bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic Variables in 1814 Sporadic Colon Cancers: A Review of Experience from a Single Institution from 1999–2005
Authors: Chew Min-Hoe , Yeo Eugene Shen-Ann , Tang Choong-Leong 
Published: July 2015

Introduction: Singapore has one of the highest age-standardized incidence rates for colorectal cancer (CRC) at 35.1% in men and 29.9% in women which is almost double that of our neighboring Southeast Asian countries. Surgery is presently the mainstay in treatment of this cancer. This present study evaluates the clinical and prognostic characteristics of sporadic cancers treated by surgical resection in a single institution in an Asian population. Methods: 1814 consecutive patients with CRC from 1999–2005 treated in the Department of Colorectal Surgery in Singapore General Hospital were reviewed. The clinciopathological characteristics of these patients were collected from a prospectively collected database maintained in the department since 1987. Univariate analysis was performed, and survival curves were constructed using the Kaplan-Meier method. Multivariate analysis was carried out on independent prognostic factors that were positive on univariate analysis. Results: All patients had a minimum follow up duration of 5 years unless they were lost to follow up. There were 921 (50.8%) males and 893 (49.2%) females with a median age of 67 years (interquartile range 22–99). The predominant location of the tumour was left-sided ie distal to (and including) the splenic flexure (n=1272, 70%), and the majority presented at an advanced AJCC stage III and IV (n=1018, 56%). The most common site for solitary metastasis is in the liver (n=194, 49%) followed by the lungs (6%). Locoregional recurrence is low at 2.6% (n=46) and distant recurrence is noted at 16.8% (n=297). Disease recurrence are 5.7%, 18.1%, and 27.5% for Stages I, II and III respectively. The median five-year Cancer Specific Survival (CSS) is 58.7 % (95% CI 56.2%–61.2%). On multivariate analysis, a high pre-operative CEA, poorly-differentiated tumour grade, signet ring cell tumours, high tumour stage (T3/T4), nodal disease (N1/N2), presence of both perineural invasion and vascular emboli were all significant factors that worsened CSS. Conclusion: Our dataset confirms the current favourable survival of colonic cancers in our country which is comparable to data from the West. Future challenges in management of patients involve improving staging, selection of high risk of recurrence of patients for closer monitoring and further adjuvant treatment to improve survival and reduce locoregional recurrence.
The Use of Internet to Search for Health Information before Surgery: A Descriptive Study
Authors: Aloweni Fazila Abu Bakar , Mostafa Sri Sukarti 
Published: July 2015

Introduction: The Internet is becoming increasingly important as a source of health information. In Singapore, two in three households have access to Internet at home and the proportion of Internet users is rising each year1. This study seeks to investigate the characteristic of patients who used the Internet to seek for health information before scheduled surgery and their preferred mode of education from the healthcare professionals. Methods: This study was carried out in a general surgical ward. Using convenience sampling, subjects were asked to fill up a standard set of closed-ended questionnaires, which consist of the patients' demographics data, their perception of using the Internet and their preferred mode of education from the health-care professionals. Results: A total of 107 subjects completed this study. The percentage of subjects who owned a computer and had access to the Internet were 90%. Higher level of education and income were more likely to search the Internet before their operation (p=0.03). There was no significance difference between age group and Internet search (p=0.574). The most preferred mode of education were Internet-based when discharge from the hospital (n=48). Conclusions: The findings showed that patients and their love ones are taking a pro-active approach in their health and are resourceful in acquiring information about their surgery. Nurses play a vital role in providing patient education and guiding them to a reliable and accurate websites. Hence, it is imperative to adopt an Internet-based education especially for the IT-literate population.
Prevalence and Risk Factors of Anaemia in Older Hospitalised Patients
Authors: Tay Matthew Rong Jie , Ong Yong Yau 
Published: July 2015

Introduction: We aim to investigate the prevalence and risk factors for anaemia among the elderly in a tertiary hospital. Methods: A retrospective study was conducted on 742 consecutive geriatric patients who were admitted to the medical unit of our hospital. The demographic and laboratory values for patients were examined. Anaemia-related data were studied. Patients with no/missing demographical or laboratory data and those who passed away after admission were excluded. Results: There was a high prevalence of anaemia in the study population. Although there were a significant proportion of nutritional causes, non-nutritional causes formed the majority. Significant risk adjusted risk factors associated with anaemia are male gender, Charlson's co-morbidity index and abnormal serum creatinine levels ≤60ml/min. (OR=1.469 [1.177–1.833], p=0.001; OR=1.147 [1.107–1.189], p<0.001; OR=1.335 [1.064–1.675], p=0.013 respectively.) Contributory factors for sub-types of anaemia were further investigated. A non-Chinese ethnicity, NSAID and anti-platelet use were significant risk factors for iron deficiency anaemia. (OR=2.035 [1.207–3.432], p=0.008; OR=8.202 [3.628–18.540], p<0.001; OR=2.080 [1.260–3.435], p=0.004 respectively.) For B12 deficiency, significant risk factors were non-Chinese ethnicity and metformin use. (OR=1.869 [1.036–3.370], p=0.038; OR=3.314 [1.690–6.499], p<0.001 respectively) A high Charleson's co-morbidity score and male gender correlated with anaemia of chronic disease. (OR=1.192 [1.104–1.288], p<0.001; OR=2.030 [1.198–3.440], p=0.009 respectively.) For anaemia of chronic renal disease, no significant predictors were found. Conclusion: Anaemia remains prevalent in the hospitalised geriatric population. Specific risk factors may help in the diagnosis and management of sub-types of anaemia.
Assessing Performance of i-STAT at the Point of Care in the Emergency Room
Authors: Yeo Chin Pin , Ngo Adeline , Ng Wai Yoong , Lim Swee Han , Jacob Edward 
Published: July 2015

Context: Point-of-care testing (POCT) for blood gas and chemistries is widely adopted in the emergency department (ED) for fast turnaround and critical medical decisions. Objective: To assess performance of ED physicians compared to laboratory technologists carrying out i-STAT analysis. Impact of user skill on POCT performance was also studied. Design: Over a 3-month period, ED physicians performed tests with their i-STAT unit with parallel blood specimens (n=60) sent to the central laboratory to be tested on another i-STAT unit and laboratory analysers (blood gas and chemistries). Comparisons to laboratory results (obtained with ABL 520 and Beckman-Coulter LX20PRO) were carried out. Two operators from ED and central laboratory performed side by side, repeated tests on the i-STAT units. Their overall within-run imprecision were compared. The analytical performance of i-STAT was further assessed by another laboratory technologist to verify its capability to deliver good results. Results: Platform comparisons showed that ED physicians performed poorer compared to laboratory technologists, particularly with chloride and pO2 (Spearman coefficient of correlation — 0.49 and 0.54 respectively indicate wide scatter). This is also mirrored in the higher overall within-run imprecision for chemistries (sodium, chloride, potassium, glucose, urea and creatinine) by an ED physician (5.4%) compared to a laboratory technologist (3.7%). Including blood gas results showed an even wider gap in their testing skills. Except at a low creatinine of 67 μmol/L, the i-STAT analyser delivered precise measurements for the chemistries and blood gas parameters. Conclusions: Performances by medical staff with the i-STAT analyser did not adequately approach the same skill level as laboratory technologists.
Combined Bipolar/Unipolar Radiofrequency Maze is Superior to Unipolar Maze in Concomitant Surgery
Authors: Chua Yeow-Leng , Soon Jia-Lin , Masakazu Nakao , Lim See-Lim 
Published: July 2015

Introduction: Atrial fibrillation is the most common arrhythmia with significant morbidity and mortality. Radiofrequency (RF) ablation, despite its shortcomings, remain an acceptable and ‘simple’ technique. Methods: We reviewed 137 consecutive concomitant irrigated RF modified maze procedures, and compared the outcomes of 65 patients undergoing Unipolar-RF versus 72 patients using the combined Uni/Bipolar-RF approach. All patients were prospectively followed clinically, with serial electrocardiography and selective echocardiography. One hundred and twenty-two patients (89.1%) underwent mitral valve procedures, and eight coronary bypass, and seven adult congenital operations were performed. Results: The predominantly male (54.7%) patients had a mean age of 58.3±11.5 years (23–88 years). At median follow-up of 3.21 years (0.01–6.06 years), 15 (10.9%) patients were lost to follow-up. Freedom from AF in the Uni/Bipolar-RF group was higher at six months: 85.1% (57/67) versus 65% (39/60) in the Unipolar-RF group (P=0.012). This superior trend persisted at five years: 100% (5/5) in the Uni/Bipolar-RF group versus 79.5% (31/39) in the Unipolar-RF group, although this is not statistically significantly (P=0.566). Patients with left atrial dilatation beyond 7.6cm were more likely to remain in AF (OR 0.44, 95% CI, 0.19–1.00, P=0.049). Perioperative mortality was 2.9%. There was no collateral damage by the device and procedure. The mean survival for patients AF-free at last follow-up is 5.73 years (95% CI, 5.48–5.98), comparable to 5.58 years (95% CI, 5.07–6.10) in those remaining in AF. Thirty (22.6%) patients were completely off anti-arrhythmic medication while 36 (25.6%) were anticoagulant-free. Conclusion: The combined Uni/bipolar-RF modified bi-atrial Maze technique is simple, safe and superior to isolated Unipolar-RF ablation. Midterm results continue to support its use although long-term durability remains to be elucidated.
Case of Idiopathic Left Ventricular Tachycardia (ILVT)
Authors: Hamid Nadira , Chia Stanley 
Published: July 2015

Introduction: The objective of this case report is to illustrate a case of idiopathic left ventricular tachycardia (ILVT). It is important to distinguish key features to differentiate ILVT from other types of ventricular tachycardias. Clinical picture: A 33-year-old male presented with palpitations. Clinical examination was unremarkable, except a heart rate of 170 beats/min. ECG showed a right bundle branch morphology, left superior frontal plane and a relatively narrow QRS duration. A diagnosis of ILVT was made. Treatment: Intravenous verapamil was given and the ILVT was terminated. Conclusion: ILVT differs from other types of VT, such as right ventricular outflow tract (RVOT), in terms of mechanisms, site of origin and management. Overall, ILVT has a good prognosis, compared to VTs seen in ischaemic cardiomyopathy.
The Successful and Novel Treatment of Non-Neurogenic Detrusor-External Sphincter Dyssynergia (DESD) with Botulinum Toxin A
Authors: Kuo Tricia LC , Ng Lay Guat 
Published: July 2015

Introduction: Our study aims to examine the treatment outcomes of patients with non-neurogenic detrusor-external sphincter dyssynergia (DESD) after the injection of botulinum toxin A (BTX-A, Botox®) to the external sphincter. Methods: A retrospective review of nine patients with DESD was performed. All patients were diagnosed with the aid of video urodynamic studies. Pre-operative evaluation was standardised using bladder diary, urine microscopy and culture, bedside ultrasound of the kidneys and bladder, and renal function test. Each received BTX-A injection of 50–100U to the external sphincter. The pre-operative and post-operative maximum flow rate (Qmax) and post-void residual urine (PVRU) were objectively compared using paired-samples t test. Results: All the injections were performed from December 2006 to March 2008. Of the nine patients, seven (77.8%) were female and two (22.2%) were male. The mean age was 49.2 years (range 20–64 years). The mean pre-operative maximum flow rate (Qmax) was 9.7±6.26 ml/s. A month later, the post-operative Qmax improved to 16.5±11.3 ml/s. Mean difference in Qmax was 6.76±8.1 ml/s ( P = 0.037). The mean preoperative post void residual urine (PVRU) was 179.2±86.8 ml. This improved to 45.7±44.4 ml post-operatively. The mean difference in PVRU of 133.6±77.2 ml ( P = 0.001). Conclusion: In patients with DESD, there is a significant improvement in PVRU and Qmax after the injection of BTX-A. Hence, BTX-A injection is an effective method of treatment for DESD. However, further studies and follow-up are required to further evaluate patient satisfaction, quality of life and need for repeated injections.
Left Ventricular Diastolic Function Assessment Using the Timing of Mitral Annular and Transmitral Flow Velocities
Authors: Huang Fei-Qiong , Zhong Liang , Zhang Rui Sheng , Tan Lay Kheng , Chua Yvonne Lay Hong , Ding Zee Pin 
Published: July 2015

Background and aims: Evaluation of left ventricular (LV) diastolic function plays an important role in clinical echocardiography. The relationship between mitral annular velocities from tissue Doppler imaging (TDI) (E′ and A′) and mitral inflow velocities (E and A) from Doppler echocardiography (DE) provide additional information about LV filling and diastolic function. The aims of this study are to i) assess the time differences between peak E and peak E′, peak A and peak A′, peak Ar and peak A, and ii) examine the effects of age and gender on these time intervals parameters in normal subjects. Methods: A total of 117 healthy subjects (age ranging from 22- to 78-years-old) were recruited for a standard of echocardiogram (ECHO). During early diastole, the time intervals from the peak of R-wave on the ECG to the peak of E-wave (R-pE), to the peak of E wave to peak of E′-wave (R-pE′) were measured. During late diastole, the time intervals from the onset of P-wave on the ECG to the peak A-wave (P-pA), to the peak Ar-wave on the pulmonary valve flow (P-pAr), to the peak A′-wave (P-pA′) were measured. Early-diastolic temporal discordance (EDTD) and late-diastolic temporal discordance (LDTD) were calculated as the differences between (R-pE) and (R-pE′), and (P-pA) and (P-pA′), respectively. Results: The mean EDTD and LDTD were 28.7 ± 10.6 ms and 21.2 ± 15.9 ms, respectively. Similarly, the mean time difference [(P-pA) - (P-pAr)] was 21.5 ± 14.1 ms. EDTD was not associated with age (r=0.15, p=NS), while LDTD was inversely correlated with age (r=-0.65, p<0.01). No significant differences were found for both EDTD and LDTD between genders. Conclusion: EDTD and LDTD, the temporal discordances between mitral annulus motion and trans-mitral flow, embody one of the earliest events at early- and late-diastole. Age is not associated with EDTD, but is accompanied by a decline in LDTD. With respect to gender, both EDTD and LDTD are not influenced.
Plasma Vitamin D Levels are Lower among Ethnic Indians in Matched Pairs of Male Acute Ischaemic Stroke Patients of Indian and Chinese Ethnicity
Authors: De Silva Deidre Anne , Talabucon Loreto Pascual , Tan Eng-King , Lee Wei-Ling 
Published: July 2015

Introduction: Ethnic Indians have a high burden of vascular disease. Vitamin D deficiency is associated with an increased risk of vascular disease including ischaemic stroke. Vitamin D levels are lower among ethnic Indians compared to ethnic Chinese in healthy individuals. We compared the plasma 25-hydroxyvitamin D [25(OH)D] levels between ethnic Indians and Chinese male ischaemic stroke patients. Methods: We prospectively recruited consecutive ethnic Indian acute ischaemic stroke male patients within seven days of symptom onset, who were admitted to the Singapore General Hospital. The subsequent ethnic Chinese acute ischaemic stroke male patient matched for age and diabetes status was recruited. Plasma 25(OH)D was measured using DiaSorin radioimmunoassay. Results: We studied 22 matched pairs of ethnic Indian and Chinese ischaemic stroke male patients. Mean plasma 25(OH)D level was lower among ethnic Indians (16.7 ± 6.1 μg/L) than ethnic Chinese patients (19.7 ± 4.4 μg/L) ( p=0.04). The mean difference was 2.9 ± 6.46 μg/L corresponding to 12.9 ± 33.1%. Conclusion: Ethnic Indian male ischaemic stroke patients had lower vitamin D levels compared to matched ethnic Chinese counterparts. Thus it is important to consider ethnicity in the understanding of stroke risk due to vitamin D deficiency.
A Misdiagnosed Spindle Cell Sarcoma
Authors: Ang Chay You , Kau Chung Yuan , Chew Ghee Kheng , Tan Mann Hong 
Published: July 2015

In recent years, outsourcing of medical services has become increasingly popular due to financial reasons. We describe a case of a 35-year-old Chinese female who presented with a tender left perianal lump and worsening pain. She had a magnetic resonce imaging of the rectum performed and reported overseas but unfortunately a left ischiorectal fossa mass was missed in the initial report. Subsequently, the patient was managed on the working diagnosis of an abscess and underwent an “excisional” biopsy of her perianal lesion. The lesion was confirmed to be malignant based on histological findings and the patient underwent neoadjuvant therapies followed by wide resection of the tumour. The tumour was eventually diagnosed as unclassified malignant spindle cell neoplasm. The patient eventually developed metastases in the lungs and bilateral inguinal lymph nodes and passed away six months post-operatively. Spindle-cell sarcomas comprise a group of highly heterogeneous soft tissue sarcomas that is best managed by an experienced multi-disciplinary team at a tertiary centre. This case highlights the importance of an early diagnosis and multi-modal approach towards sarcomas. Although certain overseas institutes provide excellent healthcare at significantly lower cost, identifying such centres are a challenge, especially for the layperson. Therefore, the risks and benefits of seeking medical services abroad should be carefully weighted and second opinions should be sought when in doubt.
Quality of Life Treatment Outcomes of Class III Skeletal Patients after Bimaxillary Osteotomies
Authors: Wee Tze Haur , Poon Choy Yoke 
Published: July 2015

Introduction: Bimaxillary osteotomies are commonly done to correct dentofacial deformities. Osteotomy at the LeFort I level and bilateral sagittal split osteotomy (BSSO) are commonly used in combination to treat patients with Class III skeletal dentofacial deformities. However, few studies are available which assess the treatment outcome measured in terms of quality of life (QoL) of Class III skeletal patients after bimaxillary osteotomies. This study aims to evaluate the long-term benefits of bimaxillary osteotomies, measured in terms of QoL outcomes of Class III skeletal patients at two (2) years post-surgery. Methods: This study was conducted at the National Dental Centre Singapore and selected patients were given 2 questionnaires each based on Oral Health Impact Profile (OHIP-14) and Orthognathic Quality of Life Questionnaire (OQLQ). The patients were told to report each question using a Likert-type scale and their perception for each question before and after surgery. Results: A total of 41 patients were recruited in this study, of which 23 were males and 18 were females. Their age ranged from 17 to 32 years old at the time of surgery and the median age was 20 years 2 months. All the patients in this study were Chinese. All the patients underwent LeFort I maxillary procedure in addition to BSSO setback surgery. The Wilcoxon Signed Rank test was used for evaluation of the statistics. There were significant changes to both OHIP-14 and OQLQ scores (p<0.001) two-years post-operatively. All the OHIP-14 domains, functional limitation (p<0.001), physical pain (p<0.001), psychological discomfort (p<0.001), physical disability (p=0.001), social disability (p<0.001) and handicap (p<0.001), were significantly decreased when compared to pre-surgical scores. The OQLQ domain scores, social aspects of deformity (p<0.001), facial aesthetics (p<0.001), oral function (p<0.001), and awareness of facial deformity (p=0.013), were also significantly lower two-years post-operatively. Conclusion: Treatment outcomes measured in terms of QoL were significantly improved in Class III skeletal patients after bimaxillary osteotomies. The function, psychosocial and facial aesthetics improved significantly after surgery and these aspects continued well into two-years post-surgery. The inclusion of QoL as a routine treatment outcome measure in orthognathic surgery would be beneficial in clinical profiling of patients, decision making and evaluating the efficacy of the procedure. It could potentially be used to evaluate surgical complications, arising from orthognathic surgery, and its impact on QoL in patients. More studies would be required to establish its correlation in the future.
Effects of benchmarking on the quality of type 2 diabetes care: results of the OPTIMISE (Optimal Type 2 Diabetes Management Including Benchmarking and Standard Treatment) study in Greece
Authors: Tsimihodimos Vasilis , Kostapanos Michael S. , Moulis Alexandros , Nikas Nikos , Elisaf Moses S. 
Published: July 2015

Objectives: To investigate the effect of benchmarking on the quality of type 2 diabetes (T2DM) care in Greece. Methods: The OPTIMISE (Optimal Type 2 Diabetes Management Including Benchmarking and Standard Treatment) study [ClinicalTrials.gov identifier: NCT00681850] was an international multicenter, prospective cohort study. It included physicians randomized 3:1 to either receive benchmarking for glycated hemoglobin (HbA1c), systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) treatment targets (benchmarking group) or not (control group). The proportions of patients achieving the targets of the above-mentioned parameters were compared between groups after 12 months of treatment. Also, the proportions of patients achieving those targets at 12 months were compared with baseline in the benchmarking group. Results: In the Greek region, the OPTIMISE study included 797 adults with T2DM (570 in the benchmarking group). At month 12 the proportion of patients within the predefined targets for SBP and LDL-C was greater in the benchmarking compared with the control group (50.6 versus 35.8%, and 45.3 versus 36.1%, respectively). However, these differences were not statistically significant. No difference between groups was noted in the percentage of patients achieving the predefined target for HbA1c. At month 12 the increase in the percentage of patients achieving all three targets was greater in the benchmarking (5.9–15.0%) than in the control group (2.7–8.1%). In the benchmarking group more patients were on target regarding SBP (50.6% versus 29.8%), LDL-C (45.3% versus 31.3%) and HbA1c (63.8% versus 51.2%) at 12 months compared with baseline ( p < 0.001 for all comparisons). Conclusion: Benchmarking may comprise a promising tool for improving the quality of T2DM care. Nevertheless, target achievement rates of each, and of all three, quality indicators were suboptimal, indicating there are still unmet needs in the management of T2DM.
NF-κB and AKT signaling prevent DNA damage in transformed pre-B cells by suppressing RAG1/2 expression and activity
Authors: Ochodnicka-Mackovicova Katarina , Bahjat Mahnoush , Bloedjes Timon A. , Maas Chiel , de Bruin Alexander M. , Bende Richard J. , van Noesel Carel J. M. , Guikema Jeroen E. J. 
Published: July 2015

Key Points
NF-κB and AKT signaling prevent RAG-dependent DNA damage in cycling-transformed pre-B cells. NF-κB activity negatively correlates with RAG expression in B-ALL patients.