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A case of iatrogenic Cushing syndrome and apparent mineralocorticoid excess presenting with accelerated hypertension and proteinuria

Kong WY, Leedman P, Irish A

Intern Med J, 2014 Sep;44(9):932-4.
PMID: 25201428 DOI: 10.1111/imj.12022
Fulltext Coupled Plasma Filtration and Adsorption (CPFA): A Single Center Experience

Abdul Cader R, Abdul Gafor H, Mohd R, Yen Kong W, Arshad N, Kong N

Nephrourol Mon, 2013 Sep;5(4):891-6.
PMID: 24350088 DOI: 10.5812/numonthly.11904

Coupled plasma filtration adsorption (CPFA) is a novel extracorporeal blood purification therapy for sepsis which adsorbs both proinflammatory and anti-inflammatory mediators from filtered plasma, thereby achieving early haemodynamic stability and a reduction in inotropic support requirement.
Fulltext Sleep position and infant care practices in an urban community in Kuala Lumpur

Lope RJ, Kong WK, Lee VW, Tiew WT, Wong SY

Med J Malaysia, 2010 Mar;65(1):45-8.
PMID: 21265248 MyJurnal

Several modifiable risk factors for sudden infant death syndrome (SIDS) have been identified such as sleeping prone or on the side, sleeping on a soft surface, bed-sharing, no prenatal care and maternal ante-natal smoking. A cross-sectional survey of infant sleep and care practices was conducted among parents of babies aged below 8 months to determine the prevalence and predictors of non-supine sleep position and the prevalence of other high-risk infant care practices for SIDS. Of 263 infants, 24.7% were placed to sleep in the non-supine position and age of infants was a factor positively associated with this (adjusted odds ratio 1.275, 95% CI=1.085, 1.499). The most common modifiable risk factor was the presence of soft toys or bedding in the infants' bed or cot (89.4%). Results from this study indicate that although the predominant sleep position of Malaysian infants in this population is supine, the majority of infants were exposed to other care practices which have been shown to be associated with SIDS.
Fulltext Attitudes of medical students towards euthanasia in a multicultural setting

Adchalingam K, Kong WH, Zakiah MA, Zaini M, Wong YL, Lang CC

Med J Malaysia, 2005 Mar;60(1):46-9.
PMID: 16250279

A cross-sectional survey of 400 medical students of multicultural backgrounds at the University of Malaya was conducted to understand their attitudes towards euthanasia and factors related to medical decisions and ethical reasoning concerning the prolongation of life, the right to die and euthanasia. The student respondents completed self-administered questionnaires that comprised of twelve questions with multiple stems addressing personal perceptions, knowledge, attitudes, and decisions about euthanasia and the relief of suffering. The majority of respondents (52%) were for the withdrawal of active therapy in a patient suffering from a terminal painful disease while 48% of them were against it. Seventy-one percent of the students involved in the study were against the idea of active euthanasia i.e. the administration of a lethal injection. However, 27% of the respondents felt that there was a moral justification to assist patients to die. Thirty-two percent of the respondents favoured the legalization of euthanasia in Malaysia while 67% of them were strongly against it. The majority (61%) of respondents would not practice euthanasia as a doctor nor would they have performed on themselves if or when it became legal. The main issue surrounding euthanasia that concerned the respondents was the misuse of it by unethical practitioners and they felt that further debate on the matter was essential, both within the local and international communities.
Fulltext The association between serum prolactin levels and interleukin-6 and systemic lupus erythematosus activity

Wan Asyraf WA, Mohd Shahrir MS, Asrul W, Norasyikin AW, Hanita O, Kong WY, et al.

Reumatismo, 2018 Dec 20;70(4):241-250.
PMID: 30570242 DOI: 10.4081/reumatismo.2018.1075

Based on the recent evidence of association between hyperprolactinemia and systemic lupus erythematosus disease activity (SLEDAI), a study was conducted to analyze the association of hyperprolactinemia with lupus nephritis disease activity. In this cross-sectional study, the analysis was conducted on SLE patients who visited the University Kebangsaan Malaysia Medical Centre (UKMMC) Nephrology Clinic from August 2015 till February 2016. The disease activity was measured using the SLEDAI score, with more than 4 indicating active lupus nephritis. Basal resting prolactin level was analyzed in 43 patients with lupus nephritis, in 27.9% of them had raised serum prolactin. The median of serum prolactin level at 0 minutes was 19.91 ng/mL (IQR: 15.95-22.65 ng/ mL) for active lupus nephritis, which was significantly higher compared to the median of serum prolactin level of 14.34 ng/mL (IQR: 11.09-18.70 ng/mL) for patients in remission (p=0.014). The serum prolactin level positively correlated with SLEDAI (rhos: 0.449, p=0.003) and the UPCI level in lupus nephritis patients (rhos: 0.241, p=0.032). The results were reproduced when the serum prolactin was repeated after 30 minutes. However, the serum prolactin levels at 0 minutes were higher than those taken after 30 minutes (p=0.001). An assessment of serum IL-6 levels found that the active lupus nephritis patients had a higher median level of 65.91 pg/ mL (IQR: 21.96-146.14 pg/mL) compared to the in-remission level of 15.84 pg/mL (IQR: 8.38-92.84 pg/mL), (p=0.039). Further correlation analysis revealed that there was no statistical correlation between the interleukin (IL)-6 levels with serum prolactin, SLEDAI and other lupus nephritis parameters. An ROC curve analysis of serum prolactin at 0 minutes and serum prolactin after 30 minutes and IL-6 levels for prediction of SLE disease activity provided the cutoff value of serum prolactin at 0 minutes, which was 14.63 ng/mL with a sensitivity of 91.7% and specificity of 58.1% and AUC of 0.74 (p=0.015). This study concurred with the previous findings that stated that hyperprolactinemia is prevalent in SLE patients and correlated with clinical disease activity and UPCI level. The baseline of the fasting serum prolactin level was found to be a sensitive biomarker for the evaluation of lupus nephritis disease activity.
Comparative proteomics of Mesembryanthemum crystallinum guard cells and mesophyll cells in transition from C3 to CAM

Guan Q, Kong W, Zhu D, Zhu W, Dufresne C, Tian J, et al.

J Proteomics, 2021 01 16;231:104019.
PMID: 33075550 DOI: 10.1016/j.jprot.2020.104019

Salinity can induce Mesembryanthemum crystallinum to shift its photosynthesis from C3 to crassulacean acid metabolism (CAM), leading to enhanced plant water use efficiency. Studying how M. crystallinum changes its carbon fixation pathways is important for potential translation into crops and enhancing crop resilience. In this study, we examined proteomic changes in guard cells and mesophyll cells in the course of the C3 to CAM transition. We collected enriched guard cells and mesophyll cells during a short period of transition. A total of 1153 proteins were identified and quantified in the two cell-types. During the transition, proteins in the guard cells and mesophyll cells exhibited differential changes. For example, we observed nocturnal carbon fixation in mesophyll cells and proteins involved in cell growth in the two cell-types. Proteins involved in osmotic adjustment, ion transport, energy metabolism and light response may play important roles in the C3 to CAM transition. Real-time PCR experiments were conducted to determine potential correlations between transcript and protein levels. These results have highlighted potential molecular mechanisms underlying the C3 to CAM transition of guard cells and mesophyll cells of the important facultative CAM plant. BIOLOGICAL SIGNIFICANCE: Fresh water resource for agricultural food production is a global challenge. Nature has evolved crassulacean acid metabolism (CAM) plants with enhanced water use efficiency. Using single cell-type proteomics, this study revealed molecular changes taking place in guard cells and mesophyll cells during the shift of ice plant photosynthesis from C3 to CAM. The results have provided important insights into the CAM transition and may facilitate effort toward enhancing crop resilience for global food security.
Risk factors for falls in older people with pre-frailty: A systematic review and meta-analysis

Jing H, Chen Y, Liang B, Tian Z, Song F, Chen M, et al.

Geriatr Nurs, 2024 Nov 08.
PMID: 39521661 DOI: 10.1016/j.gerinurse.2024.10.030

BACKGROUND: Frailty is considered highly prevalent among the elderly, and falls are a severe adverse event that occurs at a significantly higher rate in frail elderly patients, leading to serious consequences. The pre-frailty stage represents a reversible transitional state between health and frailty, and targeted interventions for pre-frail older adults can effectively reduce the incidence of falls in this population. Existing studies have not definitely identified the risk factors for falls in pre-frail older adults. This paper explores the relevant risk factors for falls in pre-frail older adults.
METHODS: PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wan fang, and VIP databases were searched for studies published from inception to 2023, without language restrictions. Observational studies were included in this systematic review that analyzed risk factors for accidental falls in pre-frail older adults. The NOS scale was used to evaluate the quality of cohort studies and case-control studies, while the AHRQ scale was used to evaluate the quality of the cross-sectional study. We utilized odds ratios (OR) and their corresponding 95 % confidence intervals (CI) to describe the statistical indicators. OR and 95 % CI values were directly extracted and organized in Excel. In cases where OR and CI values were not directly available, we extracted β and p values, calculated Exp using functions, and subsequently derived OR and 95 % CI using formulas. Finally, data pertaining to each risk factor were incorporated into RevMan 5.4 software for statistical analysis and effect size synthesis. We performed tests for heterogeneity and evaluated publication bias.
RESULTS: A total of 14,370 studies were initially identified, and 26 studies were included in the systematic review. Among these studies, 14 were of high quality, while the remaining 12 were of moderate quality. A total of 16 risk factors were identified as potential risk factors for falls in pre-frail older adults. Significant risk factors were peripheral neuropathy(OR = 3.18, 95 %CI:3.02-3.35), decreased gait speed(OR = 1.90, 95 %CI:1.60-2.27), decreased ability to perform activities of daily living(OR = 1.57, 95 % CI:1.42-1.75), grip strength decreases(OR = 1.53, 95 % CI:1.17-2.00), gender (female)(OR = 1.51, 95 % CI:1.39-1.64), pain(OR = 1.47, 95 %CI:1.41-1.54), history of falls(OR = 1.20, 95 %CI:1.13-1.28) and age(OR = 1.10, 95 %CI:1.07-1.14).
CONCLUSIONS: The occurrence of falls in pre-frail older adults is associated with multiple risk factors. These risk factors can provide clinical nursing staff with specific focal points for monitoring this population and devising targeted fall prevention measures, with the aim of reducing the incidence of falls in pre-frail older adults.
REGISTRATION: The systematic review was registered on the International Prospective Register of Systematic Review (CRD42023450670).
Transcatheter aortic valve implantation during the COVID-19 pandemic: Clinical expert opinion and consensus statement for Asia

Tay EL, Hayashida K, Chen M, Yin WH, Park DW, Seth A, et al.

J Card Surg, 2020 Sep;35(9):2142-2146.
PMID: 32720374 DOI: 10.1111/jocs.14722

OBJECTIVES: The impact of the COVID-19 pandemic on the treatment of patient with aortic valve stenosis is unknown and there is uncertainty on the optimal strategies in managing these patients.
METHODS: This study is supported and endorsed by the Asia Pacific Society of Interventional Cardiology. Due to the inability to have face to face discussions during the pandemic, an online survey was performed by inviting key opinion leaders (cardiac surgeon/interventional cardiologist/echocardiologist) in the field of transcatheter aortic valve implantation (TAVI) in Asia to participate. The answers to a series of questions pertaining to the impact of COVID-19 on TAVI were collected and analyzed. These led subsequently to an expert consensus recommendation on the conduct of TAVI during the pandemic.
RESULTS: The COVID-19 pandemic had resulted in a 25% (10-80) reduction of case volume and 53% of operators required triaging to manage their patients with severe aortic stenosis. The two most important parameters used to triage were symptoms and valve area. Periprocedural changes included the introduction of teleconsultation, preprocedure COVID-19 testing, optimization of protests, and catheterization laboratory set up. In addition, length of stay was reduced from a mean of 4.4 to 4 days.
CONCLUSION: The COVID-19 pandemic has impacted on the delivery of TAVI services to patients in Asia. This expert recommendation on best practices may be a useful guide to help TAVI teams during this period until a COVID-19 vaccine becomes widely available.
High-throughput manufacturing of epitaxial membranes from a single wafer by 2D materials-based layer transfer process

Kim H, Liu Y, Lu K, Chang CS, Sung D, Akl M, et al.

Nat Nanotechnol, 2023 May;18(5):464-470.
PMID: 36941360 DOI: 10.1038/s41565-023-01340-3

Layer transfer techniques have been extensively explored for semiconductor device fabrication as a path to reduce costs and to form heterogeneously integrated devices. These techniques entail isolating epitaxial layers from an expensive donor wafer to form freestanding membranes. However, current layer transfer processes are still low-throughput and too expensive to be commercially suitable. Here we report a high-throughput layer transfer technique that can produce multiple compound semiconductor membranes from a single wafer. We directly grow two-dimensional (2D) materials on III-N and III-V substrates using epitaxy tools, which enables a scheme comprised of multiple alternating layers of 2D materials and epilayers that can be formed by a single growth run. Each epilayer in the multistack structure is then harvested by layer-by-layer mechanical exfoliation, producing multiple freestanding membranes from a single wafer without involving time-consuming processes such as sacrificial layer etching or wafer polishing. Moreover, atomic-precision exfoliation at the 2D interface allows for the recycling of the wafers for subsequent membrane production, with the potential for greatly reducing the manufacturing cost.