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Arasakumar DRB, Brookes J, Hamilton G, Tsui J, Lim CS. The trend of percutaneous and open surgical procedures for peripheral arteriovenous malformations in the National Health Service England. Ann R Coll Surg Engl 2022; 104:661-666. [PMID: 35138948 PMCID: PMC9685930 DOI: 10.1308/rcsann.2021.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION This study aimed to assess the trend of percutaneous and open surgical procedures for peripheral arteriovenous malformations (AVMs) performed in NHS hospitals in England between 2012 and 2018. METHODS Hospital Episode Statistics (HES) is a freely available data warehouse that represents the whole population of England served by the NHS. Data from the HES database was obtained and analysed for all hospital episodes between 2012 and 2018 for the total number and trend of 'primary diagnosis', and 'primary procedures and interventions' identified for peripheral AVMs. RESULTS Over the period studied, there was an increase in the total number of admissions for peripheral AVMs; total primary diagnosis increased from 2242 to 2857 per year. Open surgery remained more commonly performed than percutaneous procedures throughout the studied period. However, the overall percentage of primary procedures and interventions being percutaneous in this period increased from 29.8% to 41.0% per year. The increase in the number of percutaneous procedures per year seemed to occur in both children (from 43 to 124) and adults (from 408 to 492) over the course of the study period. CONCLUSIONS This study concluded that open surgery remained the most commonly performed primary procedure for peripheral AVMs, although there was an increasing trend for percutaneous procedures in NHS hospitals in England. The increase in the number and percentage of percutaneous procedures for peripheral AVMs was likely to have significant resource implications for the provision of care for patients with peripheral AVMs in NHS hospitals.
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Affiliation(s)
| | - J Brookes
- Royal Free London NHS Foundation Trust, UK
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Pang C, Nisbet R, Gibson M, Evans N, Khalifa M, Papadopoulou A, Tsui J, Hamilton G, Brookes J, Lim CS. 522 Early Follow-Up Quality of Life and Mental Health of Patients with Congenital Vascular Malformations Cared for in a Multi-Disciplinary Specialist Center. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
To evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) receiving care by a single multi-disciplinary specialist center
Method
This was a prospective observational study. All patients with CVM who received care (supportive treatment only, open surgery, targeted pharmacological therapy, embolosclerotherapy), and had follow-up, between February 1st 2018 and January 31st 2020 were included. The health-related QoL, pain, and mental health were assessed with validated questionnaires: SF-36, VAS-P and HADS. The CVM were categorized into types – low-flow (LFVM) and high-flow (HFVM), and anatomical locations. Paired t-test was used for all analyses. P<0.05 were considered significant.
Results
110 patients (85 LFVM and 25 HFVM) with a mean age of 36.9 years were included. Significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both P = 0.01) in all patients. However, only patients with HFVM reported significant improvement in the bodily pain domain of SF-36 (P=0.002) and VAS-P (P = 0.02). Patients who received supportive treatment only reported significant improvement in mental health (P=0.004) and social functioning (P=0.03) domains of SF-36. Meanwhile, patients treated with embolo-sclerotherapy reported significant improvement only in VAS-P (P=0.02). Patients who received targeted pharmacological therapy reported no significant early changes.
Conclusions
The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.
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Affiliation(s)
- C Pang
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
| | - R Nisbet
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - M Gibson
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - N Evans
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - M Khalifa
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - A Papadopoulou
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - J Tsui
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
| | - G Hamilton
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
| | - J Brookes
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - CS Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
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Pang C, Arasakumar D, Evans N, Papadopoulou A, Khalifa M, Hamilton G, Brookes J, Lim CS. 518 Efficacy and Safety of Embolo-Sclerotherapy of Low-Flow Vascular Malformations Based on the Experience from a Single Specialist Centre. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
To evaluate the efficacy and safety of embolo-sclerotherapy (EST) of low-flow vascular malformations (LFVM) in a specialist vascular anomalies centre.
Method
All patients with LFVM who underwent EST from 01 January 2015–31 December 2019 were retrospectively reviewed. All ESTs were performed with foam STS 3%, ethanol, coils and/or other substances e.g., triamcinolone. LFVMs were grouped according to Puig's classification. The outcome measures were treatment effects and complications. Continuous variables were compared using analysis of variance (ANOVA) F test. Other discrete variables were compared using Chi-squared tests. P<0.05 were considered significant.
Results
A total of 207 patients, with a mean age of 32 years (range 1–71 years) were included. The use of EST with foam STS was significantly lower for type I LFVM (61.8%) compared to others (p<0.001). However, significantly higher type I LFVM (26.5%) were treated with surgery than EST (p<0.001). Overall, outcome categories were significantly different across all types of LFVM (p<0.001), with more discharges for Type I (52.9%) LFVMs but more failure to follow-up in patients with Type II (24.5%) LFVM. EST complications was significantly higher with type I (14.7%) LFVMs (p=0.030). The doses of STS in the first procedure were significantly different across all types of LFVM (p<0.001) with most type I LFVM patients receiving ≤2ml.
Conclusions
EST particularly with foam sclerotherapy is clinically effective and safe for patients with LFVM especially in those with Puig's type I and II lesions. This classification may provide an important guide to volume of sclerosant required and the potential success rate.
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Affiliation(s)
- C Pang
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
| | - D Arasakumar
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - N Evans
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - A Papadopoulou
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - M Khalifa
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - G Hamilton
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
| | - J Brookes
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - CS Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
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Pang C, Nisbet R, Gibson M, Evans N, Khalifa M, Papadopoulou A, Tsui J, Hamilton G, Brookes J, Lim CS. O064 Early follow-up quality of life and mental health of patients with congenital vascular malformations cared for in a multi-disciplinary specialist center. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction
To evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) receiving care by a single multi-disciplinary specialist centre
Methods
All patients with CVM who received care (supportive treatment only, open surgery, targeted pharmacological therapy, embolosclerotherapy), and had follow-up, between 1 February 2018 and 31 January 2020 were included. The health-related QoL, pain, and mental health were assessed with validated questionnaires: SF-36, VAS-P and HADS. The CVM were categorized into types – low-flow (LFVM) and high-flow (HFVM), and anatomical locations. Paired t-test was used for all analyses. Differences were considered significant at P<0.05.
Results
110 patients (85 LFVM and 25 HFVM) with a mean age of 36.9 years were included. Significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both P = 0.01) in all patients. However, only patients with HFVM reported significant improvement in the bodily pain domain of SF-36 (P=0.002) and VAS-P (P = 0.02). Patients who received supportive treatment only reported significant improvement in mental health (P=0.004) and social functioning (P=0.03) domains of SF-36. Meanwhile, patients treated with embolosclerotherapy reported significant improvement only in VAS-P (P=0.02). Patients who received targeted pharmacological therapy reported no significant early changes.
Conclusion
The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.
Take-home message
The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.
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Affiliation(s)
- C Pang
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
| | - R Nisbet
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
| | - M Gibson
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
| | - N Evans
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
| | - M Khalifa
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust
| | - A Papadopoulou
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust
| | - J Tsui
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
| | - G Hamilton
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
| | - J Brookes
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust
| | - CS Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
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Pang C, Evans N, Papadopoulou A, Khalifa M, Tsui J, Hamilton G, Lim CS, Brookes J. O75: SINGLE CENTRE EXPERIENCE OF SIROLIMUS THERAPY IN HEAD AND NECK VASCULAR MALFORMATIONS. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
To assess the efficacy and safety of Sirolimus in the treatment of low-flow head and neck (H&N) vascular malformations
Method
Patients who presented to our tertiary referral clinic were assessed for eligibility. Suitable patients were commenced on Sirolimus at 0.8 mg/m2, administered orally twice daily, which was approved by our trust Drug and Therapeutic Committee. Patients were reviewed on a monthly basis for a total of six months with an additional one-month review to check for effects upon ceasing treatment. Efficacy and safety were measured through functional and radiological response, laboratory investigations and quality of life questionnaire (36-Item Short Form Health Survey (SF-36), Hospital Anxiety and Depression Scale (HADS) and Visual Analogue Score for Pain (VAS-P)).
Result
Seven patients (mean age 39 years, range 23-65 years) were recruited. One patient did not complete treatment due to intolerable side effects. All patients had a partial response with no patients showing disease progression or complete response. All post-treatment MRI scans showed stable disease with five patients demonstrating a decrease in lesion volume. Five patients reported return of symptoms at one-month post review upon discontinuation of treatment. No statistical significance (P>0.05) in all eight domains of SF-36, HADS, VAS-P and radiological vascular lesion volume between pre- and post-treatment. Most common reported side effects were mouth ulcers (n=2) and metabolic/laboratory abnormality (n=2)
Conclusion
Sirolimus is an effective and safe treatment for patients with complicated low-flow H&N vascular malformations. This provides an alternative treatment where interventional therapy is considered to be limited or challenging.
Take-home message
Sirolimus is an effective and safe treatment option for patients with complicated low-flow head and neck vascular malformations where interventional therapy is limited or challenging.
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Affiliation(s)
- C Pang
- Royal Free Vascular Malformation Service, Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom, London
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, UK
| | - N Evans
- Royal Free Vascular Malformation Service, Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom, London
| | - A Papadopoulou
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - M Khalifa
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - J Tsui
- Royal Free Vascular Malformation Service, Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom, London
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, UK
- NIHR UCLH Biomedical Research Centres, London, UK
| | - G Hamilton
- Royal Free Vascular Malformation Service, Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom, London
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, UK
| | - CS Lim
- Royal Free Vascular Malformation Service, Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom, London
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, UK
- NIHR UCLH Biomedical Research Centres, London, UK
| | - J Brookes
- Royal Free Vascular Malformation Service, Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom, London
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, UK
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Tan HCL, Tan JH, Vellusamy VM, Vasavan Y, Lim CS. Wilms tumour with poor response to pre-operative chemotherapy: A report of 2 cases. Malays J Pathol 2020; 42:267-271. [PMID: 32860380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Majority of Wilms tumour (WT) responds well to pre-operative chemotherapy. In Malaysia, incidence of WT is rare with only two cases reported per one million populations yearly. This case report is to highlight on the awareness of WT in an Asian population and highlight two cases and challenges faced after pre-operative chemotherapy. CASE REPORT In this case series, we report on two cases of WT which had poor response to pre-operative chemotherapy. Both cases underwent surgery after pre-operative chemotherapy and recovery was uneventful during a two-year follow-up. DISCUSSION Both patients had chemotherapy prior planned surgery, but had unfortunate poor tumour response. The tumour progressed in size which required a radical nephrectomy. The histology report for the first case had more than 60% blastemal cells remaining despite giving pre-operative chemotherapy with no focal anaplasia. This showed poor response to chemotherapy evidenced by the high number of blastemal cells. The second case was a stromal type WT which is known for poor response and may lead to enhancement of growth and maturation induced by chemotherapy. These were the possible reason of poor response of WT in these two cases.
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Affiliation(s)
- H C L Tan
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of General Surgery, kuala Lumpur, Malaysia.
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Kim SH, Park YJ, Cha AR, Kim GW, Bang JH, Lim CS, Choi SB. A feasibility work on the applications of MRE to automotive components. ACTA ACUST UNITED AC 2018. [DOI: 10.1088/1757-899x/333/1/012013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lim JY, Tay TS, Lim CS, Lee SSC, Teo SLM, Tan KS. Mytella strigata (Bivalvia: Mytilidae): an alien mussel recently introduced to Singapore and spreading rapidly. Molluscan Research 2018. [DOI: 10.1080/13235818.2018.1423858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J. Y. Lim
- St John’s Island National Marine Laboratory, Tropical Marine Science Institute, National University of Singapore, Singapore, 119227
| | - T. S. Tay
- St John’s Island National Marine Laboratory, Tropical Marine Science Institute, National University of Singapore, Singapore, 119227
| | - C. S. Lim
- St John’s Island National Marine Laboratory, Tropical Marine Science Institute, National University of Singapore, Singapore, 119227
| | - S. S. C. Lee
- St John’s Island National Marine Laboratory, Tropical Marine Science Institute, National University of Singapore, Singapore, 119227
| | - S. L.-M. Teo
- St John’s Island National Marine Laboratory, Tropical Marine Science Institute, National University of Singapore, Singapore, 119227
| | - K. S. Tan
- St John’s Island National Marine Laboratory, Tropical Marine Science Institute, National University of Singapore, Singapore, 119227
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Abstract
Bleeding complications should be considered in the differential diagnosis of any patient on warfarin therapy. A 66-year-old man presenting with right groin pain due to a spontaneous iliopsoas hematoma is reported. Computed tomography of the abdomen and pelvis at the emergency department confirmed the diagnosis. Fresh frozen plasma was given to correct the clotting derangement. The patient was managed conservatively. He was subsequently discharged well without complication. Iliopsoas haematoma or spontaneous retroperitoneal haemorrhage is an uncommon complication that needs to be considered in the differential diagnosis of a patient on warfarin therapy with abdominal, flank or groin pain.
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Lim CS, Kim YK, Lee KN, Kim MJ, Kim KH, Kim DS, Strickman D. Response to chloroquine ofPlasmodium vivaxamong South Korean soldiers. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.1999.11813460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Lim CS, Kim YK, Lee KN, Kim SH, Hoffman KJ, Song KJ, Song JW. The analysis of circumsporozoite-protein gene sequences from South Korean isolates of Plasmodium vivax. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.2001.11813634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Moon KH, Dharmarajah B, Bootun R, Lim CS, Lane TRA, Moore HM, Sritharan K, Davies AH. Comparison of microbubble presence in the right heart during mechanochemical and radiofrequency ablation for varicose veins. Phlebology 2016; 32:425-432. [DOI: 10.1177/0268355516661113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Mechanochemical ablation is a novel technique for ablation of varicose veins utilising a rotating catheter and liquid sclerosant. Mechanochemical ablation and radiofrequency ablation have no reported neurological side-effect but the rotating mechanism of mechanochemical ablation may produce microbubbles. Air emboli have been implicated as a cause of cerebrovascular events during ultrasound-guided foam sclerotherapy and microbubbles in the heart during ultrasound-guided foam sclerotherapy have been demonstrated. This study investigated the presence of microbubbles in the right heart during varicose vein ablation by mechanochemical abaltion and radiofrequency abaltion. Methods Patients undergoing great saphenous vein ablation by mechanochemical abaltion or radiofrequency ablation were recruited. During the ablative procedure, the presence of microbubbles was assessed using transthoracic echocardiogram. Offline blinded image quantification was performed using International Consensus Criteria grading guidelines. Results From 32 recruited patients, 28 data sets were analysed. Eleven underwent mechanochemical abaltion and 17 underwent radiofrequency abaltion. There were no neurological complications. In total, 39% (11/28) of patients had grade 1 or 2 microbubbles detected. Thirty-six percent (4/11) of mechanochemical abaltion patients and 29% (5/17) of radiofrequency ablation patients had microbubbles with no significant difference between the groups ( p=0.8065). Conclusion A comparable prevalence of microbubbles between mechanochemical abaltion and radiofrequency ablation both of which are lower than that previously reported for ultrasound-guided foam sclerotherapy suggests that mechanochemical abaltion may not confer the same risk of neurological events as ultrasound-guided foam sclerotherapy for treatment of varicose veins.
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Affiliation(s)
- KH Moon
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
| | - B Dharmarajah
- Academic Section of Vascular Surgery & Division of Experimental Medicine, Imperial College London, UK
| | - R Bootun
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
| | - CS Lim
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
| | - TRA Lane
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
| | - HM Moore
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
| | - K Sritharan
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
| | - AH Davies
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
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Ryu SW, Lee JH, Kim J, Jang MA, Nam JH, Byoun MS, Lim CS. Comparison of two new generation influenza rapid diagnostic tests with instrument-based digital readout systems for influenza virus detection. Br J Biomed Sci 2016; 73:115-120. [PMID: 27327199 DOI: 10.1080/09674845.2016.1189026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Influenza rapid diagnostic tests (RDTs) have been developed to supply scientists with more sensitive and specific techniques. Newly developed digital reader-based techniques require test evaluations before their clinical application. METHODS Two types of digital influenza RDTs using a digital readout system and one conventional RDT were compared using 314 nasopharyngeal swabs of influenza. The swabs originated from symptomatic individuals suspected of influenza infection, and the presence of influenza was confirmed with influenza real-time polymerase chain reaction (PCR) testing and influenza subtyping. Methods were the Sofia® Influenza A + B Fluorescence Immunoassay (FIA), which uses a portable fluorescence analyser, the BD Veritor™ System Flu A + B, which uses a colorimetric immunochromatographic method with a reflectance-based measurement digital device, and the SD Bioline assay, which is based on a traditional immunochromatographic method. RESULTS The Sofia® Influenza A + B system, the BD Veritor™ System Flu A + B and the SD Bioline assay showed sensitivities in relative real-time PCR results of 74.2, 73.0 and 53.9%, respectively, for influenza A, and 82.5, 72.8 and 71.0%, respectively, for influenza B. All three RDTs showed 100% specificities for influenza A and influenza B. The Sofia® Influenza A + B Fluorescence Immunoassay showed sensitive and specific results for the detection of influenza B in contrast to the BD Veritor™ System Flu A + B. The two digital RDTs showed higher sensitivity and specificity than the conventional RDT in the detection of the influenza H3 subtype. CONCLUSIONS Digital-based readout systems for the detection of the influenza virus can be applied for more sensitive diagnosis in clinical settings than conventional RDTs.
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Affiliation(s)
- S-W Ryu
- a Department of Laboratory Medicine, School of Medicine , Kangwon National University , Chuncheon , Korea
| | - J-H Lee
- b Department of Laboratory Medicine , Osan Hankook General Hospital , Osan , Korea
| | - J Kim
- c Department of Laboratory Medicine, College of Medicine , Korea University , Seoul , Korea
| | - M-A Jang
- c Department of Laboratory Medicine, College of Medicine , Korea University , Seoul , Korea
| | - J-H Nam
- c Department of Laboratory Medicine, College of Medicine , Korea University , Seoul , Korea
| | - M-S Byoun
- c Department of Laboratory Medicine, College of Medicine , Korea University , Seoul , Korea
| | - C S Lim
- c Department of Laboratory Medicine, College of Medicine , Korea University , Seoul , Korea
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Lee JH, Yang TU, Lee HW, Yoon SY, Lim CS. Bacteraemia caused by Fusobacterium necrophorum: a clinical approach to Lemierre's syndrome. Br J Biomed Sci 2016; 72:203-5. [PMID: 26738404 DOI: 10.1080/09674845.2015.11665754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Lim CS, Mowers EL, Mahnert N, Skinner B, Kamdar N, Morgan DM, As-Sanie S. Risk Factors for Conversion of Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2015; 22:S61. [DOI: 10.1016/j.jmig.2015.08.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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17
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Mowers EL, Lim CS, Skinner B, Nichole M, Daniel M, As-Sanie S. Characteristics of Women Undergoing Hysterectomy for Chronic Pelvic Pain: Prevalence and Risk Factors for Endometriosis. J Minim Invasive Gynecol 2015; 22:S232. [PMID: 27679130 DOI: 10.1016/j.jmig.2015.08.816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E L Mowers
- Ob/Gyn, University of Michigan, Ann Arbor, Michigan
| | - C S Lim
- Ob/Gyn, University of Michigan, Ann Arbor, Michigan
| | - B Skinner
- Ob/Gyn, University of Michigan, Ann Arbor, Michigan
| | - M Nichole
- Ob/Gyn, University of Michigan, Ann Arbor, Michigan
| | - M Daniel
- Ob/Gyn, University of Michigan, Ann Arbor, Michigan
| | - S As-Sanie
- Ob/Gyn, University of Michigan, Ann Arbor, Michigan
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Yoo KD, An JN, Kim CT, Cho JH, Kim CD, Park SK, Chae DW, Oh YK, Lim CS, Kim YS, Kim YH, Lee JP. Clinical outcomes in Asian elderly kidney transplant recipients: a multicenter cohort study. Transplant Proc 2015; 47:600-7. [PMID: 25891695 DOI: 10.1016/j.transproceed.2015.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/28/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The kidney transplantation rate in elderly patients is increasing rapidly. However, the clinical outcomes of kidney transplantation in elderly patients have not yet been thoroughly evaluated. METHODS This multicenter cohort study included adult kidney transplant recipients (KTRs) admitted to five major tertiary hospitals in Korea between 1997 and 2012. A total of 3,565 adult participants were enrolled. Patient survival, allograft survival, and biopsy-proven acute rejection (BPAR) of 242 elderly recipients (≥ 60 years) were assessed and compared with those of a younger population. RESULTS Patients were divided into five groups according to age at time of transplantation. The proportion of elderly patients was 6.7 % (mean age, 63.1 ± 2.7 years; n = 242). The numbers of male patients (69.4%), those with diabetes mellitus history (36.3%), and those with pretransplantation ischemic heart disease history (17.7%) were significantly higher in the elderly group than in the younger age groups. Elderly patients were more likely to receive a cadaveric kidney, and overall mortality rates were significantly higher in the elderly patients (1-year survival 93.3%, 5-year survival 91.3%). However, death-censored allograft survival rate and BPAR were not affected by patient age (P = .104 and .501, respectively). Among the elderly, BPAR and female donors were independent risk factors for allograft loss. CONCLUSION The overall survival rate of the elderly KTRs was significantly lower than that of younger KTRs. However, the death-censored allograft survival rate did not differ between groups. Kidney transplantation should not be stagnated especially in elderly patients with end-stage renal disease.
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Affiliation(s)
- K D Yoo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - J N An
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - C T Kim
- School of Public Health, Seoul National University, Seoul, Korea
| | - J H Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - C D Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - S K Park
- Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - D W Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Y K Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - C S Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Y S Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Y H Kim
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea.
| | - J P Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
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Woessner DW, Eiring AM, Bruno BJ, Zabriskie MS, Reynolds KR, Miller GD, O'Hare T, Deininger MW, Lim CS. A coiled-coil mimetic intercepts BCR-ABL1 dimerization in native and kinase-mutant chronic myeloid leukemia. Leukemia 2015; 29:1668-75. [PMID: 25721898 PMCID: PMC4621806 DOI: 10.1038/leu.2015.53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/05/2015] [Accepted: 01/09/2015] [Indexed: 01/14/2023]
Abstract
Targeted therapy of chronic myeloid leukemia is currently based on small-molecule inhibitors that directly bind the tyrosine kinase domain of BCR-ABL1. This strategy has generally been successful, but is subject to drug resistance due to point mutations in the kinase domain. Kinase activity requires transactivation of BCR-ABL1 following an oligomerization event, which is mediated by the coiled-coil (CC) domain at the N-terminus of the protein. Here, we describe a rationally engineered mutant version of the CC domain, called CCmut3, which interferes with BCR-ABL1 oligomerization and promotes apoptosis in BCR-ABL1-expressing cells, regardless of kinase domain mutation status. CCmut3 exhibits strong pro-apoptotic and anti-proliferative activity in cell lines expressing native BCR-ABL1, single kinase domain mutant BCR-ABL1 (E255V and T315I) or compound mutant BCR-ABL1 (E255V/T315I). Moreover, CCmut3 inhibits colony formation by primary CML CD34+ cells ex vivo, including a sample expressing the T315I mutant. These data suggest that targeting BCR-ABL1 with CC mutants may provide a novel alternative strategy for treating patients with resistance to current targeted therapies.
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Affiliation(s)
- D W Woessner
- Department of Pharmacology and Toxicology, College of Pharmacy, The University of Utah, Salt Lake City, UT, USA
| | - A M Eiring
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT, USA
| | - B J Bruno
- Department of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The University of Utah, Salt Lake City, UT, USA
| | - M S Zabriskie
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT, USA
| | - K R Reynolds
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT, USA
| | - G D Miller
- Department of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The University of Utah, Salt Lake City, UT, USA
| | - T O'Hare
- 1] Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT, USA [2] Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT, USA
| | - M W Deininger
- 1] Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT, USA [2] Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT, USA
| | - C S Lim
- 1] Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT, USA [2] Department of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The University of Utah, Salt Lake City, UT, USA
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Garland CJ, Smirnov SV, Bagher P, Lim CS, Huang CY, Mitchell R, Stanley C, Pinkney A, Dora KA. TRPM4 inhibitor 9-phenanthrol activates endothelial cell intermediate conductance calcium-activated potassium channels in rat isolated mesenteric artery. Br J Pharmacol 2014; 172:1114-23. [PMID: 25323322 DOI: 10.1111/bph.12985] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/08/2014] [Accepted: 10/09/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Smooth muscle transient receptor potential melastatin 4 (TRPM4) channels play a fundamental role in the development of the myogenic arterial constriction that is necessary for blood flow autoregulation. As TRPM4 channels are present throughout the vasculature, we investigated their potential role in non-myogenic resistance arteries using the TRPM4 inhibitor 9-phenanthrol. EXPERIMENTAL APPROACH Pressure and wire myography were used to assess the reactivity of rat arteries, the latter in combination with measurements of smooth muscle membrane potential. Immunohistochemistry (IHC) and endothelial cell (EC) calcium changes were assessed in pressurized vessels and patch clamp measurements made in isolated ECs. KEY RESULTS The TRPM4 inhibitor 9-phenanthrol reversibly hyperpolarized mesenteric arteries to circa EK and blocked α1 -adrenoceptor-mediated vasoconstriction. Hyperpolarization was abolished and vasoconstriction re-established by damaging the endothelium. In mesenteric and cerebral artery smooth muscle, 9-phenanthrol hyperpolarization was effectively blocked by the KCa 3.1 inhibitor TRAM-34. 9-Phenanthrol did not increase mesenteric EC [Ca(2+)]i , and Na(+) substitution with N-methyl-D-glucamine only increased the muscle resting potential by 10 mV. Immunolabelling for TRPM4 was restricted to the endothelium and perivascular tissue. CONCLUSIONS AND IMPLICATIONS These data reveal a previously unrecognized action of the TRPM4 inhibitor 9-phenanthrol - the ability to act as an activator of EC KCa 3.1 channels. They do not indicate a functionally important role for TRPM4 channels in the reactivity of non-myogenic mesenteric arteries.
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Affiliation(s)
- C J Garland
- Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, UK
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21
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Jang JW, Cho CH, Kim JY, Koh YE, Woo MK, Kim KA, Yoon SY, Lim MS, Han ET, An S SA, Lim CS. Rapid genotyping of Plasmodium vivax Pvs25 and Pv38 genes by using mismatch specific endonuclease. Trop Biomed 2014; 31:600-606. [PMID: 25776585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mismatch specific endonuclease (MSE) method was used to detect natural polymorphisms in Pvs25 and Pv38 genes of Plasmodium vivax. Eighty seven patients with P. vivax were recruited in the Republic of Korea (ROK). Pvs25 and Pv38 genes were amplified by polymerase chain reaction (PCR), and the PCR amplicons were mixed with reference DNA sequences. Following the denaturation and gradual annealing, the product mixtures were cleaved by the MSE. Heteroduplex types were readily detected by gel electrophoresis, where extra bands with shorter sizes would appear from the cleavage. After MSE cleavage of 657- bp product from Pvs25 mixtures, three genotypes were detected, while Pv38 mixtures with 1220-bp products presented two genotypes in ROK isolates. After the MSE cleavage, the mismatched samples of Pvs25 and Pv38 were completely sequenced, and the results were in complete agreement with the MSE analyses. In conclusion, genotyping of Pvs25 and Pv38 with MSE cleavage could be a potential method for the high-throughput screening of the large field samples.
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Affiliation(s)
- J W Jang
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Korea
| | - C H Cho
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Korea
| | - J Y Kim
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Y E Koh
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Korea
| | - M K Woo
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Korea
| | - K A Kim
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Korea
| | - S Y Yoon
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Korea
| | - M S Lim
- BioMedical Engineering, Korea University, Seoul, Korea
| | - E T Han
- Department of Parasitology, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - S A An S
- College of Bionano Technology, Gachon Bionano Research Institute, Kyungwon University, Seongnam, Korea
| | - C S Lim
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Korea
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Bootun R, Lane TRA, Dharmarajah B, Lim CS, Najem M, Renton S, Sritharan K, Davies AH. Intra-procedural pain score in a randomised controlled trial comparing mechanochemical ablation to radiofrequency ablation: The Multicentre Venefit™ versus ClariVein® for varicose veins trial. Phlebology 2014; 31:61-5. [PMID: 25193822 DOI: 10.1177/0268355514551085] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Endovenous techniques are, at present, the recommended choice for truncal vein treatment. However, the thermal techniques require tumescent anaesthesia, which can be uncomfortable during administration. Non-tumescent, non-thermal techniques would, therefore, have potential benefits. This randomised controlled trial is being carried out to compare the degree of pain that patients experience while receiving mechanochemical ablation or radiofrequency ablation. The early results of this randomised controlled trial are reported here. METHODS Patients attending for the treatment of primary varicose veins were randomised to receive mechanochemical ablation (ClariVein®) or radiofrequency ablation (Covidien® Venefit™). The most symptomatic limb was randomised. The primary outcome measure was intra-procedural pain using a validated visual analogue scale. The secondary outcome measures were change in quality of life and clinical scores, time to return to normal activities and work as well as the occlusion rate. RESULTS One-hundred and nineteen patients have been randomised (60 in the mechanochemical ablation group). Baseline characteristics were similar. Maximum pain score was significantly lower in the mechanochemical ablation group (19.3 mm, standard deviation ±19 mm) compared to the radiofrequency ablation group (34.5 mm ± 23 mm; p < 0.001). Average pain score was also significantly lower in the mechanochemical ablation group (13.4 mm ± 16 mm) compared to the radiofrequency ablation group (24.4 mm ± 18 mm; p = 0.001). Sixty-six percent attended follow-up at one month, and the complete or proximal occlusion rates were 92% for both groups. At one month, the clinical and quality of life scores for both groups had similar improvements. CONCLUSION Early results show that the mechanochemical ablation is less painful than the radiofrequency ablation procedure. Clinical and quality of life scores were similarly improved at one month. The long-term data including occlusion rates at six months and quality of life scores are being collected.
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Affiliation(s)
- R Bootun
- Academic Section of Vascular Surgery, Imperial College London, London, UK
| | - T R A Lane
- Academic Section of Vascular Surgery, Imperial College London, London, UK
| | - B Dharmarajah
- Academic Section of Vascular Surgery, Imperial College London, London, UK
| | - C S Lim
- Academic Section of Vascular Surgery, Imperial College London, London, UK Department of Vascular Surgery, North West London Hospitals NHS Trust, Harrow, UK
| | - M Najem
- Department of Vascular Surgery, North West London Hospitals NHS Trust, Harrow, UK
| | - S Renton
- Department of Vascular Surgery, North West London Hospitals NHS Trust, Harrow, UK
| | - K Sritharan
- Academic Section of Vascular Surgery, Imperial College London, London, UK
| | - A H Davies
- Academic Section of Vascular Surgery, Imperial College London, London, UK
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Okal A, Matissek KJ, Matissek SJ, Price R, Salama ME, Janát-Amsbury MM, Lim CS. Re-engineered p53 activates apoptosis in vivo and causes primary tumor regression in a dominant negative breast cancer xenograft model. Gene Ther 2014; 21:903-12. [PMID: 25077773 PMCID: PMC4324557 DOI: 10.1038/gt.2014.70] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/11/2014] [Accepted: 06/24/2014] [Indexed: 01/10/2023]
Abstract
Inactivation of p53 pathway is reported in more than half of all human tumors and can be correlated to malignant development. Missense mutation in the DNA binding region (DBD) of p53 is the most common mechanism of p53 inactivation in cancer cells. The resulting tumor-derived p53 variants, similar to wild-type (wt) p53, retain their ability to oligomerize via the tetramerization domain (TD). Upon hetero-oligomerization, mutant p53 enforces a dominant negative effect over active wt-p53 in cancer cells. To overcome this barrier, we have previously designed a chimeric superactive p53 (p53-CC) with an alternative oligomerization domain capable of escaping transdominant inhibition by mutant p53 in vitro. In this report, we demonstrate the superior tumor suppressor activity of p53-CC and its ability to cause tumor regression of the MDA-MB-468 aggressive p53-dominant negative breast cancer tumor model in vivo. In addition, we illustrate the profound effects of the dominant negative effect of endogenous mutant p53 over wt-p53 in cancer cells. Finally, we investigate the underlying differential mechanisms of activity for p53-CC and wt-p53 delivered using viral-mediated gene therapy approach in the MDA-MB-468 tumor model.
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Affiliation(s)
- A Okal
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA
| | - K J Matissek
- 1] Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA [2] Department of Pharmaceutics and Biopharmacy, Philipps-Universität, Marburg, Germany
| | - S J Matissek
- Faculty of Biotechnology, Biberach University of Applied Sciences, Biberach, Germany
| | - R Price
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA
| | - M E Salama
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - M M Janát-Amsbury
- 1] Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA [2] Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA [3] Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - C S Lim
- 1] Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA [2] Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Onuigbo M, Agbasi N, Wu MJ, Shu KH, Kugler E, Cohen E, Krause I, Goldberg E, Garty M, Krause I, Jansen J, De Napoli IE, Schophuizen CM, Wilmer MJ, Mutsaers HA, Heuvel LP, Grijpma DW, Stamatialis D, Hoenderop JG, Masereeuw R, Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, Vrints CJ, Hoymans VY, Couttenye MM, Erkmen Uyar M, Tutal E, Bal Z, Guliyev O, Sezer S, Liu L, Wang C, Tanaka K, Kushiyama A, Sakai K, Hara S, Ubara Y, Ohashi Y, Kunugi Y, Kawazu S, Untersteller K, Seiler S, Rogacev KS, Emrich IE, Lennartz CS, Fliser D, Heine GH, Hoshino T, Ookawara S, Miyazawa H, Ueda Y, Ito K, Kaku Y, Hirai K, Mori H, Yoshida I, Kakuta S, Hayama N, Amemiya M, Okamoto H, Inoue S, Tabei K, Campos P, Dias C, Baptista J, Papoila AL, Ortiz A, Inchaustegui L, Soto K, Moon KH, Yang S, Lee DY, Kim HW, Kim B, Isnard Bagnis C, Guerraoui A, Zenasni F, Idier L, Chauveau P, Cerqueira A, Quelhas-Santos J, Pestana M, Choi JY, Jin DC, Choi YJ, Kim WY, Nam SA, Cha JH, Cernaro V, Loddo S, Lacquaniti A, Romeo A, Costantino G, Montalto G, Santoro D, Trimboli D, Ricciardi CA, Lacava V, Buemi M, Emrich IE, Zawada AM, Rogacev KS, Seiler S, Obeid R, Geisel J, Fliser D, Heine GH, Meneses GC, Silva Junior G, Costa MFB, Goncalves HS, Daher EF, Liborio AB, Martins AMC, Ekart R, Hojs N, Bevc S, Hojs R, Lim CS, Hwang JH, Chin HJ, Kim S, Kim DK, Kim S, Park JH, Shin SJ, Lee SH, Choi BS, Lemoine S, Panaye M, Juillard L, Dubourg L, Hadj-Aissa A, Guebre-Egziabher F, Silva Junior G, Vieira APF, Couto Bem AX, Alves MP, Meneses GC, Martins AMC, Liborio AB, Daher EF, Ito K, Ookawara S, Miyazawa H, Ueda Y, Kaku Y, Hirai K, Hoshino T, Mori H, Yoshida I, Tabei K, Stefan G, Capusa C, Stancu S, Margarit D, Petrescu L, Nedelcu ED, Mircescu G, Szarejko-Paradowska A, Rysz J, Hung CC, Chen HC, Ristovska V, Grcevska L, Podesta MA, Reggiani F, Cucchiari D, Badalamenti S, Buemi M, Ponticelli C, Graziani G, Nouri-Majalan N, Moghadasimousavi S, Eshaghyeh Z, Greenwood S, Koufaki P, Maclaughlin H, Rush R, Hendry BM, Macdougall IC, Mercer T, Cairns H. CKD LAB METHODS, PROGRESSION & RISK FACTORS 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Janicke DM, Steele RG, Gayes LA, Lim CS, Clifford LM, Schneider EM, Carmody JK, Westen S. Systematic Review and Meta-Analysis of Comprehensive Behavioral Family Lifestyle Interventions Addressing Pediatric Obesity. J Pediatr Psychol 2014; 39:809-25. [DOI: 10.1093/jpepsy/jsu023] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Affiliation(s)
- D G Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Lim CS, Shaharuddin MS, Sam WY. Risk assessment of exposure to lead in tap water among residents of Seri Kembangan, Selangor state, Malaysia. Glob J Health Sci 2012; 5:1-12. [PMID: 23445691 PMCID: PMC4776794 DOI: 10.5539/gjhs.v5n2p1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 10/12/2012] [Indexed: 11/12/2022] Open
Abstract
Introduction: A cross sectional study was conducted to estimate risk of exposure to lead via tap water ingestion pathway for the population of Seri Kembangan (SK). Methodology: By using purposive sampling method, 100 respondents who fulfilled the inclusive criteria were selected from different housing areas of SK based on geographical population distribution. Residents with filtration systems installed were excluded from the study. Questionnaires were administered to determine water consumption-related information and demographics. Two water samples (first-flushed and fully-flushed samples) were collected from kitchen tap of each household using HDPE bottles. A total of 200 water samples were collected and lead concentrations were determined using a Graphite Furnace Atomic Absorption Spectrophotometer (GFAAS). Results: Mean lead concentration in first-flushed samples was 3.041± SD 6.967µg/L and 1.064± SD 1.103µg/L for fully-flushed samples. Of the first-flushed samples, four (4) had exceeded the National Drinking Water Quality Standard (NDWQS) lead limit value of 10µg/L while none of the fully-flushed samples had lead concentration exceeded the limit. There was a significant difference between first-flushed samples and fully-flushed samples and flushing had elicited a significant change in lead concentration in the water (Z = -5.880, p<0.05). It was also found that lead concentration in both first-flushed and fully flushed samples was not significantly different across nine (9) areas of Seri Kembangan (p>0.05). Serdang Jaya was found to have the highest lead concentration in first-flushed water (mean= 10.44± SD 17.83µg/L) while Taman Universiti Indah had the highest lead concentration in fully-flushed water (mean=1.45± SD 1.83µg/L). Exposure assessment found that the mean chronic daily intake (CDI) was 0.028± SD 0.034µgday-1kg-1. None of the hazard quotient (HQ) value was found to be greater than 1. Conclusion: The overall quality of water supply in SK was satisfactory because most of the parameters tested in this study were within the range of permissible limit and only a few samples had exceeded the standard values for lead and pH. Non-carcinogenic risk attributed to ingestion of lead in SK tap water was found to be negligible.
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An JN, Lee JP, Oh YK, Lim CS, Shoaf S, Bricmont P, Mallikaarjun S, Volpini RA, De Braganca AC, Canale D, Goncalves JG, Brandao TPB, Andrade L, Seguro AC, Shimizu MHM, Lee J, Joo KW, Oh YK, Jung YC, Earm JH, Han JS, Poch E, Burst V, Greenberg A, Makin A, Chase S, Walther B, Blom RE, Van Dijken GD, Hene RJ, Yu-Bao W, Valerie L, Thomas E, Arvid M, Alain D, Pierre-Yves M, Feraille E, Tovbin D, Avnon L, Bloch D, Zlotnik M, Abdelkadir A, Storch S, Fezeu L, Bankir L, Hansel B, Guerrot D, Anzai N, Jutabha P, Tolle M, Jankowski V, Kretschmer A, Santos RAS, Zidek W, Jankowski J, Bader M, Bourderioux M, Ida Chiara G, Thao NK, Ludovic J, Cerina C, Gabrielle P, Bertrand K, Estelle E, Bernard E, Aleksander E, Picard N, Loffing J. Acid-base / Electrolytes. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Oh YJ, Kim M, Lee H, Lee JP, Kim H, Kim S, Oh KH, Joo KW, Lim CS, Kim S, Kim YS, Kim DK. A threshold value of estimated glomerular filtration rate that predicts changes in serum 25-hydroxyvitamin D levels: 4th Korean National Health and Nutritional Examination Survey 2008. Nephrol Dial Transplant 2012; 27:2396-403. [DOI: 10.1093/ndt/gfr763] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Lim CS, Kiriakidis S, Paleolog E, Davies AH. 03 Varicose and non-varicose veins are able to activate the hypoxia-inducible factor pathway when exposed to hypoxia. Heart 2011. [DOI: 10.1136/heartjnl-2011-301156.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Han NR, Chen ZC, Lim CS, Ng B, Hong MH. Broadband multi-layer terahertz metamaterials fabrication and characterization on flexible substrates. Opt Express 2011; 19:6990-6998. [PMID: 21503013 DOI: 10.1364/oe.19.006990] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Microscopic split-ring-resonator (SRR) arrays are fabricated on 100 μm thick polyethylene naphthalate (PEN) films by femtosecond laser micro-lens array (MLA) lithography. The transmission properties of these metamaterials are characterized by THz Time Domain Spectroscopy (THz-TDS). Tunable resonance responses can be achieved by changing SRR structural design parameters. By stacking 2D PEN metamaterial films with different frequency responses together, a broadband THz filter with full width at half maximum (FWHM) of 0.38 THz is constructed. The bandwidth of the resonance response increases up to 4.2 times as compared to the bandwidths of single layer metamaterials. Numerical simulation reveals that SRR layers inside the multi-layer metamaterials are selectively excited towards specific frequencies within the broadband response. Meanwhile, more than one SRR layers respond to the chosen frequencies, resulting in the enhancement of the resonance properties. The multi-layer metamaterials provide a promising way to extend SRR based metamaterial operating region from narrowband to broadband with a tunable feature.
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Affiliation(s)
- N R Han
- Department of Electrical and Computer Engineering, National University of Singapore, 4 Engineering Drive 3, 117576, Singapore
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Lim CS, Follansbee-Junger KW, Crawford MS, Janicke DM. Treatment Outcome Research in Rural Pediatric Populations: The Challenge of Recruitment. J Pediatr Psychol 2011; 36:696-707. [DOI: 10.1093/jpepsy/jsr018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Blackwood DJ, Lim CS, Teo SLM. Influence of fouling on the efficiency of sacrificial anodes in providing cathodic protection in Southeast Asian tropical seawater. Biofouling 2010; 26:779-785. [PMID: 20818571 DOI: 10.1080/08927014.2010.515305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Aluminum and zinc based sacrificial anodes are routinely used to provide corrosion protection to metals (typically steel) exposed to seawater, for example in steel pipelines and storage tanks. However, the high fouling rates experienced in South East Asia means that both the anodes and the metals to be protected rapidly become coated with macrofoulers, which could potentially prevent the anodes from being effective. The present study, involving exposure tests of up to 18 months, indicates that both aluminum and zinc sacrificial anodes remain effective even after being completely coated with biofouling. Furthermore, it was easier to remove the biofouling on the cathodically protected samples than on their unprotected counterparts, possibly due to the higher local pH produced by cathodic protection at the metal and seawater interface.
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Affiliation(s)
- D J Blackwood
- Department of Materials Science and Engineering, National University of Singapore, Singapore, Singapore.
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Lim CS, Miles J, Peckham TJ. Current Practice of Obtaining Informed Consent for Local Steroid Injection among the Shoulder and Elbow Surgeons in United Kingdom. Scott Med J 2010; 55:32-4. [DOI: 10.1258/rsmsmj.55.3.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Local steroid injection is a common procedure and not without risks. Aim To establish the current practice of obtaining informed consent for local steroid injection among shoulder and elbow surgeons in the UK. Methods A postal questionnaire survey was distributed to 176 orthopaedics surgeons in UK who were members of the British Elbow and Shoulder Society. Results 68% of the surgeons considered local steroid injection invasive. 88% of the surgeons obtained verbal consent only. Of these, only 19% recorded the discussion. Almost all the surgeons (96%) explained the desired effects and 26% provided statistical evidence of local steroid injection. About 88% of the surgeons mentioned other drugs included in the injection. Only 13% of them mentioned the dose of the steroid used. 82% and 77% of the surgeons offered alternative treatment options and the right to refuse injection respectively. 85% and 59% of the surgeons discussed local and systemic risks of steroid injection, respectively. The most common risk mentioned by the surgeons is short term increase of pain. Conclusions Majority of the surgeons used verbal consent only for local steroid injection. The consent discussion was not regularly documented in case notes and the information delivered varies.
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Affiliation(s)
- CS Lim
- Senior House Officer, Directorate of Trauma and Orthopaedics, Basildon
University Hospital, Nethermayne, Essex SS16 5NL, UK
| | - J Miles
- Specialist Registrar in Orthopaedics and Trauma, Directorate of Trauma
and Orthopaedics, Basildon University Hospital, Nethermayne, Essex SS16 5NL, UK
| | - TJ Peckham
- Consultant Orthopaedics Surgeon, Directorate of Trauma and Orthopaedics,
Basildon University Hospital, Nethermayne, Essex SS16 5NL, UK
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Lim CS, Gohel MS, Shepherd AC, Davies AH. Secondary care treatment of patients with varicose veins in National Health Service England: at least how it appeared on a National Health Service website. Phlebology 2010; 25:184-9. [DOI: 10.1258/phleb.2009.009035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives This study aimed to assess the trends and regional variations in secondary care treatment of patients with varicose veins in National Health Service (NHS) England based on data published by the Hospital Episode Statistics which was freely and readily available to the public and health-care policy-makers. Methods Hospital Episode Statistics data for patients being treated for varicose veins, and UK Statistics Authority population estimates in all 28 Strategic Health Authorities (SHAs) in England from 2002 to 2006 were retrieved and analysed. Results Between 2002 and 2006 there was a 20% overall reduction (46,190–37,135) in the total number of varicose vein procedures performed in NHS England per year. The number of varicose vein procedures performed per 100,000 population per year varied significantly across the SHAs ( P < 0.0001). Similarly, significant regional variations were also noted in the frequency of primary procedures of greater and small saphenous vein ( P < 0.0001). During this time, injection sclerotherapy was only performed in 15 (53.6%) SHAs. The annual proportion of varicose vein procedures performed as daycases had increased from 56% to 64% during the period. Conclusion From 2002 to 2006 there was an overall reduction in the total number of varicose vein procedures performed in NHS England with major regional variations.
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Affiliation(s)
- C S Lim
- Imperial Vascular Unit, Charing Cross Campus, Imperial College London, London, UK
| | - M S Gohel
- Imperial Vascular Unit, Charing Cross Campus, Imperial College London, London, UK
| | - A C Shepherd
- Imperial Vascular Unit, Charing Cross Campus, Imperial College London, London, UK
| | - A H Davies
- Imperial Vascular Unit, Charing Cross Campus, Imperial College London, London, UK
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Lim CS, Hong MH, Chen ZC, Han NR, Luk'yanchuk B, Chong TC. Hybrid metamaterial design and fabrication for terahertz resonance response enhancement. Opt Express 2010; 18:12421-12429. [PMID: 20588369 DOI: 10.1364/oe.18.012421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Planar hybrid metamaterial with different split ring resonators (SRR) structure dimensions are fabricated on silicon substrates by femtosecond (fs) laser micro-lens array (MLA) lithography and lift-off process. The fabricated metamaterial structures consist of: (a) uniform metamaterial with 4 SRRs at same design and dimension as a unit cell and (b) hybrid metamaterial with 4 SRRs at same design but different dimensions as a unit cell. The electromagnetic field responses of these hybrid and single dimension metamaterial structures are characterized using a terahertz (THz) time-domain spectroscopy. Transmission spectra of these metamaterial show that a broader resonance peak is formed when 2 SRRs are close to each other. FDTD simulation proves that there is a strong mutual coupling between 2 SRRs besides a strong localized electric field at the split gap, which can enhance the electric field up to 364 times for tunable, broad band and high sensitivity THz sensing. Meanwhile, the strong coupling effect could lead to the formation of an additional resonance peak at approximately 0.2 THz in the THz spectra regime.
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Affiliation(s)
- C S Lim
- Data Storage Institute, 5 Engineering Drive 1, 117608 Singapore
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Wong KCK, Lim CS, Sadarmin PP, de Bono J, Qureshi N, Jones M, Bashir Y, Rajappan K, Betts TR. 134 High incidence of acute circumflex artery injury following mitral isthmus ablation. Heart 2010. [DOI: 10.1136/hrt.2010.196113.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chin LK, Liu AQ, Lim CS, Lin CL, Ayi TC, Yap PH. An optofluidic volume refractometer using Fabry-Pérot resonator with tunable liquid microlenses. Biomicrofluidics 2010; 4:024107. [PMID: 20697582 PMCID: PMC2917882 DOI: 10.1063/1.3430605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 04/26/2010] [Indexed: 05/11/2023]
Abstract
This letter reports the development of an optofluidic Fabry-Pérot (FP) resonator, which consists of a microcavity and a pair of liquid microlenses. The microcavity forms part of the microchannel to facilitate sample injection. The liquid microlenses are used for efficient light coupling from the optical fiber to the microcavity. The liquid microlens collimates the diverging light from the optical fiber into the FP cavity, which provides real-time tuning to obtain the highest possible finesse up to 18.79. In volume refractive index measurement, a sensitivity of 960 nm per refractive index unit (RIU) and a detection range of 0.043 RIU are achieved.
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Chin LK, Liu AQ, Soh YC, Lim CS, Lin CL. A reconfigurable optofluidic Michelson interferometer using tunable droplet grating. Lab Chip 2010; 10:1072-1078. [PMID: 20358116 DOI: 10.1039/b920412a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper presents a novel optofluidic Michelson interferometer based on droplet microfluidics used to create a droplet grating. The droplet grating is formed by a stream of plugs in the microchannel with constant refractive index variation. It has a real-time tunability in the grating period through varying the flow rates of the liquids and index variation via different combinations of liquids. The optofluidic Michelson interferometer is highly sensitive and is suitable for the measurement of biomedical and biochemical buffer solutions. The experimental results show that it has a sensitivity of 66.7 nm per refractive index unit (RIU) and a detection range of 0.086 RIU.
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Affiliation(s)
- L K Chin
- School of Electrical & Electronic Engineering, Nanyang Technological University, Nanyang Avenue, Singapore
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Shepherd AC, Gohel MS, Lim CS, Hamish M, Davies AH. The treatment of varicose veins: an investigation of patient preferences and expectations. Phlebology 2010; 25:54-65. [DOI: 10.1258/phleb.2009.009008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives A number of modalities are now available for the treatment of varicose veins. The aim of the study was to investigate the factors considered important by patients when contemplating treatment of their varicose veins. Methods Consecutive new patients referred to a vascular surgery service were invited to complete a short anonymous questionnaire prior to their consultation. The questionnaire consisted of 13 multiple choice questions relating to symptoms, potential varicose vein treatments and patient knowledge of existing therapies. Results Of 111 patients, there were 83 complete responses (75%). Symptoms of pain or aching were reported as moderate or severe by 77/103 (75%) of patients and significantly limited the activities of 47/101 (47%). Although the majority (89/103 [86%]) of patients were aware of surgery, only 52/103 (51%) knew of the existence of endothermal ablation (either laser or radiofrequency) and only 23/103 (22%) were aware of foam sclerotherapy. Some 58/92 (63%) were in favour of local anaesthetic treatment. Most patients (74/103, 72%) felt inadequately informed to express a preference regarding treatment type prior to their consultation, although 24/103 (23%) expressed a preference for endovenous treatment. Interestingly, 74/92 (80%) stated that the opinion of their vascular surgeon would be likely to or definitely influence their treatment decision and the majority of patients stated that what they had read in magazines (54/80, 64%) or on the Internet (51/85, 60%) would have no influence on their decision regarding treatment, respectively. Conclusion Only a minority of patients referred with varicose veins were aware of endovenous treatments or felt adequately informed to express a treatment preference prior to consultation. Over half of patients expressed a preference for local anaesthetic therapy and a preference for a single visit treatment, although most would be strongly influenced by the opinion of their vascular surgeon and not influenced by media advertising.
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Affiliation(s)
- A C Shepherd
- Imperial Vascular Unit, Imperial College,
London
| | - M S Gohel
- Imperial Vascular Unit, Imperial College,
London
| | - C S Lim
- Imperial Vascular Unit, Imperial College,
London
| | - M Hamish
- Imperial Vascular Unit, Imperial College,
London
| | - A H Davies
- Imperial Vascular Unit, Imperial College,
London
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Abstract
Objectives A variety of endovenous therapies for the treatment of superficial venous incompetence are currently available. The aim of this study was to evaluate the prevalence of endovenous techniques used by consultant vascular surgeons in the United Kingdom. Methods An anonymous online survey of 16 multiple choice questions relating to the nature and provision of treatment for varicose veins was devised. Consultant members of the Vascular Society of Great Britain and Ireland were invited to participate by email. Results A total of 108/352 (31%) surgeons completed the survey. The majority offered surgery as the first-line treatment for primary great saphenous vein (GSV) and small saphenous vein (SSV) incompetence (69% and 74%, respectively). Endovenous procedures were offered as first-line treatment by 32/108 (29.6%) for GSV reflux, 36/51 (70.6%) surgeons performed these under local anaesthetic and 21/51 (41.2%) were performed as an outpatient procedure. The most important factor influencing treatment decisions was considered to be patient preference by 77/108 (71.3%) surgeons, although 48/61 (78.7%) respondents were restricted by primary care trusts with regard to endovenous treatments, and 33/108 (30.6%) offered different treatments to private patients. Conclusion Traditional surgery remains the most commonly offered treatment for patients with varicose veins. The provision of endovenous therapies varies greatly, and there are significant differences in local availability regarding these treatments.
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Affiliation(s)
- A C Shepherd
- Imperial Vascular Unit, Charing Cross Hospital, London, UK
| | - M S Gohel
- Imperial Vascular Unit, Charing Cross Hospital, London, UK
| | - M Hamish
- Imperial Vascular Unit, Charing Cross Hospital, London, UK
| | - C S Lim
- Imperial Vascular Unit, Charing Cross Hospital, London, UK
| | - A H Davies
- Imperial Vascular Unit, Charing Cross Hospital, London, UK
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Abstract
BACKGROUND Valvular incompetence and reflux are common features of primary varicose veins, and have long been thought to be their cause. Recent evidence, however, suggests that changes in the vein wall may precede valvular dysfunction. METHODS A literature search was performed using PubMed and Ovid using the keywords 'varicose vein wall changes', 'pathogenesis', 'aetiology' and 'valvular dysfunction'. Articles discussing the pathophysiology of complications of varicose veins, such as ulceration, recurrence, thrombophlebitis and lipodermatosclerosis, were excluded. RESULTS AND CONCLUSION Positive family history, age, sex and pregnancy are important risk factors for varicose vein formation. Areas of intimal hyperplasia and smooth muscle cell proliferation are often noted in varicose veins, although regions of atrophy are also present. The total elastin content in varicose as opposed to non-varicose veins is reduced; changes in overall collagen content are uncertain. Matrix metalloproteinases (MMPs), including MMP-1, MMP-2, MMP-3, MMP-7 and MMP-9, and tissue inhibitor of metalloproteinase (TIMP) 1 and TIMP-3 are upregulated in varicose veins. Activation of the endothelium stimulates the recruitment of leucocytes and the release of growth factors, leading to smooth muscle cell proliferation and migration. Dysregulated apoptosis has also been demonstrated in varicose veins. An understanding of the pathophysiology of varicose veins is important in the identification of potential therapeutic targets and treatment strategies.
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Affiliation(s)
- C S Lim
- Imperial Vascular Unit, Imperial College London, 4 East, Charing Cross Hospital, Fulham Palace Road, London, UK
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Arora S, Lim CS, Foo JY, Sakharkar MK, Dixit P, Liu AQ, Miao JM. Microchip system for monitoring microbial physiological behaviour under drug influences. Proc Inst Mech Eng H 2009; 223:777-86. [PMID: 19743643 DOI: 10.1243/09544119jeim570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Single-step real-time high-throughput monitoring of drug influences on bacterial cell behaviour has become important with growing interests in personalized therapy and medication. Conventional microchip assemblies to perform similar work do exist. However, most of these devices have complex set-ups incorporating micromixers, separators, pumps, or valves. These microcomponents can sometimes damage the entities being monitored because of the creation of unfavourable biological environments. This paper presents a microchip-based system that enables single-step mixing of two solutions in various ratios, without the need for additional microcomponents such as mixers and pumps, in order to screen effectively their combinatory effects on cell outcomes. In this work, in-vitro experiments were carried out using ampicillin at various concentrations to investigate their effects on Escherichia coli (E. coli). Results showed that the microchip provided effective screening, which yielded useful results such as effective dosages, ineffective dosages, and other possible outcomes; for instance, in this case, the occurrence of adaptive mutation of the bacteria at certain drug concentrations. Comparative microbiological laboratory tests were carried out as standard for confirmation of the results.
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Affiliation(s)
- S Arora
- Biomedical Engineering Research Center, Nanyang Technological University, Singapore, Singapore
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Abstract
Central sleep apnoea (CSA) is a respiratory event where cessation of breathing effort and airflow occurs. Numerous lumped models have related the physical phenomena in the arterial tree to properties of the arterial wall. However, a limited model is available that describes pulse transit time (PTT) oscillations during CSA and tidal breathing. Data from 28 children (22 males; aged 6.2 +/- 3.6 years) were obtained during overnight polysomnography. Using a lumped-element model, PTT fluctuations during both respiratory events were described and compared with actual experimental data. 222 valid CSA and 222 tidal breathing events were acquired and analysed. For the tidal breathing, undamped PTT oscillations of 3.89 s were predicted while actual data showed a mean value of 3.68 +/- 0.83 s. Conversely, a damped PTT trend was observed during CSA as predicted by the model. The results attained showed that clustered CSA occurrences led to an increase of 7.23 +/- 3.34 per cent in PTT baseline value while the model predicted 7.86 +/- 2.63 per cent. The marginal increase in PTT baseline was expected since the blood pressure and heart rate decreased during such occurrences. The findings herein suggest that the described model has the potential to describe respiratory event characteristics of a sleeping child.
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Affiliation(s)
- J Y A Foo
- Division of Research, Singapore General Hospital, Singapore, Singapore.
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Abstract
Bio-compatible ZnO nanocrystals doped with Co, Cu and Ni cations, surface capped with two types of aminosilanes and titania are synthesized by a soft chemical process. Due to the small particle size (2-5 nm), surface functional groups and the high photoluminescence emissions at the UV and blue-violet wavelength ranges, bio-imaging on human osteosarcoma (Mg-63) cells and histiocytic lymphoma U-937 monocyte cells showed blue emission at the nucleus and bright turquoise emission at the cytoplasm simultaneously. This is the first report on dual-color bio-images labeled by one semiconductor nanocrystal colloidal solution. Bright green emission was detected on mung bean seedlings labeled by all the synthesized ZnO nanocrystals. Cytotoxicity tests showed that the aminosilanes capped nanoparticles are non-toxic. Quantum yields of the nanocrystals varied from 79% to 95%. The results showed the potential of the pure ZnO and Co-doped ZnO nanocrystals for live imaging of both human cells and plant systems.
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Affiliation(s)
- Y L Wu
- Singapore Institute of Manufacturing Technology, 71 Nanyang Drive, 638075, Singapore. School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore
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Abstract
Pulse wave velocity (PWV) has shown to be a clinically important physiologic measure in the assessment of increased arterial stiffness that is linked to systolic hypertension. Pulse transit time (PTT), which is based on the principle of PWV, has become popular in childhood cardiovascular studies. A previous study has indicated PWV obtained from a Chinese population tends to be higher than that from their Caucasian counterpart of similar age but of different localities. In this study, 67 healthy children (55 Caucasian and 12 Chinese) were recruited to investigate the possible PTT difference between these two ethnic groups in the same region. However, the hypothesized PWV difference (p < 0.05) between them is not observed here in the corresponding PTT measurements (time-related PWV equivalent). Hence, preliminary results suggest that locality or inclusion of pre-ejection period, which forms the major component of the PTT measurement, may contribute to this discrepancy.
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Affiliation(s)
- J Y A Foo
- Biomedical Engineering Research Centre, Nanyang Technological University, 50 Nanyang Drive, Research Techno Plaza, 6th Storey, XFrontiers Block, 637553, Singapore.
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