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Quality indicators in pediatric colonoscopy in a low-volume center:Implications for training

World Journal of Gastroenterology 2018年第9期24卷 1013-1021页

作者： Way-Seah Lee Chun-Wei Tee Zhong-Lin Koay Tat-Seng wong Fatimah Zahraq Hee-Wei Foo Sik-Yong Ong shin-yee wong Ruey-Terng Ng Department of Paediatrics University Malaya Medical CentreKuala Lumpur 59100Malaysia Paediatric and Child Health Research Group University MalayaKuala Lumpur 50603Malaysia

AIM To study implications of measuring quality indicators on training and trainees' performance in pediatric colonoscopy in a low-volume training center.METHODS We reviewed retrospectively the performance of pediatric colonoscopies in a training center in Malaysia over 5 years(January 2010-December 2015), benchmarked against five quality indicators: appropriateness of indications, bowel preparations, cecum and ileal examination rates, and complications. The European Society of Gastrointestinal Endoscopy guideline for pediatric endoscopy and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition training guidelines were used as benchmarks.RESULTS Median(± SD) age of 121 children [males = 74(61.2%)] who had 177 colonoscopies was 7.0(± 4.6) years. On average, 30 colonoscopies were performed each year(range: 19-58). Except for investigations of abdominal pain(21/177, 17%), indications for colonoscopies were appropriate in the remaining 83%. Bowel preparation was good in 87%. One patient(0.6%) with severe Crohn's disease had bowel perforation. Cecum examination and ileal intubation rate was 95% and 68.1%. Ileal intubation rate was significantly higher in diagnosing or assessing inflammatory bowel disease(IBD) than non-IBD(72.9% vs 50.0%; P = 0.016). Performance of four trainees was consistent throughout the study period. Average cecum and ileal examination rate among trainees were 97% and 77%.CONCLUSION Benchmarking against established guidelines helps units with a low-volume of colonoscopies to identify area for further improvement.

关键词： Pediatric colonoscopies Quality indicators Performance

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Chronic liver disease is universal in children with biliary atresia living with native liver

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World Journal of Gastroenterology 2017年第43期23卷 7776-7784页

作者： Way Seah Lee Sik Yong Ong Hee Wei Foo shin yee wong Chen Xi Kong Ru Bin Seah Ruey Terng Ng Department of Paediatrics University Malaya Medical Centre Paediatrics and Child Health Research Group University Malaya

AIM To examine the medical status of children with biliary atresia(BA) surviving with native livers.METHODS In this cross-sectional review,data collected included complications of chronic liver disease(CLD)(cholangitis in the preceding 12 mo,portal hypertension,variceal bleeding,fractures,hepatopulmonary syndrome,portopulmonary hypertension) and laboratory indices(white cell and platelet counts,total bilirubin,albumin,international normalized ratio,alanine aminotransferase,aspartate aminotransferase,γ-glutamyl transpeptidase). Ideal medical outcome was defined as absence of clinical evidence of CLD or abnormal laboratory indices. RESULTS Fifty-two children [females = 32,62%; median age 7.4 years,n = 35(67%) older than 5 years] with BA(median age at surgery 60 d,range of 30 to 148 d) survived with native liver. Common complications of CLD noted were portal hypertension(40%,n = 21; 2 younger than 5 years),cholangitis(36%) and bleeding varices(25%,n = 13; 1 younger than 5 years). Fifteen(29%) had no clinical complications of CLD and three(6%) had normal laboratory indices. Ideal medical outcome was only seen in 1 patient(2%). CONCLUSION Clinical or laboratory evidence of CLD are present in 98% of children with BA living with native livers after hepatoportoenterostomy. Portal hypertension and variceal bleeding may be seen in children younger than 5 years of age,underscoring the importance of medical surveillance for complications of BA starting at a young age.

关键词：胆汁的闭锁医药地位长期的肝疾病

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Noise robustness of an operational modal-based structural damage-detection scheme using impact-synchronous modal analysis

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浙江大学学报(英文版)A辑:应用物理与工程 2023年第9期24卷 782-800页

作者： Pei Yi SIOW Zhi Chao ONG shin yee KHOO Kok-Sing LIM Department of Mechanical Engineering Faculty of EngineeringUniversiti MalayaKuala Lumpur 50603Malaysia Photonics Research Centre Deputy Vice Chancellor(Research and Innovation)OfficeUniversiti MalayaKuala Lumpur 50603Malaysia

Data-driven damage-detection schemes are usually unsupervised machine-learning models in practice,as these do not require any training.Vibration-based features are commonly used in these schemes but often require several other parameters to accurately correlate with damage,as they may not globally represent the model,making them less sensitive to damage.Modal data,such as frequency response functions(FRFs)and principal component analysis(PCA)reduced FRFs(PCA-FRFs),inherits the dynamic characteristics of the structure,and it changes when damage occurs,thus showing sensitivity to damage.However,noise from the environment or external sources such as wind,operating machines,or the in-service system itself,can reduce the modal data's sensitivity to damage if not handled properly,which affects damage-detection accuracy.This study proposes a noise-robust operational modal-based structural damage-detection scheme that uses impact-synchronous modal analysis(ISMA)to generate clean,static-like FRFs for damage diagnosis.ISMA allows modal data collection without requiring shutdown conditions,and its denoising feature aids in generating clean,static-like FRFs for damage diagnosis.Our results showed that the FRFs obtained through ISMA under noise conditions have frequency response assurance criterion(FRAC)and cross signature assurance criterion(CSAC)scores greater than 0.9 when compared with FRFs obtained through experimental modal analysis(EMA)under static conditions;this validates the denoising feature of ISMA.When the denoised FRFs are reduced to PCA-FRFs and used in an unsupervised learning-based damage-detection scheme,zero false alarms occur.

关键词： Impact-synchronous modal analysis(ISMA) Frequency response function(FRF) Principal component analysis(PCA) Unsupervised learning Damage detection

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Microglia activation,classification and microglia-mediated neuroinflammatory modulators in subarachnoid hemorrhage

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Neural Regeneration Research 2022年第7期17卷 1404-1411页

作者： Junfan Chen Zhiyuan Vera Zheng Gang Lu Wai yee Chan Yisen Zhang George Kwok Chu wong Division of Neurosurgery Department of SurgeryThe Chinese University of Hong KongHong Kong Special Administrative RegionChina Department of Neurosurgery Hainan Branch of Chinese People’s Liberation Army General HospitalSanyaHainan ProvinceChina CUHK-SDU Joint Laboratory on Reproductive Genetics School of Biomedical Sciencesthe Chinese University of Hong KongHong Kong Special Administrative RegionChina Bioinformatics Unit SDIVF R&D CentreHong Kong Science and Technology ParksHong Kong Special Administrative RegionChina Department of Interventional Neuroradiology Beijing Neurosurgical InstituteBeijing Tiantan HospitalCapital Medical UniversityBeijingChina

Subarachnoid hemorrhage is a devastating disease with significant mortality and morbidity,despite advances in treating cerebral aneurysms.There has been recent progress in the intensive care management and monitoring of patients with subarachnoid hemorrhage,but the results remain unsatisfactory.Microglia,the resident immune cells of the brain,are increasingly recognized as playing a significant role in neurological diseases,including subarachnoid hemorrhage.In early brain injury following subarachnoid hemorrhage,microglial activation and neuroinflammation have been implicated in the development of disease complications and recovery.To understand the disease processes following subarachnoid hemorrhage,it is important to focus on the modulators of microglial activation and the pro-inflammatory/anti-inflammatory cytokines and chemokines.In this review,we summarize research on the modulators of microglia-mediated inflammation in subarachnoid hemorrhage,including transcriptome changes and the neuroinflammatory signaling pathways.We also describe the latest developments in single-cell transcriptomics for microglia and summarize advances that have been made in the transcriptome-based classification of microglia and the implications for microglial activation and neuroinflammation.

关键词： activation inflammation microglia modulator neuroinflammation sequencing signal pathway single-cell analysis stroke subarachnoid hemorrhage treatment

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A useful guide of effective mesh-size decision in predicting the ultimate strength of flat-and curved plates in compression

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Journal of Ocean Engineering and Science 2023年第4期8卷 401-417页

作者： Do Kyun Kim Imjun Ban Bee yee Poh Sung-Chul shin Department of Naval Architecture and Ocean Engineering College of EngineeringSeoul National UniversitySeoulSouth Korea Research Institute of Marine Systems Engineering Seoul National UniversitySeoulKorea Group of Marine Offshore and Subsea Technology(MOST)School of EngineeringNewcastle UniversityNewcastle upon TyneUK Department of Naval Architecture and Ocean Engineering Pusan National UniversityBusanSouth Korea Ocean and Ship Technology Research Group Department of Civil and Environmental EngineeringPETRONAS University of TechnologySeri IskandarPerakMalaysia

The present study aims to determine the appropriate size of mesh or the number of the element(NoE)for flat-and curved plates,which is suggested to assess its safety subjected to axial compression based on the ultimate limit state(ULS)design and analysis concept.The unstiffened panel(=plate)and stiff-ened panel,considered primary members of ships and ship-shaped offshore structures,are subjected to repeated axial compression and tension caused by continued vertical bending moments applied to the hull girder.Plates are attached with stiffeners by welding,and 6,8 or 10 elements are generally rec-ommended to allocate in flat-plate’s breadth direction in between stiffeners for finite-element(FE)mod-elling,which enables the presentation of the shape of initial deflection applied to the plate.In the case of the load-shorting curve for curved plate,it is reported that the nonlinear behaviour characteristics,i.e.,snap-through,snap-back,secondary buckling and others,appear in typical flank angle.To take this into account,we investigated the preferred number of elements(6,8 or 10)generally applied to the flat plate whether it is an appropriate or more fine-sized element(or mesh)that should be considered.A useful guide is documented based on obtained outcomes which may help structural engineers select optimised mesh-size to predict ultimate strength and understand its characteristic of the flat and curved plates.

关键词： Ultimate strength Unstiffened panel Longitudinal compression Mesh convergence Finite-element method

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Novel role of STAT3 in microglia-dependent neuroinflammation after experimental subarachnoid haemorrhage

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Stroke & Vascular Neurology 2022年第1期7卷 62-70页

作者： Zhiyuan Vera Zheng Junfan Chen Hao Lyu Sin Yu Erica Lam Gang Lu Wai yee Chan George K C wong Department of Surgery The Chinese University of Hong KongShatinHong Kong Department of Surgery Hainan General HospitalHaikouHainanChina School of Biomedical Science The Chinese University of Hong KongShatinHong Kong

Background and purpose Signal transducer and activator of transcription 3(STAT3)may contribute to the proinflammation in the central nervous system diseases by modulating the microglial responses.Thus,this study was intended to investigate the effect of STAT3 on microglia-dependent neuroinflammation and functional outcome after experimental subarachnoid haemorrhage(SAH).Methods The SAH model was established by endovascular perforation in the mouse.Real-time PCR(RtPCR)and western blot were used to examine the dynamic STAT3 signalling pathway responses after SAH.To clarify the role of the STAT3 signalling pathway in the microglia-dependent neuroinflammation after SAH,the microglia-specific STAT3 knockout(KO)mice were generated by the Cre-LoxP system.The neurological functions were assessed by Catwalk and Morris water maze tests.Neuronal loss after SAH was determined by immunohistochemistry staining.Microglial polarisation status after STAT3 KO was then examined by RtPCR and immunofluorescence.Results The STAT3 and Janus kinase-signal transducer 2 activated immediately with the upregulation and phosphorylation after SAH.Downstream factors and related mediators altered dynamically and accordingly.Microglial STAT3 deletion ameliorated the neurological impairment and alleviated the early neuronal loss after SAH.To investigate the underlying mechanism,we examined the microglial reaction after STAT3 KO.STAT3 deletion reversed the increase of microglia after SAH.Loss of STAT3 triggered the early morphological changes of microglia and primed microglia from M1 to M2 polarisation.Functionally,microglial STAT3 deletion suppressed the SAH-induced proinflammation and promoted the anti-inflammation in the early phase.Conclusions STAT3 is closely related to the microglial polarisation transition and modulation of microglia-dependent neuroinflammation.Microglial STAT3 deletion improved neurological function and neuronal survival probably through promoting M2 polarisation and anti-inflammatory responses after SAH.STAT3 may serve as

关键词： STAT3 inflammation reversed

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Need of integrated dietary therapy for persons with diabetes mellitus and “unhealthy” body constitution presentations

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Journal of Integrative Medicine 2016年第4期14卷 255-268页

作者： yee Chi Peggy wong Dietetic Department Tuen Mun Hospital

From a perspective of Chinese medicine （CM）, persons with unregulated ＂unhealthy＂ body constitution （BC） will further develop chronic diseases, such as diabetes mellitus （DM）. Conventional dietary therapy with nutrition component has its limitations in the regulation of ＂unhealthy＂ BC. However, empirical evidence supports that ＂unhealthy＂ BC can be regulated with food natures and flavors from a perspective of CM. Presentations of ＂unhealthy＂ BC types, such as Yin-deficiency, Yang-deficiency and Yin-Yangdeficiency were found in persons with DM. It would be necessary to regulate the ＂unhealthy＂ BC presentations with integration of conventional dietary therapy and Chinese food therapy. The ultimate goal is to either stabilize glycaemic control or prevent the development of other chronic diseases leading to reduction of disease burden, such as disease-related poor quality of life, stress of healthcare professionals and the rising of healthcare cost.

关键词： body constitution diabetes mellitus Yin deficiency Yang deficiency dietary therapy

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A Stacked Ensemble Deep Learning Approach for Imbalanced Multi-Class Water Quality Index Prediction

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Computers, Materials & Continua 2023年第8期76卷 1361-1384页

作者： Wen yee wong Khairunnisa Hasikin Anis Salwa Mohd Khairuddin Sarah Abdul Razak Hanee Farzana Hizaddin Mohd Istajib Mokhtar Muhammad Mokhzaini Azizan Department of Biomedical Engineering Faculty of EngineeringUniversity of MalayaKuala Lumpur50603Malaysia Department of Electrical Engineering Faculty of EngineeringUniversity of MalayaKuala Lumpur50603Malaysia Institute of Biological Sciences Faculty of ScienceUniversity of MalayaKuala Lumpur50603Malaysia Department of Chemical Engineering Faculty of EngineeringUniversity of MalayaKuala Lumpur50603Malaysia Department of Science and Technology Studies Faculty of ScienceUniversity of MalayaKuala Lumpur50603Malaysia Department of Electrical and Electronic Engineering Faculty of Engineering and Built EnvironmentUniversiti Sains Islam MalaysiaNilaiNegeri Sembilan71800Malaysia

A common difficulty in building prediction models with real-world environmental datasets is the skewed distribution of classes.There are significantly more samples for day-to-day classes,while rare events such as polluted classes are uncommon.Consequently,the limited availability of minority outcomes lowers the classifier’s overall reliability.This study assesses the capability of machine learning(ML)algorithms in tackling imbalanced water quality data based on the metrics of precision,recall,and F1 score.It intends to balance the misled accuracy towards the majority of data.Hence,10 ML algorithms of its performance are compared.The classifiers included are AdaBoost,SupportVector Machine,Linear Discriminant Analysis,k-Nearest Neighbors,Naive Bayes,Decision Trees,Random Forest,Extra Trees,Bagging,and the Multilayer Perceptron.This study also uses the Easy Ensemble Classifier,Balanced Bagging,andRUSBoost algorithm to evaluatemulti-class imbalanced learning methods.The comparison results revealed that a highaccuracy machine learning model is not always good in recall and sensitivity.This paper’s stacked ensemble deep learning(SE-DL)generalization model effectively classifies the water quality index(WQI)based on 23 input variables.The proposed algorithm achieved a remarkable average of 95.69%,94.96%,92.92%,and 93.88%for accuracy,precision,recall,and F1 score,respectively.In addition,the proposed model is compared against two state-of-the-art classifiers,the XGBoost(eXtreme Gradient Boosting)and Light Gradient Boosting Machine,where performance metrics of balanced accuracy and g-mean are included.The experimental setup concluded XGBoost with a higher balanced accuracy and G-mean.However,the SE-DL model has a better and more balanced performance in the F1 score.The SE-DL model aligns with the goal of this study to ensure the balance between accuracy and completeness for each water quality class.The proposed algorithm is also capable of higher efficiency at a lower computational time against using the standard Synthetic

关键词： Water quality classification imbalanced data SMOTE stacked ensemble deep learning sensitivity analysis

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Hokkien Merchants and the Kian Teik Tong： Economic and Political Influence in Nineteenth- Century Penang and Its Region

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Frontiers of History in China 2016年第4期11卷 600-627页

作者： yee Tuan wong History Studies Section Penang Institute 10350 Penang Malaysia

This article explores nineteenth-century Penang＇s Hokkkien merchants and their secret society or hui-the Klan Teik Tong diande Tang）--which had a variety of roles and an extensive network. It contextualizes the merchants＇ secret society as a transnational socioeconomic and political organization rather than as an overseas Chinese criminal group in the wider Penang area. By recovering Klan Teik Tong and its network, it can be shown how these merchants secured and mobilized labour, capital, and allies in a way that cut across linguistic, ethnic, class and state boundaries in order to establish control of coolies and the lucrative opium, tin, and rice businesses, in order to exert political influence in the colonial and indigenous milieus of the nineteenth-century Penang region. They established a social contract through their Klan Teik Tong relief activities and initiation rituals, and thus were able to recruit thousands of members who were mainly labourers. With such a substantial social force, the merchants launched organized violence against their rivals to attain dominance in opium revenue farming and tin mining businesses in Penang, Krabi, and Perak. The widespread and strategic location of the Klan Teik Tong in Burma also enabled the same merchants to monopolize the Penang-Burma rice trade. The versatility of the Klan Teik Tong＇s functions allowed them to operate as an alternative political order vis-a-vis the colonial and indigenous powers. This arrangement allowed the Hokkien merchants to gain significant political clout in confronting the Siamese and Dutch authorities.

关键词： Hokkien Penang secret society social control economicdominance political influence

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A Qualitative Examination of Teacher-Student Power-Sharing in Chinese Classrooms:A Study in Hong Kong

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Frontiers of Education in China 2015年第2期10卷 251-273页

作者： Mei-yee wong Department of Social Sciences The Hong Kong Institute of EducationHong KongChina

This article explores the dynamics of power-sharing between teacher and students in learning and teaching situations,and describes the theoretical bases,implementation,and results of an empirical study in three elementary schools in Hong Kong Special Administrative Region of the People’s Republic of China.Findings from 58 class observations and interviews with 50 students,25 teachers,and three school principals suggest that teachers can empower students by acknowledging their right to and responsibility for learning and by sharing power with students.Power-sharing classroom practice requires the dual efforts of teachers and students,and can be facilitated by the teachers’interactive teaching mode,students’cooperation and willingness to engage in learning,and school policy and culture,etc.In the power-sharing classrooms,teachers played the role of facilitators and students played as collaborators.In this article,theoretical implications for understanding power-sharing and critical pedagogy are discussed.The empirical evidence from this Hong Kong study contributes to an understanding of teacher-initiated power-sharing in the Chinese context,and the practice of critical pedagogy in classrooms.

关键词： power-sharing critical pedagogy elementary schools Hong Kong education

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