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

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

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Outcome of lamivudine-resistant hepatitis B virus is generally benign except in cirrhotics

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World Journal of Gastroenterology 2005年第28期11卷 4344-4350页

作者： Yock-Young Dan Chun-Tao Wai yin-mei lee Dede Selamat Sutedja Bee-Leng Seer Seng-Gee Lim Division of Gastroenterology National University Hospital Singapore

AIM： We set to determine factors that determine clinical severity after the development of resistance.METHODS： Thirty-five Asian patients with genotypic lamivudine resistance were analyzed in three groups： 13/35 （37%） were non-cirrhotics with normal pre-treatment ALT （Group IA）, 12/35 （34%） were non-cirrhotics with elevated pre-treatment ALT （Group IB）, and 10/35 （29%） were cirrhotics （Group II）. Patients were followed for a median of 98 wk （range 26-220） after the emergence of genotypic resistance.RESULTS： Group IA patients tended to retain normal ALT. Group IB patients showed initial improvement of ALT with lamivudine but 9/12 patients （75%） developed abnormal ALT subsequently. On follow-up however, this persisted in only 33%. Group II patients also showed improvement while on treatment, but they deteriorated with the emergence of resistance with 30% death from decompensated liver disease. Pretreatment ALT levels and CPT score （in the cirrhotic group） were predictive of clinical resistance and correlated with peak ALT levels and CPT score.CONCLUSION： The phenotype of lamivudine-resistant HBV correlated with the pretreatment phenotype. The clinical course was generally benign in non-cirrhotics. However, cirrhotics had a high risk of progression and death （30%） with the development of lamivudine resistance.

关键词： Lamivudine resistance YMDD mutants Hepatitis B treatment Nucleoside analog

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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

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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

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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

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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

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Boceprevir early-access for advanced-fibrosis/cirrhosis in Asia-pacific hepatitis C virus genotype 1 non-responders/relapsers

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World Journal of Gastroenterology 2015年第28期21卷 8660-8669页

作者： Wattana Sukeepaisarnjaroen Tri Pham Tewesak Tanwandee Saroja Nazareth Sam Galhenage Lindsay Mollison Leanne Totten Alan Wigg Rosalie Altus Anton Colman Brenda Morales Sue Mason Tracey Jones Nadine leembruggen Vince Fragomelli Cheryl Sendall Richard Guan Dede Sutedja Soek Siam Tan Yock Young Dan yin mei lee Widjaja Luman Eng Kiong Teo yin Min Than Teerha Piratvisuth Seng Gee Lim Srinagarind Hospital Cabramatta Practice Siriraj Hospital Bangkok Royal Perth Hospital Fremantle Hospital Flinders Medical Centre Royal Adelaide Hospital Austin Hospital Royal Prince Alfred Hospital John Hunter Hospital Nepean Hospital Cairns Base Hospital Mount Elizabeth Medical Centre Gleneagles Hospital Selayang Hospital National University Health System Yong Loo Lin School of Medicine National University of Singapore Changi General Hospital NKC Institute of Gastroenterology and Hepatology Prince of Songkla University

AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in ***:The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR *** physicians were invited to contribute data from their patients:baseline characteristics,ontreatment responses,sustained virological response at week 12(SVR12),and safety were collected and *** analysis was performed to determine predictors of ***:150 patients were enrolled from Australia,Malaysia,Singapore and Thailand(Asians = 86,Caucasians = 63).Overall SVR12 was 61%(Asians= 59.3%,Caucasians = 63.5%).SVR12 was higher in relapsers(78%) compared with non-responders(34%).On-treatment responses predicted SVR,with undetectable HCVRNA at week 4,8 and 12 leading to SVR12 s of 100%,87%,and 82%respectively,and detectable HCVRNA at week 4,8 and 12,leading to SVR12 s of 58%,22%and 6%*** patients were similar to Caucasian patients with regards to on-treatment *** with cirrhosis(n= 69) also behaved in the same manner with regards to on-treatment *** with the IL28 B CC genotype(80%) had higher SVRs than those with the CT/TT(56%) genotype(P = 0.010).Multivariate analysis showed that TW8 and TW12 responses were independent predictors of *** adverse events occurred in 18.6%:sepsis(2%),decompensation(2.7%) and blood transfusion(14%).Discontinuations occurred in 30.7%,with 18.6%fulfilling stopping ***:Boceprevir can be used successfully in PR treatment failures with a SVR12 > 80%if they have good on-treatment responses;however,discontinuations occurred in 30%because of virological failure or adverse events.

关键词： Chronic hepatitis C Treatment failure Rapid virological response Lead-in Null response Partial response Relapse Cirrhosis Response guidedtherapy

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Finite element modeling of thermo-active diaphragm walls

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Frontiers of Structural and Civil Engineering 2020年第3期14卷 646-663页

作者： Yi RUI mei yin Centre for Smart Infrastructure and Construction Department of EngineeringUniversity of CambridgeCambridgeCB3 OFAUK Civil and Environmental Engineering Department Brunei UnivisityLondon UBS 3PHUK

There are two major challenges faced by modern society:energy security,and lowering carbon dioxide gas ***-active diaphragm walls have a large potential to remedy one of these problems,since they are a renewable energy technology that uses underground infrastructure as a heat exchange ***,extensive research is required to determine the effects of cyclic heating and cooling on their geotechnical and structural *** this paper,a series of detailed finite element analyses are carried out to capture the fully coupled thermo-hydro-mechanical response bf the ground and diaphragm *** is demonstrated that the thermal operation of the diaphragm wall causes changes in soil temperature,thermal expansion/shrinkage of pore water,and total stress applied on the diaphragm ***,in turmn,cause displacements of the diaphragm wall and variations of the bending ***,these effects on the performance of diaphragm wall are not *** thermally induced bending strain is mainly governed by the temperature differential and uneven thermal expansion/shrinkage across the wall.

关键词： thermo-active diaphragm wall finite element analysis thermo-hyro-mechanical coupling ground source heat pump

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Study on the long-term performance of shield tunnel passing through the gas-bearing strata

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Underground Space 2023年第2期9卷 1-19页

作者： Jie He Xiangyang Wei mei yin College of Civil Engineering Tongji UniversityShanghai 200092China State Key Laboratory for Disaster Reduction in Civil Engineering Tongji UniversityShanghai 200092China Key Laboratory of Geotechnical and Underground Engineering of Ministry of Education Tongji UniversityShanghai 200092China Civil and Environmental Engineering Department Brunel University LondonLondon UB83PHUK Recei

When the shield tunnel passes through the gas-bearing strata,gas and water leakage may occur depending on the sealing performance of the segment *** process involves the complex multiphase seepage flow phenomenon in unsaturated *** this study,a fully coupled solid-liquid-gas model of the GIL Utility Tunnel was established to investigate the influence of the high-pressure gas on the mechanical properties of the tunnel segments and *** constitutive model of the Extended Barcelona Basic Model was imple-mented to simulate the effect of the seepage process on soil *** results show that significant upward displacement occurred in the gas reservoir and its overlying strata,and the maximum displacement reached 30 *** addition,during the leakage of the gas and the water,an increase in the average soil effective stress was *** would induce a reduction in the suction and expansion of the yield *** tunnel tended to be stable from 20 years onwards,thus the soil deformation due to the water leakage only occurred at the early *** addition,the joint opening under the most unfavorable internal force combination was 0.69 mm,and the correspond-ing bolt stress was 119.5 MPa,which is below the yield *** results of this study help to understand the influence of high-pressure gas on tunnel safety and the sealing performance of the joints.

关键词： A coupled solid-liquid-gas model Unsaturated soil Multiphase seepage Gas-bearing strata Shield tunnel FEM

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Mechanical stretching of 3D hydrogels for neural stem cell differentiation

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Bio-Design and Manufacturing 2022年第4期5卷 714-728页

作者： Quanjing mei Ho-yin Yuen Xin Zhao Department of Biomedical Engineering The Hong Kong Polytechnic UniversityHung HomHong KongChina

While it is known that mechanical dynamics are influential in neural differentiation for critical processes like neurogenesis or neurodegeneration, studies on neural stem cell therapies usually focus on biochemical interactions rather than mechanical aspects, frequently resulting in low efficacy and unfulfilled potential. Therefore, current studies are attempting to elucidate the effect of mechanical stimulus on neural performance using conventional two-dimensional(2D) planar substrates. Yet, these2D substrates fail to capture the defining three-dimensional(3D) characteristics of the in vivo neural stem cell *** complete this research gap, we synthesized a series of soft and elastic 3D hydrogels to mimic the neural tissue mechanical environment for 3D cell culture, using long-chain polyethylene glycol diacrylate(PEGDA) and gelatin-methacryloyl(Gel MA).By varying the concentration of the polymer, we obtained biomimicking hydrogels with a tensile modulus as low as 10 k Pa and a compressive modulus as low as 0.8 k Pa. The in vitro results demonstrated that Gel MA-PEGDA hydrogels have the high biocompatibility required to support neural cell growth, proliferation, and differentiation, as well as neurite outgrowth. We then studied the effect of mechanical stretching on the behaviors of neural cells and observed that mechanical stretching could significantly enhance neurite extension and axon elongation. In addition, the neurites were more directionally oriented to the stretching direction. Immunocytochemistry and relative gene expression data also suggested that mechanical tension could upregulate the expression of neural differentiation protein and genes, including GFAP and βIII-Tubulin. Overall, this study shows that in addition to the specific mechanical properties of Gel MA-PEGDA that improve neural differentiation towards specific lineages, hydrogel stretching is also a potentially attractive strategy to improve the therapeutic outcomes of neural stem cel

关键词： Mechanical property Tensile stretching Hydrogels Neural differentiation 3D cell culture

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