 18951013 DOI: 10.1016/j.bios.2008.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 09/03/2008] [Accepted: 09/04/2008] [Indexed: 11/17/2022]
Abstract
The ability to monitor and to elicit neural activity with a high spatiotemporal resolution has grown essential for studying the functionality of neuronal networks. Although a variety of microelectrode arrays (MEAs) has been proposed, very few MEAs are integrated with signal-processing circuitry. As a result, the maximum number of electrodes is limited by routing complexity, and the signal-to-noise ratio is degraded by parasitics and noise interference. This paper presents a single-chip neuroelectronic interface integrating oxide-semiconductor field-effect transistors (OSFETs) with signal-processing circuitry. After the chip was fabricated with the standard complementary-metal-oxide-semiconductor (CMOS) process, polygates of specific transistors were etched at die-level to form OSFETs, while metal layers were retained to connect the OSFETs into two-dimensional arrays. The complete removal of polygates was confirmed by high-resolution image scanners, and the reliability of OSFETs was examined by measuring their electrical characteristics. Through a gate oxide of only 7nm thick, each OSFET can record and stimulate neural activity extracellularly by capacitive coupling. The capability of the full chip in neural recording and stimulation was further experimented using the well-characterised escape circuit of the crayfish. Experimental results indicate that the OSFET-based neuroelectronic interface can be used to study neuronal networks as faithfully as conventional electrophysiological tools. Moreover, the proposed simple, die-level fabrication process of the OSFETs underpins the development of various field-effect biosensors on a large scale with on-chip circuitry.
Collapse
Affiliation(s)
- C H Chang
- Institute of Electronics Engineering, National Tsing Hua University, HsinChu, Taiwan
| | | | | | | | | | | |
Collapse
|
30
|
Chiu PWY, Chan KF, Lee YT, Sung JJY, Lau JYW, Ng EKW. Endoscopic submucosal dissection used for treating early neoplasia of the foregut using a combination of knives. Surg Endosc 2008; 22:777-83. [PMID: 17704882 DOI: 10.1007/s00464-007-9479-2] [Citation(s) in RCA: 25] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc resection for early esophageal or gastric carcinoma limited to the mucosa. The authors report their experience with a combination of various devices to treat early neoplasia of the foregut using the ESD technique. METHODS In this prospective case series, ESD was performed for early esophageal or gastric carcinoma limited to the mucosa. These lesions were staged by endoscopic ultrasonography before resection. Magnifying endoscopy and chromoendoscopy were used to locate the tumor and define the margin. The resection was accomplished with submucosal dissection using the insulated tip knife, the hook knife, and the triangular tip knife. The resected specimen was examined systematically for the lateral and deep margins. RESULTS From January 2004 to March 2006, ESD was performed to manage 30 cases of early gastric or esophageal carcinoma. For 29 of these patients, R0 resection was successfully achieved. The mean operating time was 84.6 min. One patient experienced reactionary hemorrhage 12 h after resection, which was controlled endoscopically. There was no perforation. Most of the circumferential mucosal incisions were performed using the insulated tip knife (76.6%), whereas submucosal dissection was accomplished with a combination of various knives. One of the specimens showed involvement of the lateral margin, whereas another patient had two areas of new early gastric cancer 6 months after the initial procedure. These patients received salvage laparoscopically assisted gastrectomy. CONCLUSIONS Endoscopic submucosal dissection to manage early neoplasia of the foregut can be achieved safely and effectively with a combination of knives.
Collapse
Affiliation(s)
- P W Y Chiu
- Institute of Digestive Disease, Department of Surgery, The Chinese University of Hong Kong, 30-32, Ngan Shing Street, Shatin, N.T., Hong Kong.
| | | | | | | | | | | |
Collapse
|
31
|
Affiliation(s)
- P W Chiu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | | | | |
Collapse
|
32
|
Affiliation(s)
- Y T Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | | | | | | |
Collapse
|
33
|
Affiliation(s)
- Y T Lee
- Institute of Digestive Diseases, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | | | | | | |
Collapse
|
34
|
Affiliation(s)
- Y Q Guan
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | | | | | | | | |
Collapse
|
35
|
Jeung JU, Kim BR, Cho YC, Han SS, Moon HP, Lee YT, Jena KK. A novel gene, Pi40(t), linked to the DNA markers derived from NBS-LRR motifs confers broad spectrum of blast resistance in rice. Theor Appl Genet 2007; 115:1163-77. [PMID: 17909744 DOI: 10.1007/s00122-007-0642-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 08/31/2007] [Indexed: 05/06/2023]
Abstract
Rice blast disease caused by Magnaporthe grisea is a continuous threat to stable rice production worldwide. In a modernized agricultural system, the development of varieties with broad-spectrum and durable resistance to blast disease is essential for increased rice production and sustainability. In this study, a new gene is identified in the introgression line IR65482-4-136-2-2 that has inherited the resistance gene from an EE genome wild Oryza species, O. australiensis (Acc. 100882). Genetic and molecular analysis localized a major resistance gene, Pi40(t), on the short arm of chromosome 6, where four blast resistance genes (Piz, Piz-5, Piz-t, and Pi9) were also identified, flanked by the markers S2539 and RM3330. Through e-Landing, 14 BAC/PAC clones within the 1.81-Mb equivalent virtual contig were identified on Rice Pseudomolecule3. Highly stringent primer sets designed for 6 NBS-LRR motifs located within PAC clone P0649C11 facilitated high-resolution mapping of the new resistance gene, Pi40(t). Following association analysis and detailed haplotyping approaches, a DNA marker, 9871.T7E2b, was identified to be linked to the Pi40(t) gene at the 70 Kb chromosomal region, and differentiated the Pi40(t) gene from the LTH monogenic differential lines possessing genes Piz, Piz-5, Piz-t, and Pi-9. Pi40(t) was validated using the most virulent isolates of Korea as well as the Philippines, suggesting a broad spectrum for the resistance gene. Marker-assisted selection (MAS) and pathotyping of BC progenies having two japonica cultivar genetic backgrounds further supported the potential of the resistance gene in rice breeding. Our study based on new gene identification strategies provides insight into novel genetic resources for blast resistance as well as future studies on cloning and functional analysis of a blast resistance gene useful for rice improvement.
Collapse
Affiliation(s)
- J U Jeung
- Plant Breeding, Genetics, and Biotechnology Division, International Rice Research Institute, Los Baños, Laguna, Philippines
| | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
The ab initio/Rice-Ramsperger-Kassel-Marcus (RRKM) approach has been applied to investigate the photodissociation mechanism of 1,3,5-triazine at different wavelengths of the absorbed photon. Reaction pathways leading to various decomposition products have been mapped out at the G3(MP2,CC)//B3LYP level, and then the RRKM and microcanonical variational transition state theories have been applied to compute rate constants for individual reaction steps. Relative product yields (branching ratios) for the dissociation products have been calculated using the steady-state approach. The results show that, after being excited by 275, 248, or 193 nm photons, the triazine molecule isomerizes to an opened-ring structure on the first singlet excited-state potential energy surface (PES), which is followed by relaxation into the ground electronic state via internal conversion. On the contrary, excitation by 285 and 295 nm photons cannot initiate the ring-opening reaction on the excited-state PES, and the molecule relaxes into the energized ring isomer in the ground electronic state. The dissociation reaction starting from the ring isomer is calculated to have branching ratios of various reaction channels significantly different from those for the reaction initiating from the opened-ring structure. The existence of two distinct mechanisms of 1,3,5-triazine photodissociation can explain the inconsistency in the translational energy distributions of HCN moieties at different wavelengths observed experimentally.
Collapse
Affiliation(s)
- Y A Dyakov
- Institute of Atomic and Molecular Sciences, Academia Sinica, P.O. Box 23-166, Taipei 10764, Taiwan.
| | | | | | | | | |
Collapse
|
37
|
Chien KL, Hsu HC, Chen WJ, Chen MF, Su TC, Lee YT. Familial aggregation of metabolic syndrome among the Chinese: report from the Chin-Shan community family study. Diabetes Res Clin Pract 2007; 76:418-24. [PMID: 17097184 DOI: 10.1016/j.diabres.2006.09.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2006] [Accepted: 09/20/2006] [Indexed: 01/08/2023]
Abstract
Genetic study on metabolic syndrome is a great challenge, due to its complex traits and the pleiotropic manifestation of atherosclerosis. Familial aggregation and recurrence risk ratio can provide the insight of possible genetic mechanism. The Chin-Shan community family study was based on adolescent probands and their relatives (1356 subjects) who were recruited from one junior high school in the community. Structured questionnaires and biochemical measures were obtained in standard procedures. Definition of metabolic syndrome was followed using the criteria defined by the third adult treatment panel, with a modification of the criteria for adolescent and Asian population. Grandmothers had the highest frequencies (70%) in metabolic syndrome and various atherosclerotic risks. Three factors were found and thus explained 68% of the overall variance. Estimated heritability was the highest in LDL and cholesterol factor (0.36 and 0.40), then blood pressure/obesity factor (0.27), and insulin resistance/dyslipidemia (0.27). Recurrence risk ratio among siblings was 2.95 (95% confidence interval [CI]: 1.39-6.26). The adjusted odds ratio (OR) of proband's metabolic syndrome status was 1.99 (95% CI: 1.08-3.66). The adjusted odds ratios for the three factors for predicting metabolic syndrome were all significant, with highest risk in blood pressure/obesity factor (OR: 1.27, CI: 1.22-1.33), then insulin resistance/dyslipidemia (OR: 1.29, CI: 1.16-1.23). This study demonstrated clearly familial aggregation and recurrence risk ratio of metabolic syndrome and components among the general ethnic Chinese population in Taiwan.
Collapse
Affiliation(s)
- K L Chien
- Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
38
|
Burke DT, Al-Adawi S, Lee YT, Audette J. Martial arts as sport and therapy. J Sports Med Phys Fitness 2007; 47:96-102. [PMID: 17369805] [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: 05/14/2023]
Abstract
The term Martial Arts is often used as general phrase to describe many of the combat arts, which have developed in eastern cultures over the past millennium. This paper reviews the Martial Arts from the original context of a trio of life skills. This trio includes the healing arts such as acupuncture, the self-exploration arts such as yoga, and the vital life skills such as meditation. As Martial Arts suggests the waging of combat, the origins of the most common combat arts are reviewed, with an overview of the difference between the hard and the soft styles. The arts developed not only in the eastern, but also in all parts of the world, with references of these types of combats arts in the writings of the ancient Egyptians and Greeks. In modern times, the combat arts are performed for both exercise and sport. A review of the injuries that occur, and the health benefits that might be expected are discussed. A review of the medical literature that demonstrates some of these health benefits is included, with Tai Chi Chuan as the most studied of these. The health benefits discussed include strengthen and self-efficacy of the elderly, reduced falls, increased exercise capacity, and benefits to the immune system and autonomic nervous system. The paper emphasized the breadth of the Martial Arts and the import of these to the sports and health community.
Collapse
Affiliation(s)
- D T Burke
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | | | | | | |
Collapse
|
39
|
Guan YQ, Cai YY, Lee YT, Opas M. An automatic method for identifying appropriate gradient magnitude for 3D boundary detection of confocal image stacks. J Microsc 2006; 223:66-72. [PMID: 16872433 DOI: 10.1111/j.1365-2818.2006.01600.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gradients play an important role in 2D image processing. Many edge detection algorithms are gradient-based. We are interested in 3D boundary detection which can be considered as an extension of 2D edge detection in 3D space. In this paper, an algorithm to automatically and quantitatively measure the suitability of gradient magnitudes in detection of 3D boundary points of confocal image stacks is presented. A Measurement Function is defined to evaluate the suitability of each gradient magnitude chosen to be the threshold for 3D boundary detection. The application of Gauss's Divergence Theorem provides a solution to calculate the Measurement Function numerically. The gradient magnitude at which the maximum of the Measurement Function is achieved can be utilized as the most appropriate threshold for gradient-based boundary detection and other operations like volume visualization.
Collapse
Affiliation(s)
- Y Q Guan
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore.
| | | | | | | |
Collapse
|
40
|
Abstract
BACKGROUND AND STUDY AIMS Although colonoscopy is a well-established procedure, various technical difficulties may cause failure. This report describes experience with cap-assisted colonoscopy (CAC), a technique in which a mucosectomy cap is attached to the end of colonoscope in order to improve the success rate. PATIENTS AND METHODS From January 2003 to May 2005, CAC was used in consecutive patients with difficult colonoscopy procedures, which were defined firstly as failure to pass through the sigmoid colon after 20 min of examination, or secondly as failure to reach the cecum at the end of the procedure. Patients with prior colonic surgery, poor bowel preparation, distal colonic stricture, or obstructing tumors were excluded. The results with the CAC method were reviewed retrospectively. RESULTS A total of 100 patients met the criteria for difficult colonoscopy during the study period. When CAC was used to repeat the procedure, cecal and terminal ileal intubation could then be achieved in 94 and 70 patients, respectively. In the remaining six patients in whom cecal intubation failed, one failure was due to a tumor obstruction at the splenic flexure. CONCLUSIONS CAC can be used as a rescue method to improve the success rate of colonoscopy when failure is encountered.
Collapse
Affiliation(s)
- Y T Lee
- Institute of Digestive Diseases, Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | | | | |
Collapse
|
41
|
Chen PC, Chien KL, Su TC, Hsu HC, Sung FC, Lee YT. Metabolic Syndrome as a Predictor of Stroke in Taiwan. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s6-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
42
|
Abstract
The ab initio/Rice-Ramsperger-Kassel-Marcus (RRKM) approach has been applied to investigate the photodissociation mechanism of the azulene cation at different values of the photon energy. Reaction pathways leading to various decomposition products have been mapped out at the G3(MP2,CC)//B3LYP level and then the RRKM and microcanonical variational transition state theories have been applied to compute rate constants for individual reaction steps. Relative product yields (branching ratios) for the dissociation products have been calculated using the steady-state approach. The results show that a photoexcited azulene cation can readily isomerize to a naphthalene cation. The major dissociation channels are elimination of atomic hydrogen, an H2 molecule, and acetylene. The branching ratio of the H elimination channel decreases with an increase of the photon energy. The branching ratio of the acetylene elimination as well as that of the H2 elimination rise as the photon energy increases. The main C8H6+ fragment at all photon energies considered is a pentalene cation, and its yield decreases slightly with increasing excitation energy, whereas the branching ratios of the other C8H6+ fragments, phenylacetylene and benzocyclobutadiene cations, grow.
Collapse
Affiliation(s)
- Yu A Dyakov
- Institute of Atomic and Molecular Sciences, Academia Sinica, P.O. Box 23-166, Taipei 10764, Taiwan
| | | | | | | | | |
Collapse
|
43
|
Lee YT, Ng EKW, Hung LCT, Chung SCS, Ching JYL, Chan WY, Chu WC, Sung JJ. Accuracy of endoscopic ultrasonography in diagnosing ascites and predicting peritoneal metastases in gastric cancer patients. Gut 2005; 54:1541-5. [PMID: 15955787 PMCID: PMC1774738 DOI: 10.1136/gut.2004.055772] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative diagnosis of peritoneal metastases (PM) is difficult in patients with gastric cancer (GC). AIMS To assess the accuracy of endoscopic ultrasonography (EUS) in diagnosing ascites and its predictability for the presence of PM in GC patients. SUBJECTS Consecutive patients with newly diagnosed GC from 1998 to 2004 were studied. METHODS All patients underwent EUS, ultrasound (US), and computed tomography (CT) scan for preoperative staging and the presence of ascites. The results were compared with operative findings. The diagnosis of PM was confirmed by histopathology or peritoneal fluid cytology. RESULTS A total of 301 patients were recruited and in 250 patients the presence of ascites (n = 93) and PM (n = 71) were confirmed. EUS was more sensitive (87.1%) than combined US and CT scan examinations (16.1%) and operative findings (laparoscopy or laparotomy) (40.9%) in diagnosing ascites. Sensitivity, specificity, positive and negative predictive values, and accuracy for predicting the presence of PM were 73%, 84%, 64%, 89%, and 81% by EUS; 18%, 99%, 87%, 75%, and 76% by combining US and CT scan; and 77%, 94%, 83%, 91%, and 89% by operative findings, respectively. In multivariate logistic regression analysis, EUS detected ascites was the only significant independent predictor for the presence of PM (p<0.001; odds ratio 4.7 (95% confidence interval 2.0-11.2)). CONCLUSION EUS is a sensitive method for diagnosing ascites which is an important predictive factor for the presence of PM in GC patients.
Collapse
Affiliation(s)
- Y T Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong, China.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
The ab initio/Rice-Ramsperger-Kassel-Marcus (RRKM) approach has been applied to investigate the photodissociation mechanism of azulene at 6.4 eV (the laser wavelength of 193 nm) upon absorption of one UV photon followed by internal conversion into the ground electronic state. Reaction pathways leading to various decomposition products have been mapped out at the G3(MP2,CC)//B3LYP level and then the RRKM and microcanonical variational transition state theories have been applied to compute rate constants for individual reaction steps. Relative product yields (branching ratios) for the dissociation products have been calculated using the steady-state approach. The results show that photoexcited azulene can readily isomerize to naphthalene and the major dissociation channel is elimination of an H-atom from naphthalene. The branching ratio of this channel decreases with an increase of the photon energy. Acetylene elimination is the second probable reaction channel and its branching ratio rises as the photon energy increases. The main C8H6 fragments at 193 nm are phenylacetylene and pentalene and the yield of the latter grows fast with the increasing excitation energy.
Collapse
Affiliation(s)
- Yu A Dyakov
- Institute of Atomic and Molecular Sciences, Academia Sinica, P.O. Box 23-166, Taipei 10764, Taiwan
| | | | | | | | | |
Collapse
|
45
|
Lee YT, Lee CM, Lin CS, Sheu SH, Kuo WK, Tsai CW, Huang LC, Huang HC, Wang JS, Tseng WK. A double-blind comparison of the efficacy and tolerability of telmisartan 40-80 mg vs. losartan 50-100 mg in Taiwanese hypertensive patients. Int J Clin Pract 2005:40-5. [PMID: 15617458 DOI: 10.1111/j.1742-1241.2004.00409.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A multicentre, randomised, double-blind, double-dummy, parallel-group, dose-titration study was conducted to determine the efficacy and tolerability of telmisartan 40-80 mg once daily compared with losartan 50-100 mg once daily in 180 Taiwanese patients with mild-to-moderate essential hypertension. After an initial 2-week placebo run-in phase, patients were randomised in a double-blind, double-dummy fashion to receive either telmisartan 40 mg or losartan 50 mg. If blood pressure control (diastolic blood pressure [DBP] <90 mmHg or > or = 10 mmHg reduction in DBP) was achieved after 4 weeks, the dose was maintained for the second 4 weeks of the active treatment phase; if not, the dose was doubled to telmisartan 80 mg or losartan 100 mg, respectively, for the second 4 weeks of double-blind treatment. Telmisartan 40-80 mg (n = 86) was as effective as losartan 50-100 mg (n = 90) in reducing trough seated DBP (11.1 vs. 8.7 mmHg, p = 0.144), and was significantly more effective than losartan in reducing trough seated systolic blood pressure (SBP) (22.1 vs. 16.5 mmHg, p = 0.032) and standing SBP (21.0 vs. 16.3 mmHg, p = 0.033). Significantly fewer patients treated with telmisartan than those treated with losartan required uptitration after 4 weeks' treatment (32.6% vs. 61.5%, p = 0.001). Both telmisartan and losartan were well tolerated.
Collapse
Affiliation(s)
- Y T Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- Y T Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
| | | |
Collapse
|
47
|
Affiliation(s)
- Y T Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China.
| |
Collapse
|
48
|
Ng WH, Chan YL, Sung JY, Lee YT, Lee SF, Chung SSC. Comparison of breath-hold 2D phase-contrast with non breath-hold cine phase-contrast MRA in the assessment of azygos venous blood flow in portal hypertension. Magn Reson Mater Phy 2004; 16:211-7. [PMID: 15022053 DOI: 10.1007/s10334-003-0026-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2003] [Accepted: 10/23/2003] [Indexed: 11/28/2022]
Abstract
Azygos venous blood flow as an index of blood flow through the gastroesophageal collaterals and varices is of value in the prediction of gastrointestinal bleeding. Measurement of azygos venous blood flow has been achieved by non breath-hold (NBH) cine phase-contrast magnetic resonance imaging. The objective of this study was to compare the faster breath-hold (BH) phase-contrast technique with the standard (NBH) cine phase-contrast technique in the measurement of azygos blood flow. Thirty-two cirrhotic patients with esophageal varices were examined by magnetic resonance imaging using a BH technique and a NBH cine phase-contrast technique to measure the flow velocity, flow volume and calibre of the azygos vein at the mid-right atrial level. The flow values were obtained on the velocity image of the phase-contrast study. Values obtained from the two methods were evaluated statistically for the strength and significance of correlation by the Pearson test. Measurement by the BH method performed at full-inspiration as well as end-expiration was also obtained in 15 healthy volunteers. The breath-hold phase-contrast method has significant but weak correlation with non BH cine phase-contrast method in the measurement of azygos venous blood flow volume (r = 0.55, p < 0.01) and flow velocity (r = 0.43, p = 0.01). However, the calibre of the azygos vein gave a strong correlation in these two methods (0.82). In the subgroup of patients whose azygos blood flow velocity was greater than 7.4 cm/s, the correlation of azygos blood flow volume is strong (r = 0.80, p < 0.01). The azygos vein calibre remains highly correlated between the BH and NBH method, in both high flow velocity (r = 0.73) and low flow velocity (r = 0.83) groups. Breath-hold sequence leads to higher values for flow velocity and flow volume in the cirrhotic patients and also the control group. In patients with portal hypertension, BH 2D phase-contrast (PC) magnetic resonance angiography (MRA) could give a comparable estimation of the calibre of the azygos vein as the NBH 2D cine PC MRA but not for azygos flow volume. In patients with high azygos flow velocity, the strong correlation in flow volume between the BH and NBH method suggests that the BH method may be a time-saving alternative to the NBH method.
Collapse
Affiliation(s)
- W H Ng
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
| | | | | | | | | | | |
Collapse
|
49
|
Leong RWL, Lee YT, Ching JYL, Sung JJY. Quality of life in Chinese patients with inflammatory bowel disease: validation of the Chinese translation of the Inflammatory Bowel Disease Questionnaire. Aliment Pharmacol Ther 2003; 17:711-8. [PMID: 12641521 DOI: 10.1046/j.1365-2036.2003.01489.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Health-related quality of life is an important outcome measure in inflammatory bowel disease. The Inflammatory Bowel Disease Questionnaire is a quality of life questionnaire that has not been validated previously in Chinese patients with inflammatory bowel disease. AIM To develop and validate a Chinese translation of the Inflammatory Bowel Disease Questionnaire, specifically determining its construct validity, discriminant ability, reliability and sensitivity to change. METHODS We developed a Chinese version of the Inflammatory Bowel Disease Questionnaire. Chinese patients with Crohn's disease and ulcerative colitis completed the Chinese Inflammatory Bowel Disease Questionnaire and visual analogue scales measuring systemic, social, bowel and emotional well-being. Patients also completed a validated Chinese SF-36 generic quality of life questionnaire, the Crohn's disease activity index or the clinical activity index for ulcerative colitis. RESULTS One hundred and thirty-five patients (59 with Crohn's disease and 76 with ulcerative colitis) were enrolled, 99 of whom also completed the Chinese Inflammatory Bowel Disease Questionnaire for a second time. The Chinese Inflammatory Bowel Disease Questionnaire correlated well with the SF-36 for all four domains (Spearman: r = 0.55-0.80), the Crohn's disease activity index (r = -0.62-0.72) and the clinical activity index for ulcerative colitis (r = -0.44-0.68), as well as with the visual analogue scales. The Chinese Inflammatory Bowel Disease Questionnaire accurately distinguished between active and inactive disease. Test-re-test reliability showed excellent intra-class correlation (0.76-0.92; all P < 0.001). The Chinese Inflammatory Bowel Disease Questionnaire was also sensitive to changes in disease activity (P < 0.05). CONCLUSION The Chinese Inflammatory Bowel Disease Questionnaire is a valid and reliable test that correlates well with the patients' subjective well-being and clinical disease activity.
Collapse
Affiliation(s)
- R W L Leong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | | | | | | |
Collapse
|
50
|
Chang W, Ma M, Hwang C, Chen W, Lin F, Lee Y. Crit Care 2003; 7:P068. [DOI: 10.1186/cc1957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|