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A case of persistent refractory hypoglycemia from polysubstance recreational drug use

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World Journal of Emergency Medicine 2023年第1期14卷 75-77页

作者： Jie Er Janice Soo Mingwei Ng Terence Kee Liem Chong boon kiat kenneth tan R Ponampalam Department of Emergency Medicine Singapore General Hospital169608Singapore

Dear editor,Studies have revealed a significant prevalence of mixed substance abuse,[1-3]and a focused approach towards polysubstance use has been emphasized.[4]Among recreational drugs,cases of hypoglycemia from ecstasy,[5]amphetamine,[6]eutylone,[7]and cannabinoid[8]use have been reported,but none of these cases have had persistent refractory hypoglycemia.

关键词： drugs cases prevalence

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Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: Real-world perspective

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World Journal of Gastroenterology 2017年第22期23卷 4054-4063页

作者： James Weiquan Li boon-Bee George Goh Pik-Eu Chang Chee-kiat tan Department of Gastroenterology and Hepatology Duke-NUS Medical School

To compare the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) classification systems when applied to HCC patients from the largest tertiary-level centre in *** thousand two hundred and seventy hepatocellular carcinoma (HCC) patients prospectively enrolled in a tertiary-level centre registry in Singapore since 1988 were studied. Patients were grouped into their respective BCLC and HKLC stages. Data such as demography, aetiology of HCC and type of treatment were collected. Survival data was based on census with the National Registry of Births and Deaths on 31st October 2015. Statistical analyses were done using SPSS version 21 (Chicago, IL, United States). Survival analyses were done by the Kaplan-Meier method. Differences in survival rates were compared using the log-rank *** median age at presentation was 63 years (range 13-94); male 82.4%; Chinese 89.4%, Malay 7.1%, Indian, 2.8%. Hepatitis B was the predominant aetiology (75.0%; Hepatitis C 7.2%, Hepatitis B and C co-infection 3.8%, non-viral 14.0%). Both BCLC and HKLC staging systems showed good separation with overall log rank test confirming significant survival differences between stages in our cohort (P < 0.001). 206 out of the 240 patients (85.8%) assigned for curative treatment by the BCLC treatment algorithm received curative therapy for HCC [Stage 0 93.2% (68/73); Stage A 82.6% (138/167)]. In contrast, only 341/558 (61.1%) patients received curative treatment despite being assigned for curative treatment by the HKLC treatment algorithm [Stage I 72.7% (264/363); Stage II 40.2% (66/164); Stage Va 35.5% (11/31)]. Patients who were assigned to curative treatment by HKLC but did not receive curative treatment had significantly poorer ECOG (P < 0.001), higher Child-Pugh status (P < 0.001) and were older (median age 66 vs 61, P < 0.001) than those who received curative therapy. Median overall survival in patients assigned to curative treatment groups

关键词： Hepatocellular carcinoma Barcelona Clinic Liver Cancer Hong Kong Liver Cancer Staging systems Prognosis Survival

Characterization of Baram and tanjung sands as potential proppants

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Energy Geoscience 2021年第3期2卷 175-180页

作者： Henry Elochukwu kenneth Kho Khai kiat Department of Petroleum Engineering Curtin UniversityCDT25098009MiriSarawakMalaysia

Baram and tanjung sands were evaluated for potential use as *** was conducted on Baram and tanjung sands following ISO and ASTM recommended *** showed that Baram and tanjung sand mineralogy is predominantly quartz with presence of metal *** descriptors of both sands for sphericity and roundness were above *** sand was retained by 20/40 mesh size with mean size of 448.2 mm,bulk density of 1.32 g/cc,acid solubility of 1.5%and crush resistance of 4000 *** tanjung sand was retained by 30/50 mesh size with mean size of 383.2 mm,bulk density of 1.30 g/cc,acid solubility of 1.20%and crush resistance of 8000 *** indicates that Baram sand has larger grain size that supports high permeability at low closure stress,making this sand suitable for shallow depth hydraulic fracturing operations,whereas tanjung sand is more suitable for deeper domains with high closure *** results and economic comparison with commercial frac sand and other proppant types support using Baram and tanjung sands as potential proppants.

关键词： Baram sand tanjung sand Crush resistance Proppant Hydraulic fracturing

Low serum albumin predicts early mortality in patients with severe hypoxic hepatitis

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World Journal of Hepatology 2017年第22期9卷 959-966页

作者： Pik-Eu Chang boon-Bee George Goh Victoria Ekstrom Ming-Liang Ong Chee-kiat tan Department of Gastro enterology and Hepatology Singapore General Hospital Duke-NUS Medical School

To evaluate the incidence, etiology, and predictors of mortality of severe hypoxic hepatitis. METHODSWe used computerized patient records to identify consecutive cases of severe hypoxic hepatitis admitted to a tertiary hospital in Singapore over a one-year period. We defined severe hypoxic hepatitis as elevation of serum transaminases more than 100 times upper limit of normal in the clinical setting of cardiac, circulatory or respiratory failure after exclusion of other causes of hepatitis. We used multivariable regression analysis to determine predictors for mortality. RESULTSWe identified 75 cases of severe hypoxic hepatitis out of 71380 hospital admissions over one year, providing an incidence of 1.05 cases per 1000 admissions. Median age was 65 years (range 19-88); 57.3% males. The most common etiologies of severe hypoxic hepatitis were acute myocardial infarction and sepsis. Fifty-three patients (71%) died during the hospitalization. The sole independent predictive factor for mortality was serum albumin measured at the onset of severe hypoxic hepatitis. Patients with low serum albumin of less than 28 g/L have more than five-fold increase risk of death (OR = 5.39, 95%CI: 1.85-15.71). CONCLUSIONSevere hypoxic hepatitis is uncommon but has a high mortality rate. Patients with low serum albumin are at highest risk of death.

关键词： Severe Mortality Albumin Incidence Hypoxic hepatitis Predictors Etiology Prognosis

The Classical and Regulatory Functions of C1q in Immunity and Autoimmunity

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Cellular & Molecular Immunology 2008年第1期5卷 9-21页

作者： Jinhua Lu boon King Teh Linda Wang Yinan Wang Yen Seah tan Min Chern Lai kenneth B. M. Reid Department of Microbiology Yong Loo Lin School of Medicine and 2NUS Immunology Program National University of Singapore Blk MD4 5 Science Drive 2 Singapore 117597 MRC Immunochemistry Unit Department of Biochemistry University of Oxford South Parks Road Oxford OXI 3QU UK

A classical function of Clq is to bind immune complexes and initiate complement activation producing membrane lytic complexes, opsonins and anaphylatoxins. This classical pathway of complement activation is also elicited when Clq binds some other ligands. Besides complement activation, Clq also regulates cell differentiation, adhesion, migration, activation and survival. Clq deficiency is associated with autoimmunity as well as increased susceptibility to infections. In this article, we discuss the basic properties of Clq, its expression, and classical and regulatory functions. Cellular ＆ Molecular Immunology.

关键词： C1q macrophage dendritic cell apoptotic cell autoimmunity

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Clinical applications, limitations and future role of transient elastography in the management of liver disease

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2016年第1期7卷 91-106页

作者： Pik Eu Chang George boon-Bee Goh Jing Hieng Ngu Hiang Keat tan Chee kiat tan Department of Gastroen- terology and Hepatology Singapore General Hospital George boon-Bee Goh Duke- NUS Graduate Medical School

Transient elastography(TE) is a reliable tool for the non-invasive assessment of liver fibrosis in routine clinical practice. TE is currently approved for use in Europe, Asia and the United States. The widespread adoption of this technology is certain to increase the use of TE worldwide. Although TE has been well validated in chronic viral hepatitis, its clinical role in other liver diseases remains less clear. The advent of new treatment for chronic hepatitis C and emerging prevalence of non-alcoholic steatohepatitis raises new questions on the role of TE in current clinical practice. This review aims to examine the clinical applications, limitations and future role of TE in current clinical practice in light of the changing epidemiology of liver diseases and new clinical management paradigms. In current clinical practice, TE is the most accurate noninvasive method for diagnosis of liver cirrhosis. TE is useful to rule out fibrosis and cirrhosis but does not have sufficient accuracy to discern between various stages of fibrosis. The clinical role of TE has evolved from cross-sectional point-in-time assessment of fibrosis and cirrhosis to the more relevant role of prediction of vital clinical end-points. This provides clinicians with the ability to modify treatment strategies based on the information provided by TE. TE has evolved over the past decade to become an essential tool to assist the clinician in the management of chronic liver disease.

关键词： Liver stiffness Transient elastography Non-invasive Fibrosis Chronic

Dynamic phenotypic heterogeneity and the evolution of multiple RNA subtypes in hepatocellular carcinoma:the PLANET study

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National Science Review 2022年第3期9卷 96-109页

作者： Weiwei Zhai Hannah Lai Neslihan Arife Kaya Jianbin Chen Hechuan Yang Bingxin Lu Jia Qi Lim Siming Ma Sin Chi Chew Khi Pin Chua Jacob Josiah Santiago Alvarez Pauline Jieqi Chen Mei Mei Chang Lingyan Wu Brian K.P.Goh Alexander Yaw-Fui Chung Chung Yip Chan Peng Chung Cheow Ser Yee Lee Juinn Huar Kam Alfred Wei-Chieh Kow Iyer Shridhar Ganpathi Rawisak Chanwat Jidapa Thammasiri boon Koon Yoong Diana Bee-Lan Ong Vanessa H.de Villa Rouchelle D.Dela Cruz Tracy Jiezhen Loh Wei Keat Wan Zeng Zeng Anders Jacobsen Skanderup Yin Huei Pang Krishnakumar Madhavan Tony kiat-Hon Lim Glenn Bonney Wei Qiang Leow Valerie Chew Yock Young Dan Wai Leong Tam Han Chong Toh Roger Sik-Yin Foo Pierce Kah-Hoe Chow Genome Institute of Singapore Agency for Science Technology and Research Key Laboratory of Zoological Systematics and Evolution Institute of Zoology Chinese Academy of Sciences Center for Excellence in Animal Evolution and Genetics Chinese Academy of Sciences School of Biological Sciences Nanyang Technological University Division of Biosciences Faculty of Life Sciences Division of Surgery and Surgical Oncology National Cancer Centre Department of Hepato-Pancreato-Biliary and Transplant Surgery Singapore General Hospital Division of Hepatobiliary and Pancreatic Surgery Department of Surgery University Surgical Cluster National University Health System Hepato-Pancreato-Biliary Surgery Unit Department of Surgery National Cancer Institute Division of Pathology National Cancer Institute Department of Surgery Faculty of Medicine University of Malaya Department of Surgery and Center for Liver Disease Management and Transplantation The Medical City 13. Department of Laboratories The Medical City Department of Pathology Singapore General Hospital Institute for Infocomm Research ASTAR Department of Pathology National University Health System Translational Immunology Institute (TII) Sing Health Duke-NUS Academic Medical Centre Division of Gastroenterology and Hepatology University Medicine Cluster National University Hospital Department of Biochemistry Yong Loo Lin School of Medicine National University of Singapore Cancer Science Institute of Singapore National University of Singapore Division of Medical Oncology National Cancer Center Singapore Cardiovascular Research Institute National University of Singapore National University Healthcare System Singhealth-Duke-NUS Academic Surgery Program Duke-NUS Graduate Medical School Institute of Molecular and Cell Biology Agency for Science Technology and Research

Intra-tumor heterogeneity(ITH) is a key challenge in cancer treatment, but previous studies have focused mainly on the genomic alterations without exploring phenotypic(transcriptomic and immune)heterogeneity. Using one of the largest prospective surgical cohorts for hepatocellular carcinoma(HCC)with multi-region sampling, we sequenced whole genomes and paired transcriptomes from 67 HCC patients(331 samples). We found that while genomic ITH was rather constant across stages, phenotypic ITH had a very different trajectory and quickly diversified in stage Ⅱ patients. Most strikingly, 30% of patients were found to contain more than one transcriptomic subtype within a single tumor. Such phenotypic ITH was found to be much more informative in predicting patient survival than genomic ITH and explains the poor efficacy of single-target systemic therapies in HCC. Taken together, we not only revealed an unprecedentedly dynamic landscape of phenotypic heterogeneity in HCC, but also highlighted the importance of studying phenotypic evolution across cancer types.

关键词： NADH oxidase H2O2 production oxidative phosphorylation