Publications by authors named "Choo C"

237 Publications

Long-Term Embolic Outcomes After Detection of Left Ventricular Thrombus by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Imaging: A Matched Cohort Study.

Circ Cardiovasc Imaging 2019 11 11;12(11):e009723. Epub 2019 Nov 11.

Cardiovascular Division, Department of Medicine (P.S.V., K.-H.A.C., F.K., P.S.N., O.O., C.S.), University of Minnesota Medical School, Minneapolis, MN.

Background: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is more sensitive than echocardiography for the detection of intracardiac thrombus because of its unique ability to identify thrombus based on tissue characteristics related to avascularity. The long-term prognostic significance of left ventricular (LV) thrombus detected by LGE CMR is unknown.

Methods: We performed a matched cohort study of consecutive adult patients with LV thrombus detected by LGE CMR who were matched on the date of CMR, age, and LV ejection fraction to up to 3 patients without LV thrombus. We investigated the long-term incidence of a composite of embolic events: stroke, transient ischemic attack, or extracranial systemic arterial embolism. We also compared outcomes among patients with LV thrombus detected by LGE CMR stratified by whether the LV thrombus was also detected by echocardiography or not.

Results: Of 157 LV thrombus patients, 155 were matched to 400 non-LV thrombus patients. During a median follow-up of 3.3 years, the cumulative incidence of embolism was significantly higher in LV thrombus patients compared with the matched non-LV thrombus patients (<0.001), with annualized rates of 3.7% and 0.8% for LV thrombus and matched non-LV thrombus patients, respectively. LV thrombus was the only independent predictor of the composite embolic end point (hazard ratio, 3.99 [95% CI, 1.54-10.35]; =0.004). The cumulative incidence of embolism was not different in patients with LV thrombus that was also detected by echocardiography versus patients with LV thrombus not detected by echocardiography (=0.25).

Conclusions: Despite contemporary antithrombotic treatment, LV thrombus detected by LGE CMR is associated with a 4-fold higher long-term incidence of embolism compared with matched non-LV thrombus patients. LV thrombus detected by LGE CMR but not by echocardiography is associated with a similar risk of embolism as that detected by both LGE CMR and echocardiography.
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http://dx.doi.org/10.1161/CIRCIMAGING.119.009723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941143PMC
November 2019

Isolated peripancreatic necrosis (PPN) is associated with better clinical outcomes compared with combined pancreatic and peripancreatic involvement (CPN)- a systematic review and meta-analysis.

Pancreatology 2020 Jan 25;20(1):1-8. Epub 2019 Oct 25.

Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, 55455, USA. Electronic address:

Background And Aims: Peripancreatic necrosis (PPN) is considered as a distinct entity with a better outcome when compared with combined pancreatic and peripancreatic necrosis (CPN), but there is no systematic review to summarize the evidence. Our study aimed to perform a meta-analysis of existing observational studies comparing the outcomes of PPN with CPN.

Methods: Studies in adult patients comparing the outcomes of PPN and CPN from PubMed, Medline, and Scopus databases from inception to November 2018 were systematically searched. The primary outcome was mortality, and secondary outcomes included multi-organ failure, persistent organ failure, infected necrosis, need for interventions including open necrosectomy. Pooled adjusted odds ratios, and 95% confidence intervals (CI) were obtained by the random-effects model. Forrest plots were constructed to show the summary pooled estimate. Heterogeneity was assessed by using I2 measure of inconsistency.

Results: A total of 6 studies involving 1851 patients (1295 (70%) with CPN and 556 (30%) with PPN) were included. Patients with CPN had a significantly higher mortality (OR 2.49, 95% CI: 1.61-3.87), risk for multi-organ failure (OR 3.24, 95% CI: 2.38-4.43), persistent organ failure (OR 2.79, 95% CI: 1.53-5.08), and infected necrosis (OR 6.21, 95% CI: 3.85-10.03). They underwent more interventions (OR 5.86, 95% CI: 3.69-9.32), including open necrosectomy (OR 5.04, 95% CI: 3.33-7.63). Heterogeneity was low (I2 = 18.1, p = 0.296), and there was no publication bias.

Conclusion: Isolated peripancreatic necrosis portends an overall better prognosis when compared to necrosis involves pancreatic parenchyma. Clinicians should recognize this distinction for management decisions.
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http://dx.doi.org/10.1016/j.pan.2019.10.004DOI Listing
January 2020

C-Choline PET Guided Salvage Radiation Therapy for Isolated Pelvic and Paraortic Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Rationale and Early Genitourinary or Gastrointestinal Toxicities.

Adv Radiat Oncol 2019 Oct-Dec;4(4):659-667. Epub 2019 Jul 4.

Department of Radiation Oncology, Rochester, Minnesota.

Purpose: To assess gastrointestinal (GI) and genitourinary (GU) adverse events (AEs) of C-choline-positron emission tomography (CholPET) guided lymph node (LN) radiation therapy (RT) in patients who experience biochemical failure after radical prostatectomy.

Methods And Materials: From 2013 to 2016, 107 patients experienced biochemical failure of prostate cancer, had CholPET-detected pelvic and/or paraortic LN recurrence, and were referred for RT. Patients received androgen suppression and CholPET guided LN RT (median dose, 45 Gy) with a simultaneous integrated boost to CholPET-avid sites (median dose, 56.25 Gy), all in 25 fractions. RT-naïve patients had the prostatic fossa included in the initial treatment volumes followed by a sequential boost (median dose, 68 Gy). GI and GU AEs were reported per Common Terminology Criteria for Adverse Events (version 4.0) with data gathered retrospectively. Differences in maximum GI and GU AEs at baseline, immediately post-RT, and at early (median, 4 months) and late (median, 14 months) follow-up were assessed.

Results: Median follow-up was 16 months (interquartile range [IQR], 11-25). Median prostate-specific antigen at time of positive CholPET was 2.3 ng/mL (IQR, 1.3-4.8), with a median of 2 (IQR, 1-4) choline-avid LNs per patient. Most recurrences were within the pelvis (53%) or pelvis + paraortic (40%). Baseline rates of grade 1 to 2 GI AEs were 8.4% compared with 51.9% (4.7% grade 2) of patients post-RT ( < .01). These differences resolved by 4-month (12.2%,  = .65) and 14-month AE assessments (9.1%,  = .87). There was no significant change in grade 1 to 2 GU AEs post-RT (64.1%) relative to baseline (56.0%,  = .21), although differences did arise at 4-month (72.2%,  = .01) and 14-month (74.3%,  = .01) AE assessments.

Conclusions: Salvage CholPET guided nodal RT has acceptably low rates of acute GI and GU AEs and no significant detriment in 14-month GI AEs. These data are of value in counseling patients and designing prospective trials evaluating the oncologic efficacy of this treatment strategy.
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http://dx.doi.org/10.1016/j.adro.2019.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817538PMC
July 2019

Smartphone Application in Postgraduate Clinical Psychology Training: Trainees' Perspectives.

Int J Environ Res Public Health 2019 10 30;16(21). Epub 2019 Oct 30.

Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore.

M-learning refers to the learning that takes advantage of mobile technologies. Although research shows enhanced educational outcomes from m-learning in some Asian countries, the generalizability to postgraduate clinical psychology training in Singapore remains unclear. Current professional standards in clinical psychology training emphasize the importance of attainment of clinical competencies in trainees. Although learning theories indicated potential for m-learning to be incorporated into the local clinical psychology curriculum, trainees' perspectives have not been adequately explored on m-learning. The study aimed to address this gap by exploring the use of m-learning via a novel smartphone application in clinical psychology training using mixed-methods design. Eight clinical psychology trainees between the ages of 26 to 43 years old (mean age of 31.75, SD = 5.49) enrolled in a relevant coursework subject were recruited. Participants were randomly allocated to the experimental and control groups. The experimental group accessed the novel application weekly, from week 1 to week 6, and participants in the control group accessed the application after week 6. Participants from both groups completed a brief demographic questionnaire, and the following scales New General Self-Efficacy Scale adapted for Education (NGSES-E) and self-reported scale of learning outcomes (SLO). The qualitative study explored how participants perceived and experienced the novel application. Participants from the experimental group were invited to provide open-ended responses about the novel application. Data were analyzed using thematic analysis. Results from the qualitative analysis yielded four themes of: Convenience, preferred learning style, building confidence, and putting theory into practice. Findings from the qualitative study were consistent with previous studies about advantages of m-learning: That the e-platform was convenient, the learning style was engaging, which helped to build confidence, and facilitate practical learning of skills. The qualitative results were helpful in understanding the users' perspectives and experience of the novel application, indicating that future research in this innovative area is necessary. However, the quantitative outcomes were not significant, limitations would be discussed, and recommendations made for future research.
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http://dx.doi.org/10.3390/ijerph16214206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862580PMC
October 2019

A pilot study comparing parent and adolescent online health information seeking behaviours in elective pediatric surgical situations.

Pediatr Surg Int 2020 Feb 25;36(2):227-233. Epub 2019 Oct 25.

Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.

Purpose: Little is known of how children seek health information. This study evaluates online health information (OHI) seeking behaviours in adolescents undergoing major elective surgical procedures and compares responses within parent-child dyads.

Methods: With institutional approval, we prospectively surveyed parents of children admitted to our institution for major elective operations between November 2017 and November 2018, using convenience sampling. Patients aged 12 years and above were also invited. Each respondent completed an anonymized modification of a previously published survey on Internet usage. Chi squared tests were used for categorical data, with significance at P value < 0.05.

Results: Ninety-one parents and 19 patients (median age 15 years, range 12-18) responded, with 13 parent-child pairs. Daily Internet access was reported by 84 (93%) parents and 18 (95%) children, but OHI was sought in 77% of parents and 74% of children. Six (32%) children could not name their admitting condition, compared to 10 (11%) parents. Nine (50%) children consulted family and friends for information compared to 27 (30%) parents. Parents were more likely to access hospital websites (n = 15, 44%) compared to no children (p = 0.01), while most children (n = 7, 70%) accessed non-health websites (e.g. Wikipedia). In the 13 parent-child pairs, only one parent accurately assessed what their child understood of their condition. Most patients (63.6%) did not understand the aspects of their condition that their parents deemed important.

Conclusions: This study highlights the differences in parental and child behaviours. Children are equally important to include when counselling. Surgeons can guide both parties to reliable Internet sources for health information.
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http://dx.doi.org/10.1007/s00383-019-04592-0DOI Listing
February 2020

Calcium absorption in the fluted giant clam, Tridacna squamosa, may involve a homolog of voltage-gated calcium channel subunit α1 (CACNA1) that has an apical localization and displays light-enhanced protein expression in the ctenidium.

J Comp Physiol B 2019 12 4;189(6):693-706. Epub 2019 Oct 4.

Department of Biological Sciences, National University of Singapore, Kent Ridge, Singapore, 117543, Republic of Singapore.

In light, giant clams can increase rates of shell formation and growth due to their symbiotic relationship with phototrophic zooxanthellae residing extracellularly in a tubular system. Light-enhanced shell formation necessitates increase in the uptake of Ca from the ambient seawater and the supply of Ca through the hemolymph to the extrapallial fluid, where calcification occurs. In this study, the complete coding cDNA sequence of a homolog of voltage-gated calcium channel subunit α1 (CACNA1), which is the pore-forming subunit of L-type voltage-gated calcium channels (VGCCs), was obtained from the ctenidium (gill) of the giant clam, Tridacna squamosa. It consisted of 6081 bp and encoded a 223 kDa polypeptide with 2027 amino acids, which was characterized as the α1D subunit of L-type VGCC. Immunofluorescence microscopy demonstrated that CACNA1 had an apical localization in the epithelial cells of filaments and tertiary water channels in the ctenidium of T. squamosa, indicating that it was well positioned to absorb exogenous Ca. Additionally, there was a significant increase in the protein abundance of CACNA1 in the ctenidium of individuals exposed to light for 12 h. With more pore-forming CACNA1, there could be an increase in the permeation of exogenous Ca into the ctenidial epithelial cells through the apical membrane. Taken together, these results denote that VGCC could augment exogenous Ca uptake through the ctenidium to support light-enhanced shell formation in T. squamosa. Furthermore, they support the proposition that light-enhanced phenomena in giant clams are attributable primarily to the direct responses of the host's transporters/enzymes to light, in alignment with the symbionts' phototrophic activity.
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http://dx.doi.org/10.1007/s00360-019-01238-4DOI Listing
December 2019

Isolated biopsy-proven recurrence of prostate carcinoma in the spermatic cord after radical prostatectomy detected with 11C-Choline PET/CT.

Urol Case Rep 2019 Sep 31;26:100985. Epub 2019 Jul 31.

Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 200 First Street SW, Rochester, MN, 55905, USA.

We report an unusual case of a solitary prostatic metastasis in the spermatic cord, following robotic-assisted laparoscopic radical prostatectomy with pelvic lymph node dissection and salvage radiotherapy, detected with the use of C-Choline PET/CT, heralded by a progressive rise in PSA. This lesion was biopsy-proven and surgically resected through radical left-sided orchiectomy. Postoperatively his PSA was undetectable and remained undetectable with no evidence of recurrent disease.
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http://dx.doi.org/10.1016/j.eucr.2019.100985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685691PMC
September 2019

The effects of letrozole on women with endometriosis undergoing ovarian stimulation for fertilization.

Gynecol Endocrinol 2020 Mar 7;36(3):257-260. Epub 2019 Aug 7.

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

This study aimed to analyze the effects of a new protocol with letrozole on the outcomes of fertilization (IVF) cycles in women with endometriosis. This retrospective cohort study was conducted for women diagnosed with endometriosis undergoing IVF from an infertility clinic. A new protocol, combination therapy with letrozole and gonadotropin, was used from August 2016 to January 2018 ('protocol 1',  = 38). From March 2014 to July 2016, conventional IVF with gonadotropin was administered ('protocol 2',  = 26). Age and ovarian reserve were comparable between the two groups. The patients who received protocol 1 resulted in a significantly lower peak estradiol level in IVF compared with those received protocol 2 (722 ± 1076 pg/mL versus 2168 ± 1521 pg/mL,  < .001). The length of stimulation, the total dose of gonadotropin, number of oocytes retrieved, fertilization rates, and number of embryos obtained were similar between the two groups. The mean percentage of mature oocytes was lower (69.9 ± 23.7% versus 80.2 ± 21.0%,  = .029) in patients with protocol 1. While maintaining low estrogen levels, the combination therapy with letrozole and gonadotropin produce similar oocyte and embryo yield to the conventional IVF protocol in women with endometriosis.
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http://dx.doi.org/10.1080/09513590.2019.1650338DOI Listing
March 2020

Mindfulness and hemodynamics in asians: a literature review.

Asian J Psychiatr 2019 Aug 24;44:112-118. Epub 2019 Jul 24.

Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, 119228, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, 119228, Singapore; Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Viet Nam; Faculty of Education, Huaibei Normal University, 100 Dongshan Road, Huaibei 235000, China. Electronic address:

Introduction: Mindfulness interventions have been increasingly incorporated into clinical settings. Evidence supporting mindfulness practices are predominantly established in Western populations. Neurophysiological evidence has not been established to support the effectiveness of mindfulness practice in Asian populations. Greater understanding of the neurophysiological mechanisms underlying mindfulness would enable hemodynamics as measured by fNIRS to be used to monitor mindfulness practice as an adjunct to psychotherapy with Asian clients.

Method: Research relating to fNIRS and hemodynamics for mindfulness in Asians was reviewed. The inclusion criteria for this review were recent publications in peer-reviewed journals from 2008 to 2018, with the search terms 'fNIRS', 'hemodynamics' and 'mindfulness', for studies in Asia.

Findings: Databases included Medline, PubMed, PSYCINFO, Google Scholar and SCOPUS. Initial searches yielded 86 results. Five duplicated articles were removed, and remaining abstracts were screened; and assessed for eligibility against the structured performa. Three full text papers which fit the inclusion criteria were included in the current review.

Conclusion: This review highlighted the paucity of rigorous empirically validated research for hemodynamics as measured with fNIRS for mindfulness practice in Asia.
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http://dx.doi.org/10.1016/j.ajp.2019.07.035DOI Listing
August 2019

Estrogenic phytochemical from Labisia pumila (Myrsinaceae) with selectivity towards estrogen receptor alpha and beta subtypes.

Fitoterapia 2019 Sep 8;137:104256. Epub 2019 Jul 8.

Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hajiochi, Tokyo 192-03, Japan.

Labisia pumila var. alata (Myrsinaceae) or "Kacip fatimah" is a famous Malay traditional herb used for the maintenance of women's health. The extracts of L.pumila displayed estrogenic activity in rats. Nonetheless, the estrogenic bioactives were not identified. The aim of the study is to identify estrogenic compounds contributing to the established estrogenic activity. Bioactivity-guided-isolation method guided the isolation of pure bioactives. The hexane extract was subjected to a series of silica gel flash and open column chromatography with increasing amount of ethyl acetate in hexane or methanol in chloroform. Each fraction or pure compounds were evaluated on it's estrogen receptor (ER) binding activity with the fluorescence polarization competitive ERα and ERβ binding assay kit. Cytotoxic assay using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay method was used to establish the cytotoxic activity of the compounds. Four alkyl resorcinols and a dimeric 1,4-benzoquinone, namely belamcandol B (1), 5-pentadec-10'-(Z)-enyl resorcinol (2), 1,3-dihydroxy-5-pentadecylbenzene (3), 5-(heptadec-12'-(Z)-enyl) resorcinol (4) and demethylbelamcandaquinone B (5) were identified with selective binding affinities towards either ERα or ERβ exhibiting selectivity ratio from 0.15-11.9. Alkyl resorcinols (2)-(4) exhibited cytotoxic activity towards HL60 cells with IC values from 19.5-22.0 μM. Structural differences between compounds influence the binding affinities to ER subtypes. Further study is needed to establish the agonist or antagonist effect of these compounds on various tissues and to identify if these compounds exert cytotoxic activity through the ERs. When consuming L.pumila as a complementary medicine, careful consideration regarding it's estrogenic compound content should be given due consideration.
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http://dx.doi.org/10.1016/j.fitote.2019.104256DOI Listing
September 2019

Estrogenic phytochemical from Labisia pumila (Myrsinaceae) with selectivity towards estrogen receptor alpha and beta subtypes.

Fitoterapia 2019 Sep 8;137:104256. Epub 2019 Jul 8.

Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hajiochi, Tokyo 192-03, Japan.

Labisia pumila var. alata (Myrsinaceae) or "Kacip fatimah" is a famous Malay traditional herb used for the maintenance of women's health. The extracts of L.pumila displayed estrogenic activity in rats. Nonetheless, the estrogenic bioactives were not identified. The aim of the study is to identify estrogenic compounds contributing to the established estrogenic activity. Bioactivity-guided-isolation method guided the isolation of pure bioactives. The hexane extract was subjected to a series of silica gel flash and open column chromatography with increasing amount of ethyl acetate in hexane or methanol in chloroform. Each fraction or pure compounds were evaluated on it's estrogen receptor (ER) binding activity with the fluorescence polarization competitive ERα and ERβ binding assay kit. Cytotoxic assay using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay method was used to establish the cytotoxic activity of the compounds. Four alkyl resorcinols and a dimeric 1,4-benzoquinone, namely belamcandol B (1), 5-pentadec-10'-(Z)-enyl resorcinol (2), 1,3-dihydroxy-5-pentadecylbenzene (3), 5-(heptadec-12'-(Z)-enyl) resorcinol (4) and demethylbelamcandaquinone B (5) were identified with selective binding affinities towards either ERα or ERβ exhibiting selectivity ratio from 0.15-11.9. Alkyl resorcinols (2)-(4) exhibited cytotoxic activity towards HL60 cells with IC values from 19.5-22.0 μM. Structural differences between compounds influence the binding affinities to ER subtypes. Further study is needed to establish the agonist or antagonist effect of these compounds on various tissues and to identify if these compounds exert cytotoxic activity through the ERs. When consuming L.pumila as a complementary medicine, careful consideration regarding it's estrogenic compound content should be given due consideration.
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http://dx.doi.org/10.1016/j.fitote.2019.104256DOI Listing
September 2019

Health-Related Quality of Life in Pediatric Patients with Leukemia in Singapore: A Cross-Sectional Pilot Study.

Int J Environ Res Public Health 2019 06 12;16(12). Epub 2019 Jun 12.

Department of Pediatrics, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.

There has been a paradigm shift in health service delivery to a more holistic approach, which considers Quality of Life (QoL) and overall functioning. Health-Related Quality of Life (HRQoL) is a multidimensional construct that encompasses physical functioning as well as psychosocial aspects of emotional and social functioning. This study explored factors related to HRQoL in Asian pediatric patients with leukemia in Singapore. The available variables included: age, treatment duration, household income, gender, ethnicity, religion, diagnosis, and phase of treatment. It is hypothesized that the relationships will be significant. In the current study, there were 60 patients (60% males) with leukemia; their ages ranged from 1 to 21 years (Mean = 8.03, Standard Deviation = 4.55). The hypothesis was partially supported. Age had a significant positive relationship with physical functioning, (60) = 0.28, < 0.05, physical health, (60) = 0.28, < 0.05, and the total HRQoL score, (60) = 0.29, < 0.05. Treatment duration had a positive relationship with school functioning, (60) = 0.28, < 0.05. All other correlations were statistically non-significant. The effects of the available psychosocial variables of gender, ethnicity, and religion were examined on scores from the Pediatric Quality of Life Inventory (PedsQL). Ethnicity had a significant effect on social functioning, U = 292.00, < 0.05, = 0.3 (medium effect size). Specifically, Chinese (Median = 85.00, = 33) had significantly higher scores on social functioning than others (Median = 70.00, = 27). The remaining comparisons were statistically non-significant. The current findings added to QoL research, and provided an impetus for more research in the area of HRQoL for children with leukemia in Singapore.
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http://dx.doi.org/10.3390/ijerph16122069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617504PMC
June 2019

Diagnostic pitfalls of acute eosinophilic pneumonia in an adolescent boy following cigarette smoking: A case report.

Medicine (Baltimore) 2019 May;98(20):e15590

Department of Pediatrics, Chang Gung Memorial Hospital at Linkou.

Rationale: Acute eosinophilic pneumonia (AEP) is characterized by acute febrile respiratory symptoms, bilateral lung infiltrates, and pulmonary eosinophilia. AEP is closely related to cigarette smoking but is rarely suspected in pediatric cases despite the fact that there is a relatively high incidence of cigarette smoking among adolescents in Taiwan.

Patient Concerns: We report a case of a previously healthy 15-year-old boy who presented with fever and acute progressive dyspnea. Due to lack of awareness of cigarette smoking history in adolescents and the nonspecific signs and symptoms of AEP at early stages, the patient was initially treated as community-acquired pneumonia (CAP) but was unresponsive to antibiotics treatment.

Diagnoses: A combination of a recent onset smoking history and pulmonary eosinophilia on bronchoalveolar lavage confirmed the diagnosis of cigarette-induced AEP.

Interventions: Corticosteroid treatment was prescribed.

Outcomes: The condition improved within 24 hours, with resolution of alveolar infiltrates on chest radiographs.

Lessons: With the increasing incidence of smoking amongst adolescents in Taiwan, careful history questioning regarding cigarette smoking is necessary. Due to similarities in initial clinical and radiographic features of AEP and CAP, adolescents with suspected CAP who are unresponsive to antibiotic treatment but have a subsequent rise in peripheral eosinophils should raise the clinician's suspicion of AEP related to cigarette smoking.
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http://dx.doi.org/10.1097/MD.0000000000015590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531086PMC
May 2019

Increased apical sodium-dependent glucose transporter abundance in the ctenidium of the giant clam upon illumination.

J Exp Biol 2019 04 9;222(Pt 7). Epub 2019 Apr 9.

Department of Biological Sciences, National University of Singapore, Kent Ridge, Singapore 117543, Republic of Singapore

Giant clams contain phototrophic zooxanthellae, and live in nutrient-deficient tropical waters where light is available. We obtained the complete cDNA coding sequence of a homolog of mammalian sodium/glucose cotransporter 1 () from the ctenidium of the fluted giant clam, had a host origin and was expressed predominantly in the ctenidium. Molecular characterizations reveal that SGLT1-like of could transport urea, in addition to glucose, as other SGLT1s do. It has an apical localization in the epithelium of ctenidial filaments and water channels, and the apical anti-SGLT1-like immunofluorescence was stronger in individuals exposed to light than to darkness. Furthermore, the protein abundance of SGLT1-like increased significantly in the ctenidium of individuals exposed to light for 12 h, although the transcript level remained unchanged. As expected, could perform light-enhanced glucose absorption, which was impeded by exogenous urea. These results denote the close relationships between light-enhanced glucose absorption and light-enhanced SGLT1-like expression in the ctenidium of Although glucose absorption could be trivial compared with the donation of photosynthates from zooxanthellae in symbiotic adults, SGLT1-like might be essential for the survival of aposymbiotic larvae, leading to its retention in the symbiotic stage. , glucose uptake through SGLT1-like might be augmented by the surface microbiome through nutrient cycling, and the absorbed glucose could partially fulfill the metabolic needs of the ctenidial cells. Additionally, SGLT1-like could partake in urea absorption, as is known to conduct light-enhanced urea uptake to benefit the nitrogen-deficient zooxanthellae.
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http://dx.doi.org/10.1242/jeb.195644DOI Listing
April 2019

Reducing seed migration to near zero with stranded-seed implants: Comparison of seed migration rates to the chest in 1000 permanent prostate brachytherapy patients undergoing implants with loose or stranded seeds.

Brachytherapy 2019 May - Jun;18(3):306-312. Epub 2019 Mar 8.

Department of Radiation Oncology, Mayo Clinic, Rochester, MN.

Purpose: Pulmonary seed emboli to the chest may occur after permanent prostate brachytherapy (PPB). The purpose of this study is to analyze factors associated with seed migration to the chest in a large series of PPB patients from a single institution undergoing implant with either loose seeds (LS), mixed loose and stranded seeds (MS), or exclusively stranded seeds in an absorbable vicryl suture (VS).

Methods And Materials: Between May 1998 and July 2015, a total of 1000 consecutive PPB patients with postoperative diagnostic chest x-rays at 4 months after implant were analyzed for seed migration. Patients were grouped based on seed implant technique: LS = 391 (39.1%), MS = 43 (4.3%), or VS = 566 (56.6%). Univariate and multivariate analysis were performed using Cox proportional hazards regression models to determine predictors of seed migration.

Results: Overall, 18.8% of patients experienced seed migration to the chest. The incidence of seed migration per patient was 45.5%, 11.6%, and 0.9% (p < 0.0001), for patients receiving LS, MS, or VS PPB, respectively. The right and left lower lobes were the most frequent sites of pulmonary seed migration. On multivariable analysis, planimetry volume (p = 0.0002; HR = 0.7 per 10 cc [0.6-0.8]), number of seeds implanted (p < 0.0001, HR = 2.4 per 25 seeds [1.7-3.4]), LS implant (p < 0.0001, HR = 15.9 [5.9-42.1]), and MS implant (p = 0.001, HR = 7.9 [2.3-28.1]) were associated with seed migration to the chest.

Conclusions: In this large series, significantly higher rates of seed migration to the chest are observed in implants using any LS with observed hazard ratios of 15.9 and 7.9 for LS and MS respectively, as compared with implants using solely stranded seeds.
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http://dx.doi.org/10.1016/j.brachy.2019.01.007DOI Listing
December 2019

Mesenchymal chondrosarcoma of maxilla in paediatric patient.

BMJ Case Rep 2019 Mar 9;12(3). Epub 2019 Mar 9.

Department of Otorhinolaryngology - Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, Kelantan, Malaysia.

Chondrosarcoma (CS) is a malignant tumour of long and flat bone characterised by the formation of cartilage. Mesenchymal chondrosarcoma (MCS) is a rare subtype of CS that is more aggressive and may lead to erroneous diagnosis in a limited biopsy. The diagnosis is mainly based on the histopathological appearance of biphasic pattern of undifferentiated small round cells separated by islands of well-differentiated hyaline cartilage. We report a case of 13-year-old boy who initially presented with gum swelling and the biopsy result suggested a benign fibrous lesion. Following an extensive lesion shown in radiologic findings, the tumour excision was done and finally was diagnosed as an MCS of the maxilla. The patient was given postoperative chemotherapy (EURO-EWING 99 regimen), and now on regular follow-up for monitoring of local recurrence or tumour metastasis.
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http://dx.doi.org/10.1136/bcr-2018-228969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424280PMC
March 2019

Radon concentrations in the community groundwater system of South Korea.

Environ Monit Assess 2019 Feb 26;191(3):189. Epub 2019 Feb 26.

Department of Geology, Kyungpook National University, 80, Daehak-ro, Bukgu, Daegu, South Korea.

Groundwater samples were collected from 3818 wells used for the community groundwater system (CGS) in the remote rural areas of South Korea and analyzed to determine radon concentrations. Radon concentrations varied with rock type, ranging from 0.1 to 2393.5 Bq/L with an average of 86.6 Bq/L and a median of 46.4 Bq/L. Among 10 geological units, the median CGS radon concentration was highest (59.6-103.0 Bq/L) in granite, and lower in sedimentary rocks (16.9-21.1 Bq/L) and porous volcanic rocks (17.6 Bq/L), respectively. Of the 3818 samples, 26.1% exceeded the World Health Organization (WHO) radon level limit of 100 Bq/L. The application of the natural radon reduction rate (26.5%) recently suggested by Yun et al. Applied Radiation and Isotopes, 126(1), 23-25 (2017) to the CGS water tank appeared to decrease exceedance of the WHO radon level limit to 20.2%. Because of the high radon concentrations in CGS groundwater in South Korea, the establishment of a radon level limit for drinking water is strongly recommended to ensure the health and safety of the people using CGS water.
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http://dx.doi.org/10.1007/s10661-019-7301-yDOI Listing
February 2019

Demographic factors affecting parental attitudes to clinical research in pediatric surgery: A pilot study.

J Pediatr Surg 2019 May 5;54(5):1019-1023. Epub 2019 Feb 5.

Duke-NUS Medical School, Singapore; Department of Paediatric Surgery, KK, Women's, and Children's Hospital, Singapore. Electronic address:

Purpose: The purpose of this study was to evaluate demographic factors impacting parental attitudes to clinical research in pediatric surgery.

Methods: A prospective survey administered to caregivers accompanying children (pediatric surgical outpatient clinic or day surgery) using convenience sampling (September-November 2017) using a previously published survey with Likert scale was performed. Questions included demographics, parental willingness to enroll children in specified types of research, and beliefs regarding conduct of research.

Results: Eighty-four parents were surveyed (100 approached). No demographic factors significantly predicted research participation involving sample collection (urine, saliva, blood) or research requiring follow-up. However, mothers were less likely to agree to studies using common medications (p = 0.049) or common surgical procedures (p = 0.013) and less likely to agree to randomization involving surgery (assigning to common surgical procedure, p = 0.013; surgery vs no surgery, p = 0.031). University graduates were less likely to agree to randomization to surgery vs no surgery (p = 0.02). Beliefs regarding conduct of research were similar, except that non-university graduates were more likely to believe that privacy would be compromised (p = 0.003). Boys were deemed less likely to be too sick for participation (p = 0.03) and more likely to want to participate (p = 0.03).

Conclusion: Behavioral and attitude differences in caregivers can inform strategies for recruitment among researchers. Impact of caregiver and child gender on responses requires further evaluation.

Type Of Study: Treatment study.

Level Of Evidence: Level II.
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http://dx.doi.org/10.1016/j.jpedsurg.2019.01.046DOI Listing
May 2019

Demographic factors affecting parental attitudes to clinical research in pediatric surgery: A pilot study.

J Pediatr Surg 2019 May 5;54(5):1019-1023. Epub 2019 Feb 5.

Duke-NUS Medical School, Singapore; Department of Paediatric Surgery, KK, Women's, and Children's Hospital, Singapore. Electronic address:

Purpose: The purpose of this study was to evaluate demographic factors impacting parental attitudes to clinical research in pediatric surgery.

Methods: A prospective survey administered to caregivers accompanying children (pediatric surgical outpatient clinic or day surgery) using convenience sampling (September-November 2017) using a previously published survey with Likert scale was performed. Questions included demographics, parental willingness to enroll children in specified types of research, and beliefs regarding conduct of research.

Results: Eighty-four parents were surveyed (100 approached). No demographic factors significantly predicted research participation involving sample collection (urine, saliva, blood) or research requiring follow-up. However, mothers were less likely to agree to studies using common medications (p = 0.049) or common surgical procedures (p = 0.013) and less likely to agree to randomization involving surgery (assigning to common surgical procedure, p = 0.013; surgery vs no surgery, p = 0.031). University graduates were less likely to agree to randomization to surgery vs no surgery (p = 0.02). Beliefs regarding conduct of research were similar, except that non-university graduates were more likely to believe that privacy would be compromised (p = 0.003). Boys were deemed less likely to be too sick for participation (p = 0.03) and more likely to want to participate (p = 0.03).

Conclusion: Behavioral and attitude differences in caregivers can inform strategies for recruitment among researchers. Impact of caregiver and child gender on responses requires further evaluation.

Type Of Study: Treatment study.

Level Of Evidence: Level II.
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http://dx.doi.org/10.1016/j.jpedsurg.2019.01.046DOI Listing
May 2019

Molecular characterization, cellular localization, and light-enhanced expression of Beta-Na/H Exchanger-like in the whitish inner mantle of the giant clam, Tridacna squamosa, denote its role in light-enhanced shell formation.

Gene 2019 May 11;695:101-112. Epub 2019 Feb 11.

Department of Biological Sciences, National University of Singapore, Kent Ridge, Singapore 117543, Republic of Singapore; The Tropical Marine Science Institute, National University of Singapore, Kent Ridge, Singapore 119227, Republic of Singapore. Electronic address:

The fluted giant clam, Tridacna squamosa, lives in symbiosis with photosynthetic zooxanthellae, and can engage in light-enhanced growth and shell formation. Light-enhanced shell formation necessitates the elimination of excess H from the extrapallial fluid adjacent to the shell. This study aimed to clone Na/HExchanger (NHE) from the whitish inner mantle adjacent to the extrapallial fluid of T. squamosa, to determine its cellular and subcellular localization, and to evaluate the effect of light exposure on its mRNA expression level and protein abundance therein. The complete coding cDNA sequence of NHE obtained was identified as a homolog of beta NHE (βNHE-like). It consisted of 2925 bp, encoding for a polypeptide of 974 amino acids and 107.1 kDa, and was expressed predominantly in the inner mantle. There, βNHE-like was localized in the apical membrane of the seawater-facing epithelium by immunofluorescence microscopy. After exposure to light for 12 h, the seawater-facing epithelium of the inner mantle displayed consistently stronger immunostaining than that of the control exposed to 12 h of darkness. Western blotting confirmed that light exposure significantly enhanced the protein abundance of βNHE-like in the inner mantle. These results denote that some of the excess H generated during light-enhanced shell formation can be excreted through the light-dependent βNHE-like of the seawater-facing epithelium to minimize the impact on the whole-body pH. Importantly, the excreted H could dehydrate exogenous HCO, and facilitate the absorption of inorganic carbon through the seawater-facing epithelium dedicated for light-enhanced shell formation due to its close proximity with the shell-facing epithelium. NUCLEOTIDE SYMBOL COMBINATIONS: Pairs: R = A/G; W = A/T; Y = C/T. Triples: D = A/G/T.
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http://dx.doi.org/10.1016/j.gene.2019.02.009DOI Listing
May 2019

Quality of Life in Patients With a Major Mental Disorder in Singapore.

Front Psychiatry 2018 18;9:727. Epub 2019 Jan 18.

Department of Psychological Medicine, National University of Singapore, Singapore, Singapore.

There has been a paradigm shift in mental health service delivery, from a focus on reducing symptoms to a more holistic approach, which considers Quality of Life (QoL). This study aimed to explore prediction of Quality of Life (QoL) in Asian patients with a major mental disorder i.e., depression or schizophrenia in Singapore. In the current study, there were 43 patients (65.1% females) with depression. Their ages ranged from 18 to 65 ( = 44.63, = 12.22). The data were combined with the data on patients with schizophrenia, where there were 43 patients (65.1% females) with schizophrenia, their ages ranging from 18 to 65 ( = 44.60, = 12.19). The components of QoL were examined i.e., Physical Component Summary (PCS) and Mental Component Summary (MCS). For all patients, social support and age accounted for 17.3% of the variance in PCS, = 8.66, < 0.001. For patients with depression, disorder severity, age, and duration of treatment accounted for 48.3% of the variance in PCS, = 12.15, < 0.001. For patients with schizophrenia, education (Primary or Lower vs. Post-Secondary or Higher) and emotional coping accounted for 21.3% of the variance in PCS, = 5.40, < 0.01. For all patients, self-efficacy and age accounted for 27.0% of the variance in MCS, = 15.37, < 0.001. For patients with depression, disorder severity accounted for 45.6% of the variance in MCS, = 34.33, < 0.001. For patients with schizophrenia, number of hospitalizations accounted for 18.5% of the variance in MCS, = 9.29, < 0.01. The findings were discussed in regards to implications in interventions to enhance QoL of patients with schizophrenia and depression in Singapore.
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http://dx.doi.org/10.3389/fpsyt.2018.00727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346635PMC
January 2019

Methotrexate as an Adjuvant in Severe Thyroid Eye Disease: Does It Really Work as a Steroid-Sparing Agent?

Ophthalmic Plast Reconstr Surg 2019 Jul/Aug;35(4):369-373

Oculoplastic Department, Singapore National Eye Centre, Singapore.

Purpose: To compare the efficacy and safety of adjunctive oral methotrexate with intravenous pulsed methylprednisolone against methylprednisolone alone in the treatment of severe thyroid eye disease.

Methods: Retrospective review of clinical data of patients with severe sight-threatening thyroid eye disease with compressive optic neuropathy treated with methylprednisolone with and without methotrexate. Eye disease outcome measures (e.g., VISA inflammatory score and vision) at 0, 3, 6, 12, and 18 months were recorded.

Results: There were 72 subjects including 33 who had methylprednisolone alone and 39 with methylprednisolone with methotrexate. There were no statistical differences in demographics and baseline measures of disease activity or vision between the 2 treatment groups. No significant statistical differences in the cumulative dosage of methylprednisolone or occurrence of restrictive myopathy, raised intraocular pressure, proptosis, and exposure keratopathy between the groups at 0, 3, 6, 12, and 18 months were found. However, subjects who received methylprednisolone with methotrexate had better visual acuity of more than 2 lines on Snellen chart (p = 0.026) and VISA inflammatory score (p = 0.034) at 3 months, but no differences at 6, 12, and 18 months. Three patients who received methylprednisolone with methotrexate had transient worsening of liver function. No patient developed severe adverse reaction.

Conclusions: The results demonstrated improved vision and disease activity at 3 months in the combination treatment group. This may suggest that the addition of methotrexate to methylprednisolone is beneficial for accelerating suppression of disease activity and hastens visual recovery. Addition of methotrexate to methylprednisolone did not reduce the requirement for steroids.
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http://dx.doi.org/10.1097/IOP.0000000000001279DOI Listing
December 2019

Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion.

Malays Orthop J 2018 Nov;12(3):19-23

Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Restoration of a functional hand is the ultimate goal following a distal radius tumour resection. The early outcomes of mobile wrist reconstruction are satisfactory; however, long-term results are unpredictable due to late wrist instability and degenerative arthritis. Our aim is to compare mobile wrist reconstruction with wrist fusion (pan-carpal fusion) in our cohort of patients. A retrospective cohort study was performed for functional outcomes of all patients who underwent resection for distal radius tumour and treated with either fusion or reconstruction of the wrist in a single institution from years 2000-2013 with a minimum of three years follow-up. Eleven patients were included in the study, six of whom had wrist reconstruction with proximal fibula graft and the remaining five wrist fusion, with a mean follow-up of 6.3 years. The mean Musculoskeletal Tumour Society (MSTS) score was 82.78%, ranging from 70% to 93.3%. Average grip strength compared to the normal contralateral hand was 60.0% for total wrist fusion, which was better than wrist reconstruction with 58.07%. There was no difference in the functional outcome between fusion and mobile reconstruction in our study. Osteoarthritis changes and subluxation of the wrist joint were the most common findings in the long-term follow-up for this group. There was no difference in the functional outcome of the long-term follow-up between the two groups.
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http://dx.doi.org/10.5704/MOJ.1811.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287129PMC
November 2018

Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion.

Malays Orthop J 2018 Nov;12(3):19-23

Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Restoration of a functional hand is the ultimate goal following a distal radius tumour resection. The early outcomes of mobile wrist reconstruction are satisfactory; however, long-term results are unpredictable due to late wrist instability and degenerative arthritis. Our aim is to compare mobile wrist reconstruction with wrist fusion (pan-carpal fusion) in our cohort of patients. A retrospective cohort study was performed for functional outcomes of all patients who underwent resection for distal radius tumour and treated with either fusion or reconstruction of the wrist in a single institution from years 2000-2013 with a minimum of three years follow-up. Eleven patients were included in the study, six of whom had wrist reconstruction with proximal fibula graft and the remaining five wrist fusion, with a mean follow-up of 6.3 years. The mean Musculoskeletal Tumour Society (MSTS) score was 82.78%, ranging from 70% to 93.3%. Average grip strength compared to the normal contralateral hand was 60.0% for total wrist fusion, which was better than wrist reconstruction with 58.07%. There was no difference in the functional outcome between fusion and mobile reconstruction in our study. Osteoarthritis changes and subluxation of the wrist joint were the most common findings in the long-term follow-up for this group. There was no difference in the functional outcome of the long-term follow-up between the two groups.
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http://dx.doi.org/10.5704/MOJ.1811.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287129PMC
November 2018

A novel noninvasive appendicitis score with a urine biomarker.

J Pediatr Surg 2019 Jan 5;54(1):91-96. Epub 2018 Oct 5.

Department of Paediatric Surgery, KK Women's & Children's Hospital, Singapore.

Purpose: The aim of our study was to develop an appendicitis score incorporating a urine biomarker, Leucine rich alpha-2-glycoprotein (LRG), for evaluation of children with abdominal pain.

Methods: From January to August 2017 we prospectively enrolled children aged 4-16 years old admitted for suspected appendicitis. Urine samples for LRG analysis were obtained preoperatively and quantified by enzyme-linked immunosorbent assay (ELISA) after correction for patient hydration status. The diagnosis of appendicitis was based on operative findings and histology. Logistic regression was used to identify prospective predictors.

Results: A total of 148 patients were recruited, of which 42(28.4%) were confirmed appendicitis. Our Appendicitis Urinary Biomarker (AuB) model incorporated urine LRG with 3 clinical predictors: 'constant pain', 'right iliac fossa tenderness', 'pain on percussion'. Area under the ROC curve for AuB was 0.82 versus 0.78 for the Pediatric Appendicitis Score (PAS) on the same cohort of patients. A model-calculated risk score of <0.15 is interpreted as low risk of appendicitis. Sensitivity for the AuB at this cutoff was 97.6%, specificity 37.7%, negative predictive value 97.6%, positive predictive value 38.3%, and negative likelihood ratio 0.06.

Conclusion: The noninvasive AuB score appears promising as a diagnostic tool for excluding appendicitis in children without the need for blood sampling.

Type Of Study: Study of diagnostic test.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.10.025DOI Listing
January 2019

Light-enhanced expression of Carbonic Anhydrase 4-like supports shell formation in the fluted giant clam Tridacna squamosa.

Gene 2019 Jan 11;683:101-112. Epub 2018 Oct 11.

Department of Biological Sciences, National University of Singapore, Kent Ridge, Singapore 117543, Republic of Singapore; The Tropical Marine Science Institute, National University of Singapore, Kent Ridge, Singapore 119227, Republic of Singapore.

Giant clams represent symbiotic associations between a host clam and its extracellular zooxanthellae. They are able to grow in nutrient-deficient tropical marine environments and conduct light-enhanced shell formation (calcification) with the aid of photosynthates donated by the symbiotic zooxanthellae. In light, there is a high demand for inorganic carbon (C) to support photosynthesis in the symbionts and light-enhanced calcification in the host. In this study, we cloned and characterized a host Carbonic Anhydrase 4 homolog (CA4-like) from the whitish inner mantle of the giant clam Tridacna squamosa. The full cDNA coding sequence of CA4-like consisted of 1002 bp, encoding for 334 amino acids of 38.5 kDa. The host CA4-like was phenogramically distinct from algal CAs. The transcript level of CA4-like in the inner mantle was ~3-fold higher than those in the colorful outer mantle and the ctenidium. In the inner mantle, CA4-like was immunolocalized in the apical membrane of the seawater-facing epithelial cells, but absent from the shell-facing epithelium. Hence, CA4-like was positioned to catalyze the conversion of HCO to CO in the ambient seawater which would facilitate CO uptake. The absorbed CO could be converted back to HCO by the cytoplasmic CA2-like. As the protein abundance of CA4-like increased in the inner mantle after 6 or 12 h of light exposure, there could be an augmentation of the total CA4-like activity to increase C uptake in light. It is plausible that the absorbed C was allocated preferentially for shell formation due to the close proximity of the seawater-facing epithelium to the shell-facing epithelium in the inner mantle that contains only few zooxanthellae.
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http://dx.doi.org/10.1016/j.gene.2018.10.023DOI Listing
January 2019

Permanent prostate brachytherapy monotherapy with I-125 for low- and intermediate-risk prostate cancer: Outcomes in 974 patients.

Brachytherapy 2019 Jan - Feb;18(1):1-7. Epub 2018 Oct 4.

Department of Radiation Oncology, Mayo Clinic, Rochester, MN. Electronic address:

Purpose: To report outcomes of patients undergoing low-dose-rate (LDR) brachytherapy and investigate factors associated with biochemical failure and survival.

Methods: Consecutive patients undergoing LDR with I-125 at our institution between 1998 through 2013 for primary intact prostate cancer were examined. Those with low- and intermediate-risk disease receiving LDR with a minimum of 2 years followup and at least one post-LDR prostate-specific antigen (PSA) were included.

Results: About 974 patients satisfied inclusion criteria. With median followup of 72 months, biochemical failure occurred in 45 patients. Freedom from biochemical failure as defined by the Phoenix criterion was 96% and 88% at 5 and 10 years, worse for intermediate risk as compared with low risk, with 10-year freedom from biochemical failure of 76% versus 92% (hazard ratio [HR] = 3.7, p < 0.001), respectively. On multivariable analysis, increased prebiopsy PSA, Gleason 4 + 3, and no androgen deprivation therapy were associated with biochemical failure. Gleason 4 + 3 was the factor most strongly associated with biochemical failure (HR = 7.01, p < 0.001). No examined factors were associated with local failure. Gleason 4 + 3 disease increased the likelihood of distant metastasis (HR = 12.4, p = 0.003) and prostate cancer-specific death (HR = 13.2, p < 0.001). No difference in outcomes between patients with Gleason 3 + 3 versus 3 + 4 was observed.

Conclusions: LDR brachytherapy provided excellent outcomes in this large series of patients treated for localized organ-confined prostate cancer. Local recurrence at 10 years was low at 2.1%. Primary Gleason 4 + 3, higher pretreatment PSA, and no receipt of androgen deprivation therapy were the only factors associated with biochemical failure. Primary Gleason 4 disease was also predictive of distant metastases and decreased prostate cancer-specific survival.
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http://dx.doi.org/10.1016/j.brachy.2018.09.003DOI Listing
April 2019

Surgical reduction technique (transpedicle) for unstable thoracolumbar burst fractures with retropulsion resulting in severe spinal canal stenosis: a preliminary case report.

AME Case Rep 2018 23;2:38. Epub 2018 Jul 23.

Orthopaedic Surgery Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia.

Thoracolumbar burst fractures are common entity in polytraumatized patients. The retropulsed burst vertebral fracture may result in spinal canal invasion with or without neurological deficit. In this situation, early surgical stabilization with decompression is vital to restore neurological function. We employed a posterior approach with a unique transpedicular reduction technique at the level of fracture for decompression and stabilisation.
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http://dx.doi.org/10.21037/acr.2018.07.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6155616PMC
July 2018

Factors Associated with the Risk of Developing Coronary Artery Disease in Medicated Patients with Major Depressive Disorder.

Int J Environ Res Public Health 2018 09 21;15(10). Epub 2018 Sep 21.

Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore.

The aim of this study was to identify factors associated with high Framingham Risk Score (FRS) in medicated patients with major depressive disorder (MDD). We examined 61 medicated patients with MDD (mean age 37.77 ± 7.67, 90.2% women) and 43 non-depressed controls (mean age 38.26 ± 9.20, 90.7% women). We administered the Hamilton Depression Rating Scale (HAM-D) and measured systolic blood pressure (SBP), diastolic BP (DBP), mean arterial BP (MAP), pulse wave velocity (PWV), intima-media thickness (IMT), interleukin-6 (IL-6) and triglycerides. We found that medicated patients with MDD had significantly higher levels of HAM-D score ( < 0.01), SBP ( = 0.015), MAP ( = 0.037), IL-6 level ( = 0.007), as compared with controls. Medicated patients who remained moderately to severely depressed showed significantly higher SBP ( = 0.049), DBP ( = 0.009), MAP ( = 0.024), IL-6 level ( = 0.019), left PWV ( = 0.004) and average PWV ( = 0.026) than those with mild depression. Multivariate regression showed that the interaction effect between HAM-D score and triglyceride level ( = 0.018) was significantly associated with FRS in medicated patients with MDD. This study highlights that the interaction effect of the severity of depression and the triglyceride level, was a modifiable factor positively associated with high FRS.
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http://dx.doi.org/10.3390/ijerph15102073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210477PMC
September 2018

Telemedicine in long-term care of glaucoma patients.

J Telemed Telecare 2020 Jan-Feb;26(1-2):92-99. Epub 2018 Sep 12.

Departments of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, USA.

Introduction: This manuscript describes data from an original study, simulating a tele-glaucoma programme in an established clinic practice with an interdisciplinary team. This is a ‘real life’ trial of a telemedicine approach to see a follow-up patient. The goal is to evaluate the accuracy of such a programme to detect worsening and/or unstable disease. Such a programme is attractive since in-clinic time could be reduced for both the patient and provider. This study evaluates agreement between in-person and remote assessment of glaucoma progression.

Methods: A total of 200 adult glaucoma patients were enrolled at a single institution. The in-person assessment by an optometrist or glaucoma specialist at time of enrolment was used as the gold standard for defining progression. Collated clinical data were then reviewed by four masked providers who classified glaucoma as progression or non-progression in each eye by comparing data from enrolment visit to data from the visit immediately prior to enrolment. Agreement of glaucoma progression between the masked observer and the in-person assessment was determined using Kappa statistics. Intra-observer agreement was calculated using Kappa to compare in-person to remote assessment when both assessments were performed by the same provider (n = 279 eyes).

Results: A total of 399 eyes in 200 subjects were analysed. Agreement between in-person versus remote assessment for the determination of glaucoma progression was 63%, 62%, 69% and 68% for each reader 1–4 (kappa values = 0.19, 0.20, 0.35 and 0.33, respectively). For intra-observer agreement, reader 1 agreed with their own in-person assessment for 65% of visits (kappa = 0.18).

Discussion: Intra-observer agreement was similar to the agreement for each provider who did not see the patient in person. This similarity suggests that telemedicine may be equally effective at identifying glaucomatous disease progression, regardless of whether the same provider performed both in-clinic and remote assessments. However, fair agreement levels highlight a limitation of using only telemedicine data to determine progression compared with clinical detail available during in-patient assessment.
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http://dx.doi.org/10.1177/1357633X18797175DOI Listing
November 2020
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