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Paradigm shift in gastrointestinal surgery−combating sarcopenia with prehabilitation:Multimodal review of clinical and scientific data

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World Journal of Gastrointestinal Surgery 2021年第8期13卷 734-755页

作者： Frederick H Koh Jason MW Chua Joselyn LJ Tan Fung-Joon Foo Winson J Tan Sharmini S Sivarajah Leonard ming Li Ho Bin-Tean Teh min-hoe chew Division of Surgery Sengkang General HospitalSingapore 544886Singapore Institute of Molecular and Cell Biology Agency for Science Technology and ResearchSingapore 138673Singapore Duke-NUS Graduate Medical School National Cancer Centre SingaporeSingapore 169610Singapore

A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and *** included an increased risk of total complications,major complications,re-admissions,infections,severe infections,30 d mortality,longer hospital stay and increased hospitalization expenditures.A program to enhance recovery after surgery was meant to address these complications;however,compliance to the program since its introduction has been less than *** the last decade,the concept of prehabilitation,or"pre-surgery rehabilitation",has been *** presurgical period represents a window of opportunity to boost and optimize the health of an individual,providing a compensatory"buffer"for the imminent reduction in physiological reserve *** results have been *** review the literature to critically review the utility of prehabilitation,not just in the clinical realm,but also in the scientific realm,with a resource management point-of-view.

关键词： Sarcopenia Prehabilitation Surgery Frailty Value Gastrointestinal surgery

Prediction of overall survival following colorectal cancer surgery in elderly patients

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World Journal of Gastrointestinal Surgery 2019年第5期11卷 247-260页

作者： Isaac Seow-En Winson Jianhong Tan Sreemanee Raaj Dorajoo Sharon Hui Ling Soh Yi Chye Law Soo Yeun Park Gyu-Seok Choi Wah Siew Tan Choong Leong Tang min hoe chew Department of Colorectal Surgery Singapore General HospitalSingapore 169608Singapore Department of General Surgery Sengkang General HospitalSingapore 544886Singapore Department of Pharmacy National University of SingaporeSingapore 117559Singapore Yong Loo Lin School of Medicine National University of SingaporeSingapore 117597Singapore Colorectal Cancer Center Kyungpook National University Chilgok HospitalKyungpook National University School of MedicineDaegu 702-210South Korea

BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC)becomes less dependent on the malignant disease and more on their pre-morbid *** major surgery for these elderly patients can be *** accurate tool demonstrating post-operative survival probability would be useful for surgeons and their *** To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring *** In this retrospective cohort study,patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained *** with evidence of metastatic disease,and those who underwent emergency surgery or had surgery for benign colorectal conditions were excluded from the *** primary outcome was overall 3-year overall survival(OS)following surgery.A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital,South *** analyses were performed using Stata/MP Version *** A total of 1267 patients were identified for *** median post-operative length of stay was 8[interquartile range(IQR)6-12]d and median follow-up duration was 47(IQR 19-75)*** OS was 78(IQR 65-85)*** multivariate analysis,the factors significant for predicting overall mortality were serum albumin<35 g/dL,serum carcinoembryonic antigen≥20μg/L,T stage 3 or 4,moderate tumor cell differentiation or worse,mucinous histology,rectal tumors,and pre-existing chronic obstructive lung *** age alone was not found to be *** Korean cohort consisted of 910 *** Singapore cohort exhibited a poorer OS,likely due to a higher proportion of advanced *** the clinicopathologic di

关键词： Colorectal cancer surgery Elderly Overall survival Pre-operative prognostic score

Critical evaluation of contemporary management in a new Pelvic Exenteration Unit: The first 25 consecutive cases

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World Journal of Gastrointestinal Oncology 2017年第5期9卷 218-227页

作者： min hoe chew Yu-Ting Yeh Ee-Lin Toh Stephen Aditya Sumarli Ghee Kheng chew Lui Shiong Lee Mann Hong Tan Tiffany Priyanthi Hennedige Shin Yi Ng Say Kiat Lee Tze Tec Chong Hairil Rizal Abdullah Terence Lin Hon Goh Mohamed Zulfikar Rasheed Kok Chai Tan Choong Leong Tang Department of Colorectal Surgery Singapore General Hospital Department of Obstetrics and Gynaecology Singapore General Hospital Department of Urology Singapore General Hospital Department of Orthopaedic Surgery Singapore General Hospital Division of Oncological Imaging National Cancer Centre Singapore Department of Anaesthesiology Singapore General Hospital Vascular Surgery Singapore General Hospital Department of Plastic Reconstructive and Aesthetic SurgerySingapore General Hospital

To critically appraise short-term outcomes in patients treated in a new Pelvic Exenteration (PE) Unit. METHODSThis retrospective observational study was conducted by analysing prospectively collected data for the first 25 patients (16 males, 9 females) who underwent PE for advanced pelvic tumours in our PE Unit between January 2012 and October 2016. Data evaluated included age, co-morbidities, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) status, preoperative adjuvant treatment, intra-operative blood loss, procedural duration, perioperative adverse event, lengths of intensive care unit (ICU) stay and hospital stay, and oncological outcome. Quantitative data were summarized as percentage or median and range, and statistically assessed by the χ2 test or Fisher’s exact test, as applicable. RESULTSAll 25 patients received comprehensive preoperative assessment via our dedicated multidisciplinary team approach. Long-course neoadjuvant chemoradiotherapy was provided, if indicated. The median age of the patients was 61.9-year-old. The median ASA and ECOG scores were 2 and 0, respectively. The indications for PE were locally invasive rectal adenocarcinoma (n = 13), advanced colonic adenocarcinoma (n = 5), recurrent cervical carcinoma (n = 3) and malignant sacral chordoma (n = 3). The procedures comprised 10 total PEs, 4 anterior PEs, 7 posterior PEs and 4 isolated lateral PEs. The median follow-up period was 17.6 mo. The median operative time was 11.5 h. The median volume of blood loss was 3306 mL, and the median volume of red cell transfusion was 1475 mL. The median lengths of ICU stay and of hospital stay were 1 d and 21 d, respectively. There was no case of mortality related to surgery. There were a total of 20 surgical morbidities, which occurred in 12 patients. The majority of the complications were grade 2 Clavien-Dindo. Only 2 patients experienced grade 3 Clavien-Dindo complications, and both required procedura

关键词： Colorectal cancer Advanced pelvic tumour Sacrectomy Oncological outcome Pelvic exenteration Chordoma

Critical appraisal of laparoscopic vs open rectal cancer surgery

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World Journal of Gastrointestinal Surgery 2016年第6期8卷 452-460页

作者： Winson Jianhong Tan min hoe chew Angela Renayanti Dharmawan Manraj Singh Sanchalika Acharyya Carol Tien Tau Loi Choong Leong Tang Department of Colorectal Surgery Singapore General Hospital Centre for Qualitative Medicine DUKE NUS Graduate Medical School

AIM:To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection(LRR) and the impact of conversion in patients with rectal ***:An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical *** were compared in three groups:Open surgery(OP),laparoscopic surgery,and converted laparoscopic ***-term outcomes,long-term outcomes,and survival analysis were ***:Among 633 patients studied,200 patients had successful laparoscopic resections with a conversion rate of 11.1%(25 out of 225).Factors predictive of survival on univariate analysis include the laparoscopic approach(P = 0.016),together with factors such as age,ASA status,stage of disease,tumor grade,presence of perineural invasion and vascular emboli,circumferential resection margin < 2 mm,and postoperative adjuvant *** survival benefit of laparoscopic surgery was no longer significant on multivariateanalysis(P = 0.148).Neither 5-year overall survival(70.5% vs 61.8%,P = 0.217) nor 5-year cancer free survival(64.3% vs 66.6%,P = 0.854) were significantly different between the laparoscopic group and the converted ***:LRR has equivalent long-term oncologic out c ome s w he n c ompare d t o *** c opic conversion does not confer a worse prognosis.

关键词： Rectal cancer Laparoscopic Outcomes Conversion Prognosis

Cement Treated Singapore Marine Clay with Incineration Fly Ash

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Cement Treated Singapore Marine Clay with Incineration Fly A...

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

第一届中国水利水电岩土力学与工程学术讨论会

作者： chew Soon hoe LEE Fook Hou Department of Civil Engineering National Univercity of Singapore Singapore Department of Civil Engineering National Univercity of Singapore Singapore

＜正＞The use of cement treatment of soft Singapore marine clay （SMC） to improve its strength and stiffness properties has been well established. However, only limited studies have been found on the use of incineration fly ash （IFA） for geotechnical applications, such as for soft soil stabilization. The re-utilization of IFA as part of jet-grouting material or deep cement mixing material in Singapore could be one of the possible solutions to minimize its adverse effect on environment and the shortage of landfill site. The effect of the inclusion of IFA on the engineering properties of cement treated SMC was evaluated though a series of experimental investigations including basic physical properties test and unconfined compression （UC） test. XRD analysis and pH value test were also carried out to determine the effect of IFA on the physico-chemical behavior of cement treated SMC. This paper presents changes in engineering properties and relates them to the physico-chemical behavior of the cement-ash-clay mixture.

关键词： cement treat Singapore marine clay (SMC) incineration fly ash (IFA) engineering properties physico-chemical behavior Biography: MA Rui, male, doctor, engineer.

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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