Early Recognition of Pediatric Strokes in the Emergency Department: Epidemiology, Clinical Presentation, and Factors Impeding Stroke Diagnosis in Children

Si Qi Tan(Si Qi Tan),Wen Qi Cher(Wen Qi Cher),Shu-Ling Chong(Shu-Ling Chong),Angelina Su Yin Ang(Angelina Su Yin Ang ),Sashikumar Ganapathy(Sashikumar Ganapathy ),Derrick Wei Shih Chan(Derrick Wei Shi 대한소아신경학회 2022 대한소아신경학회지 Vol.31 No.1

Purpose: Strokes are challenging to diagnose in pediatric emergency departments (EDs) as level of suspicion is low and atypical presentations are common. We analyzed clinical features, epidemiology and factors of delayed identification in arterial ischemic strokes (AIS) and hemorrhagic strokes (HS). Methods: Single-center retrospective cohort study of children aged between 29 days and 18 years old diagnosed with stroke between July 2016 to June 2021. Results: Among 36 children, 11 (30.5%) had AIS, 25 (69.4%) had HS. Median age for AIS was 9 years (interquartile range [IQR], 2 to 9) and HS 9 years (IQR, 1 to 11.5) (P=0.715). Focal neurological deficit was seen in 72.7% of AIS and 20% of HS (P=0.006). Only 18.2% of AIS and 52.0% of HS presented within 6 hours of symptoms. Median time from symptom onset to ED presentation was 24 hours (IQR, 12 to 28) for AIS and 7 hours (IQR, 1.8 to 48) for HS (P=0.595). Most (85.6%) arrived by own transport. Median time from presentation to neuroimaging was 7 hours (IQR, 0.9 to 7) for AIS and 4.8 (IQR, 1.3 to 16.8) hours for HS (P=0.376). Eleven patients, 9/25 (36.0%) HS and 2/11 (18.2%) AIS, did not have stroke as differential diagnosis at ED (P=0.714). Common initial diagnoses were viral illness or headaches. On univariate analysis, age <1 (odds ratio [OR], 17.5; 95% confidence interval [CI], 1.2 to 250.4; P=0.035) and absence of focal neurological deficit (OR, 13.091; 95% CI, 1.5 to 117.9; P=0.022) were significant factors for delayed identification. Conclusion: Index of suspicion for pediatric strokes among caregivers and clinicians should be increased. Public awareness campaigns are recommended.

Atypical Ductal Hyperplasia of the Breast on Core Needle Biopsy: Risk of Malignant Upgrade on Surgical Excision

Tiffany Sin Hui Bong,Jun Kiat Thaddaeus Tan,Juliana Teng Swan Ho,Puay Hoon Tan,Wing Sze Lau,Tuan Meng Tan,Jill Su Lin Wong,Veronique Kiak Mien Tan,Benita Kiat Tee Tan,Preetha Madhukumar,Wei Sean Yong 한국유방암학회 2022 Journal of breast cancer Vol.25 No.1

Purpose This study identified factors predicting malignant upgrade for atypical ductal hyperplasia (ADH) diagnosed on core-needle biopsy (CNB) and developed a nomogram to facilitate evidence-based decision making. Methods This retrospective analysis included women diagnosed with ADH at the National Cancer Centre Singapore (NCCS) in 2010–2015. Cox proportional hazards regression was used to identify clinical, radiological, and histological factors associated with malignant upgrade. A nomogram was constructed using variables with the strongest associations in multivariate analysis. Multivariable logistic regression coefficients were used to estimate the predicted probability of upgrade for each factor combination. Results Between 2010 and 2015, 238,122 women underwent mammographic screening under the National Breast Cancer Screening Program. Among 29,564 women recalled, 5,971 CNBs were performed. Of these, 2,876 underwent CNBs at NCCS, with 88 patients (90 lesions) diagnosed with ADH and 26 lesions upgraded to breast malignancy on excision biopsy. In univariate analysis, factors associated with malignant upgrade were the presence of a mass on ultrasound (p = 0.018) or mammography (p = 0.026), microcalcifications (p = 0.047), diffuse microcalcification distribution (p = 0.034), mammographic parenchymal density (p = 0.008). and ≥ 3 separate ADH foci found on biopsy (p = 0.024). Mammographic parenchymal density (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.005–0.35; p = 0.014), presence of a mass on ultrasound (HR, 10.50; 95% CI, 9.21–25.2; p = 0.010), and number of ADH foci (HR, 1.877; 95% CI, 1.831–1.920; p = 0.002) remained significant in multivariate analysis and were included in the nomogram. Conclusion Our model provided good discrimination of breast cancer risk prediction (C-statistic of 0.81; 95% CI, 0.74–0.88) and selected for a subset of women at low risk (2.1%) of malignant upgrade, who may avoid surgical excision following a CNB diagnosis of ADH.

What Can We Do for Chronic Scrotal Content Pain?

Wei Phin Tan,Laurence A Levine 대한남성과학회 2017 The World Journal of Men's Health Vol.35 No.3

Chronic scrotal content pain remains one of the more challenging urological problems to manage. This is a frustrating disorder to diagnose and effectively treat for both the patient and clinician, as no universally accepted treatment guidelines exist. Many patients with this condition end up seeing physicians across many disciplines, further frustrating them. The pathogenesis is not clearly understood, and the treatment ultimately depends on the etiology of the problem. This article reviews the current understanding of chronic scrotal content pain, focusing on the diagnostic work-up and treatment options.

Effects of Trimebutine Maleate on Colonic Motility through Ca^2+- activated K^+ Channels and L-type Ca^2+ Channels

Wei Tan,Hong Zhang,He-Sheng Luo,Hong Xia 대한약학회 2011 Archives of Pharmacal Research Vol.34 No.6

The effects of trimebutine maleate (TM) on spontaneous contractions of colonic longitudinal muscle were investigated in guinea pigs. The contractile responses of smooth muscle strips were recorded by an isometric force transducer. Membrane and action potentials were detected by an intracellular microelectrode technique. The whole-cell patch clamp recording technique was used to record the changes in large conductance Ca^2+-activated K^+ (BKca) and L-type Ca^2+ currents in colonic smooth muscle cells. At high concentrations (30, 100, and 300 μM), TM inhibited the amplitude of spontaneous contractions. At low concentrations (1 and 10 μM), TM attenuated the frequency and tone of smooth muscle strips, whereas TM had no influence on the amplitude of spontaneous contractions. TM depolarized the membrane potentials, but decreased the amplitude and frequency of action potentials at high concentrations. TM inhibited BKca and L-type Ca^2+ currents in a dose-dependent manner. In the presence of the BKca channel opener, NS1619, TM also inhibited BKca currents. Bayk8644, a L-type Ca^2+channel opener, increased L-type Ca^2+ currents. This augmentation was also attenuated by TM. These results suggest that TM attenuates intestinal motility through inhibition of L-type Ca^2+ currents, and depolarizes membrane potentials by reducing BKca currents. Thus, TM may be a multiple-ion channel regulator in the gastrointestinal tract.

Resolution-enhanced Reconstruction of 3D Object Using Depth-reversed Elemental Images for Partially Occluded Object Recognitionz

Tan-Chun Wei,Dong-Hak Shin,이병국 한국광학회 2009 Current Optics and Photonics Vol.13 No.1

Computational integral imaging (CII) is a new method for 3D imaging and visualization. However, it suffers from seriously poor image quality of the reconstructed image as the reconstructed image plane increases. In this paper, to overcome this problem, we propose a CII method based on a smart pixel mapping (SPM) technique for partially occluded 3D object recognition, in which the object to be recognized is located at far distance from the lenslet array. In the SPM-based CII, the use of SPM moves a far 3D object toward the near lenslet array and then improves the image quality of the reconstructed image. To show the usefulness of the proposed method, we carry out some experiments for occluded objects and present the experimental results.

Distribution of diagenetic alterations within depositional facies and sequence stratigraphic framework of fan delta and subaqueous fan sandstones: evidence from the Lower Cretaceous Bayingebi Formation, Chagan sag, China–Mongolia frontier area

Wei Wei,Xiaomin Zhu,Mingxuan Tan,Chenbingjie Wu,Dianbin Guo,Hui Su 한국지질과학협의회 2016 Geosciences Journal Vol.20 No.1

Linking siliciclastic diagenesis to sequence stratigraphy allows a better understanding of the parameters controlling the spatial and temporal distribution of diagenetic alterations. A study of the subaqueous fan and fan delta sandstones of the Bayingebi Formation, Lower Cretaceous, Chagan sag (China), reveals that the distribution of diagenetic alterations can be constrained within a sequence stratigraphic framework. Eogenetic alterations, which were encountered in the sandstones of subaqueous fan and fan delta, include: (1) replacement of detrital silicates and mud matrix by kaolinites in sandstones of the late highstand systems tract (HST) and the lowstand systems tract (LST). The formation of kaolinites is attributed to the influx of meteoric water when the base level fell and the channels migrated laterally on preexisting floodplains or channel deposits. (2) Infiltrated clays, which rim around detrital grains, mainly occur in channel sandstones of the LST due to the percolation of mud-rich surface waters. (3) Calcite I (δ18OVPDB = –20.19‰ to −3.64‰ and δ13CVPDB = –0.67‰ to –3.1‰), Calcite II (δ18OVPDB = –14‰ to –18.28‰ and δ13CVPDB = –2.2‰ to –3.60‰), dolomite (δ18OVPDB = –17.91‰ to –21.04‰ and δ13CVPDB = –0.46‰ to –1.66‰) and ankerite (δ18OVPDB = –15.02 to –20.42‰ and δ13CVPDB = –0.074 to –1.43‰), which are associated with palaeosol horizons mainly developed on top of overbank and channel sandstones of transgressive systems tract (TST) and early stage of the HST. Such extensive eogenetic calcite cements may act as potential layers for the formation of reservoir compartments for underlying sandstones. Mesogenetic alterations include: (1) abundant quartz overgrowths in the overbank sandstones of subaqueous fan in the LST and pro-fan-delta sandstones in the HST, in which early carbonate cements are lacking and grain-coats are thin. (2) Illite, chlorite and albitized feldspars, which occur in small amounts, are most common in the LST and late stage of the HST sandstones. Such cementation by calcite, dolomite, quartz overgrowths and formation of illite led to porosity and permeability deterioration during mesodiagenesis. This study revealed the importance of integration of diagenesis with sequence stratigraphy of subaqueous fan and fan delta sandstones in improving our ability to predict the spatial and temporal distribution of eogenetic alterations and their subsequent impact on mesogenetic alterations, and thus on reservoir quality modifications.

Radiation-induced Cochlea Hair Cell Death: Mechanisms and Protection

Tan, Pei-Xin,Du, Sha-Sha,Ren, Chen,Yao, Qi-Wei,Yuan, Ya-Wei Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.10

Cochlea hair cell death is regarded to be responsible for the radiation-induced sensorineural hearing loss (SNHL), which is one of the principal complications of radiotherapy (RT) for head and neck cancers. In this mini-review, we focus on the current progresses trying to unravel mechanisms of radiation-induced hair cell death and find out possible protection. P53, reactive oxygen species (ROS) and c-Jun N-terminal kinase (JNK) pathways have been proposed as pivotal in the processes leading to radiation hair cell death. Potential protectants, such as amifostine, N-acetylcysteine (NAC) and epicatechin (EC), are claimed to be effective at reducing radiation-inducedhair cell death. The RT dosage, selection and application of concurrent chemotherapy should be pre-examined in order to minimize the damage to cochlea hair cells.

Technical Note : The FasT-Fix Repair Technique for Ramp Lesion of the Medial Meniscus

( Wei Ping Li ),( Zhong Chen ),( Bin Song ),( Rui Yang ),( Wei Quan Tan ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.1

Introduction: This technical note describes a new arthroscopic technique to repair the peripheral attachment lesion of the posterior horn of the medial meniscus. The operation was performed under arthroscopy using a standard anterior portal. Surgical Technique: A FasT-Fix needle was inserted obliquely close to the tibial plateau and the first implant was inserted into the joint capsule depending on its bending angle underneath the meniscus. The second implant was inserted through 1/3 periphery of the meniscus into the meniscocapsular area. The pre-tied self-sliding knot was tensioned to achieve secure fixation of the posterior meniscal peripheral attachment at the original attachment point. Materials and Methods: From August 2011 to February 2014, 23 knees were diagnosed as ramp lesion, underwent meniscal repair using FasT-Fix technique. Results: All patients were followed up for average 14 months. The Lysholm score improved from preoperative 64.4±4.52 to postoperative 91.2±4.60. Conclusions: We believe that the FasT-Fix technique via the standard anterior portal can be a more convenient and less traumatic alternative for repair of the peripheral attachment lesion of the posterior horn of the medial meniscus in the anterior cruciate ligament deficient knee.

Bioprospecting of Endophytic Fungi as Promising Anti-MRSA Agents

Wei, Yee-Min,Tan, Joo-Shun,Tang, Hock-Wei,Tong, Woei-Yenn,Leong, Chean-Ring,Tan, Wen-Nee The Korean Society of Pharmacognosy 2022 Natural Product Sciences Vol.28 No.3

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious threat to the global healthcare system. Ineffective and resistance to antibiotic treatments have increased morbidity and mortality rates worldwide. New and effective antibiotics are needed to combat against bacterial resistance. Endophytic fungi are crucial reservoirs of novel bioactive metabolites. In particular, the secondary metabolites show promising therapeutic potential, notably, antibacterial. This review discussed the emerging potential of endophytic fungi as anti-MRSA agents. The ecological sources of endophytic fungi were discussed with the synthesis of bioactive metabolites. The mode of antibacterial actions was elucidated to give a better understanding of the mechanisms involved. This review may serve as an important reference for future discovery and developments of anti-MRSA agents from endophytic fungi.

Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer

Tan, Ru,Yao, Shu-Zhan,Huang, Zhao-Qin,Li, Jun,Li, Xin,Tan, Hai-Hua,Liu, Qing-Wei Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.18

Background: Lymph node metastasis is believed to be a dependent negative prognostic factor of esophageal cancer. To explore detection methods with high sensitivity and accuracy for metastases to regional and distant lymph nodes in the clinic is of great significance. This study focused on clinical application of FDG PET/CT and contrast-enhanced multiple-slice helical computed tomography (MSCT) in lymph node staging of esophageal cancer. Materials and Methods: One hundred and fifteen cases were examined with enhanced 64-slice-MSCT scan, and FDG PET/CT imaging was conducted for neck, chest and upper abdomen within one week. The primary lesion, location and numbers of metastatic lymph nodes were observed. Surgery was performed within one week after FDG PET/CT detection. All resected lesions were confirmed histopathologically as the gold standard. Comparative analysis of the sensitivity, specificity, and accuracy based on FDG PET/CT and MSCT was conducted. Results: There were 946 lymph node groups resected during surgery from 115 patients, and 221 were confirmed to have metastasis pathologically. The sensitivity, specificity, accuracy of FDG PET/CT in detecting lymph node metastasis were 74.7%, 97.2% and 92.0%, while with MSCT they were 64.7%, 96.4%, and 89.0%, respectively. A significance difference was observed in sensitivity (p=0.030), but not the others (p>0.05). The accuracy of FDG PET/CT in detecting regional lymph node with or without metastasis were 91.9%, as compared to 89.4% for MSCT, while FDG PET/CT and MSCT values for detecting distant lymph node with or without metastasis were 94.4% and 94.7%. No significant difference was observed for either regional or distant lymph node metastasis. Additionally, for detecting para-esophageal lymph nodes metastasis, the sensitivity of FDG PET/CT was 72%, compared with 54.7% for MSCT (p=0.029). Conclusions: FDG PET/CT is more sensitive than MSCT in detecting lymph node metastasis, especially for para-esophageal lymph nodes in esophageal cancer cases, although no significant difference was observed between FDG PET/CT and MSCT in detecting both regional and distant lymph node metastasis. However, enhanced MSCT was found to be of great value in distinguishing false negative metastatic lymph nodes from FDG PET/CT. The combination of FDG PET/CT with MSCT should improve the accuracy in lymph node metastasis staging of esophageal cancer.