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  1. Lee CY, Jenq CC, Chandratilake M, Chen J, Chen MM, Nishigori H, et al.
    Adv Health Sci Educ Theory Pract, 2021 Dec;26(5):1555-1579.
    PMID: 34254202 DOI: 10.1007/s10459-021-10060-z
    Clinical reasoning is the thought process that guides practice. Although a plethora of clinical reasoning studies in healthcare professionals exists, the majority appear to originate from Western cultures. A scoping review was undertaken to examine clinical reasoning related research across Asian cultures. PubMed, SciVerse Scopus, Web of Science and Airiti Library databases were searched. Inclusion criteria included full-text articles published in Asian countries (2007 to 2019). Search terms included clinical reasoning, thinking process, differential diagnosis, decision making, problem-based learning, critical thinking, healthcare profession, institution, medical students and nursing students. After applying exclusion criteria, n = 240 were included in the review. The number of publications increased in 2012 (from 5%, n = 13 in 2011 to 9%, n = 22) with a steady increase onwards to 12% (n = 29) in 2016. South Korea published the most articles (19%, n = 46) followed by Iran (17%, n = 41). Nurse Education Today published 11% of the articles (n = 26), followed by BMC Medical Education (5%, n = 13). Nursing and Medical students account for the largest population groups studied. Analysis of the articles resulted in seven themes: Evaluation of existing courses (30%, n = 73) being the most frequently identified theme. Only seven comparative articles showed cultural implications, but none provided direct evidence of the impact of culture on clinical reasoning. We illuminate the potential necessity of further research in clinical reasoning, specifically with a focus on how clinical reasoning is affected by national culture. A better understanding of current clinical reasoning research in Asian cultures may assist curricula developers in establishing a culturally appropriate learning environment.
  2. Zhang YT, Lu DD, Chen JY, Yu B, Liang JB, Mi JD, et al.
    Animal, 2018 Oct;12(10):2056-2064.
    PMID: 29362016 DOI: 10.1017/S1751731118000058
    Fermented soybean meal (FSM), which has lower anti-nutritional factors and higher active enzyme, probiotic and oligosaccharide contents than its unfermented form, has been reported to improve the feeding value of soybean meal, and hence, the growth performance of piglets. However, whether FSM can affect the bacterial and metabolites in the large intestine of piglets remains unknown. This study supplemented wet-FSM (WFSM) or dry-FSM (DFSM) (5% dry matter basis) in the diet of piglets and investigated its effects on carbon and nitrogen metabolism in the piglets' large intestines. A total of 75 41-day-old Duroc×Landrace×Yorkshire piglets with an initial BW of 13.14±0.22 kg were used in a 4-week feeding trial. Our results showed that the average daily gain of piglets in the WFSM and DFSM groups increased by 27.08% and 14.58% and that the feed conversion ratio improved by 18.18% and 7.27%, respectively, compared with the control group. Data from the prediction gene function of Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) based on 16S ribosomal RNA (rRNA) sequencing showed that carbohydrate metabolism function families in the WFSM and DFSM groups increased by 3.46% and 2.68% and that the amino acid metabolism function families decreased by 1.74% and 0.82%, respectively, compared with the control group. These results were consistent with those of other metabolism studies, which showed that dietary supplementation with WFSM and DFSM increased the level of carbohydrate-related metabolites (e.g. 4-aminobutanoate, 5-aminopentanoate, lactic acid, mannitol, threitol and β-alanine) and decreased the levels of those related to protein catabolism (e.g. 1,3-diaminopropane, creatine, glycine and inosine). In conclusion, supplementation with the two forms of FSM improved growth performance, increased metabolites of carbohydrate and reduced metabolites of protein in the large intestine of piglets, and WFSM exhibited a stronger effect than DFSM.
  3. Van Kriekinge G, Sohn WY, Aljunid SM, Soon R, Yong CM, Chen J, et al.
    Asian Pac J Cancer Prev, 2018 Apr 25;19(4):933-940.
    PMID: 29693347
    Purpose: To comparatively evaluate the results of a 2-dose human papillomavirus (HPV) vaccination programme
    with the AS04-adjuvanted HPV16/18 vaccine (AS04-HPV-16/18v) or HPV-6/11/16/18 vaccine (4vHPVv), in addition
    to cervical cancer (CC) screening, in Malaysia. Methods: A lifetime Markov model replicating the natural history of
    HPV in 13-year-old girls was adapted to Malaysia to assess the impact of vaccination on pre-cancerous lesions, genital
    warts and CC cases, CC deaths, quality-adjusted life years (QALYs), and costs from the perspective of the Malaysian
    Ministry of Health. Vaccine effectiveness was based on efficacy and HPV type distribution. Both vaccines were assumed
    to have equal efficacy against vaccine-type HPV but differed for protection against non-vaccine types. Vaccine price
    parity was used and health and cost outcomes were discounted at 3%/annum. Sensitivity analyses tested the robustness
    of the results. Results: The model predicted that AS04-HPV-16/18v would result in 361 fewer CC cases and 115 fewer
    CC deaths than 4vHPVv, whereas 4vHPVv averted 4,241 cases of genital warts over the cohort’s lifetime. Discounted
    total costs showed savings of 18.50 million Malaysian Ringgits and 246 QALYs in favour of AS04-HPV-16/18v. In
    one-way sensitivity analyses, the discount rate was the most influential variable for costs and QALYs, but AS04-HPV-
    16/18v remained dominant throughout. A two-way sensitivity analysis to assess the longevity of cross-protection for both
    vaccines confirmed the base-case. Conclusions: In Malaysia, the use of AS04-HPV-16/18v, in addition to screening,
    was modelled to be dominant over 4vHPVv, with greater estimated CC benefits and lower costs.
  4. Jeon AJ, Teo YY, Sekar K, Chong SL, Wu L, Chew SC, et al.
    BMC Cancer, 2023 Feb 03;23(1):118.
    PMID: 36737737 DOI: 10.1186/s12885-022-10444-3
    BACKGROUND: Conventional differential expression (DE) testing compares the grouped mean value of tumour samples to the grouped mean value of the normal samples, and may miss out dysregulated genes in small subgroup of patients. This is especially so for highly heterogeneous cancer like Hepatocellular Carcinoma (HCC).

    METHODS: Using multi-region sampled RNA-seq data of 90 patients, we performed patient-specific differential expression testing, together with the patients' matched adjacent normal samples.

    RESULTS: Comparing the results from conventional DE analysis and patient-specific DE analyses, we show that the conventional DE analysis omits some genes due to high inter-individual variability present in both tumour and normal tissues. Dysregulated genes shared in small subgroup of patients were useful in stratifying patients, and presented differential prognosis. We also showed that the target genes of some of the current targeted agents used in HCC exhibited highly individualistic dysregulation pattern, which may explain the poor response rate.

    DISCUSSION/CONCLUSION: Our results highlight the importance of identifying patient-specific DE genes, with its potential to provide clinically valuable insights into patient subgroups for applications in precision medicine.

  5. Guan J, He Z, Qin M, Deng X, Chen J, Duan S, et al.
    BMC Infect Dis, 2021 Feb 10;21(1):166.
    PMID: 33568111 DOI: 10.1186/s12879-021-05823-3
    BACKGROUND: An unexpected dengue outbreak occurred in Hunan Province in 2018. This was the first dengue outbreak in this area of inland China, and 172 cases were reported.

    METHODS: To verify the causative agent of this outbreak and characterise the viral genes, the genes encoding the structural proteins C/prM/E of viruses isolated from local residents were sequenced followed by mutation and phylogenetic analysis. Recombination, selection pressure, potential secondary structure and three-dimensional structure analyses were also performed.

    RESULTS: Phylogenetic analysis revealed that all epidemic strains were of the cosmopolitan DENV-2 genotype and were most closely related to the Zhejiang strain (MH010629, 2017) and then the Malaysia strain (KJ806803, 2013). Compared with the sequence of DENV-2SS, 151 base substitutions were found in the sequences of 89 isolates; these substitutions resulted in 20 non-synonymous mutations, of which 17 mutations existed in all samples (two in the capsid protein, six in the prM/M proteins, and nine in the envelope proteins). Moreover, amino acid substitutions at the 602nd (E322:Q → H) and 670th (E390: N → S) amino acids may have enhanced the virulence of the epidemic strains. One new DNA binding site and five new protein binding sites were observed. Two polynucleotide binding sites and seven protein binding sites were lost in the epidemic strains compared with DENV-2SS. Meanwhile, five changes were found in helical regions. Minor changes were observed in helical transmembrane and disordered regions. The 429th amino acid of the E protein switched from a histamine (positively charged) to an asparagine (neutral) in all 89 isolated strains. No recombination events or positive selection pressure sites were observed. To our knowledge, this study is the first to analyse the genetic characteristics of epidemic strains in the first dengue outbreak in Hunan Province in inland China.

    CONCLUSIONS: The causative agent is likely to come from Zhejiang Province, a neighbouring province where dengue fever broke out in 2017. This study may help clarify the intrinsic geographical relatedness of DENV-2 and contribute to further research on pathogenicity and vaccine development.

  6. Chen H, Lin H, Lin Z, Chen J, Chen W
    BMC Ophthalmol, 2016 May 01;16(1):47.
    PMID: 27138378 DOI: 10.1186/s12886-016-0221-5
    BACKGROUND: Ocular biometry is important for preoperative assessment in cataract and anterior segment surgery. The purpose of this study was to investigate normative ocular biometric parameters and their associations in an older Chinese population.

    METHODS: This was a cross-sectional observational study. From 2013 to 2014, we recruited inhabitants aged 50 years or older in Guangzhou, China. Among 1,117 participants in the study, data from 1,015 phakic right eyes were used for analyses. Ocular parameters including axial length (AL), anterior chamber depth (ACD), and corneal curvature (K) were measured using an IOL Master.

    RESULTS: The mean AL, ACD, and K were 23.48 mm [95 % confidence interval (CI), 23.40-23.55], 3.03 mm (CI, 3.01-3.05), and 44.20 mm (CI, 44.11-44.29), respectively. A mean reduction in ACD with age was observed (P = 0.002) in male subjects but not in female subjects (P = 0.558). Male subjects had significantly longer ALs (23.68 mm versus 23.23 mm, P 

  7. Chen JJ, Tan JA, Chua KH, Tan PC, George E
    BMJ Open, 2015 Jul 22;5(7):e007648.
    PMID: 26201722 DOI: 10.1136/bmjopen-2015-007648
    OBJECTIVES: Single nucleotide polymorphism (SNP) with a mutation can be used to identify the presence of the paternally-inherited wild-type or mutant allele as result of the inheritance of either allele in the fetus and allows the prediction of the fetal genotype. This study aims to identify paternal SNPs located at the flanking regions upstream or downstream from the β-globin gene mutations at CD41/42 (HBB:c.127_130delCTTT), IVS1-5 (HBB:c.92+5G>C) and IVS2-654 (HBB:c.316-197C>T) using free-circulating fetal DNA.

    SETTING: Haematology Lab, Department of Biomedical Science, University of Malaya.

    PARTICIPANTS: Eight couples characterised as β-thalassaemia carriers where both partners posed the same β-globin gene mutations at CD41/42, IVS1-5 and IVS2-654, were recruited in this study.

    OUTCOME MEASURES: Genotyping was performed by allele specific-PCR and the locations of SNPs were identified after sequencing alignment.

    RESULTS: Genotype analysis revealed that at least one paternal SNP was present for each of the couples. Amplification on free-circulating DNA revealed that the paternal mutant allele of SNP was present in three fcDNA. Thus, the fetuses may be β-thalassaemia carriers or β-thalassaemia major. Paternal wild-type alleles of SNP were present in the remaining five fcDNA samples, thus indicating that the fetal genotypes would not be homozygous mutants.

    CONCLUSIONS: This preliminary research demonstrates that paternal allele of SNP can be used as a non-invasive prenatal diagnosis approach for at-risk couples to determine the β-thalassaemia status of the fetus.

  8. Vermunt J, Bragg F, Halsey J, Yang L, Chen Y, Guo Y, et al.
    PMID: 34728472 DOI: 10.1136/bmjdrc-2021-002495
    INTRODUCTION: We examined the associations between long-term usual random plasma glucose (RPG) levels and cause-specific mortality risks among adults without known diabetes in China.

    RESEARCH DESIGN AND METHODS: The China Kadoorie Biobank recruited 512,891 adults (59% women) aged 30-79 from 10 regions of China during 2004-2008. At baseline survey, and subsequent resurveys of a random subset of survivors, participants were interviewed and measurements collected, including on-site RPG testing. Cause of death was ascertained via linkage to local mortality registries. Cox regression yielded adjusted HR for all-cause and cause-specific mortality associated with usual levels of RPG.

    RESULTS: During median 11 years' follow-up, 37,214 deaths occurred among 452,993 participants without prior diagnosed diabetes or other chronic diseases. There were positive log-linear relationships between RPG and all-cause, cardiovascular disease (CVD) (n=14,209) and chronic kidney disease (CKD) (n=432) mortality down to usual RPG levels of at least 5.1 mmol/L. At RPG <11.1 mmol/L, each 1.0 mmol/L higher usual RPG was associated with adjusted HRs of 1.14 (95% CI 1.12 to 1.16), 1.16 (1.12 to 1.19) and 1.44 (1.22 to 1.70) for all-cause, CVD and CKD mortality, respectively. Usual RPG was positively associated with chronic liver disease (n=547; 1.45 (1.26 to 1.66)) and cancer (n=12,680; 1.12 (1.09 to 1.16)) mortality, but with comparably lower risks at baseline RPG ≥11.1 mmol/L. These associations persisted after excluding participants who developed diabetes during follow-up.

    CONCLUSIONS: Among Chinese adults without diabetes, higher RPG levels were associated with higher mortality risks from several major diseases, with no evidence of apparent thresholds below the cut-points for diabetes diagnosis.

  9. Yang Q, Gao Y, Ke J, Show PL, Ge Y, Liu Y, et al.
    Bioengineered, 2021 12;12(1):7376-7416.
    PMID: 34612807 DOI: 10.1080/21655979.2021.1974657
    Antibiotics, as antimicrobial drugs, have been widely applied as human and veterinary medicines. Recently, many antibiotics have been detected in the environments due to their mass production, widespread use, but a lack of adequate treatment processes. The environmental occurrence of antibiotics has received worldwide attention due to their potential harm to the ecosystem and human health. Research status of antibiotics in the environment field is presented by bibliometrics. Herein, we provided a comprehensive overview on the following important issues: (1) occurrence of antibiotics in different environmental compartments, such as wastewater, surface water, and soil; (2) toxicity of antibiotics toward non-target organisms, including aquatic and terrestrial organisms; (3) current treatment technologies for the degradation and removal of antibiotics, including adsorption, hydrolysis, photodegradation and oxidation, and biodegradation. It was found that macrolides, fluoroquinolones, tetracyclines, and sulfonamides were most frequently detected in the environment. Compared to surface and groundwaters, wastewater contained a high concentration of antibiotic residues. Both antibiotics and their metabolites exhibited toxicity to non-target organisms, especially aquatic organisms (e.g., algae and fish). Fluoroquinolones, tetracyclines, and sulfonamides can be removed through abiotic process, such as adsorption, photodegradation, and oxidation. Fluoroquinolones and sulfonamides can directly undergo biodegradation. Further studies on the chronic effects of antibiotics at environmentally relevant concentrations on the ecosystem were urgently needed to fully understand the hazards of antibiotics and help the government to establish the permissible limits. Biodegradation is a promising technology; it has numerous advantages such as cost-effectiveness and environmental friendliness.
  10. Chen J, Er HM, Mohamed SM, Chen YS
    Biomed J, 2015 Jul-Aug;38(4):301-6.
    PMID: 25673170 DOI: 10.4103/2319-4170.151031
    BACKGROUND: Euphorbia hirta has been reported to possess anti-inflammatory activity. This study was carried out to determine the prostaglandin E 2 (PGE 2 ) inhibition activity of the fractions of the E. hirta aqueous extract on rabbit synovial fibroblast cells (HIG-82).
    METHODS: E. hirta aqueous extract was fractionated into five fractions (fractions A, B, C, D, and E) by reversed phase flash chromatography. Rabbit synovial fibroblast cells (HIG-82) were activated with phorbol myristate acetate and treated with the fractions. The amount of PGE 2 released into the medium was measured by enzyme-linked immunosorbent assay.
    RESULTS: Fraction A (0.1, 1, and 10 μg/ml) had the greatest PGE 2 inhibitory effect among the five fractions, and showed a greater extent of PGE 2 inhibition compared to the aqueous extract. In contrast, Fraction E had the greatest stimulatory effect on PGE 2 release.
    CONCLUSIONS: Fraction A of the aqueous extract inhibited the production of PGE 2 from activated HIG-82 cells to a greater extent than the crude aqueous extract. Bioactive compounds with anti-inflammatory activity are likely to be concentrated in Fraction A of E. hirta aqueous extract.
  11. Liu L, Chen J, Lim PE, Wei D
    Bioresour Technol, 2018 May;255:140-148.
    PMID: 29414159 DOI: 10.1016/j.biortech.2018.01.114
    The single cell oil (SCO) production by the mono and mixed culture of microalgae Chlorella pyrenoidosa and red yeast Rhodotorula glutinis was investigated using non-detoxified cassava bagasse hydrolysate (CBH) as carbon source. The results suggested that the two strains were able to tolerate and even degrade some byproducts presented in the CBH, and the mixed culture approach enhanced the degradation of certain byproducts. Biomass (20.37 ± 0.38 g/L) and lipid yield (10.42 ± 1.21 g/L) of the mixed culture achieved in the batch culture were significantly higher than that of the mono-cultures (p 
  12. Huang Q, Gu L, Zhu J, Peng C, Du S, Liu Q, et al.
    Cancer, 2020 May 01;126 Suppl 9:2062-2072.
    PMID: 32293724 DOI: 10.1002/cncr.32748
    BACKGROUND: A quantitative nephrometry scoring system specifically for renal sinus tumors will assist in classifying surgical complexity and treatment planning.

    METHODS: By using preoperative computed tomography, magnetic resonance imaging, and 3-dimensional image reconstruction, 5 critical components were assessed: the ratio of the sinus area occupied by the tumor in relation to the whole sinus area (R), the compression of the renal segmental vessels or collection system by the tumor (O), the anteroposterior relation of the tumor relative to the segmental vessels or collection system (A), the tumor diameter (D), and whether the tumor affects a solitary kidney (S) ("ROADS"). The ROADS score, indicating low, moderate, or high surgical complexity, was then used to guide surgical strategy planning, including cooling techniques, surgical approaches, and parenchyma incision techniques. A cohort of 134 patients with renal sinus tumors was treated based on their ROADS score and was retrospectively analyzed.

    RESULTS: The authors successfully performed 113 nephron-sparing surgeries and 21 radical nephrectomies with a complication rate of 7.9%. During follow-up, 3 cases were classified according to surgical margin status because they lacked an intact tumor capsule. There was only 1 case of local recurrence, and there were no cases of metastasis. A high ROADS score was correlated with greater operative complexity, such as longer operation and ischemia times and higher estimated blood loss and complication rates. However, renal function and short-term oncologic outcomes were not related to the score.

    CONCLUSIONS: The ROADS scoring system provides a standardized, quantitative, 3-dimensional anatomic classification to guide surgical strategy in renal sinus tumors.

  13. Huang D, Li Y, Cui F, Chen J, Sun J
    Carbohydr Polym, 2016 Feb 10;137:701-708.
    PMID: 26686182 DOI: 10.1016/j.carbpol.2015.10.102
    A novel polysaccharide-peptide complex CNP-1-2 with molecular weight of 9.17 × 10(4) Da was obtained from Clinacanthus nutans Lindau leaves by hot water extraction, ethanol precipitation, and purification with Superdex 200 and DEAE-Sepharose Fast Flow column chromatography. CNP-1-2 exhibited the highest growth inhibitory effect on human gastric cancer cells SGC-7901 with inhibition ratio of 92.34% and stimulated activation of macrophages with NO secretion level of 47.53 μmol/L among the polysaccharide fractions. CNP-1-2 comprised approximately 87.25% carbohydrate and 9.37% protein. Monosaccharide analysis suggested that CNP-1-2 was composed of L-rhamnose, l-arabinose, D-mannose, D-glucose and D-galactose with a molar ratio of 1.30:1.00:2.56:4.95:5.09. Methylation analysis, FT-IR, and (1)H NMR spectroscopy analysis revealed that CNP-1-2 might have a backbone consisting of 1,4-linked Glcp, 1,3-linked Glcp, 1,3-linked Manp, 1,4-linked Galp, 1,2,6-linked Galp and 1,2,6-linked Galp. Its side chain might be composed of 1-linked Araf, 1,6-linked Galp and 1-linked Rhap residues. AFM (atomic force micrograph) analysis revealed that CNP-1-2 had the molecular aggregation along with branched and entangled structure.
  14. Das R, Vecitis CD, Schulze A, Cao B, Ismail AF, Lu X, et al.
    Chem Soc Rev, 2017 Sep 29.
    PMID: 28959815 DOI: 10.1039/c6cs00921b
    The efficient handling of wastewater pollutants is a must, since they are continuously defiling limited fresh water resources, seriously affecting the terrestrial, aquatic, and aerial flora and fauna. Our vision is to undertake an exhaustive examination of current research trends with a focus on nanomaterials (NMs) to considerably improve the performance of classical wastewater treatment technologies, e.g. adsorption, catalysis, separation, and disinfection. Additionally, NM-based sensor technologies are considered, since they have been significantly used for monitoring water contaminants. We also suggest future directions to inform investigators of potentially disruptive NM technologies that have to be investigated in more detail. The fate and environmental transformations of NMs, which need to be addressed before large-scale implementation of NMs for water purification, are also highlighted.
  15. Xiao G, Chen J, Show PL, Yang Q, Ke J, Zhao Q, et al.
    Chemosphere, 2021 Nov;282:130966.
    PMID: 34082314 DOI: 10.1016/j.chemosphere.2021.130966
    Biological methods are promising treatment methods to remove pollutants from wastewater. Recently, microalgae have been proved to be of strong application potential in wastewater treatment. In this study, a microalga - antibiotic treatment system was built to evaluate the treatment capacity of microalgae in antibiotic wastewater. In the group with Chlorella pyrenoidosa, the removal rate of cefradine was 41.47 ± 0.62% after 24 h of treatment, which was 3.4 times higher than that without microalgae (12.37 ± 2.30%). Algal decomposition was the main removal mechanism. Meanwhile, the effect of multiple microalgae species on antibiotic treatment was studied. The removal rates of cefradine by C. pyrenoidosa cultivated in the filtered fluid of Microcystis aeruginosa were 75.48 ± 0.29%, which was significantly higher than those by C. pyrenoidosa only. Those indicated that multiple microalgae species strategy was a potential enhancement strategy for algae-based antibiotic treatment. Finally, amoxicillin and norfloxacin were used to study the treatment potential of this technology for more different kinds antibiotics and the integration of microalgae with activated sludge was also investigated. Amoxicillin can be quickly removed by microalgae, but the removal effect of norfloxacin by microalgae is poor. The refractory antibiotic norfloxacin can be treated by co-culturing microalgae and activated sludge. Those showed the good expansibility of microalgae-based technology. The findings indicated that with microalgae-based antibiotic removal method has good application potential, and combined with other technologies, it can effectively remove the refractory antibiotics.
  16. Alamoodi AH, Zaidan BB, Al-Masawa M, Taresh SM, Noman S, Ahmaro IYY, et al.
    Comput Biol Med, 2021 Dec;139:104957.
    PMID: 34735945 DOI: 10.1016/j.compbiomed.2021.104957
    A substantial impediment to widespread Coronavirus disease (COVID-19) vaccination is vaccine hesitancy. Many researchers across scientific disciplines have presented countless studies in favor of COVID-19 vaccination, but misinformation on social media could hinder vaccination efforts and increase vaccine hesitancy. Nevertheless, studying people's perceptions on social media to understand their sentiment presents a powerful medium for researchers to identify the causes of vaccine hesitancy and therefore develop appropriate public health messages and interventions. To the best of the authors' knowledge, previous studies have presented vaccine hesitancy in specific cases or within one scientific discipline (i.e., social, medical, and technological). No previous study has presented findings via sentiment analysis for multiple scientific disciplines as follows: (1) social, (2) medical, public health, and (3) technology sciences. Therefore, this research aimed to review and analyze articles related to different vaccine hesitancy cases in the last 11 years and understand the application of sentiment analysis on the most important literature findings. Articles were systematically searched in Web of Science, Scopus, PubMed, IEEEXplore, ScienceDirect, and Ovid from January 1, 2010, to July 2021. A total of 30 articles were selected on the basis of inclusion and exclusion criteria. These articles were formed into a taxonomy of literature, along with challenges, motivations, and recommendations for social, medical, and public health and technology sciences. Significant patterns were identified, and opportunities were promoted towards the understanding of this phenomenon.
  17. Cao W, Kadir AA, Wang Y, Wang J, Dai B, Zheng Y, et al.
    Digit Health, 2023;9:20552076231181473.
    PMID: 37342095 DOI: 10.1177/20552076231181473
    BACKGROUND: As a principal cause of mortality and disability worldwide, stroke imposes considerable burdens on society and effects on the lives of patients, families, and communities. Owing to their growing global popularity, health-related applications (apps) offer a promising approach to stroke management but show a knowledge gap regarding mobile apps for stroke survivors.

    METHODS: This review was conducted across the Android and iOS app stores in September-December 2022 to identify and describe all apps targeting stroke survivors. Apps were included if they were designed for stroke management and contained at least one of the following components: medication taking, risk management, blood pressure management, and stroke rehabilitation. Apps were excluded if they were unrelated to health, not in Chinese or English, or the targeted users were healthcare professionals. The included apps were downloaded, and their functionalities were investigated.

    RESULTS: The initial search yielded 402 apps, with 115 eligible after title and description screening. Some apps were later excluded due to duplicates, registration problems, or installation failures. In total, 83 apps were included for full review and evaluated by three independent reviewers. Educational information was the most common function (36.1%), followed by rehabilitation guidance (34.9%), communication with healthcare providers (HCPs), and others (28.9%). The majority of these apps (50.6%) had only one functionality. A minority had contributions from an HCP or patients.

    CONCLUSION: With the widespread accessibility and availability of smartphone apps across the mHealth landscape, an increasing number of apps targeting stroke survivors are being released. One of the most important findings is that the majority of the apps were not specifically geared toward older adults. Many of the currently available apps lack healthcare professionals' and patients' involvement in their development, and most offer limited functionality, thus requiring further attention to the development of customized apps.

  18. Yang F, Guo GZ, Chen JQ, Ma HW, Liu T, Huang DN, et al.
    Epidemiol Infect, 2014 Feb;142(2):225-33.
    PMID: 23587429 DOI: 10.1017/S0950268813000897
    A suspected dengue fever outbreak occurred in 2010 at a solitary construction site in Shenzhen city, China. To investigate this epidemic, we used serological, molecular biological, and bioinformatics techniques. Of nine serum samples from suspected patients, we detected seven positive for dengue virus (DENV) antibodies, eight for DENV-1 RNA, and three containing live viruses. The isolated virus, SZ1029 strain, was sequenced and confirmed as DENV-1, showing the highest E-gene homology to D1/Malaysia/36000/05 and SG(EHI)DED142808 strains recently reported in Southeast Asia. Further phylogenetic tree analysis confirmed their close relationship. At the epidemic site, we also detected 14 asymptomatic co-workers (out of 291) positive for DENV antibody, and DENV-1-positive mosquitoes. Thus, we concluded that DENV-1 caused the first local dengue fever outbreak in Shenzhen. Because no imported case was identified, the molecular fingerprints of the SZ1029 strain suggest this outbreak may be due to vertical transmission imported from Southeast Asia.
  19. Koh MT, Liu CS, Chiu CH, Boonsawat W, Watanaveeradej V, Abdullah N, et al.
    Epidemiol Infect, 2016 Apr;144(6):1192-200.
    PMID: 26468043 DOI: 10.1017/S0950268815002393
    Surveillance data on the burden of pertussis in Asian adults are limited. This cross-sectional study evaluated the prevalence of serologically confirmed pertussis in adults with prolonged cough in Malaysia, Taiwan and Thailand. Adults (⩾19 years) with cough lasting for ⩾14 days without other known underlying cause were enrolled from outpatient clinics of seven public and/or private hospitals. Single blood samples for anti-pertussis toxin antibodies (anti-PT IgG) were analysed and economic impact and health-related quality of life (EQ-5D) questionnaires assessed. Sixteen (5·13%) of the 312 chronically coughing adults had serological evidence of pertussis infection within the previous 12 months (anti-PT IgG titre ⩾62·5 IU/ml). Three of them were teachers. Longer duration of cough, paroxysms (75% seroconfirmed, 48% non-seroconfirmed) and breathlessness/chest pain (63% seroconfirmed, 36% non-seroconfirmed) were associated with pertussis (P < 0·04). Of the seroconfirmed patients, the median total direct medical cost per pertussis episode in public hospitals (including physician consultations and/or emergency room visits) was US$13 in Malaysia, US$83 in Taiwan (n = 1) and US$26 in Thailand. The overall median EQ-5D index score of cases was 0·72 (range 0·42-1·00). Pertussis should be considered in the aetiology of adults with a prolonged or paroxysmal cough, and vaccination programmes considered.
    Study site in Malaysia: Klinik Kesihatan Seremban, Negeri Sembilan; Primary Care Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
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