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Gastroesophageal reflux disease at the turn of millennium

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World Journal of Gastroenterology 2003年第10期9卷 2135-2136页

作者： lee-guan lim Khek-Yu Ho Department of Medicine National University HospitalSingapore

Gastroesophageal reflux disease (GERD) has been an area of active research in the Asia-Pacific region in the recent years. This article outlines some of the interesting research findings. It comprises three parts. The first part dealt with recent data on the changing epidemiology of GERD in *** second part summarized published studies on the relationship between GERD and Helicobacter pylori, relevant to the Asia-Pacific region. The last part discussed some of the recent advances in the treatment of GERD.

关键词： Gastroesophageal Reflux Helicobacter Infections Humans

Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices

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World Journal of Gastroenterology 2009年第30期15卷 3823-3826页

作者： lee-guan lim Yin-Mei lee Lenny Tan Stephen Chang Seng-Gee lim Department of Gastroenterology and Hepatology National University HospitalSingapore 119074Singapore Department of Diagnostic Radiology National University HospitalSingapore 119074Singapore Department of Surgery National University HospitalSingapore 119074Singapore

A 48-year-old Indian male with alcoholic liver cirrhosis was admitted after being found unresponsive. He was hypotensive and had hematochezia. Esophagogastroduodenoscopy (EGD) showed small esophageal varices and a clean-based duodenal ulcer. He continued to have hematochezia and anemia despite blood transfusions. Colonoscopy was normal. Repeat EGD did not reveal any source of recent bleed. Twelve days after admission, his hematochezia ceased. He refused further investigation and was discharged two days later. He presented one week after discharge with hematochezia. EGD showed non-bleeding Grade 1 esophageal varices and a clean-based duodenal ulcer. Colonoscopy was normal. Abdominal computed tomography (CT) showed liver cirrhosis with mild ascites, paraumbilical varices, and splenomegaly. He had multiple episodes of hematochezia, requiring repeated blood transfusions. Capsule endoscopy identified the bleeding site in the jejunum. Concurrently, CT angiography showed paraumbilical varices inseparable from a loop of small bowel, which had herniated through an umbilical hernia. The lumen of this loop of small bowel opacified in the delayed phase, which suggested variceal bleeding into the small bowel. Portal vein thrombosis was present. As he had severe coagulopathy and extensive paraumbilical varices, surgery was of high risk. He was not suitable for transjugular intrahepatic porto-systemic shunt as he had portal vein thrombosis. Percutaneous paraumbilical embolization via caput medusa was performed on day 9 of hospitalization. Following the embolization, the hematochezia stopped. However, he defaulted subsequent follow-up.

关键词： Embolization Jejunal varices Obscurebleed Capsule endoscopy Angiography

Alanine aminotransferase is an inadequate surrogate marker for detecting lamivudine resistance

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World Journal of Gastroenterology 2010年第37期16卷 4691-4696页

作者： lee guan lim Myat Oo Aung Bee Leng Seet Cindy Tan Yock Young Dan Yin Mei lee Dede Selamat Sutedja Mark Fernandes guan Huei lee Evelyn Koay Seng Gee lim Department of Gastroenterology and Hepatology National University Health System Yong Yoo Lin School of Medicine National University of Singapore Department of Medicine National University Health System Yong Yoo Lin School of Medicine National University of Singapore Molecular Diagnostic Centre National University Health System Yong Yoo Lin School of Medicine National University of Singapore Investigative Medicine Unit National University Health System Yong Yoo Lin School of Medicine National University of Singapore

AIM: To investigate the accuracy of serum alanine aminotransferase (ALT) in diagnosing lamivudine resistance and factors that contributed to abnormal serum ***: This was a retrospective study of chronic hepatitis B patients on lamivudine therapy who were followed for 3-mo with liver function tests and hepatitis B virus (HBV) DNA measurement. Lamivudine resistance was defined as HBV DNA ≥ 1 log from nadir on at least 2 occasions, confirmed by genotyping. Serum ALT levels in patients with lamivudine resistance were compared to serum ALT levels in those without lamivudine resistance. RESULTS: There were 111 patients with and 117 without lamivudine resistance. The area under the receiver operating characteristic of serum ALT to diagnose lamivudine resistance was 0.645 ± 0.037. Serum ALT > 42.5 U/L gave the best diagnostic accuracy with sensitivity = 61%, specificity = 60%, positive predictive value = 60%, negative predictive value = 61%, positive likelihood ratio = 1.53 and negative likelihood ratio = 0.65 for predicting lamivudine resistance, missing 39% of resistant patients. Using other serum ALT cutoffs, diagnostic accuracy was lower. By multivariate analysis, baseline abnormal serum ALT was associated with abnormal ALT during resistance (OR = 5.98, P = 0.003), and males were associated with serum ALT flares during resistance (OR = 8.9, P = 0.016). CONCLUSION: Serum ALT is inadequate for diagnosing lamivudine resistance and has implications where viral resistance testing is suboptimal and for reimbursement of rescue therapy.

关键词： Antiviral therapy Chronic hepatitis B Sensitivity Specificity YMDD mutants

Acute-on-chronic liver failure in a multi-ethnic Asian city:A comparison of patients identified by Asia-Pacific Association for the Study of the Liver and European Association for the Study of the Liver definitions

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World Journal of Hepatology 2017年第28期9卷 1133-1140页

作者： Anandraj Selva Rajoo Seng-Gee lim Wah Wah Phyo Thandar Tun Yock-Young Dan Yin-Mei lee How-Cheng Low Kieron lim Poh-Seng Tan guan-Huei lee Yong Loo Lin School of Medicine National University of SingaporeSingapore 119077Singapore Institute of Molecular and Cell Biology ASTARSingapore 138668Singapore Division of Gastroenterology and Hepatology Department of MedicineNational University HospitalSingapore 119228Singapore Department of Hepatology Mandalay General Hospital30th StChan Aye Tharsan TownshipMandalayMyanmar

AIM To explore the applicability of the Asia-Pacific Association for the Study of the Liver(APASL) and European Association for the Study of the Liver(EASL) guidelines for acute-on-chronic liver failure(ACLF) in profiling patients and determining the *** Patients admitted to a tertiary hospital in Singapore with acute decompensation of liver disease from January 2004to July 2014 are screened for ACLF according to the APASL and EASL criteria. The patients' data(including basic demographics, information about existing chronic liver disease, information about the acute decompensation, relevant laboratory values during admission, treatment, and outcome) are retrospectively analyzed to determine the background, precipitating factors and *** A total of 458 liver patients is analyzed, and 78 patients with ACLF are identified. Sixty-three patients(80.8%) meet the APASL criteria, 64 patients(82.1%) meet the EASL criteria, and 49 patients(62.8%) fulfilled both criteria. The most common causes of acute liver injury are bacterial infections(59.0%), hepatitis B flare(29.5%), and variceal bleeding(24.4%). The common aetiologies of the underlying chronic disease included hepatitis B(43.6%), alcoholic(20.5%) and cryptogenic(11.5%) liver disease. The overall mortality rate is 61.5%. Increased age, the number of organ failures(as per CLIF-SOFA score), peak creatinine, INR, and amylase levels are associated with increased mortality or the need for liver transplantation. 14.3% of patients undergo liver transplantation with a 100% 1-year survival rate. CONCLUSION Both APASL and EASL criteria have identified ACLF patients with high three-month mortality, but those who fulfill APASL criteria alone have a better survival.

关键词： Acute-on-chronic liver failure Survival Prognosis Liver decompensation Liver cirrhosis

The need for pre-emptive control strategies for mpox in Asia and Oceania

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Infectious Disease Modelling 2024年第1期9卷 214-223页

作者： Gregory Gan AJanhavi guan Tong Jue Tao lim Borame L.Dickens Saw Swee Hock School of Public Health National University of SingaporeSingapore lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore

Introduction:The transmission dynamics of the recent mpox outbreak highlights the lack of infrastructure available to rapidly respond to novel STI outbreaks,of which Asia and Oceania remains particularly ***,we simulate outbreaks in this setting and propose the use of pre-emptive vaccination within the men who have sex with men(MSM)community before the arrival and establishment of the *** and methods Using data driven heterogeneous sexual contact networks,we simulated outbreaks of mpox in Singapore,Hong Kong,and *** individual based SEIR compartmental model was used to simulate epidemic trajectories and the impact of different vaccination uptakes was assessed in their ability to avert or suppress outbreaks upon the arrival of mpox within the MSM ***:The highly dense sexual networks of Singapore and Sydney experience rapid outbreaks,with infection peaks occurring at day 41 and 23 respectively,compared to Hong Kong which occurs at day *** the simulations with no vaccination,68.2%–89.7%of the MSM community will become infected with mpox across the different cities,over a simulation period of 1 *** implementing vaccination strategies,the infection rate across the cities can be reduced to as low as 3.1%of the population(range:3.1%–82.2%)depending on the implementation and uptake of the *** is also extremely effective in slowing the start of the epidemic,delaying the epidemic peak by 36–50 days in Hong Kong,or even preventing the outbreak of ***:With extremely dense and well-connected sexual contact networks,where 65.2%–83.2%of the population are connected to a super-spreader in the different contact networks,pre-emptive or immediate vaccination upon identification of the first case is strongly recommended to help better manage the outbreak of mpox and prevent potential straining of healthcare systems.

关键词： Monkeypox virus Modelling Network model Mpox Contact matrix Sexual contact

Risk factors for ribavirin treatment failure in Asian organ transplant recipients with chronic hepatitis E infection

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World Journal of Hepatology 2019年第6期11卷 553-561页

作者： En Xian Sarah Low Edhel Tripon Kieron lim Poh Seng Tan How Cheng Low Yock Young Dan Yin Mei lee Mark Muthiah Wai Mun Loo Calvin Jianyi Koh Wah Wah Phyo JunXiong Pang Seng Gee lim guan-Huei lee Department of Medicine Ng Teng Fong General HospitalNational University Health SystemSingapore 609606Singapore Centre for Liver Disease Management and Transplant of Medical City Manila 1605Philippines Mount Elizabeth Medical Centre Singapore 228510Singapore Division of Gastroenterology and Hepatology National University Health SystemSingapore 119228Singapore Department of Medicine National University of SingaporeSingapore 119077Singapore Centre for Infectious Disease Epidemiology and Research National University of SingaporeSingapore 117549Singapore Department of Medicine Yong Loo Lin School of MedicineNational University of SingaporeSingapore 119228Singapore

BACKGROUND Hepatitis E virus(HEV)infection is a cause of chronic hepatitis in immunosuppressed *** virologic response rates to a 12-wk course of ribavirin therapy were reported to be>70%in the *** study describes the outcome of HEV treatment in a transplant center in *** To study the outcome of ribavirin treatment in a series of chronic HEV patients,and the cause of treatment *** We studied all of the transplant recipients who were diagnosed with HEV infection between 2012 to *** outcome of therapy and virologic relapse are monitored for three years after the end of *** Ten transplant recipients(4 liver,5 kidney,and 1 bone marrow transplantation)with positive HEV RNA were *** patients received at least 12 wk of ribavirin therapy,and the remaining patient resolved after reducing immunosuppression *** subjects had prolonged viremia that lasted more than one year,despite continuous ribavirin *** ribavirin-treated patients(44.4%)had HEV RNA relapse after achieving a virologic response by the end of *** overall failure rate is 66.7%.Being a kidney transplant recipient is the strongest risk factor for not achieving an initial sustained virologic response(0/5 treated,Chi-Square test,P<0.05).The most common side effect of ribavirin is anemia(100%)(haemoglobin reduction of 3-6.2 g/dL).Seven patients required either a blood transfusion or erythropoietin *** The sustained virologic response rate of 12-wk ribavirin therapy for HEV infection in this Asian series was lower than *** transplant recipients had a higher rate of treatment failure due to higher immunosuppression requirements and adverse effects.

关键词： Toxicity Antiviral agents Hepatitis E virus Virus classification Systemic immunity Immune responses Persistent infection

Search for a cure for chronic hepatitis B infection: How close are we?

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World Journal of Hepatology 2015年第9期7卷 1272-1281页

作者： Wah Wah Phyo Alex Yu Sen Soh Seng Gee lim guan Huei lee Department of Gastroenterology and Hepatology University Medicine Cluster National University Hospital of Singapore

Chronic hepatitis B(CHB) remains a significant unmet medical need, with 240 million chronically infected persons worldwide. It can be controlled effectively with either nucleoside/nucleotide-based or interferonbased therapies. However, most patients receiving these therapies will relapse after treatment withdrawal. During recent years, the advances in molecular biology and immunology have enabled a better understanding of the viral-host interaction and inspired new treatment approaches to achieve either elimination of the virus from the liver or durable immune control of the infection. This review aims to provide a brief overview on the potential new therapies that may overcome the challenge of persistent CHB infection in the near future.

关键词： Hepatitis B Antiviral therapy Covalentlyclosed circular DNA Drug target Immunomodulator

Intrinsic electrochemical activity modulation of MOF-derived C/N-NiCoMn-LDH/Ag electrode for low temperature hybrid supercapacitors

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Journal of Materials Science & Technology 2023年第19期150卷 145-158页

作者： Xiaohui guan Jingyang Chen Enze Zhu Penggang Yin Liu Yang Xin guan guangsheng Wang School of Chemical Engineering Northeast Electric Power UniversityJilin 132012China School of Chemistry Beihang UniversityBeijing 100191China Department of Applied Physics Eindhoven University of Technology5600MB Eindhoventhe Netherlands

Layered double hydroxides(LDHs)are promising electrode candidates for ***,lim-itations like inferior cycling stability and unsatisfactory charge storage capability at low temperatures have exerted negative effects on their ***,a novel synthetic process has been elaborately designed and provided to have the composition and structure of the C/N-NiCoMn-LDH/Ag(C/N-CNMA)delicately *** the experimental and theoretical researches unveil that the incorporated manganese species and elemental silver could dramatically modulate the bandgap,crystallinity and surface electron structure of the LDH,leading to the remarkable improvement in its conductivity,exposed active sites and intrinsic electrochemical activity,and thus the OH^(*)and O^(*)adsorption free energy could be remarkably optimized,even at low *** addition,the low crystallinity C/N-CNMA is of great electrochemical compatibility with both the KOH aqueous electrolyte and the isobutyl alcohol(IPA)modulated organohydrogel *** means of adjusting the solvation and hydrogen bonding in the electrolytes,the assembled hybrid supercapacitors deliver excellent energy density,power density and cycling stability in the temperature range of-30 to 25℃.Specifically,the gel electrolyte with IPA as the anti-freezing functional additive displays high flexibility and ionic conductivity at low temperatures.

关键词： Low crystallinity Intrinsic electrochemical activity modulation IPA modulated organohydrogel electrolyte Anti-freezing Low temperature hybrid supercapacitors

Validation of genetic variants associated with metabolic dysfunctionassociated fatty liver disease in an ethnic Chinese population

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World Journal of Hepatology 2020年第12期12卷 1228-1238页

作者： guan Huei lee Wah Wah Phyo Wai Mun Loo Raymond Kwok Taufique Ahmed Asim Shabbir Jimmy So Calvin Jianyi Koh Juanda Leo Hartono Mark Muthiah Kieron lim Poh Seng Tan Yin Mei lee Seng Geelim Yock Young Dan Division of Gastroenterology and Hepatology Department of MedicineNational University Health SystemSingapore 119228Singapore Yong Loo Lin School of Medicine National University of SingaporeSingapore 117597Singapore Department of Medicine Khoo Teck Puat HospitalSingapore 768828Singapore Department of Surgery National University Health SystemSingapore 119228Singapore

BACKGROUND Genetic factors play an important role in the pathogenesis and development of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To study the association of single nucleotide polymorphisms(SNPs),previously identified in Western populations,with the risk of MAFLD in a Singapore Chinese population and their interactions with environmental and medical risk *** A retrospective case-control study was conducted with 72 MAFLD cases and 72 controls with no hepatic steatosis on computed tomography,magnetic resonance imaging,or controlled attenuation parameter *** were recruited from two tertiary *** alleles such as NCAN,GCKR,LYPLAL1,PNPLA3,PPP1R3B,FDFT1,COL13A1,EFCAB4B,PZP,and TM6SF2 were genotyped using the TaqMan®Predesigned SNP Genotyping *** Weight and body mass index(BMI)were 1.2-times higher in patients(70.6 kg,95%confidence interval[CI]:57.1-84.1 vs 60.8 kg,95%CI:48.5-73.1,P<0.001 and 26.9 kg,95%CI:23-40.8 vs 23.3 kg 95%CI:19-27.6,P<0.001 respectively).The prevalence of diabetes mellitus in patients was 40.3%and 20.8%in controls(P=0.011).Patients had higher mean triglycerides than controls(P<0.001).PNPLA3 GG was more likely to be associated with MAFLD(43.4%CC vs 69.7%GG,P=0.017,and 44.8%CG vs 69.7%GG,P=0.022).In multivariable analysis,hypertriglyceridemia(odds ratio[OR]:2.0495%CI:1.3-3.1,P=0.001),BMI(OR:1.295%CI:1.1-1.4,P<0.001)and PNPLA3 GG(OR:3.495%CI:1.3-9.2,P=0.014)were associated with MAFLD(area under the receiver operating characteristic curve of 0.823).CONCLUSION Among the Chinese population of Singapore,PNPLA3 homozygous GG allele is a strong predictor of MAFLD,whereas LYPLAL1,GCKR,FDFT1,COL13A1,PZP,and TM6SF2 are not significantly ***,high BMI,and PNPLA3 GG are independent predictors of MAFLD.

关键词： Single nucleotide polymorphism PNPLA3 Genotyping Metabolic dysfunction-associated fatty liver disease Non-alcoholic steatohepatitis Hypertriglyceridemia Body mass index Waist-hip ratio,Screening Hepatic steatosis