BACKGROUND: The posterior approach for ptosis, including the Fasanella-Servat procedure and Muller's muscle-conjunctival resection (MMCR), has been proven effective for mild- to moderately affected patients whose levator muscle function remains relatively intact. Traditionally, MMCR was reserved for phenylephrine test-positive patients for whom various modifications and several nomograms have been developed. METHODS: We reviewed the literature for the Fasanella-Servat procedure and MMCR. The methods and results of the different modifications were analyzed and compared. Nomograms of these two procedures were summarized. RESULTS: MMCR mainly involved resection of Muller's muscle and conjunctiva in the original design by Putterman and co-workers. The suggested resection ranged from 8 to 9 mm for the achievement of the maximal effect produced by topical epinephrine. Perry included tarsectomy in his procedure and developed a new nomogram that included a 1:1 ratio of the ptosis correction to the amount of tarsus resection. The effect of tarsectomy for the Fasanella-Servat procedure in terms of eyelid elevation was approximately one-half the value seen in phenylephrine test-negative patients. We've performed MMCR with tarsectomy regardless of the response to phenylephrine with similar results to Perry. Surgical indications and possible complications of MMCR with tarsectomy for Asian patients are discussed. CONCLUSIONS: MMCR is an effective and simple method for the correction of ptosis. With baseline MMCR, the additional tarsectomy has proven to be a powerful tool for ptosis correction irrespective of phenylephrine test results.
Ankle ; Asian Continental Ancestry Group ; Blepharoplasty ; Blepharoptosis ; Conjunctiva ; Epinephrine ; Eyelids ; Humans ; Nomograms ; Phenylephrine

Humans ; Multiple Organ Failure ; Plasma Exchange ; Respiratory Insufficiency/therapy* ; Thyroid Crisis/therapy*

No abstract available.
Gynecology* ; Laparoscopy*

The intracellular calcium signaling, which is modulated by the microenvironment of cells, is closely related to the cell's self renewal, differentiation, proliferation, and its apoptosis. The study on the quantitative modulation of the intracellular calcium signals could not only help to understand the dynamic behavior of such kind of signaling, but also play a significant role in the control of cell fate, simulation of cell behavior and bionics of cellular biological systems. This paper briefly reviewed the progress on the quantitative modulation of intracellular calcium signals induced by shear flow, including (1) experimental phenomena and the associated mechanisms of shear flow activated intracellular calcium response; (2) mathematical modeling and simulation of the intracellular calcium response induced by shear flow; (3) feedback control of the intracellular calcium signals by shear flow.

Tuberculous menigitis is relatively common disease and delay in treatment is associated with many neurologic sequelae. Of the neurologic disorder, diabets insipidus is extreamly rare. Diabetes insipidus is a syndrome characterized by the excretion of abnormally large volumes of dilute urine. It is divided into central diabets insipidus, nephrogenic diabetes insipidus, primary polydipsia and gestational daibetes insipidus. In this four type of diabetes insipidus, central diabetes insipidus is a polyuric disorder results from a lack of sufficient antidiuretic hormone to effect appropriate concentration of the urine for water conservration. We report a 25-year old male who had prolonged head ache and subsequently followed by polyuria. He was dia gonsed as the tuberculous meningitis by laboratory find ing and smear of CSF, and diagnosed central diabetes insipidus by serum osmolality & Na+ & AVP (arginine va sopressin), urine osmolality & specific gravity, adminis tration of vasopressin. He maintained the water balance of body by administration of vasopressin, but without im provement of mental status, sudden cardiac arrest occurs on 20th hospital day
Adult ; Death, Sudden, Cardiac ; Diabetes Insipidus* ; Diabetes Insipidus, Nephrogenic ; Diabetes Insipidus, Neurogenic ; Head ; Humans ; Male ; Nervous System Diseases ; Osmolar Concentration ; Polydipsia, Psychogenic ; Polyuria ; Specific Gravity ; Tuberculosis, Meningeal* ; Vasopressins ; Water

OBJECTIVE: To compare the diagnostic performance of digital breast tomosynthesis (DBT) and conventional breast ultrasound (US) to characterize breast lesions as benign or malignant. MATERIALS AND METHODS: A total of 332 women, presenting for screening examinations or for breast biopsy between March and June 2012 were recruited to undergo digital mammography (DM), DBT, and breast US examination. Among them, 113 patients with 119 breast lesions depicted on DM were finally included. Three blinded radiologists performed an enriched reader study and reviewed the DBT and US images. Each reader analyzed the lesions in random order, assigned Breast Imaging Reporting and Data System (BI-RADS) descriptors, rated the images for the likelihood of malignancy (%) and made a BI-RADS final assessment. Diagnostic accuracy, as assessed by the area under the receiver operating characteristic curve, sensitivity, and specificity of DBT and US were compared. RESULTS: Among the 119 breast lesions depicted on DM, 75 were malignant and the remaining 44 were benign. The average diagnostic performance for characterizing breast lesions as benign or malignant in terms of area under the curve was 0.899 for DBT and 0.914 for US (p = 0.394). Mean sensitivity (97.3% vs. 98.7%, p = 0.508) and specificity (44.7% vs. 39.4%, p = 0.360) were also not significantly different. CONCLUSION: Digital breast tomosynthesis may provide similar reader lesion characterization performance to that of US for breast lesions depicted on DM.
Adult ; Aged ; Biopsy ; Breast/*pathology ; Breast Neoplasms/*diagnosis/radiography/ultrasonography ; Female ; Humans ; Mammography/*methods ; Middle Aged ; ROC Curve ; Radiographic Image Enhancement/*methods ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography, Mammary/*methods

INTRODUCTIONThe Optic Neuritis Treatment Trial (ONTT) has established that the magnetic resonance imaging (MRI) findings at the time of presentation of optic neuritis (ON) is the strongest indicator of the development of multiple sclerosis (MS). Reports from Singapore as well as other Asian countries have indicated that these abnormalities are less frequently encountered compared to that reported by the ONTT. This paper aims to describe systematically the brain MRI as well as the optic nerve abnormalities in patients after an episode of acute optic neuritis.

MATERIALS AND METHODSPatients who presented with acute optic neuritis were retrieved from our prospective optic neuritis study and their MRI scans were reviewed and graded in accordance with the standardised classification employed in the ONTT.

RESULTSFifteen of 24 patients had MRI brain and optic nerves performed during the acute episode. In the evaluation of brain abnormalities, 40% were classified as grade 0, 20% grade I, 20% grade II, 6.7% grade III and 13.3% grade IV. Optic nerve abnormalities were observed in 80% of cases. At study entry, 10 patients had idiopathic (monosymptomatic) ON, 3 had multiple sclerosis (MS), one each with infective and autoimmune optic neuritis, respectively. The single patient who developed MS at study completion presented with grade II brain abnormalities at the initial MRI. For those with idiopathic ON, our study revealed a higher percentage of grade 0-I brain changes as well as a lower lesion load compared to the ONTT.Lesion Load and grade was also lower in anterior optic neuritis compared with retrobulbar disease.

CONCLUSIONOur study revealed a lower percentage of grade II-IV brain MRI abnormalities as well as less lesion load in idiopathic ON compared to the ONTT. This may be related to the lower prevalence of MS in our predominantly Asian population. As diagnostic tests and understanding of neuromyelitis optica or Devic's disease improves, we may see more patients being diagnosed with this condition, which may also explain our findings. Our data also showed that MRI grade and lesion load in cases of anterior ON was lower than for retrobulbar disease. MRI in ON has an essential role in characterising the disease, evaluating for associated brain lesions, and assessing prognosis in retrobulbar disease but may be less useful in anterior disease.

Acute Disease ; Adolescent ; Adult ; Asia ; ethnology ; Brain ; abnormalities ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Medical Audit ; Middle Aged ; Multiple Sclerosis ; Optic Neuritis ; classification ; diagnosis ; ethnology ; physiopathology ; Prospective Studies ; Singapore ; Young Adult

SAG (Sensitive to Apoptosis Gene), also known as RBX2 (RING box protein 2), ROC2 (Regulator of Cullins 2), or RNF7 (RING Finger Protein 7), was originally cloned in our laboratory as a redox inducible antioxidant protein and later characterized as the second member of the RBX/ROC RING component of the SCF (SKP1-CUL-F-box Proteins) E3 ubiquitin ligase. When acting alone, SAG scavenges oxygen radicals by forming inter- and intra-molecular disulfide bonds, whereas by forming a complex with other components of the SCF E3 ligase, SAG promotes ubiquitination and degradation of a number of protein substrates, including c-JUN, DEPTOR, HIF-1α, IκBα, NF1, NOXA, p27, and procaspase-3, thus regulating various signaling pathways and biological processes. Specifically, SAG protects cells from apoptosis, confers radioresistance, and plays an essential and non-redundant role in mouse embryogenesis and vasculogenesis. Furthermore, stress-inducible SAG is overexpressed in a number of human cancers and SAG overexpression correlates with poor patient prognosis. Finally, SAG transgenic expression in epidermis causes an early stage inhibition, but later stage promotion, of skin tumorigenesis triggered by DMBA/TPA. Given its major role in promoting targeted degradation of tumor suppressive proteins, leading to apoptosis suppression and accelerated tumorigenesis, SAG E3 ligase appears to be an attractive anticancer target.
Animals ; Antioxidants ; metabolism ; Apoptosis ; Carrier Proteins ; chemistry ; genetics ; metabolism ; Cell Transformation, Neoplastic ; Humans ; RING Finger Domains ; Substrate Specificity ; Ubiquitin-Protein Ligases ; chemistry ; metabolism ; Ubiquitination

There have been recent descriptions of the novel coronavirus disease 2019 (COVID-19) presenting as ‘varicella-like exanthem’. We report three cases of patients with VaricellaZoster Virus (VZV) and COVID-19 co-infections, presenting in three varied ways. These cases highlight the need for heightened alertness to how such co-infections can present, to pick up overlapping ‘dual pathologies’ during this current pandemic given that infection control measures including airborne precautions are crucial for both COVID-19 and VZV.

Most important international guidelines recommend the use of CHA 2 DS 2 -VASc and HASBLED scores for stroke and bleeding risk assessments in atrial fibrillation (AF) patients, respectively. The 2020 AF guidelines of European Society of Cardiology have revised the definition of “C: congestive heart failure (HF)” component, and now patients with either HF with reduced ejection fraction or preserved ejection fraction should be assigned 1 point.Hypertrophic cardiomyopathy was also included. Besides, the revised “V: vascular diseases” component included both prior myocardial infarction and “angiographically significant coronary artery disease”. It is important to understand that the stroke and bleeding risks of AF patients were not static and should be re-assessed regularly. A high HAS-BLED score itself should not be the only reason to withhold or discontinue oral anticoagulants, but remind physicians for the corrections of modifiable bleeding risk factors and more regular follow up. In the future, the AF duration and left atrial function may play an important role for personalized evaluation of individual stroke risk while more studies are necessary.