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Williams D, Kave B, Begg F, Marshall C, Segal R, Ng I. Impacts on staff after implementation of a respiratory protection program in a Victorian public hospital. Infect Dis Health 2021; 26:265-272. [PMID: 34176771 DOI: 10.1016/j.idh.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND In October 2020, the Royal Melbourne Hospital implemented a Respiratory Protection Program (RPP), which was initiated by the Victorian Government. This study was to evaluate the effectiveness of the program. METHODS A cohort of 158 employees, who were identified as high risk to respiratory biohazard exposure, were invited to participate in the RPP. We provided a bundle of interventions, which included an online training package, and mandatory quantitative fit testing. The main outcomes included the participants' knowledge and attitude toward respiratory protection equipment (RPE), which were assessed via an online survey. Their donning and doffing skills, and user seal check techniques on four different types of N95 respirators were also assessed by an observer using a pre-determined marking sheet. We compared these outcomes before and after participation in the program. RESULTS There was a total of 125 participants, all of whom completed the knowledge and attitude assessment, and 69 completed the skill assessment before and after the program. There was a statistically significant improvement in their knowledge scores, donning and doffing skills, and user seal check techniques after participation in the RPP. Participants also reported significant increased level of confidence in their RPE knowledge, training and skills; and workplace safety. CONCLUSION This initial report of the implementation of a novel RPP in a Victorian major tertiary hospital provides guidance on the benefits to respiratory protection, staff knowledge, skills, confidence and morale that can be acquired from a scalable online training package combined with mandatory quantitative fit testing.
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Affiliation(s)
- D Williams
- University of Melbourne, Parkville, Victoria, 3050, Australia; Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia
| | - B Kave
- Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia
| | - F Begg
- Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia
| | - C Marshall
- University of Melbourne, Parkville, Victoria, 3050, Australia; Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia; The Peter Doherty Institute of Infection and Immunity Victoria, 792 Elizabeth Street, Melbourne, Victoria, 3000, Australia
| | - R Segal
- University of Melbourne, Parkville, Victoria, 3050, Australia; Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia
| | - I Ng
- University of Melbourne, Parkville, Victoria, 3050, Australia; Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia.
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Soon Y, Tan A, Ng I, Tan T, Tey J. P1.15-29 Impact of Radiation Therapy Quality Assurance on Progression-Free and Overall Survival in Randomized Trials of Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.962] [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: 10/28/2022]
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3
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Ng I, Kumarakulasinghe N, Syn N, Soo R. P2.13-27 Development, Internal Validation, and Calibration of a Risk Score to Predict Survival in Patients with EGFR Mutant NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1422] [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: 10/28/2022]
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4
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Preece G, Ng I, Lee K, Mezzavia P, Krieser R, Williams DL, Stewart O, Segal R. A Randomised Controlled Trial Comparing Fibreoptic-Guided Tracheal Intubation through Two Supraglottic Devices: Ambu® Auragain™ Laryngeal Mask and LMA® Fastrach™. Anaesth Intensive Care 2018; 46:474-479. [DOI: 10.1177/0310057x1804600508] [Citation(s) in RCA: 10] [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: 11/17/2022]
Abstract
The Ambu®AuraGain™ laryngeal mask (LM) (Ambu A/S, Ballerup, Denmark) is one of the few readily available second-generation supraglottic airway devices (SADs) that offer a conduit for fibreoptic-guided endotracheal intubation. We aimed to compare fibreoptic intubation through this device with the LMA® (laryngeal mask airway) Fastrach™ (Teleflex Medical, Co. Westmeath, Ireland), which has been a recommended dedicated rescue device for the management of the unanticipated difficult airway. This randomised controlled trial compared a previously described fibreoptic score in 116 patients with no known airway pathology, who had asleep fibreoptic endotracheal intubation via either the AuraGain LM or the LMA Fastrach. Time, ease and success rate of SAD and endotracheal tube (ETT) insertion and complications were recorded. The AuraGain LM demonstrated better laryngeal alignment with 29 out of 59 patients in the AuraGain LM (AG) group having a Grade 4 view (only vocal cords visible), compared to 20 out of 54 patients in the LMA Fastrach (FT) group (P=0.003). It allowed significantly quicker and easier ETT intubation when used as a conduit. The AuraGain LM was also quicker to insert compared to the Fastrach LMA. Similar rates of minor complications, such as sore throat and dysphonia occurred in both groups. Our study indicates that when used in patients with complete muscle relaxation and no known airway pathology, the AuraGain LM achieves better laryngeal alignment and quicker, easier and more successful fibreoptic-guided ETT intubation than the Fastrach LMA.
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Affiliation(s)
- G. Preece
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - I. Ng
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - K. Lee
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - P. Mezzavia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - R. Krieser
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - D. L. Williams
- Director, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; Clinical Professor, University of Melbourne; Melbourne, Victoria
| | - O. Stewart
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria
| | - R. Segal
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; University of Melbourne; Melbourne, Victoria
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5
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Ng I, Krieser R, Mezzavia P, Lee K, Tseng C, Douglas NWR, Segal R. The Use of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) for Pre-Oxygenation in Neurosurgical Patients: A Randomised Controlled Trial. Anaesth Intensive Care 2018; 46:360-367. [DOI: 10.1177/0310057x1804600403] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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
This study explored the use of high-flow nasal oxygen (HFNO) in both pre-oxygenation and apnoeic oxygenation in adults who were intubated following a non–rapid sequence induction. Fifty patients were randomised to receive pre-oxygenation via a standard facemask or the Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) device. After five minutes of pre-oxygenation, induction and muscle relaxant agents were given. While waiting for complete paralysis, patients in the standard facemask group received bag–mask ventilation (BMV), whereas patients in the HFNO group received apnoeic oxygenation via the THRIVE device. Serial blood samples for arterial blood gas analysis were taken. Baseline patient and airway characteristics were similar. The median PaO2 after pre-oxygenation was 357 (interquartile range [IQR] 324–450 [range 183– 550]) mmHg in the facemask group, compared to 471 (IQR 429–516 [range 185–550]) mmHg in the HFNO group (P=0.01). The median arterial partial pressure of oxygen (PaO2) in the HFNO group decreased after a period of apnoeic oxygenation, and was significantly lower when compared to patients who received BMV in facemask group. The arterial carbon dioxide partial pressure (PaCO2) level after complete paralysis was significantly higher in the HFNO group when compared to the facemask group (median 52 [IQR 48–55 {range 40–65}] versus median 43 [IQR 40–48 {range 35–63}] mmHg, P=0.0005 and P=0.004 respectively). There were no differences in the time to muscle paralysis and time to intubation. Seven patients required use of airway adjuncts during BMV in the facemask group, compared to none in the HFNO group (P=0.004). No complications were observed in either group. HFNO produces a higher PaO2 after pre-oxygenation and safe PaO2 during intubation. However, the subsequent fall in PaO2 and rise in PaCO2 indicates that it is not as effective as BMV in maintaining oxygenation and ventilation following neuromuscular blockade.
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Affiliation(s)
- I. Ng
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - R. Krieser
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - P. Mezzavia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - K. Lee
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - C. Tseng
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - N. W. R. Douglas
- Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, Victoria
| | - R. Segal
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; University of Melbourne; Melbourne, Victoria
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Douglas N, Ng I, Nazeem F, Lee K, Mezzavia P, Krieser R, Steinfort D, Irving L, Segal R. A randomised controlled trial comparing high-flow nasal oxygen with standard management for conscious sedation during bronchoscopy. Anaesthesia 2017; 73:169-176. [DOI: 10.1111/anae.14156] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/27/2022]
Affiliation(s)
- N. Douglas
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - I. Ng
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - F. Nazeem
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - K. Lee
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - P. Mezzavia
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - R. Krieser
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
| | - D. Steinfort
- Department of Respiratory Medicine; Royal Melbourne Hospital; Parkville Victoria Australia
| | - L. Irving
- Department of Respiratory Medicine; Royal Melbourne Hospital; Parkville Victoria Australia
| | - R. Segal
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital; Parkville Victoria Australia
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7
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Ng I, Kumarakulasinghe N, Syn N, Teng R, Soo R. P3.01-022 Prognostic Value of Clinical, Immune and Biochemical Markers in EGFR-Mutant NSCLC Patients Treated with First-Line EGFR TKIs. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1463] [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: 11/28/2022]
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8
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Makris N, Zhu A, Papadimitriou GM, Mouradian P, Ng I, Scaccianoce E, Baselli G, Baglio F, Shenton ME, Rathi Y, Dickerson B, Yeterian E, Kubicki M. Mapping temporo-parietal and temporo-occipital cortico-cortical connections of the human middle longitudinal fascicle in subject-specific, probabilistic, and stereotaxic Talairach spaces. Brain Imaging Behav 2017; 11:1258-1277. [PMID: 27714552 PMCID: PMC5382125 DOI: 10.1007/s11682-016-9589-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Originally, the middle longitudinal fascicle (MdLF) was defined as a long association fiber tract connecting the superior temporal gyrus and temporal pole with the angular gyrus. More recently its description has been expanded to include all long postrolandic cortico-cortical association connections of the superior temporal gyrus and dorsal temporal pole with the parietal and occipital lobes. Despite its location and size, which makes MdLF one of the most prominent cerebral association fiber tracts, its discovery in humans is recent. Given the absence of a gold standard in humans for this fiber tract, its precise and complete connectivity remains to be determined with certainty. In this study using high angular resolution diffusion MRI (HARDI), we delineated for the first time, six major fiber connections of the human MdLF, four of which are temporo-parietal and two temporo-occipital, by examining morphology, topography, cortical connections, biophysical measures, volume and length in seventy brains. Considering the cortical affiliations of the different connections of MdLF we suggested that this fiber tract may be related to language, attention and integrative higher level visual and auditory processing associated functions. Furthermore, given the extensive connectivity provided to superior temporal gyrus and temporal pole with the parietal and occipital lobes, MdLF may be involved in several neurological and psychiatric conditions such as primary progressive aphasia and other aphasic syndromes, some forms of behavioral variant of frontotemporal dementia, atypical forms of Alzheimer's disease, corticobasal degeneration, schizophrenia as well as attention-deficit/hyperactivity Disorder and neglect disorders.
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Affiliation(s)
- Nikos Makris
- Departments of Psychiatry and Neurology Services, Center for Morphometric Analysis, Center for Neural Systems Investigations, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Building 149, 13th Street, Charlestown, Boston, MA, 02129, USA.
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA.
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, 02215, USA.
- McLean Hospital, Harvard Medical School (Affiliated School/Hospital), Belmont, MA, 02478, USA.
| | - A Zhu
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA
- VA Boston Healthcare System, Boston, MA, 02130, USA
| | - G M Papadimitriou
- Departments of Psychiatry and Neurology Services, Center for Morphometric Analysis, Center for Neural Systems Investigations, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Building 149, 13th Street, Charlestown, Boston, MA, 02129, USA
| | - P Mouradian
- Departments of Psychiatry and Neurology Services, Center for Morphometric Analysis, Center for Neural Systems Investigations, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Building 149, 13th Street, Charlestown, Boston, MA, 02129, USA
| | - I Ng
- Departments of Psychiatry and Neurology Services, Center for Morphometric Analysis, Center for Neural Systems Investigations, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Building 149, 13th Street, Charlestown, Boston, MA, 02129, USA
| | - E Scaccianoce
- Department of Bioengineering, Politecnico di Milano, Milan, Italy
| | - G Baselli
- Department of Bioengineering, Politecnico di Milano, Milan, Italy
| | - F Baglio
- Department of Bioengineering, Politecnico di Milano, Milan, Italy
| | - M E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA
- VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA
| | - Y Rathi
- Departments of Psychiatry and Neurology Services, Center for Morphometric Analysis, Center for Neural Systems Investigations, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Building 149, 13th Street, Charlestown, Boston, MA, 02129, USA
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA
| | - B Dickerson
- Departments of Psychiatry and Neurology Services, Center for Morphometric Analysis, Center for Neural Systems Investigations, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Building 149, 13th Street, Charlestown, Boston, MA, 02129, USA
| | - E Yeterian
- Department of Psychology, Colby College, Waterville, ME, 04901, USA
| | - M Kubicki
- Departments of Psychiatry and Neurology Services, Center for Morphometric Analysis, Center for Neural Systems Investigations, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Building 149, 13th Street, Charlestown, Boston, MA, 02129, USA
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA
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9
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Tan H, Leung C, Chan K, Ng I, Lo R. GATA6 exhibits tumor suppressive effects in hepatocellular carcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx361.042] [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: 11/14/2022] Open
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10
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Ng I, Sim XLJ, Tsiripillis M, Segal R, Mezzavia P, Lee K, Morris J. Current sedation practice for patients undergoing endobronchial ultrasound examination: a prospective cohort study. Anaesth Intensive Care 2015; 43:664-665. [PMID: 26310421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Ng I, Segal R, Lee KL, Ilyas S, Story D. A prospective audit of difficult airway equipment at University of Melbourne-affiliated hospitals. Anaesth Intensive Care 2015; 43:528. [PMID: 26099768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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12
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Ilyas S, Symons J, Bradley WPL, Segal R, Taylor H, Lee K, Balkin M, Bain C, Ng I. A prospective randomised controlled trial comparing tracheal intubation plus manual in-line stabilisation of the cervical spine using the Macintosh laryngoscope vs the McGrath®Series 5 videolaryngoscope. Anaesthesia 2014; 69:1345-50. [DOI: 10.1111/anae.12804] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2014] [Indexed: 12/23/2022]
Affiliation(s)
- S. Ilyas
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital and University of Melbourne; Melbourne Victoria Australia
| | - J. Symons
- Department of Anaesthesia and Perioperative Medicine; The Alfred and Monash University; Melbourne Victoria Australia
| | - W. P. L. Bradley
- Department of Anaesthesia and Perioperative Medicine; The Alfred and Monash University; Melbourne Victoria Australia
| | - R. Segal
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital and University of Melbourne; Melbourne Victoria Australia
| | - H. Taylor
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital and University of Melbourne; Melbourne Victoria Australia
| | - K. Lee
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital and University of Melbourne; Melbourne Victoria Australia
| | - M. Balkin
- Department of Anaesthesia and Perioperative Medicine; The Alfred and Monash University; Melbourne Victoria Australia
| | - C. Bain
- Department of Anaesthesia and Perioperative Medicine; The Alfred and Monash University; Melbourne Victoria Australia
| | - I. Ng
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital and University of Melbourne; Melbourne Victoria Australia
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Watson MJ, Wong DM, Kluger R, Chuan A, Herrick MD, Ng I, Castanelli DJ, Lin L, Lansdown AK, Barrington MJ. Psychometric evaluation of a direct observation of procedural skills assessment tool for ultrasound-guided regional anaesthesia. Anaesthesia 2014; 69:604-12. [DOI: 10.1111/anae.12625] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- M. J. Watson
- University of Newcastle; Newcastle New South Wales Australia
| | - D. M. Wong
- St. Vincent's Hospital; Melbourne Victoria Australia
| | - R. Kluger
- St. Vincent's Hospital; Melbourne Victoria Australia
| | - A. Chuan
- Liverpool Hospital; Macquarie University; Sydney New South Wales Australia
| | - M. D. Herrick
- University of Melbourne; Macquarie University; Sydney New South Wales Australia
| | - I. Ng
- Director of Regional Anesthesiology; Geisel School of Medicine at Dartmouth; Lebanon Pennsylvania USA
| | | | - L. Lin
- University of Melbourne; Melbourne Victoria Australia
| | - A. K. Lansdown
- Monash Medical Centre; Department of Anaesthesia and Perioperative Medicine; Monash University; Melbourne Victoria Australia
| | - M. J. Barrington
- Austin Health; Melbourne Victoria Australia
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
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Whittaker S, Lethbridge G, Kim C, Keon Cohen Z, Ng I. An ultrasound needle insertion guide in a porcine phantom model. Anaesthesia 2013; 68:826-9. [DOI: 10.1111/anae.12262] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/27/2022]
Affiliation(s)
- S. Whittaker
- Anaesthetic Department; Royal Melbourne Hospital; Melbourne; Vic.; Australia
| | - G. Lethbridge
- Anaesthetic Department; Royal Melbourne Hospital; Melbourne; Vic.; Australia
| | - C. Kim
- Anaesthetic Department; Royal Melbourne Hospital; Melbourne; Vic.; Australia
| | - Z. Keon Cohen
- Anaesthetic Department; Alfred Hospital; Melbourne; Vic.; Australia
| | - I. Ng
- Anaesthetic Department; Royal Melbourne Hospital; Melbourne; Vic.; Australia
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Ng I, Hill AL, Williams DL, Lee K, Segal R. Randomized controlled trial comparing the McGrath videolaryngoscope with the C-MAC videolaryngoscope in intubating adult patients with potential difficult airways. Br J Anaesth 2012; 109:439-43. [PMID: 22677878 DOI: 10.1093/bja/aes145] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Difficult and failed intubations, although rarely encountered, are major causes of morbidity and mortality in the current anaesthetic practice. To reduce the incidence of difficult and failed intubations, several devices including the recently developed videolaryngoscopes are available. This randomized controlled study aims to compare the use of the McGrath videolaryngoscope with the C-MAC videolaryngoscope in adult patients with potential difficult airways. METHODS A total of 130 patients with the Mallampati grade of ≥3, requiring orotracheal intubation, were randomized to either having intubation with the McGrath videolaryngoscope or the C-MAC videolaryngoscope. The primary outcome was time to intubation. The laryngoscopic view, the number of intubation attempts, the proportion of intubation success, the ease of intubation, the haemodynamic responses to intubation, and the incidence of any complications were also recorded. RESULTS Time to successful intubation with the C-MAC videolaryngoscope was shorter when compared with the McGrath videolaryngoscope {50 s [inter-quartile range (IQR) 38-70] vs 67 s (IQR 49-108), P<0.001}, despite the McGrath videolaryngoscope providing significantly more grade 1 laryngoscopic views. The C-MAC videolaryngoscope also resulted in significantly fewer intubation attempts and greater ease of intubation when compared with the McGrath videolaryngoscope. There were no statistically significant differences in the proportion of intubation success, the number of complications, and the changes in haemodynamic responses between the two videolaryngoscopes. CONCLUSIONS The C-MAC videolaryngoscope allowed a quicker intubation time, fewer intubation attempts, and greater ease of intubation compared with the McGrath videolaryngoscope when used in patients with the Mallampati grade of ≥3.
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Affiliation(s)
- I Ng
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia.
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16
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Reyes KB, Lee HY, Ng I, Goh KY. Abducens (sixth) nerve palsy presenting as a rare case of isolated brainstem metastasis from a primary breast carcinoma. Singapore Med J 2011; 52:e220-e222. [PMID: 22173259] [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: 05/31/2023]
Abstract
Most isolated abducens (sixth) nerve palsies are ischaemic in nature. However, there are other causes that can mimic an abducens nerve palsy, which requires aggressive diagnostic management. A 56-year-old hypertensive woman presented with a right abduction deficit. Her past history revealed that she had undergone a mastectomy and completed a course of chemo- and radiation therapy for breast carcinoma. She was well until she develped binocular diplopia five months later. Magnetic resonance imaging showed a right pontine mass. Stereotactic biopsy was performed, and histopathology revealed a metastatic carcinoma that was compatible with an origin from the breast primary. We conclude that identifying and managing patients with metastatic lesions involves a multidisciplinary approach. Thorough history-taking and neuro-ophthalmologic evaluation would help physicians in establishing the primary differentials, which could not only be sight-saving but life-saving as well.
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Affiliation(s)
- K B Reyes
- Neuro-Ophthalmology Service, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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Venketasubramanian N, Chan BPL, Chang HM, Chua HC, Gan RN, Hui F, Lee W, Ng I, Sharma VK, Singh R, Teoh HL, Wang E, Chen CLH. Brain attack: needing resuscitation. Singapore Med J 2011; 52:620-630. [PMID: 21879224] [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: 05/31/2023]
Abstract
The brain is extremely susceptible to focal ischaemia. Following vascular occlusion, a core of severely damaged brain tissue develops, surrounded by an ischaemic penumbra. This potentially-salvageable penumbra may be estimated by advanced neuroimaging techniques, particularly by diffusion-perfusion mismatch. Clinical trials have demonstrated the efficacy of intravenous thrombolysis within three hours of onset of ischaemic stroke in reducing short-term disability. Recanalisation is enhanced by intra-arterial thrombolysis, sonothrombolysis and clot-retrieval devices. Occasionally, reperfusion injury may lead to clinical deterioration. The search continues for effective neuroprotectants. Brain perfusion needs to be maintained through blood and intracranial pressure management. Hemicraniectomy for 'malignant' cerebral oedema reduces death and disability. Elevated glucose should be controlled and hypoxia alleviated. Public education of symptoms and the need for immediate presentation to a medical facility is needed. Stroke unit care reduces death and disability with little increase in cost. Current evidence supports urgent efforts to resuscitate the brain after stroke.
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Affiliation(s)
- N Venketasubramanian
- Division of Neurology, University Medicine Cluster, National University Health Systems, 5 Lower Kent Ridge Road, Singapore 119074.
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Tan EC, Lim E, Cham B, Knight L, Ng I. Partial trisomy 3p and partial monosomy 11q associated with atrial septal defect, cleft palate, and developmental delay: a case report. Cytogenet Genome Res 2011; 134:319-24. [PMID: 21654159 DOI: 10.1159/000328835] [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] [Accepted: 04/14/2011] [Indexed: 11/19/2022] Open
Abstract
Unbalanced translocation involving both chromosome 3p duplication and 11q deletion in the same patient is extremely rare; only 1 live-born case was reported previously. This karyotype was also detected during prenatal diagnosis of 2 different pregnancies in a Taiwanese family which were both terminated. In all 3 cases, only standard karyotyping was done to detect the abnormal karyotypes. Here, we report a 4-year-old boy with cleft palate, atrial septal defect, and hypotonia with gross and fine motor delay. Oligonucleotide-based array comparative genomic hybridization showed copy number gain from 3pter to 3p24.2 (approximately 24.5 Mb) and copy number loss from 11q25 to 11qter (approximately 5.8 Mb). This de novo unbalanced translocation event involving a terminal 3p duplication and a terminal 11q deletion provides candidate genes for further investigation of dosage effect leading to the patient's multiple phenotypic abnormalities. Genotype-phenotype correlation is difficult to make in this case due to the large number of genes involved. However, the description of such cases together with precise gene-level mapping of chromosomal breakpoints will add to further refinement of candidate genes to be investigated for terminal imbalances in 3p and 11q when more similar cases are reported.
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Affiliation(s)
- E-C Tan
- KK Research Centre, KK Women's and Children's Hospital, Singapore. tanec @ bigfoot.com
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Ng I, Sim XLJ, Williams D, Segal R. A randomised controlled trial comparing the McGrath(®) videolaryngoscope with the straight blade laryngoscope when used in adult patients with potential difficult airways. Anaesthesia 2011; 66:709-14. [PMID: 21564049 DOI: 10.1111/j.1365-2044.2011.06767.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Studies show that both straight blade laryngoscopy and videolaryngoscopy can improve the view of the larynx when compared with the Macintosh blade laryngoscopy. However, no study has compared these two devices. A total of 80 patients with Mallampati grade ≥ 3 were randomly assigned to either have orotracheal intubation with the McGrath(®) videolaryngoscope or the Henderson straight blade. The primary outcome was laryngoscopic view. Time to intubation, number of attempts, ease of intubation and complications were also recorded. Thirty-nine out of 40 patients had grade-1 views in the McGrath group, compared with 29 out of 40 cases in the Henderson group (p = 0.003). There were no statistically significant differences in the secondary outcomes. Two patients suffered from minor oropharyngeal injuries in the Henderson group. Apart from offering significantly more grade-1 laryngoscopic views, the McGrath videolaryngoscope did not improve other clinical outcomes compared with the straight blade, when used in patients with poor Mallampati scores.
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Affiliation(s)
- I Ng
- Royal Melbourne Hospital, Victoria, Australia.
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21
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Abstract
Analysis of slow waves in arterial blood pressure (ABP) and intracranial pressure (ICP) has been used as an index to describe cerebrovascular pressure-reactivity. It has been previously demonstrated that the pressure-reactivity index (PRx) can be used to reflect global cerebrovascular reactivity with changes in ABP. A positive PRx signifies a positive association between ABP and ICP, indicating a non-reactive vascular bed, while a negative PRx is reflective of intact cerebral autoregulation, where ABP waves provoke inversely correlated waves in ICP. To date, there has been no characterization of pressure-reactivity following decompressive craniectomy. In this prospective observational study, 33 patients who underwent surgery for acute brain injury with mass lesions for which the bone flap was left out were studied. The PRx was calculated as a moving correlation coefficient between 30 consecutive samples of values of ICP and ABP averaged for a period of 10 s. The time profiles of mean PRx values at 6-hourly intervals were analysed and compared with that in seven patients treated by medical therapy alone. The initial mean PRx 6 h after surgery was positive, indicative of disturbed pressure-reactivity. With time, PRx trended towards a more negative value, suggestive of an improving cerebrovascular autoregulatory reserve. The mean PRx 24 h after surgery was 0.28 (+/-0.26), while the mean PRx 72 h after surgery was 0.15 (+/-0.25) (p = 0.012). In contrast, the mean PRx in patients that were not decompressed did not change significantly with time (p = 0.357). Surgery in acute brain injury for which the bone flap is left out in anticipation of raised intracranial pressure in the postoperative period leads to an improved PRx as compared with controls. Craniectomy in this situation may have a contribution to the restoration of disturbed cerebrovascular pressure-reactivity.
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Affiliation(s)
- E C Wang
- Department of Neurosurgery, National Neuroscience Institute, Singapore
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Ng I, Lee KK, Lim JHG, Wong HB, Yan XY. Investigating gender differences in outcome following severe traumatic brain injury in a predominantly Asian population. Br J Neurosurg 2009; 20:73-8. [PMID: 16753620 DOI: 10.1080/02688690600682259] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective of this study was to investigate if there are possible gender differences in relation to outcome following closed severe traumatic brain injury (TBI) in a predominantly Asian population. A study was conducted using our prospectively maintained TBI database of 672 patients with severe TBI admitted into our neurosurgical intensive care unit. All patients were managed on a standardized protocol in accordance with the Guidelines to the management of severe traumatic brain injury. Glasgow Outcome Score was used to measure the outcome of patients 6 months postinjury. There were 525 males and 147 females, with the latter significantly older than their counterpart. Females had a significantly higher mortality and poorer outcome compared with males. However, this difference was no longer significant when variables (presence of multiple injuries, postresuscitation pupil abnormalities and Glasgow Coma Score) are controlled for. However, both crude and adjusted odd ratios revealed that females aged 60 and below were significantly more likely to have a poorer outcome.
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Affiliation(s)
- I Ng
- Department of Neurosurgery, National Neuroscience Institute, Singapore.
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Abstract
We present a case of an elderly lady with a symptomatic large intra-axial right frontoparietal arachnoid cyst displacing the corticospinal tract (CST) posteromedially on diffusion tensor imaging. This information assisted the surgeons in confirming the symptomatic nature of the lesion, in planning an appropriate surgical procedure, as well as in prognostication of recovery.
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Affiliation(s)
- J D Thorat
- Department of Neurosurgery, National Neuroscience Institute, Singapore
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Thorat JD, Wang EC, Lee KK, Seow WT, Ng I. Barbiturate therapy for patients with refractory intracranial hypertension following severe traumatic brain injury: its effects on tissue oxygenation, brain temperature and autoregulation. J Clin Neurosci 2007; 15:143-8. [PMID: 17997313 DOI: 10.1016/j.jocn.2006.08.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 08/22/2006] [Accepted: 08/26/2006] [Indexed: 11/30/2022]
Abstract
The aim of this study was to explore the effects of barbiturate coma on cerebral tissue oxygen tension and cerebrovascular pressure reactivity (PRx), as an index of cerebral autoregulation in severe head injury patients. This was a prospective observational clinical study of 12 patients with severe traumatic brain injury, carried out at a tertiary-level neurosurgical intensive care unit between April 2002 and May 2005. All patients received standard neurosurgical intensive care and monitoring. Probes for intracranial pressure (ICP), brain temperature (BT) and brain tissue oxygenation (PTiO2) were inserted into (noncontused) normal-looking white matter. Cerebrovascular PRx was measured as a moving correlation between ICP and arterial blood pressure. Barbiturate coma was instituted when ICP became refractory (ICP>20 mmHg). All data from the multimodal monitoring were digitally extracted and statistically analysed. The mean ICP decreased with barbiturate coma in eight of the 12 patients (75% of the patients), but only four achieved a value below 20 mmHg. Of eight patients with prebarbiturate PTiO2 levels above 10 mmHg, six had a further improvement in oxygenation. Thus, concordant favourable changes in ICP, PRx and PTiO2 with barbiturate coma were seen in those who survived. Effective response to barbiturates can be detected by improved PTiO2 and autoregulation (PRx) in severe head injury patients.
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Affiliation(s)
- J D Thorat
- Acute Brain Injury Research Laboratory, Department of Neurosurgery, Tan Tock Seng Hospital, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
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Sun CK, Ng KT, Sun BS, Ho JWY, Lee TK, Ng I, Poon RTP, Lo CM, Liu CL, Man K, Fan ST. The significance of proline-rich tyrosine kinase2 (Pyk2) on hepatocellular carcinoma progression and recurrence. Br J Cancer 2007; 97:50-7. [PMID: 17551499 PMCID: PMC2359657 DOI: 10.1038/sj.bjc.6603827] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Understanding the precise molecular mechanisms that trigger liver cancer cell migration and invasion could develop novel therapeutic strategies targeting cancer cell invasion to increase the sensitivity to current treatment modalities. In the current study, 49 patients with hepatocellular carcinoma (HCC) were included prospectively. Liver tumour and adjacent non-tumour tissues were detected for the expression of Proline-rich tyrosine kinase 2 (Pyk2), focal adhesion kinase (FAK), ezrin and fibronectin at protein and/or gene levels. Correlation between the expressions of Pyk2/FAK with the clinical pathological data was analysed. Protein expression of Pyk2 was also examined in a nude mice orthotopic liver tumour model with higher metastatic potential. There were 59% (29 out of 49) and 57% (28 out of 49) of HCC patients with higher levels of Pyk2 and FAK protein/gene expression, respectively. We observed a positive correlation between the protein and gene expression levels of Pyk2 and FAK (P=0.000, r=0.875). Overexpression of Pyk2 and FAK was significantly correlated with shorter disease-free survival. Patients with higher levels of Pyk2/FAK had larger tumour size and advanced Edmonson grading. In the animal studies, Pyk2 overexpression was found in infiltrative tumour cells and lung metastatic nodules. In conclusion, overexpression of Pyk2 and FAK was found in nearly 60% of HCC patients and was significantly correlated with poor prognosis. The significance of Pyk2 in HCC invasiveness was confirmed by animal studies.
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Affiliation(s)
- C K Sun
- Centre of Cancer Research and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - K T Ng
- Centre of Cancer Research and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - B S Sun
- Centre of Cancer Research and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
- Department of Pathology, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - J W Y Ho
- Centre of Cancer Research and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - T K Lee
- Centre of Cancer Research and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - I Ng
- Department of Surgery, Yuquan Hospital, Tsinghua University, Beijing, China
| | - R T P Poon
- Centre of Cancer Research and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - C M Lo
- Centre of Cancer Research and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - C L Liu
- Centre of Cancer Research and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - K Man
- Centre of Cancer Research and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
- E-mail:
| | - S T Fan
- Centre of Cancer Research and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China
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Ang BT, Wong J, Lee KK, Wang E, Ng I. Temporal changes in cerebral tissue oxygenation with cerebrovascular pressure reactivity in severe traumatic brain injury. J Neurol Neurosurg Psychiatry 2007; 78:298-302. [PMID: 17028122 PMCID: PMC2117644 DOI: 10.1136/jnnp.2005.082735] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the temporal relationship between cerebrovascular pressure reactivity and brain tissue oxygenation in patients with severe head injury. METHODS In 40 patients, brain tissue oxygenation and intracranial pressure were monitored. Time-averaged values for intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP) and brain tissue oxygenation (PtiO2) were computed. The pressure reactivity index (PRx) was calculated. The mean values of the variables were obtained at the 6-h and 72-h post-injury time points, and the difference between the two time points for each of the variables was denoted as delta (delta). RESULTS Of the 40 patients, 32 were survivors and 8 were non-survivors. Statistically significant differences were present between these two groups with regard to deltaMAP (p = 0.013), ICP at 6 h (p = 0.027), CPP at 72 h (p = 0.018), deltaCPP (p = 0.033), PRx at 6 h (p = 0.029), PRx at 72 h (p = 0.002), PtiO2 at 72 h (p < 0.0005) and deltaPtiO2 (p = 0.023) values, reflecting an improvement with time in survivors and a deterioration with time in non-survivors. In non-survivors, the magnitude of change in PtiO2 and CPP with time correlated in a negative linear fashion (p = 0.042 and 0.029, respectively) with the change in PRx with time, whereas no such relationship was seen in survivors. CONCLUSION The severity of brain tissue oxygenation derangement correlates with increasing cerebrovascular dysautoregulation in patients succumbing to severe head injury, supporting the utility of PRx as a monitoring variable and the rationale for a target-driven approach to head injury management.
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Affiliation(s)
- B T Ang
- Acute Brain Injury Research Laboratory, Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore 308433, Singapore
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Lim CCT, Petersen ET, Ng I, Hwang PYK, Hui F, Golay X. MR regional perfusion imaging: visualizing functional collateral circulation. AJNR Am J Neuroradiol 2007; 28:447-8. [PMID: 17353310 PMCID: PMC7977861] [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: 05/14/2023]
Abstract
SUMMARY We applied regional perfusion imaging (RPI), a new arterial spin-labeling MR imaging method that selectively studies regions of the brain perfused by individual carotid and basilar arteries. In a patient with cerebrovascular disease, RPI showed cerebral tissue perfused by pial collateral vessels, thereby demonstrating the relationship between anatomic and functional information, which was lacking in conventional x-ray angiography. RPI may be useful to study functional collateral circulation and hence guide therapy in ischemic disease.
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Affiliation(s)
- C C T Lim
- Department of Neuroradiology, National Neuroscience Institute, Singapore.
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Lee KK, Seow WT, Ng I. Demographical profiles of adult severe traumatic brain injury patients: implications for healthcare planning. Singapore Med J 2006; 47:31-6. [PMID: 16397718] [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: 05/06/2023]
Abstract
INTRODUCTION In Singapore, severe traumatic brain injury (TBI) continues to be a major public health problem and devastating condition, with significant mortality and morbidity. By understanding the incidence, prevalence and implications of severe TBI in Singapore, strategic plans to meet the unique needs of these patients in the local context may be developed. METHODS The demographical profiles of the adult severe TBI patients in Singapore were studied in this retrospective review of 528 patients admitted to the National Neuroscience Institute (NNI) from January 1999 to December 2003. RESULTS There were 420 male and 108 female patients, age ranging from 15 to 96 years old, with a mean and standard deviation (SD) of 44.6 +/- 19.9 years, admitted to NNI during the study period. Motor vehicle and fall-related accidents were the leading causes of severe TBI. Three high-risk groups identified were young adults, elderly, and foreign workers. CONCLUSION Preventive measures targeting at these high-risk groups are important to reduce the incidence of severe TBI.
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Affiliation(s)
- K K Lee
- Department of Nursing Administration, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433.
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Alfarano C, Andrade CE, Anthony K, Bahroos N, Bajec M, Bantoft K, Betel D, Bobechko B, Boutilier K, Burgess E, Buzadzija K, Cavero R, D'Abreo C, Donaldson I, Dorairajoo D, Dumontier MJ, Dumontier MR, Earles V, Farrall R, Feldman H, Garderman E, Gong Y, Gonzaga R, Grytsan V, Gryz E, Gu V, Haldorsen E, Halupa A, Haw R, Hrvojic A, Hurrell L, Isserlin R, Jack F, Juma F, Khan A, Kon T, Konopinsky S, Le V, Lee E, Ling S, Magidin M, Moniakis J, Montojo J, Moore S, Muskat B, Ng I, Paraiso JP, Parker B, Pintilie G, Pirone R, Salama JJ, Sgro S, Shan T, Shu Y, Siew J, Skinner D, Snyder K, Stasiuk R, Strumpf D, Tuekam B, Tao S, Wang Z, White M, Willis R, Wolting C, Wong S, Wrong A, Xin C, Yao R, Yates B, Zhang S, Zheng K, Pawson T, Ouellette BFF, Hogue CWV. The Biomolecular Interaction Network Database and related tools 2005 update. Nucleic Acids Res 2005; 33:D418-24. [PMID: 15608229 PMCID: PMC540005 DOI: 10.1093/nar/gki051] [Citation(s) in RCA: 447] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The Biomolecular Interaction Network Database (BIND) (http://bind.ca) archives biomolecular interaction, reaction, complex and pathway information. Our aim is to curate the details about molecular interactions that arise from published experimental research and to provide this information, as well as tools to enable data analysis, freely to researchers worldwide. BIND data are curated into a comprehensive machine-readable archive of computable information and provides users with methods to discover interactions and molecular mechanisms. BIND has worked to develop new methods for visualization that amplify the underlying annotation of genes and proteins to facilitate the study of molecular interaction networks. BIND has maintained an open database policy since its inception in 1999. Data growth has proceeded at a tremendous rate, approaching over 100 000 records. New services provided include a new BIND Query and Submission interface, a Standard Object Access Protocol service and the Small Molecule Interaction Database (http://smid.blueprint.org) that allows users to determine probable small molecule binding sites of new sequences and examine conserved binding residues.
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Affiliation(s)
- C Alfarano
- The Blueprint Initiative of Mount Sinai Hospital, 600 University Avenue, Toronto, ON, Canada M5G 1X5
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Ng I, Yap E, Lim J. Changes in cerebral hemodynamics and cerebral oxygenation during surgical evacuation for hypertensive intracerebral putaminal hemorrhage. Acta Neurochir Suppl 2005; 95:97-101. [PMID: 16463829 DOI: 10.1007/3-211-32318-x_21] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the changes in cerebral hemodynamics, tissue oxygenation and blood flow before and after surgery for spontaneous intracerebral hematomas. METHODS Eleven patients who underwent surgical decompression of spontaneous putaminal hematoma were studied. Intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygen (PtiO2), and carbon dioxide tensions (PtiCO2), brain pH and regional cerebral blood flow (rCBF) were recorded prior to removing the bone flap and then on skin closure on completion of the operation. RESULTS Following surgical decompression, mean ICP decreased significantly (P < 0.05); mean CPP, PtiO2, brain pH and rCBF improved although the changes were not significant. CONCLUSION Surgical decompression for spontaneous intracerebral hematomas leads to significant reductions in ICP. This is accompanied by improvements in CPP, PtiO2 and rCBF in the penumbra.
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Affiliation(s)
- I Ng
- Department of Neurosurgery, National Neuroscience Institute, Singapore.
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Gasco J, Sendra J, Lim J, Ng I. Linear correlation between stable intracranial pressure decrease and regional cerebral oxygenation improvement following mannitol administration in severe acute head injury patients. Acta Neurochir Suppl 2005; 95:73-7. [PMID: 16463824 DOI: 10.1007/3-211-32318-x_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVES We investigated the relationship between stable decrease in intracranial pressure (ICP) following mannitol administration and variations in regional oxygenation (PtiO2) in severe traumatic brain injured (STBI) patients. METHODS Fourteen STBI patients (Glasgow Coma Scale score < or = 8) admitted to the neurointensive care unit during a 12-month period were studied. Multiparameter data, including parenchymal tissue oxygen (PtiO2) and carbon dioxide tension, cerebral perfusion pressure, mean arterial pressure; temperature, pH and pressure reactivity index were measured. Point values from 53 mannitol administrations were extracted every five seconds and divided into five consecutive 30-minute epochs. Mean values and trends were identified. Postadministration epoch with maximum decrease in ICP was selected along with the means of the corresponding variables. These data were compared with baseline to derive the delta values. Mean deltaICP was then compared with deltaPtiO2 in each patient using linear correlation. FINDINGS In patients with ICP0 > 20 mmHg (group A), PtiO2 increased in 69.6% of samples, whereas in group B (ICP0 < 20 mmHg), PtiO2 increased in only 50% of the samples. There was a significant negative correlation between mean deltaICP and deltaPtiO2 in both groups; Group A: r = -0.79 (P = 0.01); Group B: r = -0.92 (P = 0.01). CONCLUSIONS There is a strong negative correlation between stable decrease in ICP following mannitol administration and improvement in regional oxygenation around the peri-contusional area. The data suggest a potentially favourable interaction between mannitol therapy and cerebral internal milieu in STBI patients.
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Affiliation(s)
- J Gasco
- Acute Brain Injury Research Laboratory, Department of Neurosurgery (Main Campus), National Neuroscience Institute, Singapore
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Abstract
Cerebral ischemia is one of the most important causes of secondary insults following acute brain injury. While intracranial pressure monitoring in the intensive care unit constitutes the cornerstone of neurocritical care monitoring, it does not reflect the state of oxygenation of the injured brain. The holy grail of neuromonitoring is a modality that would reflect accurately real time the status of oxygenation in the tissue of interest, is robust, artefact free and that which provides information that can be used for therapeutic interventions and to improve outcome. Such a device could conceivably be used to augment the sensitivity of current multi-modality monitoring systems in the neurocritical management of brain injured patients. This article examines the availability of data in the literature to support clinical use of local tissue oxygen probes in intensive care.
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Affiliation(s)
- I Ng
- Acute Brain Injury Research Laboratory, Department of Neurosurgery, National Neuroscience Institute, TTSH Campus, Singapore.
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Tan JE, Ng I, Lim J, Wong HB, Yeo TT. Patients who talk and deteriorate: a new look at an old problem. Ann Acad Med Singap 2004; 33:489-93. [PMID: 15329762] [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: 04/30/2023]
Abstract
BACKGROUND AND METHODS We sought to review established prognostic indicators applied to Asian population, and to identify new risk factors for deterioration in patients who talked and deteriorated after traumatic brain injury (TBI). This retrospective study used our prospectively maintained TBI database. From August 1999 to July 2001, 324 patients were admitted to the neurosurgical intensive care unit (ICU). Thirty-eight patients (11.8%) talked between injury and subsequent deterioration into coma. Independent outcome predictors were studied. RESULTS AND CONCLUSION Fourteen patients had subdural haematomas, 9 extradural haematomas, 19 contusions/haematomas and 3 subarachnoid haemorrhages. 81.5% of the patients had mass lesions potentially requiring surgery. Twenty patients had good functional recovery at 6 months (Glasgow Outcome Score 4 and 5); 18 were dead or vegetative. Age, gender, type of intracranial lesion and presence of coagulopathy were significantly correlated with outcome. Intracranial haematomas continue to be most significant in patients who talk and deteriorate. Coagulopathy was the strongest prognostic predictor of poor outcome with fibrinolytic parameters being reliable prognostic markers of head injury. Early identification, continued monitoring and treatment of coagulopathy should be our new look at improving outcome of these patients.
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Affiliation(s)
- J E Tan
- Acute Brain Injury Research Laboratory, Section of Neurotrauma, Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433
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Ooi GC, Khong PL, Chan GCF, Chan KN, Chan KL, Lam W, Ng I, Ha SY. Magnetic resonance screening of iron status in transfusion-dependent β-thalassaemia patients. Br J Haematol 2004; 124:385-90. [PMID: 14717788 DOI: 10.1046/j.1365-2141.2003.04772.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The clinical utility of dual sequence (T1- and T2-weighted) magnetic resonance (MR) imaging in estimating liver iron concentration (LIC) in 32 transfusion-dependent beta-thalassaemia major (24 females; age 18.5+/-5.9 years) patients on desferrioxamine was evaluated. Signal intensity ratios (SIR) between liver, spleen and pancreas to psoas muscle were determined on both sequences. Relationships between clinical and MR parameters, and accuracy of SIR thresholds in determining adequacy of chelation from LIC were analysed. Liver T1- and T2-SIR were related to LIC (P < 0.001). T1-SIR < 0.60 predicted severe iron overload (LIC > 15 mg/g) with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100%, 87%, 33% and 100% respectively. T2-SIR < 0.1 yielded 100% sensitivity, 93% specificity, 50% PPV and 100% NPV. T1-SIR > or = 1.1 predicted LIC < 7 mg/g with 69% sensitivity, 88% specificity, 85% PPV and 74% NPV. T2-SIR > or = 0.20 yielded 56.5% sensitivity, 94% specificity, 90% PPV and 71% NPV. LIC correlated with liver T1-SIR, liver T2-SIR and serum ferritin (r = -0.76, -0.65, 0.47, respectively; P < 0.01). Serum ferritin was inversely related to liver T1-SIR, liver T2-SIR and spleen T2-SIR (r = -0.35, -0.43, -0.40, respectively; P < 0.05). Mean total transfusion burden was not related to any MR parameter. Although neither MR sequence was a highly accurate predictor of LIC, SIR thresholds are useful to determine presence of iron overload and adequacy of chelation treatment.
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Affiliation(s)
- G C Ooi
- Department of Diagnostic Radiology, The University of Hong Kong, Room 405/Block K, Queen Mary Hospital, Hong Kong SAR, China.
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Shirhan MD, Moochhala SM, Ng PY, Lu J, Ng KC, Teo AL, Yap E, Ng I, Hwang P, Lim T, Sitoh YY, Rumpel H, Jose R, Ling E. Spermine reduces infarction and neurological deficit following a rat model of middle cerebral artery occlusion: a magnetic resonance imaging study. Neuroscience 2004; 124:299-304. [PMID: 14980380 DOI: 10.1016/j.neuroscience.2003.10.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2003] [Indexed: 10/26/2022]
Abstract
The role of nitric oxide (NO) in post-ischemic cerebral infarction has been extensively examined, but few studies have investigated its role on the neurological deficit. In the present study, we investigated the effect of spermine on the temporal evolution of infarct volume, NO production and neurological deficit using magnetic resonance imaging in a model of permanent focal cerebral ischemia in rats. Spermine given at 10 mg/kg 2 h after ischemia reduced the infarct volume by 40% and abolished brain NO production and improved the neurological score 24 h, 48 h and 72 h after ischemia. Spermine also reduced the neurological deficit as evaluated by rotamex, grip strength and neurological severity score tests.
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Affiliation(s)
- M D Shirhan
- Department of Pharmacology, National University of Singapore, Singapore
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37
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Wilder-Smith E, Tan EK, Law HY, Zhao Y, Ng I, Wong MC. Spinocerebellar ataxia type 3 presenting as an L-DOPA responsive dystonia phenotype in a Chinese family. J Neurol Sci 2003; 213:25-8. [PMID: 12873751 DOI: 10.1016/s0022-510x(03)00129-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The clinical spectrum of spinocerebellar ataxia 3 (SCA 3) disease is wide and varied. We describe a Chinese patient with a mutation at the SCA 3 locus with clinical features of levodopa-responsive dystonia. The family history was suggestive of being autosomally dominant. Levodopa responsiveness though rare has been described in families with features of parkinsonism. Noteworthy is the relatively late onset of disease (>40 years) possibly explained by the low number of affected alleles at 59, the usual range being from 62 to 86, with the lowest recorded number at 56. This expands the wide and varied phenotypic manifestations of SCA 3, and highlights the observation that features suggestive of levodopa-responsive dystonia (DRD) such as focal dystonia, gait difficulty with diurnal fluctuation of symptoms, and a marked response to low doses of levodopa can be presenting features of SCA 3. SCA 3 should be considered a differential diagnosis in adult patients who present with DRD phenotype and with a positive family history.
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Affiliation(s)
- E Wilder-Smith
- Division of Neurology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore.
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38
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Ng I, Yap E, Tan WL, Kong NY. Blood-brain barrier disruption following traumatic brain injury: roles of tight junction proteins. Ann Acad Med Singap 2003; 32:S63-6. [PMID: 14968742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- I Ng
- National Neuroscience Institute, Acute Brain Injury Research Laboratory, Section of Neurotrauma, Department of Neurosurgery, 11 Jalan Tan Tock Seng, Singapore 308433
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39
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Abstract
We report the prevalence and ethnic differences of autosomal-dominant cerebellar ataxia (ADCA) in Singapore. Amongst 204 patients with ataxia who underwent genetic testing for dentatorubral-pallidoluysian atrophy (DRPLA) and for spinocerebellar ataxias (SCA) 1, 2, 3, 6, 7, 8, 10 and 12, 58 (28.4%) patients from 36 families tested positive. SCA 3 was identified in 31 (53.4%) patients from 15 families, SCA 2 in 17 (29.3%) patients from 12 families and SCA 1 in four (6.9%) patients from four families. Other SCA subtypes were rare. SCA 2 was the only subtype identified amongst ethnic Malay and ethnic Indian families. The estimated prevalence of ADCA in Singaporean families was at least 1 : 27,000. Based on the history and ancestry of Singaporeans, our study supported a founder effect for specific SCA subtypes and the association of ethnicity-specific SCA subtypes. Our findings suggest that SCA 2 is relatively common amongst the Malay race and that priority testing for SCA 3 and SCA 2 for ethnic Chinese, and SCA 2 for ethnic Malay, may be cost effective and relevant for the region.
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Affiliation(s)
- Y Zhao
- Department of Clinical Research, Singapore General Hospital, Singapore.
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40
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Abstract
Primary extramedullary plasmacytoma (EMP) of the lacrimal gland is rare. Here we describe the histopathologic and imaging findings in a 77-year-old patient with primary extramedullary plasmacytoma of the lacrimal gland. The usefulness of CD79a in the diagnosis of plasmacytoma and the good response of the tumor to combined surgery and radiotherapy are illustrated. Plamacytoma should be included in the differential diagnosis of lacrimal tumors.
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Affiliation(s)
- C S Chim
- University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
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41
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Abstract
Most surgeons undertaking anterior cervical discectomy (ACD) introduce a bone graft or cage into the disc space when the decompression is complete to prevent segmental collapse and preserve cervical spine alignment. We have conducted a prospective observational cohort study to investigate the relationship between cervical spine alignment and clinical outcome in 55 patients undergoing ACD without interbody graft or cage. At 12 months, the overall alignment of the cervical spine and the presence of segmental kyphosis at the operated level were correlated with clinical outcome measured by SF 36, Neck Disability Index and visual analogue neck pain score. Loss of the overall cervical lordosis was present in 30 patients and segmental kyphosis was found in 18. Analysis of clinical outcome showed no statistical differences between patients with preserved and abnormal cervical and segmental alignment. Disturbance of cervical and segmental alignment is common in patients following cervical discectomy, but does not appear to compromise clinical outcome at 12 months.
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Affiliation(s)
- R J Laing
- Academic Department of Neurosurgery, University of Cambridge, Cambridge, UK.
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Tan EK, Law HY, Zhao Y, Lim E, Chan LL, Chang HM, Ng I, Wong MC. Spinocerebellar ataxia in Singapore: predictive features of a positive DNA test? Eur Neurol 2001; 44:168-71. [PMID: 11053966 DOI: 10.1159/000008228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Significant differences in frequency of the different spinocerebellar ataxia (SCA) subtypes have been described to occur in different populations. A 'blunderbuss' diagnostic DNA testing approach would entail unnecessary healthcare cost. In this study, we determine the prevalence of SCA subtypes and predictive features of a positive DNA test in consecutive clinically diagnosed SCA cases in Singapore. Twenty-one consecutive patients from 14 families were evaluated over a 3-year period. Thirteen patients (61.9%) from 6 families had a positive DNA test. Eleven of these (all ethnic Chinese) had SCA 3 (abnormal CAG size ranged from 61 to 71), and 2 ethnic Malays had SCA 2 (abnormal CAG size of 39). Clinical features which were highly predictive of a positive DNA SCA test in our population included presence of a positive family history, chorea and dystonia, muscle and tongue fasciculations, gaze-evoked nystagmus, and hypertonia. Our study draws attention to the observation that knowledge of relatively specific features of the most common SCA subtype in a local population can greatly enhance the practical accuracy of the choice of which SCA DNA test to order.
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Affiliation(s)
- E K Tan
- Department of Neurology, Singapore General Hospital, Singapore, Republic of Singapore
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Lim SK, Ali A, Law HY, Ng I, Ming Chung MC, Lee SH. An anemic patient with phenotypical beta-thalassemic trait has elevated level of structurally normal beta-globin mRNA in reticulocytes. Am J Hematol 2000; 65:243-50. [PMID: 11074543 DOI: 10.1002/1096-8652(200011)65:3<243::aid-ajh12>3.0.co;2-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Of the numerous beta-thalassemic mutations linked or unlinked to the beta-globin gene, all invariably cause a decrease in or an absence of structurally normal beta-globin mRNA when assayed. Here we report an anemic patient with an elevated alpha-/beta globin synthesis ratio of 2.0 in his reticulocytes. The patient's blood film showed marked red cell anisopoikilocytosis, microcytosis, and hypochromia, consistent with a typical beta-thalassemic trait phenotype. Acid-eluted erythrocytes contained numerous Heinz bodies. Molecular analysis of the patient's reticulocyte mRNA indicated that, compared to normal controls, there was a 3-fold elevation of beta-globin mRNA when assayed by RT-PCR and a 1.5-fold elevation of beta-globin mRNA when assayed by RNA slot blotting. The level of alpha-globin mRNA was normal when compared to that of normal adult controls. Extensive structural analysis of the beta-globin mRNA and gene by sequencing of RT-PCR and PCR products, respectively, did not detect any mutations. Tryptic mapping of purified beta-globin chains also did not show any abnormal tryptic fragments. These data indicated that a relative insufficiency of structurally normal beta-globin mRNA was not a cause of this beta-thalassemic phenotype. Therefore, the lesion that caused this particular thalassemic phenotype is not linked to the beta-globin allele.
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Affiliation(s)
- S K Lim
- National University Medical Institutes, The National University of Singapore, Singapore.
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Chan KL, Fan ST, Saing H, Wei W, Lo CM, Ng I, Tsoi NS, Chan J, Tso WK, Yuen KY, Tam PK, Wong J. Post liver transplantation stenosis of biliary-enteric anastomoses in infancy: diagnosis and treatment. Transplant Proc 2000; 32:2233-4. [PMID: 11120147 DOI: 10.1016/s0041-1345(00)01649-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K L Chan
- Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, People's Republic of China
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Chan KL, Fan ST, Saing H, Wei W, Lo CM, Ng I, Tsoi NS, Chan J, Tso WK, Yuen KY, Tam PK, Wong J. Liver transplantation is not contraindicated in infancy. Transplant Proc 2000; 32:2142-3. [PMID: 11120107 DOI: 10.1016/s0041-1345(00)01609-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K L Chan
- Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, People's Republic of China
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Abstract
OBJECTIVE Animal model systems have shown that head trauma can induce cell death in regions of the brain away from the site of the impact via a process of apoptosis. We sought to determine whether there was evidence of cellular apoptosis in clinically collected materials from human head trauma patients, as well as to attempt to determine the pathway by which it may occur. METHODS Thirty-one sequential specimens of brain tissue excised during emergency craniotomy for evacuation of cerebral contusions with mass effect were examined. Non-necrotic pericontusional tissues were detected in 11 samples. These were examined for the presence of apoptotic cells by the terminal deoxynucleotide transferase-mediated nick end labeling method as well as by immunohistochemistry to detect possible expression of the apoptosis-related genes p53, bcl-2, and bax. RESULTS Bax expression was detected in all patients, whereas bcl-2 expression was noted in six patients. Terminal deoxynucleotide transferase-mediated nick end labeling-positive cells were noted in eight patients. One instance of p53-positive immunostaining was observed. Patients with bcl-2 expression had a better survival rate than patients in whom no bcl-2 expression was noted (P = 0.01). CONCLUSION Although necrosis seemed to be the main finding in cerebral contusions, these results support the hypothesis that apoptosis does occur in patients after traumatic brain injury, and this may contribute to the secondary injury processes that are seen with head injury. Patients in whom anti-apoptotic bcl-2 is induced seem to have a better prognosis. This may have important clinical significance in the development of bcl-2 homologs or bax inhibitors to prevent apoptosis.
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Affiliation(s)
- I Ng
- Department of Neurosurgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
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Abstract
Salmonella typhi is the only species of Salmonella which grows exclusively in humans, in whom it causes enteric typhoid fever. Strains of S. typhi show very little variation in electrophoretic types, restriction fragment length polymorphisms, cell envelope proteins, and intervening sequences, but the same strains are very heterogeneous for ribotypes which are detected with the restriction endonuclease PstI. In addition, the genome of S. typhi has been proven to undergo genomic rearrangement due to homologous recombination between the seven copies of rrn genes. The relationship between ribotype heterogeneity and genomic rearrangement was investigated. Strains of S. typhi which belong to 23 different genome types were analyzed by ribotyping. A limited number of ribotypes were found within the same genome type group; e. g., most strains of genome type 3 belonged to only two different ribotypes, which result from recombination between rrnH and rrnG operons. Different genome type groups normally have different ribotypes. The size and identity of the PstI fragment containing each of the seven different rrn operons from S. typhi Ty2 were determined, and from these data, one can infer how genomic rearrangement forms new ribotypes. It is postulated that genomic rearrangement, rather than mutation, is largely responsible for producing the ribotype heterogeneity in S. typhi.
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Affiliation(s)
- I Ng
- Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada T2N 1N4
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Ng I, Yeo TT, Soong R, Tang WT, Ong PL, Lew T, Goh HS, Smith D. Young Investigator's Award: induction of apoptosis following traumatic head injury in humans. Ann Acad Med Singap 1999; 28:363-5. [PMID: 10575519] [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: 02/14/2023]
Abstract
Apoptosis or programmed cell death plays an important role in many developmental and pathological processes of the central nervous system. In head injury, apoptosis has been recently implicated in many studies on animal brain samples the phenomenon of apoptotic gene expression (bax and bcl-2). Twenty specimens of contused brain tissue (temporal and frontal lobe) from 20 patients who underwent emergency craniotomy and removal of mass lesions were obtained from May to October 1997. The samples collected were immediately snap frozen in liquid nitrogen and stored at -80 degrees C. Immunohistochemical analysis was performed to detect the expression of bcl-2, bax and p53 using standard avidin-biotin complex second antibody conjugate methodology utilising commercially available primary and secondary antibodies. The average age of cohort was 46.24 +/- 22.17 years, the average Glasgow Coma Scale on admission was 9.19 +/- 4.72, and the average duration from injury to collection of the sample was 20.62 +/- 40.57 hours. There was documented hypoxia and hypotension seen in 5 of the 20 patients (25%). Significant levels of bax protein expression were noted in all samples, and p53 expression in 30% of samples. No bcl-2 expression was observed. Our study showed that for the first time the strong expression of the pro-apoptotic gene (bax) and low levels of the anti-apoptotic gene (bcl-2), thus implicating the mechanism of apoptosis in brain injury following trauma. The use of agents to inhibit apoptosis may be beneficial in head injury patients.
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Affiliation(s)
- I Ng
- Department of Neurosurgery, Tan Tock Seng Hospital, Singapore
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49
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Gibbons B, Tan SY, Barber JC, Ng CF, Knight LA, Lam S, Ng I. Duplication of 8p with minimal phenotypic effect transmitted from a mother to her two daughters. J Med Genet 1999; 36:419-22. [PMID: 10353792 PMCID: PMC1734374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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50
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Harmanec D, Leong TY, Sundaresh S, Poh KL, Yeo TT, Ng I, Lew TW. Decision analytic approach to severe head injury management. Proc AMIA Symp 1999:271-5. [PMID: 10566363 PMCID: PMC2232640] [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: 02/14/2023] Open
Abstract
Severe head injury management in the intensive care unit is extremely challenging due to the complex domain, the uncertain intervention efficacies, and the time-critical setting. We adopt a decision analytic approach to automate the management process. We document our experience in building a simplified influence diagram that involves about 3000 numerical parameters. We identify the inherent problems in structuring a model with unclear domain relationships, numerous interacting variables, and real-time multiple inputs. We analyze the effectiveness and limitations of the decision analytic approach and present a set of desiderata for effective knowledge acquisition in this setting. We also propose a semi-qualitative approach to parameter elicitation.
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Affiliation(s)
- D Harmanec
- Medical Computing Laboratory, School of Computing, National University of Singapore, Singapore.
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