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Efficacy of texture analysis of pre-operative magnetic resonance imaging in predicting microvascular invasion in hepatocellular carcinoma

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World Journal of Clinical Oncology 2022年第11期13卷 918-928页

作者： Jordan Zheng Ting Sim Terrence Chi Hong Hui Tong Kuan Chuah Hsien Min Low Cher Heng tan Vishal GShelat Department of Diagnostic Radiology Tan Tock Seng HospitalSingapore 308433Singapore School of Engineering Ngee Ann PolytechnicSingapore 599489Singapore Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore

BACKGROUND Presence of microvascular invasion(MVI)indicates poorer prognosis postcurative resection of hepatocellular carcinoma(HCC),with an increased chance of tumour *** present standards,MVI can only be diagnosed postoperatively on *** analysis potentially allows identification of patients who are considered‘high risk’through analysis of pre-operative magnetic resonance imaging(MRI)*** will allow for better patient selection,improved individualised therapy(such as extended surgical margins or adjuvant therapy)and pre-operative *** This study aims to evaluate the accuracy of texture analysis on pre-operative MRI in predicting MVI in *** Retrospective review of patients with new cases of HCC who underwent hepatectomy between 2007 and 2015 was *** criteria:No preoperative MRI,significant movement artefacts,loss-to-follow-up,ruptured HCCs,previous hepatectomy and adjuvant *** patients were divided into MVI(n=15)and non-MVI(n=35)groups based on tumour *** images of the tumour on post-contrast-enhanced T1-weighted MRI were *** qualitative(performed by radiologists)and quantitative data(performed by software)were *** texture parameters were extracted based on the largest cross-sectional area of each tumor and analysed using MaZda *** separate methods were *** 1,2 and 3 exclusively made use of features derived from arterial,portovenous and equilibrium phases *** 4 and 5 made use of the comparatively significant features to attain optimal *** Method 5 achieved the highest accuracy of 87.8%with sensitivity of 73%and specificity of 94%.CONCLUSION Texture analysis of tumours on pre-operative MRI can predict presence of MVI in HCC with accuracies of up to 87.8%and can potentially impact clinical management.

关键词： Carcinoma Hepatocellular Magnetic resonance imaging Liver neoplasms Retrospective studies Margins of excision

Airway Foreign Body in Children

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International Journal of Clinical Medicine 2012年第7期3卷 655-660页

作者： Hui Sing Chew Henry Kun Kiaang tan Department of Otolaryngology KK Women’s and Children’s Hospital Singapore City Singapore Department of Otorhinolaryngology Tan Tock Seng Hospital Singapore City Singapore

Introduction: Foreign body aspiration is not uncommon in children. It can be associated with significant morbidity and mortality. This study aims to determine and analyze the characteristics of local pediatrics airway foreign body (FB) aspiration. Methods: A retrospective study of medical records from KK hospital (1997-2010) is done. Patient demographics, clinical/investigative findings, duration of hospitalization and complications are analyzed. Results: The sample consisted of 26 patients (eight months - 13 years of age), who underwent rigid bronchoscopy for FB removal over the last 13 years. Seventy-seven percent were three years of age or younger. Peak incidence (61.6%) was at one to two years of age. Nineteen were males and seven were females. The top three clinical presentations were: cough (61.5%), choking (46.2%) and wheezing (42.3%). Decreased air entry (34.6%), tachypnea (26.9%) and no significant findings (23.1%) were the most common features on physical examination. The most common radiographic findings were consolidation (30.8%), presence of a foreign body (23.1%) and no abnormality (23.1%). Aspiration was primarily into the right main bronchus (38.5%), and 61.5% of the FB was organic in nature [principally peanuts (38.5%)]. Mean hospitalization duration was three days. Delayed diagnose in three cases were secondary to mis-diagnoses as croup (n = two) and respiratory tract infection (n = one). Complications were noted in eight cases (30.8%). There was no mortality. Conclusion: High index of suspicion is required in diagnosing airway FB. Physician’s diagnostic acumen is vital in prompt successful treatment. Heightening public’s awareness is the key to prevention of pediatrics FB aspiration.

关键词： Airway Foreign Body Children

Choledochoscopy:An update

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World Journal of Gastrointestinal Endoscopy 2021年第12期13卷 571-592页

作者： Tsinrong Lee Thomas Zheng Jie Teng Vishal G Shelat School of Medicine Nanyang Technological UniversitySingapore 308232Singapore Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore

Choledochoscopy,or cholangioscopy,is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic *** its conception in 1879,many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary *** ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative ***,with the evolving understanding of biliary disorders,there are significant innovative ideas and techniques to fill this void,such as nuanced instances of biliary stenting and retrieving migrated ductal *** this in mind,we present a review of the current advancements in choledochoscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions,complications,limitations and put forth areas for further study.

关键词： Choledochoscopy Cholangioscopy Indeterminate biliary strictures Difficult bile stones Primary sclerosing cholangitis Cholangiocarcinoma

Bullous eruption as a cutaneous manifestation of eosinophilic granulomatosis with polyangiitis

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Rheumatology & Autoimmunity 2021年第1期1卷 54-57页

作者： Paula PTjokrosaputro Tsui YLian Dingyuan Wang Joyce SSLee Chuanhui Xu Department of Rheumatology Allergy and ImmunologyTan Tock Seng HospitalSingaporeSingapore National Skin Centre SingaporeSingapore

Cutaneous manifestations are variable in patients with eosinophilic granulomatosis with polyangiitis(EGPA).We report a case where bullous eruption was a presenting manifestation of EGPA.A 55-year-old Chinese man with a background of adult-onset asthma and chronic sinusitis was admitted for a 3-week history of lower limb weakness and a large bulla on his right calf with surrounding *** biopsy showed a subepidermal blister with significant dermal eosinophilia,without *** patient was diagnosed with EGPA with systemic involvement on the basis of a thorough medical history,eosinophilia,cardiac magnetic resonance imaging showing acute myocarditis,and nerve biopsy with eosinophilic vasculitic *** responded well to corticosteroids and *** bullous eruptions are rarely described as manifestations of *** recognition of this entity is crucial for its early diagnosis.

关键词： bullous eruption cutaneous EGPA

Lateral cortex blowout during PFNA blade insertion in a subtrochanteric fracture - Should bone quality determine the type of nail used？

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Chinese Journal of Traumatology 2015年第2期18卷 116-119页

作者： Sunil Gurpur Kini Lai Choon Hin Jikku Haniball Department of Orthopaedics University College London Hospitals London United Kingdom Department of Orthopaedics. tan tock seng hospital Singapore

Subtrochanteric fractures pose a therapeutic challenge to the surgeons. With the advent of proximal femoral nails, most of the cases are treated with nailing. Newer nails like proximal femoral nail antirotation （PFNA） require the blade to be directly hammered into the bone compared to older nails where the screws are drilled and tapped before insertion. We report one such case in a middle aged female that had intraoperative lateral cortex blowout during PFNA blade insertion in a sclerotic bone. This occurrence to the best of our knowledge is unreported in literature. It is therefore imperative to consider the quality of bone before a decision is made on the implant chosen.

关键词： Subtrochanteric fractures Proximal femoral nail antirotation Sclerotic bone

Carcinosarcoma of gallbladder:A world review

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World Journal of Clinical Oncology 2021年第12期12卷 1244-1263页

作者： Thomas Zheng Jie Teng Branden Qi Yu Chua Vishal G Shelat Department of General Surgery Tan Tock Seng HospitalSingapore 308433Singapore Undergraduate Medicine Lee Kong Chian School of MedicineSingapore 308232Singapore

BACKGROUND Gallbladder carcinosarcoma is a rare hepatobiliary tumor comprising of both carcinomatous and sarcomatous *** to its rarity,the literature with regards to the topic is scarce and currently lacking,spanning less than 100 *** To summarize the current literature on gallbladder *** A literature review was performed on the PubMed database using the keywords“Gallbladder”AND“Carcinosarcoma”from 1970 to ***,similar searches were performed on MEDLINE and Web of *** Risk factors noted include female gender,gallstones and chronic *** the absence of any diagnostic biochemical testing or tumor markers,imaging modality serves as the key initial impression tool,which can be histologically confirmed only *** surgery is the only curative option,the use of adjunctive chemotherapy has been considered on top of excision in recent years,with some *** While this study has taken steps to bridge the gap in the literature,more cases should be reported to further ascertain the current associations and management potential for gallbladder carcinosarcoma.

关键词： Carcinosarcoma Gallbladder Gallstone Malignancy Carcinoma Sarcoma

Role of dopamine in the pathophysiology of Parkinson’s disease

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Translational Neurodegeneration 2023年第1期12卷 281-295页

作者： Zhi Dong Zhou Ling Xiao Yi Dennis Qing Wang Tit Meng Lim Eng King tan National Neuroscience Institute of Singapore 11 Jalan Tan Tock SengSingapore 308433Singapore Department of Neurology Singapore General HospitalOutram RoadSingapore 169608Singapore Signature Research Program in Neuroscience and Behavioral Disorders Duke-NUS Graduate Medical School Singapore8 College RoadSingapore 169857Singapore Department of Neurology Zhujiang HospitalSouthern Medical UniversityGuangzhou 510280China Department of Biological Science National University of SingaporeSingapore 119077Singapore

A pathological feature of Parkinson’s disease(PD)is the progressive loss of dopaminergic neurons and decreased dopamine(DA)content in the substantia nigra pars compacta in PD *** is the neurotransmitter of dopaminergic *** evidence suggests that DA interacts with environmental and genetic factors to contribute to PD *** of DA synthesis,storage,transportation and metabolism have been shown to promote neurodegeneration of dopaminergic neurons in various PD *** is unstable and can undergo oxidation and metabolism to produce multiple reactive and toxic by-products,including reactive oxygen species,DA quinones,and 3,*** we summarize and highlight recent discoveries on DA-linked pathophysiologic pathways,and discuss the potential protective and therapeutic strategies to mitigate the complications associated with DA.

关键词： Dopamine Dopamine quinones 3,4-Dihydroxyphenylacetaldehyde Neurodegeneration Pathogenesis Parkinson’s disease Reactive oxygen species Therapeutic strategies

Pulsatile Flow Studies in Saccular Aneurysm Models using Particle Image Velocimetry

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临床医学工程 1998年第3期 60-63页

作者： S.C.M.Yu W.K.Chan F.Hui Singapore 639798 Nanyang Technological University Department of Diagnostic Imaging Singapore 308433 tan tock seng hospital School of Mechanical and Ploduction Engineering

In vitro flow studies in saccular aneurysm models had been investigated using Particle Image Velocimetry over a range of Reynolds numbers (400 to 1, 400) and Womersly numbers (22 to 65). Both steady and pulsating flow experiments had been conducted. It was found that at steady flow condition, a recirculating vortex would be fanned inside the aneurysm. The vortex would become stronger at higher Reynolds numbers but weaker at larger anenrysm size. Under the pulsating flow conditions, the vortex appeared and disappeared at different phase of a cycle. The sequence is only punctuated by quasi-inviscid flow behavior.

关键词： In Pulsatile Flow Studies in Saccular Aneurysm Models using Particle Image Velocimetry 阳石 YAG test

继发性红细胞增多症和动静脉畸形患者急性神经病学事件

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世界核心医学期刊文摘（心脏病学分册） 2005年第7期1卷 49-50页

作者： Gill D.S. Ng C.-K. Ng K.-S. 高登峰 Cardiology Registrar Department of Cardiology Tan Tock Seng Hospital 11 Jalan Tan Tock Seng 3080433 Singapore

General internists and adult cardiologist are seeing adult congenital heart disease more frequently in their clinical practices. We report the case of a polycythaemic patient with the cerebral and pulmonary arteriovenous malformations(AVMs) who presents with a transient ischaemic attack(TIA). Treatment strategies such as antiplatelet drugs and vensection may at best be ineffective and at worst detrimental to the patient.

关键词：动静脉畸形神经病学红细胞增多症内科医生损害作用先天性心脏病心脏病学