1.Vestibular dysfunction in patients with idiopathic parkinson's disease..
Hyung LEE ; Tae Wan KIM ; Ji Eun KIM ; Jeong Geun LIM ; Sang Doe YI ; Young Choon PARK ; Seong Ryong LEE
Journal of the Korean Neurological Association 1998;16(2):172-179
BACKGROUND AND OBJECTIVES: Qualitative oculomotor abnormalities have been reported in parkinsonian patients for many years, but conflicting results have been obtained. This study was performed to evaluate the correlation between the severity of the disease and the abnormalities of the ocular movements in idiopathic parkinson's disease. METHODS: We gave the vestibular function tests in patients with idiopathic parkinson's disease and normal controls. Eye movement recordings were made with automated electronystagmography and rotation test was performed. A total of 46 patients (mean age : 61.2+/-6.7) and 24 controls (mean age : 60.5+/-4.3) were studied. The severity of the disease was divided into two groups by modified Hoehn & Yahr staging ; H-Y stage 1 and 2 as a mild group and stage 3 and 4 as a severe group. RESULTS: Saccadic latency and accuracy, pursuitic gain and velocity, vestibulo-ocular reflex (VOR) suppression by vision were significantly altered in patients, whereas mean velocity of optokinetic nystagmus (OKN) and VOR gain in darkness were normal. Alteration of saccadic latency and accuracy, pursuitic gain and velocity, VOR suppression by vision were profound in the severe group compared with a mild group and controls, but the above parameters did not differ between a mild group and controls. In a hemiparkinson's group, saccadic latency and accuracy, pursuitic gain, OKN mean velocity and gain was not different between the both sides. CONCLUSION: The results indicate that severe Parkinson's disease damages nigrostriatal or other specific pathways which were involved in the regulation of the saccadic, pursuitic and pursuitic-mediated visual fixation system. In a hemiparkinson's group asymmetric damage of dopaminergic innervation which was involved in the regulation of ocular movements was not found.
Darkness
;
Electronystagmography
;
Eye Movements
;
Humans
;
Nystagmus, Optokinetic
;
Parkinson Disease*
;
Reflex, Vestibulo-Ocular
;
Vestibular Function Tests
2.Effects of Lower Rib Expansion Limitation on Maximal Respiratory Pressure and Abdominal Muscle Activity During Maximal Breathing in Healthy Subjects
Gyu-wan LEE ; Tae-Lim YOON ; Young-jung LEE ; Ki-song KIM ; Chung-hwi YI
Journal of Korean Physical Therapy 2020;32(6):394-399
Purpose:
The aim of this study was to determine the effects of lower rib cage lateral expansion limitation on the maximal inspiratory and expiratory pressures and on abdominal muscle activity during maximal respiratory breathing in healthy subjects.
Methods:
Fifteen healthy male subjects voluntarily participated in this cross-sectional study. During maximal breathing, maximal inspiratory and expiratory pressures were measured, and abdominal muscle activity was determined with using surface electromyography. Also, the measurement was repeated with using a non-elastic belt to the lower rib cage for limiting of lateral expansion. A Wilcoxon signed-rank test was performed for obtaining the statistical difference with a significance level of 0.05.
Results:
The findings of this study are as follows: 1) There were no significant differences in maximal inspiratory and expiratory pressure with and without lower rib cage lateral expansion (p>0.05), 2) There was no significant difference in abdominal muscle activity during the maximal inspiratory phase (p>0.05). However, right external oblique muscle activity decreased significantly during maximum exhalation with lower rib expansion limitation (p<0.05).
Conclusion
The results of the current study indicate that a non-elastic belt was effective in decreasing right external oblique muscle activity during forced expiratory breathing in healthy subjects.
3.Effects of Lower Rib Expansion Limitation on Maximal Respiratory Pressure and Abdominal Muscle Activity During Maximal Breathing in Healthy Subjects
Gyu-wan LEE ; Tae-Lim YOON ; Young-jung LEE ; Ki-song KIM ; Chung-hwi YI
Journal of Korean Physical Therapy 2020;32(6):394-399
Purpose:
The aim of this study was to determine the effects of lower rib cage lateral expansion limitation on the maximal inspiratory and expiratory pressures and on abdominal muscle activity during maximal respiratory breathing in healthy subjects.
Methods:
Fifteen healthy male subjects voluntarily participated in this cross-sectional study. During maximal breathing, maximal inspiratory and expiratory pressures were measured, and abdominal muscle activity was determined with using surface electromyography. Also, the measurement was repeated with using a non-elastic belt to the lower rib cage for limiting of lateral expansion. A Wilcoxon signed-rank test was performed for obtaining the statistical difference with a significance level of 0.05.
Results:
The findings of this study are as follows: 1) There were no significant differences in maximal inspiratory and expiratory pressure with and without lower rib cage lateral expansion (p>0.05), 2) There was no significant difference in abdominal muscle activity during the maximal inspiratory phase (p>0.05). However, right external oblique muscle activity decreased significantly during maximum exhalation with lower rib expansion limitation (p<0.05).
Conclusion
The results of the current study indicate that a non-elastic belt was effective in decreasing right external oblique muscle activity during forced expiratory breathing in healthy subjects.
4.Incidence and risk factors of delirium in post-anaesthesia care unit.
Yuhe KE ; Sophia CHEW ; Edwin SEET ; Wan Yi WONG ; Vera LIM ; Nelson CHUA ; Jinbin ZHANG ; Beatrice LIM ; Vanessa CHUA ; Ne Hooi Will LOH ; Lian Kah TI
Annals of the Academy of Medicine, Singapore 2022;51(2):87-95
INTRODUCTION:
Post-anaesthesia care unit (PACU) delirium is a potentially preventable condition that results in a significant long-term effect. In a multicentre prospective cohort study, we investigate the incidence and risk factors of postoperative delirium in elderly patients undergoing major non-cardiac surgery.
METHODS:
Patients were consented and recruited from 4 major hospitals in Singapore. Research ethics approval was obtained. Patients older than 65 years undergoing non-cardiac surgery >2 hours were recruited. Baseline perioperative data were collected. Preoperative baseline cognition was obtained. Patients were assessed in the post-anaesthesia care unit for delirium 30-60 minutes after arrival using the Nursing Delirium Screening Scale (Nu-DESC).
RESULTS
Ninety-eight patients completed the study. Eleven patients (11.2%) had postoperative delirium. Patients who had PACU delirium were older (74.6±3.2 versus 70.6±4.4 years, P=0.005). Univariate analysis showed those who had PACU delirium are more likely to be ASA 3 (63.6% vs 31.0%, P=0.019), had estimated glomerular filtration rate (eGFR) of >60mL/min/1.73m2 (36.4% vs 10.6%, P=0.013), higher HbA1C value (7.8±1.2 vs 6.6±0.9, P=0.011), raised random blood glucose (10.0±5.0mmol/L vs 6.5±2.4mmol/L, P=0.0066), and moderate-severe depression (18.2% vs 1.1%, P=0.033). They are more likely to stay longer in hospital (median 8 days [range 4-18] vs 4 days [range 2-8], P=0.049). Raised random blood glucose is independently associated with increased PACU delirium on multivariate analysis.
Aged
;
Anesthesia
;
Anesthesia Recovery Period
;
Delirium/etiology*
;
Humans
;
Incidence
;
Postoperative Complications/etiology*
;
Prospective Studies
;
Risk Factors
5.Comprehensive characterization of genomic features and clinical outcomes following targeted therapy and secondary cytoreductive surgery in OCCC: a single center experience
Silvana Talisa WIJAYA ; Natalie YL NGOI ; Jerold WZ LOH ; Tuan Zea TAN ; Diana LIM ; Irfan Sagir KHAN ; Yee Liang THIAN ; Alexa LAI ; Bertrand WL ANG ; Pearl TONG ; Joseph NG ; Jeffrey JH LOW ; Arunachalam ILANCHERAN ; Siew Eng LIM ; Yi Wan LIM ; David SP TAN
Journal of Gynecologic Oncology 2024;35(5):e69-
Objective:
Ovarian clear cell carcinoma (OCCC) is associated with chemoresistance. Limited data exists regarding the efficacy of targeted therapies such as immune checkpoint inhibitors (ICI) and bevacizumab, and the role of secondary cytoreductive surgery (SCS).
Methods:
We retrospectively analyzed genomic features and treatment outcomes of 172 OCCC patients treated at our institution from January 2000 to May 2022. Next-generation sequencing (NGS) was performed where sufficient archival tissue was available.
Results:
64.0% of patients were diagnosed at an early stage, and 36.0% at an advanced stage.Patients with advanced/relapsed OCCC who received platinum-based chemotherapy plus bevacizumab followed by maintenance bevacizumab had a median first-line progressionfree survival (PFS) of 12.2 months, compared with 9.3 months for chemotherapy alone (hazard ratio=0.69; 95% confidence interval [CI]=0.33, 1.45). In 27 patients who received an ICI, the overall response rate was 18.5% and median duration of response was 7.4 months (95% CI=6.5, 8.3). In 17 carefully selected patients with fewer than 3 sites of relapse, median PFS was 35 months (95% CI=0, 73.5) and median overall survival was 96.8 months (95% CI=44.6, 149.0) after SCS. NGS on 58 tumors revealed common mutations in ARID1A (48.3%), PIK3CA (46.6%), and KRAS (20.7%). Pathogenic alterations in PIK3CA, FGFR2, and NBN were associated with worse survival outcomes. Median tumor mutational burden was 3.78 (range, 0–16). All 26 patients with available loss of heterozygosity (LOH) scores had LOH <16%.
Conclusion
Our study demonstrates encouraging outcomes with bevacizumab and ICI, and SCS in select relapsed OCCC patients. Prospective trials are warranted.
6.Comprehensive characterization of genomic features and clinical outcomes following targeted therapy and secondary cytoreductive surgery in OCCC: a single center experience
Silvana Talisa WIJAYA ; Natalie YL NGOI ; Jerold WZ LOH ; Tuan Zea TAN ; Diana LIM ; Irfan Sagir KHAN ; Yee Liang THIAN ; Alexa LAI ; Bertrand WL ANG ; Pearl TONG ; Joseph NG ; Jeffrey JH LOW ; Arunachalam ILANCHERAN ; Siew Eng LIM ; Yi Wan LIM ; David SP TAN
Journal of Gynecologic Oncology 2024;35(5):e69-
Objective:
Ovarian clear cell carcinoma (OCCC) is associated with chemoresistance. Limited data exists regarding the efficacy of targeted therapies such as immune checkpoint inhibitors (ICI) and bevacizumab, and the role of secondary cytoreductive surgery (SCS).
Methods:
We retrospectively analyzed genomic features and treatment outcomes of 172 OCCC patients treated at our institution from January 2000 to May 2022. Next-generation sequencing (NGS) was performed where sufficient archival tissue was available.
Results:
64.0% of patients were diagnosed at an early stage, and 36.0% at an advanced stage.Patients with advanced/relapsed OCCC who received platinum-based chemotherapy plus bevacizumab followed by maintenance bevacizumab had a median first-line progressionfree survival (PFS) of 12.2 months, compared with 9.3 months for chemotherapy alone (hazard ratio=0.69; 95% confidence interval [CI]=0.33, 1.45). In 27 patients who received an ICI, the overall response rate was 18.5% and median duration of response was 7.4 months (95% CI=6.5, 8.3). In 17 carefully selected patients with fewer than 3 sites of relapse, median PFS was 35 months (95% CI=0, 73.5) and median overall survival was 96.8 months (95% CI=44.6, 149.0) after SCS. NGS on 58 tumors revealed common mutations in ARID1A (48.3%), PIK3CA (46.6%), and KRAS (20.7%). Pathogenic alterations in PIK3CA, FGFR2, and NBN were associated with worse survival outcomes. Median tumor mutational burden was 3.78 (range, 0–16). All 26 patients with available loss of heterozygosity (LOH) scores had LOH <16%.
Conclusion
Our study demonstrates encouraging outcomes with bevacizumab and ICI, and SCS in select relapsed OCCC patients. Prospective trials are warranted.
7.Comprehensive characterization of genomic features and clinical outcomes following targeted therapy and secondary cytoreductive surgery in OCCC: a single center experience
Silvana Talisa WIJAYA ; Natalie YL NGOI ; Jerold WZ LOH ; Tuan Zea TAN ; Diana LIM ; Irfan Sagir KHAN ; Yee Liang THIAN ; Alexa LAI ; Bertrand WL ANG ; Pearl TONG ; Joseph NG ; Jeffrey JH LOW ; Arunachalam ILANCHERAN ; Siew Eng LIM ; Yi Wan LIM ; David SP TAN
Journal of Gynecologic Oncology 2024;35(5):e69-
Objective:
Ovarian clear cell carcinoma (OCCC) is associated with chemoresistance. Limited data exists regarding the efficacy of targeted therapies such as immune checkpoint inhibitors (ICI) and bevacizumab, and the role of secondary cytoreductive surgery (SCS).
Methods:
We retrospectively analyzed genomic features and treatment outcomes of 172 OCCC patients treated at our institution from January 2000 to May 2022. Next-generation sequencing (NGS) was performed where sufficient archival tissue was available.
Results:
64.0% of patients were diagnosed at an early stage, and 36.0% at an advanced stage.Patients with advanced/relapsed OCCC who received platinum-based chemotherapy plus bevacizumab followed by maintenance bevacizumab had a median first-line progressionfree survival (PFS) of 12.2 months, compared with 9.3 months for chemotherapy alone (hazard ratio=0.69; 95% confidence interval [CI]=0.33, 1.45). In 27 patients who received an ICI, the overall response rate was 18.5% and median duration of response was 7.4 months (95% CI=6.5, 8.3). In 17 carefully selected patients with fewer than 3 sites of relapse, median PFS was 35 months (95% CI=0, 73.5) and median overall survival was 96.8 months (95% CI=44.6, 149.0) after SCS. NGS on 58 tumors revealed common mutations in ARID1A (48.3%), PIK3CA (46.6%), and KRAS (20.7%). Pathogenic alterations in PIK3CA, FGFR2, and NBN were associated with worse survival outcomes. Median tumor mutational burden was 3.78 (range, 0–16). All 26 patients with available loss of heterozygosity (LOH) scores had LOH <16%.
Conclusion
Our study demonstrates encouraging outcomes with bevacizumab and ICI, and SCS in select relapsed OCCC patients. Prospective trials are warranted.
8.Effects of Deletions in the Regulatory Domain on the Stability and Enzymatic Characteristics of Tyrosine Hydroxylase.
Young Soo YOO ; Sang Doe YI ; Jung Kun LIM ; Yong Sik KIM ; Eun Joo NAM ; Wan Suk JOO ; Uhn LEE ; Young Jae LEE
Journal of the Korean Neurological Association 2002;20(1):60-66
BACKGROUND: Various vectors have been developed and tried for the delivery of tyrosine hydroxylase (TH) in order to supplement dopamine, which is severely deficient in Parkinson's disease, however, none of the protocols tried have yielded fruitful results that can be applied directly to humans. One of the problems revealed from previous trials was a short duration of expression of the delivered gene, that is, tyrosine hydroxylase. METHODS: To extend the stability and to improve the enzymatic characteristics of the protein, part of the regulatory domain was deleted via PCR technique. The cDNA for regulatory domain-deleted THs (dTH) were sub-cloned into a retroviral vector and the resulting recom-binant retrovirus was used to infect NIH-3T3. After selection, expression levels of TH were determined by Western blot analysis and the enzymatic characteristics were examined. RESULTS: The deletion increased steady state expression level of TH protein by 7-fold for d19TH (TH with amino acids #2-19 are deleted) and 3-fold for d31TH (TH with amino acids #2-31 are deleted. The elevated expression level of d19TH is likely due to the enhanced stability of the protein as determined by a treatment of cycloheximide. The activity of d19TH was also increased approximately by 3-fold but no increase of the L-dopa production was observed. However, the production of L-dopa was dramatically increased when GTP cyclohydrolase I (GTPCH I) was co-transfected suggesting that the activity of d19TH is dependent on the presence of cofactor. d19TH seem to be free of feedback inhibition at low concentration of dopamine (10 nM~1 nM) but more sensitive to the inhibition at high concentration of dopamine (10 mM). CONCLUSIONS: The deletion of 18 amino acids on the regulatory domain increases the stability of the protein, reduces the activity, and frees it from the feedback inhibi-tion by the end product.
Amino Acids
;
Blotting, Western
;
Cycloheximide
;
DNA, Complementary
;
Dopamine
;
Fruit
;
GTP Cyclohydrolase
;
Humans
;
Levodopa
;
Parkinson Disease
;
Polymerase Chain Reaction
;
Retroviridae
;
Staphylococcal Protein A
;
Tyrosine 3-Monooxygenase*
;
Tyrosine*
;
Zidovudine
9.Difficult and failed intubation in Caesarean general anaesthesia: a four-year retrospective review.
Yi Lin LEE ; Michelle Leanne LIM ; Wan Ling LEONG ; Eileen LEW
Singapore medical journal 2022;63(3):152-156
INTRODUCTION:
General anaesthesia is associated with higher maternal morbidity and mortality when compared with regional anaesthesia, related mainly to failure of intubation, hypoxia and aspiration. The aim of this retrospective review was to define the incidence of failed and difficult intubation in parturients undergoing general anaesthesia for Caesarean delivery at a high-volume obstetric hospital in Singapore.
METHODS:
All parturients who underwent Caesarean delivery under general anaesthesia from 2013 to 2016 were identified and their medical records were reviewed to extract pertinent data. Difficult intubation was defined as 'requiring more than one attempt at intubation or documented as such, based on the opinion of the anaesthetist'. A failed intubation was defined as 'inability to intubate the trachea, with subsequent abandonment of intubation as a means of airway management'.
RESULTS:
Records of 660 Caesarean sections under general anaesthesia were extracted. The mean age of the parturients was 32.1 ± 5.5 years and the median body mass index was 27.5 (interquartile range 24.6-31.1) kg/m2. Rapid sequence induction with cricoid pressure was employed for all patients, with thiopentone and succinylcholine being administered for 91.2% and 98.1% of patients, respectively. There were 33 difficult intubations among 660 patients, yielding an incidence of 5.0%. Junior trainees performed about 90% of all intubations and 28 (84.8%) out of 33 difficult intubations. Repeat intubations were performed by senior residents/fellows (57.1%) and consultants (14.3%). No instance of failed intubation was reported.
CONCLUSION
The local incidence of difficult obstetric intubation was one in 20. No failure of intubation was observed.
Adult
;
Airway Management
;
Anesthesia, General
;
Cesarean Section
;
Female
;
Humans
;
Intubation, Intratracheal
;
Pregnancy
;
Retrospective Studies
10.Usefulness of neutrophil to lymphocyte ratio in patients with chronic obstructive pulmonary disease: a prospective observational study.
Seung Jun LEE ; Hyang Rae LEE ; Tae Won LEE ; Sunmi JU ; Sujin LIM ; Se Il GO ; Jung Wan YOU ; Yu Ji CHO ; Gyeong Won LEE ; Yi Yeong JEONG ; Ho Cheol KIM ; Jong Deog LEE
The Korean Journal of Internal Medicine 2016;31(5):891-898
BACKGROUND/AIMS: Neutrophil to lymphocyte ratio (NLR) in peripheral blood is a useful systemic inflammatory response biomarker. However, NLR has not been studied in patients with chronic obstructive pulmonary disease (COPD). This study was aimed to evaluate the usefulness of NLR in patients with COPD. METHODS: NLR was prospectively measured and compared in patients with COPD exacerbation (n = 59), patients with stable COPD (n = 61), and healthy controls (n = 28). NLR in patients with COPD exacerbation was repeatedly measured in the convalescent period. The correlation between NLR and clinical parameters was evaluated, and the predictors for respiratory hospitalization were analyzed by multivariate logistic regression. RESULTS: NLR values were significantly higher in patients with COPD exacerbation compared with stable COPD patients and controls (12.4 ± 10.6, 2.4 ± 0.7, 1.4 ± 0.5, respectively; p < 0.001). NLR was significantly decreased during the convalescent period in patients with COPD exacerbation (4.5 ± 4.6 vs. 11.5 ± 8.8, p < 0.001). NLR exhibited a significant correlation with the body mass index, degree of airway obstruction, dyspnea, and exercise capacity (BODE) index, the 6-minute walk test, and the modified Medical Research Council scale. NLR ≥ 2.8 was an independent predictor with a borderline significance for respiratory hospitalization (odds ratio, 2.083; p = 0.079). Body mass index and forced expiratory volume in 1 second were independent predictors for respiratory hospitalization. CONCLUSIONS: NLR is a straightforward and effective biomarker of COPD exacerbation that may serve as a predictor for respiratory hospitalization in patients with COPD.
Airway Obstruction
;
Body Mass Index
;
Dyspnea
;
Forced Expiratory Volume
;
Hospitalization
;
Humans
;
Logistic Models
;
Lymphocytes*
;
Neutrophils*
;
Observational Study*
;
Prospective Studies*
;
Pulmonary Disease, Chronic Obstructive*