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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

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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

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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

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Application of NOMA for cellular-connected UAVs:opportunities and challenges

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Science China(Information Sciences) 2021年第4期64卷 26-39页

作者： Wee kiat NEW chee Yen LEOW Keivan NAVAIE Yanshi SUN Zhiguo DING Wireless Communication Centre School of Electrical Engineering Faculty of EngineeringUniversiti Teknologi Malaysia Key Laboratory of Wireless-Optical Communications Chinese Academy of SciencesSchool of Information Science and Technology University of Science and Technology of China School of Electrical and Electronic Engineering The University of Manchester School of Computing and Communications Lancaster University

Unmanned aerial vehicles(UAVs) have gained considerable interests in numerous civil applications. To push forward its potentials, cellular-connected UAVs have been introduced. Nevertheless, cellular networks face several bottlenecks such as spectrum scarcity and limited concurrent connectivity. To address these issues, non-orthogonal multiple access(NOMA) can be adopted. NOMA provides several opportunities for cellular-connected UAVs such as larger rate region, balanced performance between system throughput and fairness, and reduced delay. In this paper, we review important findings of the related studies, and outline new opportunities and challenges in NOMA for cellular-connected UAVs. Monte-Carlo simulations are then performed to analyze the new aerial user’s(AU)’s signal characteristics and evaluate the NOMA performance for co-existence of AU and terrestrial user(TU). Our preliminary results show that NOMA is a promising strategy for cellular-connected UAVs.

关键词： cellular-connected UAVs non-orthogonal multiple access signal characteristics aerial user rate terrestrial user rate

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Need for surveillance of concomitant peripheral artery disease in patients with coronary disease: results of the AGATHA survey in Malaysia

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Journal of Geriatric Cardiology 2007年第4期4卷 195-199页

作者： Kui Hian Sim Kok Han chee Inderjit Singh Choon kiat Ang HoungBang Liew Kim Heung tan Omar Ismail Department of Cardiology Sarawak General Hospital Sarawak Malaysia Department of Cardiology Universiti Malaya Medical Centre Petaling Jaya Malaysia Department of Cardiology Penang General Hospital Penang Malaysia

Background For patients with cardiovascular disease (CVD), co-existence of peripheral artery disease (PAD) predicts increased mortality, and such patients are also more likely to benefit from aggressive therapy. Surveillance of PAD is often neglected at health clinics. Our aim is to highlight the importance and ease of surveillance of PAD in patients with CVD. Objective To determine the prevalence of symptomatic and asymptomatic PAD in a Malaysian patient population with documented CVD. Methods and Results A total of 393 subjects with established CVD were recruited from three centres (85 women and 308 men), as part of a larger international (AGATHA) survey. PAD, determined by presence of claudicant symptoms on interview and/or abnormal ankle-brachial index (ABI) score of less than 0.9, was present in 21.4% of patients-of whom 64% were asymptomatic. Abnormal ABI is associated with higher systolic blood pressure and number of arterial beds affected. Conclusions Concomitant PAD is prevalent among CVD patients in Malaysia. ABI screening is simple and yields a high proportion of patients with extensive atherosclerosis who may require more aggressive atherosclerotic risk management.(J Geriatr Cardiol 2007;4:195-199.)

关键词： arteriosclerosis atherothrombosis Malaysia cardiovascular diseases epidemiologic factors anklebrachial index peripheral arterial disease

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Comparative analysis of current diagnostic PCR assays in detecting pathogenic Leptospira isolates from environmental samples

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Asian Pacific Journal of Tropical Medicine 2019年第10期12卷 472-478页

作者： May-Ling Yap Zamberi Sekawi Hui-Yee chee Han kiat Alan Ong Vasantha Kumari Neela Department of Medical Microbiology and Parasitology Faculty of Medicine and Health SciencesUniversiti Putra Malaysia43400 SerdangSelangorMalaysia Department of Pre-Clinical Sciences Faculty of Medicine and Health SciencesUniversiti Tunku Abdul RahmanBandar Sungai Long43000 KajangSelangorMalaysia

Objective:To compare the efficiency of routine diagnostic PCR assays in detecting pathogenic Leptospira isolated from water and ***:Seven routine assays targeting six genes(lip L32,fla B,gyr B,lfb1,sec Y and lig B)were evaluated and compared on the cultures of two groups of pathogenic Leptospira from different *** group included 19 described reference strains recovered from infected human or animals,and another group included 22 environmental isolates from recreational and residential sites in *** latter have been confirmed for presence of pathogenic Leptospira *** positivity or detection sensitivity of each assay was determined and compared between the two ***:Validation on reference strains showed 100.0%PCR sensitivity for all assays except lig B-PCR(95.0%)that failed to amplify Leptospira interrogans serovar *** marked contrast,there was a notable decline in sensitivity in the environmental isolates(lip L32-PCR,95.5%;fla B-PCR,90.9%;gyr B-PCR,77.3%;lfb1-PCR,59.1%;sec Y-PCRs,40.9%G1/G2-PCR,36.4%;lig B-PCR,13.6%),implying a large genetic distance between the two groups,as well as nucleotide polymorphism among environmental ***:High proportion of false-negative PCR results suggests a need of prudent selection of primers in detecting environmental pathogenic *** findings offer valuable insights on the extensive biodiversity of genus Leptospira and its impact on the efficacy and development of molecular detection tool.

关键词： Leptospira Pathogenic species Environmental samples PCR Sensitivity

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Assessment of left ventricular ejection fraction: comparison of two dimensional echocardiography, cardiac magnetic resonance imaging and 64-row multi-detector computed tomography

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Journal of Geriatric Cardiology 2006年第1期3卷 2-8页

作者： chee Khoon LIEW Rapaee ANNUAR Tiong Kiam ONG Sze Piaw CHIN Tobias Seyfarth Yean Yip FONG Choon kiat ANG Houng Bang LIEW Kui Hian SIM Department of Cardiology Sarawak General Hospital Sarawak Malaysia University Malaysia Sarawak Siemens Cardiac Solutions Erlangen Germany Department of Cardiology Sarawak General Hospital SarawakMalaysia

Objectives To compare left ventricular ejection fraction (LVEF) determined from 64-row multi-detector computed tomography (64-row MDCT) with those determined from two dimensional echocardiography (2D echo) and cardiac magnetic resonance imaging (CMR). Methods Thirty-two patients with coronary artery disease underwent trans-thoracic 2D echo, CMR and contrast-enhanced 64-row MDCT for assessment of LVEF within 48 hours of each other. 64-row MDCT LVEF was derived using the Syngo Circulation software; CMR LVEF was by Area Length Ejection Fraction (ALEF) and Simpson method and 2D echo LVEF by Simpson *** The LVEF was 49.13 ± 15.91% by 2D echo, 50.72 ± 16.55% (ALEF method) and 47.65 ± 16.58%(Simpson method) by CMR and 50.00 ± 15.93% by 64-row MDCT. LVEF measurements by 64-row MDCT correlated well with LVEF measured with CMR using either the ALEF method (Pearson correlation r = 0.94, P ＜0.01) or Simpson method (r = 0.92, P＜0.01). It also correlated well with LVEF measured using 2D echo (r = 0.80, P ＜ 0.01). Conclusion LVEF measurements by 64-row MDCT correlated well with LVEF measured by CMR and 2D echo. The correlation between 64-row MDCT and CMR was better than the correlation between 2D echo with CMR. Standard data set from a 64-row MDCT coronary study can be reliably used to calculate the LVEF.

关键词： ejection fraction echocardiography magnetic resonance imaging computed tomography

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Feasibility and accuracy of coronary imaging in elderly patients using the 64-row multi-detector computed tomography: a correlation study with conventional coronary angiography

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Journal of Geriatric Cardiology 2006年第1期3卷 9-14页

作者： chee Khoon LIEW Sze Piaw CHIN Tiong Kiam ONG Seyfarth Tobias Yean Yip FONG Choon kiat ANG Houng Bang LIEW Rapaee ANNUAR Kui Hian SIM Deptartment of Cardiology Sarawak General Hospital SarawakMalaysia Siemens Cardiac Solutions Erlangen Germany Universitv Malaysia Sarawak Malaysia

Background Elderly patients generally have higher occurrence of coronary calcification, increased heart rate and difficulty with prolonged breath-holding. The aim of our study was to investigate the feasibility and accuracy of using 64-row multi-detector computed tomography (MDCT) in the assessment of coronary artery stenoses in elderly patients. Methods One hundred and fifty two patients with suspected or known coronary artery disease were divided into 4 groups according to their age (Group A: 40-49 years,n=34; Group B: 50-59 years, n=57; Group C: 60-69 years, n=48; Group D: 70 years and above; n=13). Coronary CT angiography (CTA) using a 64-row MDCT was performed and the findings were compared with that of conventional coronary angiography (CCA).Using axial images, multi-planar reconstructions (MPR) and maximum intensity projections (MIP), coronary segments of lumen diameter = 1.5mm were analyzed for the presence of significant stenosis (= 50% ). Results Percentages of poor image quality from coronary CTA preventing reliable correlations with CCA were 21%, 14%, 19% and 62% in Groups A to D respectively. Patients in Group D had significantly higher calcium scores compared with the other groups (P＜0.001). In patients where CTA images were of acceptable quality, percentages of accurate correlations with CCA were 89.8%, 93.4%, 86.6% and 78.0% for Groups A to D *** were no significant difference in serum creatinine, heart rate and contrast volume between the 4 groups. Conclusions The 64-row MDCT coronary angiography was less accurate and feasible for patients aged 70 years or above due to heavy coronary calcification and inability to perform a satisfactory breath-hold. However, a high diagnostic accuracy with the MDCT is possible in patients aged less than 70 years.

关键词： computed tomography angiography coronary artery disease elderly

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High-resolution computed tomography in patients with atypical 'cardiac' chest pain: a study investigating patients at 10-year cardiovascular risks defined by the Framingham and PROCAM scores

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Journal of Geriatric Cardiology 2006年第1期3卷 17-21页

作者： Choon kiat ANG Alan Yean Yip FONG Sze Piaw CHIN Tiong Kiam ONG Seyfarth M Tobias chee Khoon LIEW Rapaee ANNUAR Houng Bang LIEW Kui Hian SIM Deptartment of Cardiology Sarawak General Hospital Sarawak Malaysia Siemens Medical Solutions Germany Deptartment of Cardiology Sarawak General Hospital SarawakMalaysia University Malaysia Sarawak Malaysia

Background and objective Atypical 'cardiac' chest pain (ACCP) is not usually caused by myocardial ischaemia. Current noninvasive investigations for these symptoms are not yet as accurate as invasive coronary angiography. The latest 64-row multi-detector computed tomography (MDCT) technology is non-invasive, has high specificity and negative predictive values for the detection of significant coronary disease. Our aim was to investigate if this modality can provide more information in the assessment of outpatients with ACCP in addition to established cardiovascular risk scores. Methods Seventy consecutive patients presenting to the outpatient clinic with ACCP underwent 64-row MDCT scan of the coronary arteries. They were categorized into low, medium or high risk groups based upon the Framingham and PROCAM scores. We defined a clinically abnormal MDCT scan as coronary stenosis =50% or calcium score ＞400 Agatston. Results Fifty-three (75.7%) patients did not have clinically abnormal scans. Framingham score classified 43 patients as low-risk while PROCAM classified 59 patients as low-risk. MDCT scans were abnormal for 18.6% and 22.0% of the respective low-risk group of patients. For patients with medium-to-high risk, 33.3% and 36.4% of Framingham and PROCAM patient groups respectively had abnormal MDCT scans. Conclusion MDCT adds valuable information in the assessment of patients with ACCP by identifying a significant proportion of patients categorized as low-risk to have underlying significant coronary stenosis and coronary calcification by established cardiovascular risk scores.

关键词： multi-detector computed tomography atypical 'cardiac' chest pain coronary artery disease risk stratification

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集成了500V启动单元的ICE3BS02离线开关电源电流模式控制器

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电子设计应用 2004年第5期 118-119页

作者： Lim chee Siong Simon Jeoh Meng kiat Infineon公司

概述ICE3BS02是开关电源电流控制脉宽调制器.它尤其适用于LCD显示器、打印机和笔记本电脑的适配器、DVD播放器、机顶盒及工业辅助电源的AC/DC电源.本文将介绍此款IC的特点.

关键词： ICE3BS02 开关电源电流控制脉宽调制器 “主动”间歇模式自动重启模式过压保护输出过载保护系统开环保护

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