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Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review

World Journal of Gastrointestinal Surgery 2024年第3期16卷 777-789页

作者： kai siang.chan Biquan Liu Ming Ngan Aloysius Tan Kwang Yeong How Kar Yong Wong Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore

BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality *** 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on *** LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical *** and/or PE is a major and complex surgery with high post-operative *** invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic *** is a single-center retrospective cohort study from 1st January 2015 to 31st March *** criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic ***-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also *** criteria were patients with systemic metastases with non-resectable *** patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal *** sur-gery was defined based on technical difficulty of surgery(*** PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication ***-gorical values were described as percentages and analysed by the chi-square *** variables were expressed as median(range)and analysed by Mann-Whitney U *** overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table ***-rank test was performed to determine statistical significance between cumulative *** significance was defined as P<*** estimates with li

关键词： Laparoscopy Minimally invasive surgical procedures Multivisceral resection Pelvic Exenteration Rectal neoplasms Robotic surgical procedures

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Outcomes of liver resection in hepatitis C virus-related intrahepatic cholangiocarcinoma:A systematic review and meta-analysis

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World Journal of Virology 2024年第1期13卷 107-119页

作者： Feng Yi Cheo kai siang.chan Vishal G Shelat Yong Loo Lin School of Medicine National University of SingaporeSingapore 117597Singapore Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore

BACKGROUND Cholangiocarcinoma is the second most common primary liver *** incidence and mortality rates have been increasing in recent *** C virus(HCV)infection is a risk factor for development of cirrhosis and ***,surgical resection remains the only curative treatment option for *** aim to study the impact of HCV infection on outcomes of liver resection(LR)in intrahepatic cholangiocarcinoma(ICC).AIM To study the outcomes of curative resection of ICC in patients with HCV(i.e.,HCV+)compared to patients without HCV(i.e.,HCV-).METHODS We conducted a systematic review and meta-analysis of randomized controlled trials(RCTs)and observational studies to assess the outcomes of LR in ICC in HCV+patients compared to HCV-patients in tertiary care ***,EMBASE,The Cochrane Library and Scopus were systematically searched from inception till August *** studies were RCTs and non-RCTs on patients≥18 years old with a diagnosis of ICC who underwent LR,and compared outcomes between patients with HCV+vs HCV-.The primary outcomes were overall survival(OS)and recurrence-free *** outcomes include perioperative mortality,operation duration,blood loss,intrahepatic and extrahepatic *** Seven articles,published between 2004 and 2021,fulfilled the selection *** of the studies were retrospective ***,incidence of male patients,albumin,bilirubin,platelets,tumor size,incidence of multiple tumors,vascular invasion,bile duct invasion,lymph node metastases,and stage 4 disease were comparable between HCV+and *** transaminase[MD 22.20,95%confidence interval(CI):13.75,30.65,P<0.00001]and aspartate transaminase levels(MD 27.27,95%CI:20.20,34.34,P<0.00001)were significantly higher in HCV+group compared to *** of cirrhosis was significantly higher in HCV+group[odds ratio(OR)5.78,95%CI:1.38,24.14,P=0.02]compared to *** of poorly

关键词： Cholangiocarcinoma Bile duct cancer Hepatitis C Surgical resection Hepatectomy

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Finite barrier bound state

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Light(Science & Applications) 2024年第4期13卷 664-671页

作者： Tao Liu kai Bai Yicheng Zhang Duanduan Wan Yun Lai C.T.chan Meng Xiao Key Laboratory of Artificial Micro-and Nano-structures of Ministry of Education and School of Physics and Technology Wuhan University430072 WuhanChina. National Laboratory of Solid State Microstructures School of Physicsand Collaborative Innovation Center of Advanced MicrostructuresNanjing University210093 NanjingChina. Department of Physics The Hong Kong University of Science and TechnologyClear Water BayKowloon999077Hong KongChina. Wuhan Institute of Quantum Technology 430206 WuhanChina

A boundary mode localized on one side of a finite-size lattice can tunnel to the opposite side which results in unwanted *** wisdom tells that the tunneling probability decays exponentially with the size of the system which thus requires many lattice sites before eventually becoming negligibly *** we show that the tunneling probability for some boundary modes can apparently vanish at specific ***,similar to bound states in the continuum,a boundary mode can be completely trapped within very few lattice sites where the bulk bandgap is not even *** intriguingly,the number of trapped states equals the number of lattice sites along the normal direction of the *** provide two configurations and validate the existence of this peculiar finite barrier-bound state experimentally in a dielectric photonic crystal at microwave *** work offers extreme flexibility in tuning the coupling between localized states and channels as well as a new mechanism that facilitates unprecedented manipulation of light.

关键词： boundary state eventually

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Sound event localization and detection based on deep learning

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Journal of Systems Engineering and Electronics 2024年第2期35卷 294-301页

作者： ZHAO Dada DING kai QI Xiaogang CHEN Yu FENG Hailin School of Mathematics and Statistics Xidian UniversityXi’an 710071China Science and Technology on Near-Surface Detection Laboratory Wuxi 214035China

Acoustic source localization(ASL)and sound event detection(SED)are two widely pursued independent research *** recent years,in order to achieve a more complete spatial and temporal representation of sound field,sound event localization and detection(SELD)has become a very active research *** paper presents a deep learning-based multioverlapping sound event localization and detection algorithm in three-dimensional ***-Mel spectrum and generalized cross-correlation spectrum are joined together in channel dimension as input *** features are classified and regressed in parallel after training by a neural network to obtain sound recognition and localization results *** channel attention mechanism is also introduced in the network to selectively enhance the features containing essential information and suppress the useless ***,a thourough comparison confirms the efficiency and effectiveness of the proposed SELD *** experiments show that the proposed algorithm is robust to reverberation and environment and can achieve higher recognition and localization accuracy compared with the baseline method.

关键词： sound event localization and detection(SELD) deep learning convolutional recursive neural network(CRNN) channel attention mechanism

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Genomics-driven derivatization of the bioactive fungal sesterterpenoid variecolin:Creation of an unnatural analogue with improved anticancer properties

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Acta Pharmaceutica Sinica B 2024年第1期14卷 421-432页

作者： Dexiu Yan Jemma Arakelyan Teng Wan Ritvik Raina Tsz Ki chan Dohyun Ahn Vladimir Kushnarev Tsz Kiu Cheung Ho Ching chan Inseo Choi Pui Yi Ho Feijun Hu Yujeong Kim Hill Lam Lau Ying Lo Law Chi Seng Leung Chun Yin Tong kai Kap Wong Wing Lam Yim Nikolay S.Karnaukhov Richard Y.C.Kong Maria V.Babak Yudai Matsuda Department of Chemistry City University of Hong KongHong Kong SARChina iGEM Team“VarieCure” City University of Hong KongHong Kong SARChina Department of Biomedical Engineering City University of Hong KongHong Kong SARChina Moscow Clinical Research Center Named After A.S.Loginov Moscow 111123Russian Federation

A biosynthetic gene cluster for the bioactive fungal sesterterpenoids variecolin(1)and variecolactone(2)was identified in Aspergillus aculeatus ATCC *** production of 1 and 2 was achieved in Aspergillus oryzae by expressing the sesterterpene synthase VrcA and the cytochrome P450 ***,the replacement of VrcB with homologous P450s from other fungal terpenoid pathways yielded three new variecolin analogues(5-7).Analysis of the compounds’anticancer activity in vitro and in vivo revealed that although 5 and 1 had comparable activities,5 was associated with significantly reduced toxic side effects in cancer-bearing mice,indicating its potentially broader therapeutic *** study describes the first tests of variecolin and its analogues in animals and demonstrates the utility of synthetic biology for creating molecules with improved biological activities.

关键词： Animal studies Anticancer properties Biosynthesis Natural products Sesterterpenoids Synthetic biology Terpene synthases Variecolin

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Diagnosis,severity stratification and management of adult acute pancreatitis–current evidence and controversies

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World Journal of Gastrointestinal Surgery 2022年第11期14卷 1179-1197页

作者： kai siang.chan Vishal G Shelat Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore Yong Loo Lin School of Medicine National University of SingaporeSingapore 117597Singapore

Acute pancreatitis(AP)is a disease spectrum ranging from mild to severe with an unpredictable natural *** of cases(80%)are mild and ***,severe AP(SAP)has a mortality risk of up to 30%.Establishing aetiology and risk stratification are essential pillars of clinical *** AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a *** of management of mild AP include pain control and management of aetiology to prevent *** SAP,patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care *** prophylactic antibiotics have limited clinical benefit and should not be given in *** able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral *** unable to tolerate per-orally,nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical *** retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute *** step-up strategy including percutaneous retroperitoneal drainage,endoscopic debridement,or minimal-access necrosectomy are sufficient in most SAP *** should be monitored for diabetes mellitus and pseudocyst.

关键词： Atlanta classification Drainage Infections Necrosectomy Pancreatitis Risk stratification

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Carbon footprints in minimally invasive surgery:Good patient outcomes,but costly for the environment

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World Journal of Gastrointestinal Surgery 2023年第7期15卷 1277-1285页

作者： kai siang.chan Hong Yee Lo Vishal G Shelat Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore Yong Loo Lin School of Medicine National University of SingaporeSingapore 117597Singapore

Advancements in technology and surgical training programs have increased the adaptability of minimally invasive surgery(MIS).Gastrointestinal MIS is superior to its open counterparts regarding post-operative morbidity and *** has become the first-line surgical intervention for some types of gastrointestinal surgery,such as laparoscopic cholecystectomy and *** dioxide(CO_(2))is the main gas used for insufflation in ***_(2)contributes 9%-26%of the greenhouse effect,resulting in global *** rise in global CO_(2)concentration since 2000 is about 20 ppm per decade,up to 10 times faster than any sustained rise in CO_(2)during the past 800000 *** 1970,there has been a steady yet worrying increase in average global temperature by 1.7℃ per century.A recent systematic review of the carbon footprint in MIS showed a range of 6-814 kg of CO_(2)emission per surgery,with higher CO_(2)emission following robotic compared to laparoscopic ***,with superior benefits of MIS over open surgery,this poses an ethical dilemma to surgeons.A recent survey in the United Kingdom of 130 surgeons showed that the majority(94%)were concerned with climate change but felt that the lack of leadership was a barrier to improving environmental *** the deleterious environmental effects of MIS,this study aims to summarize the trends of MIS and its carbon footprint,awareness and attitudes towards this issue,and efforts and challenges to ensuring environmental sustainability.

关键词： Carbon footprint Environment Environmental pollution Minimally invasive surgical procedures Sustainability

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Outcomes of patients with post-hepatectomy hypophosphatemia:A narrative review

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World Journal of Hepatology 2022年第8期14卷 1550-1561页

作者： kai siang.chan Swetha Mohan Vishal G Shelat Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore

Phosphate is an essential electrolyte for proper mineralisation of bone,buffering of urine,and diverse cellular ***(HP)is a clinical spectrum which range from asymptomatic to severe complications such as neuromuscular and pulmonary complications,or even ***-hepatectomy HP(PHH)has been reported to be 55.5%-100%.Post-hepatectomy,there is rapid uptake of phosphate and increased mitotic counts to aid in regeneration of residual ***,PHH may be due to increased urinary phosphorous from activation of matrix extracellular phosphoglycoprotein in the injured liver,which decreases phosphate influx into hepatocytes to sustain adenosine triphosphate synthesis.A literature review was performed on Pub Med till January *** included 8 studies which reported on impact of PHH on post-operative *** patients with diseased liver,PHH was reported to have either beneficial or deleterious effects on post-hepatectomy liver failure(PHLF),morbidity and/or mortality in various *** living donor hepatectomy,PHLF was higher in *** of correction of PHH with reduced postoperative complications have been *** of PHH should be done based on extent of *** studies were however heterogenous;further studies should be conducted to assess PHH on post-operative outcomes with standardized phosphate replacement regimes.

关键词： Hepatectomy Hepatocellular Carcinoma Hypophosphatemia Phosphates Liver neoplasms Liver transplantation

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On-table hepatopancreatobiliary surgical consults for difficult cholecystectomies:A 7-year audit

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 273-278页

作者： kai siang.chan Elizabeth Hwang JeeKeem Low SameerP Junnarkar Cheong Wei Terence Huey Vishal G Shelat Department of General Surgery Tan Tock Seng Hospital308433Singapore

Background: Cholecystectomy is considered a general surgical operation. However, general surgeons are not trained to manage severe complications such as bile duct injury(BDI) and should refer to hepatopancreatobiliary(HPB) surgeons when difficulty arises. This study aimed to investigate the outcomes of patients who had on-table HPB consults during cholecystectomy. Methods: This is an audit of 50 patients who required on-table HPB consult during cholecystectomy from 2011 to 2017. Consultations were classified as “proactive” and “reactive”, where consults were made before or after surgical incision, respectively. Patient demographics and perioperative details were collected. Results: The median age of the patients was 62.5 years [interquartile range(IQR) 50.8–71.3 years]. Eight(16%) patients had underlying HPB co-morbidity. Gallbladder wall was thickened in all patients(median 5 mm, IQR 4–7 mm), and common bile duct was of normal caliber in all patients(median 5 mm, IQR 4–6 mm). Median length of operation and length of stay were 165 min(IQR 124–209 min) and five days(IQR 3–7 days), respectively. Subtotal cholecystectomy was performed in 18(36%) patients. Forty-eight patients were initially managed by laparoscopic approach, 15(31%) required open conversion;majority(9/15, 60%) were initiated before on-table consult. Majority of referrals(98%) were reactive. Common reasons for referral included unclear anatomy or anatomical variations(30%), presence of dense adhesions and/or contracted gallbladder(18%) and impacted stones in Hartmann’s pouch(16%). Three(6%) patients were referred for BDI(2 Strasberg D and 1 Strasberg E1), and two(4%) were referred for torrential bleeding from arterial injury(1 cystic artery and 1 right hepatic artery). Any morbidity and 30-day readmission were 22% and 6%, respectively. There was no 90-day mortality. Conclusions: Calling for help in BDI is obligatory, but in other instances is a personal choice. Calling for help prior to open conversion i

关键词： Bile duct injury Cholecystectomy Cholecystitis On-table consult Quality indicators Hepatopancreatobiliary surgery

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Monkeypox awareness,knowledge,and attitude among undergraduate preclinical and clinical students at a Malaysian dental school:An emerging outbreak during the COVID-19 era

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Asian Pacific Journal of Tropical Medicine 2022年第10期15卷 461-467页

作者： Galvin Sim siang Lin Wen Wu Tan Daryl Zhun Kit chan kai Shen Ooi Hasnah Hashim Department of Dental Materials Faculty of DentistryAsian Institute of MedicineScience and Technology(AIMST)University08100BedongKedahMalaysia Department of Dental Public Health Faculty of DentistryAsian Institute of MedicineScience and Technology(AIMST)University08100BedongKedahMalaysia Department of Paediatrics Faculty of MedicineUniversiti Kebangsaan Malaysia Medical Centre56000Kuala LumpurMalaysia

Objective:To evaluate the awareness,knowledge,and attitude on monkeypox viral infection among preclinical and clinical dental students in ***:A cross-sectional study was conducted among 229 preclinical and clinical dental students via an online self-reported *** questionnaire included 3 items on awareness,15 items on knowledge,9 items on attitude and 2 open-ended *** were presented as frequencies and ***-square test was used to compare knowledge and awareness scores between preclinical and clinical dental students and content analysis was performed for open-ended ***:Preclinical and clinical dental students were aware of the existence of monkeypox(89.5%and 94.4%,respectively),that the disease emerged in non-endemic countries(81.0%and 87.1%,respectively)and that it was declared a public health emergency of international concern by the World Health Organization(73.3%and 79.0%,respectively).Clinical dental students’overall knowledge level was significantly higher than preclinical dental students(P=0.014).Both preclinical(95.2%)and clinical(96.8%)dental students demonstrated positive attitudes toward monkeypox with no significant difference(P=0.736)noted between *** themes emerged from the open-ended questions:(1)reimplementation of nationwide lockdown,(2)impact on the economy and health,and(3)disruption to the educational *** also anticipated their face-to-face learning to be reduced should there be a new ***:Both preclinical and clinical dental students showed comparable awareness and attitudes,while the latter demonstrated greater satisfactory knowledge toward the re-emergence of monkeypox during the COVID-19 ***,efforts to improve dental students’understanding of this alarming outbreak are required,to safeguard their health and minimise transmission.

关键词： Communicable disease Monkeypox virus Public health Tropical disease Zoonoses

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