Displaying publications 1 - 20 of 64 in total

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  1. Ismail MN, Wannudri W, Zawiah H
    Malays J Nutr, 1995 Sep;1(2):141-9.
    PMID: 22692059 MyJurnal
    Seventeen members of the national sepaktakraw squad undergoing centralised training participated in a comprehensive study to determine their daily food intake, activity patterns and energy requirements. Food intake was recorded as a mean of 3-days weighed food intake and the nutrient contents were calculated using a local food composition table. The energy cost of standardised activities was determined by indirect calorimetry while time and motion study was used to estimate the daily energy expenditure of each subject. The mean daily energy intake was 2784±373 kcal (11.6±1.6 MJ) while the mean daily energy expenditure was 3004±298 kcal (12.6±1.2 MJ), with a negative energy balance of 220 kcal ((0.9 MJ). Intake of other nutrients were adequate when compared with the Malaysian RDA, with the exception of niacin. The results of the activity pattern study indicated that the subjects spent about 80% of the day doing light activities while 20% of the day was devoted to their training programme comprising of moderate to heavy activities. This data set represents the first of its kind in Malaysia and should provide impetus for further research in this area which would help establish dietary guidelines for Malaysian sportsmen.
  2. Ismail MN, Wannudri W, Zawiah H
    Malays J Nutr, 1997 Mar;3(1):71-81.
    PMID: 22692236
    A study to predict energy requirements of national athletes, 84 males and 24 females in 9 and 4 different types of sports respectively, were conducted during centralised training. Parameters assessed were anthropometry, 3-day activity pattern and energy cost (kcal/min) of common activities to derive total daily energy expenditure (TDEE). Based on body mass index (BMI), 68 males or 81% and 19 females or 79% of the athletes were classified as normal. The mean body fat content for males and females were 13.8 ± 4.5% and 24.7 ± 5.3%, respectively. The mean daily activity pattern of males and females athletes were similar for light activities (16½ hr or 68% of day), for moderate activities (3½ hr or 15% of day in male, 4 hr or 17% in females) while moderate to heavy activities related to training were 4 hr (17%) and 3½ hr (15%) in males and females, respectively. Energy cost of some common activities ranges from 1.00-3.00 kcal/min in males and 0.84-2.04 kcal/min in females, while values for jogging were 6.60 kcal/min and 5.62 kcal/min in males and females, respectively. The mean TDEE in male ranges from 2938 kcal (12.3 MJ) in boxers (57 kg) to 4861 kcal (20.3 MJ) in weightlifters (110 kg) while the mean TDEE in female ranges from 2099 kcal (8.8 MJ) in athletics (51 kg) to 3098 kcal (13.0 MJ) in basketball (61.4 kg). The calculated physical activity level (PAL) values using measured BMR for males and females athletes ranges from 1.99-2.58 and 1.77-2.34, respectively. In conclusion, the estimated energy requirement for the various sports event studied ranges from 44-55 kcal/kg/day in males and 38-50 kcal/kg/day in female athletes.
  3. Johari MI, Ismail MN, Mohamad F, Yusof MA
    BMJ Case Rep, 2021 Jan 18;14(1).
    PMID: 33461997 DOI: 10.1136/bcr-2020-236420
    Primary cardiac valve tumours are rare. This is a case report of a 32-year-old non-smoker man with a history of stroke 1 year prior and no other cardiovascular risk factors. The patient was admitted to our acute stroke ward for recurrent left hemiparesis, slurring of speech, facial asymmetry and central retinal artery occlusion. Initial laboratory investigations and ECG were normal. An urgent CT brain showed a large hypodense area at the right frontal, parietal, temporal, occipital region with effaced sulci and right lateral ventricle with midline shift and cerebral oedema in keeping with acute infarction. We proceeded with CT angiography of the cerebral and carotid on the following day, which revealed no evidence of thrombosis, aneurysm or arteriovenous malformation. There were no abnormal beaded vessels to suggest vasculitis. Transthoracic echocardiography revealed a large mobile mass in the left atrium. Meanwhile, MRI cardiac confirmed a large ill-defined mobile solid mass attached to the mitral valve's inferoseptal component suggestive of mitral valve myxoma. This case report highlights the significance of considering a cardiogenic source of emboli in patients with large cerebral infarcts and other cardiac embolic phenomena. Imaging modalities such as echocardiography and cardiac MRI will help detect treatable conditions, such as valvular myxoma and prevent further complications.
  4. Abdul Satar N, Ismail MN, Yahaya BH
    Molecules, 2021 Feb 18;26(4).
    PMID: 33670440 DOI: 10.3390/molecules26041056
    Cancer stem cells (CSCs) represent a small subpopulation within a tumour. These cells possess stem cell-like properties but also initiate resistance to cytotoxic agents, which contributes to cancer relapse. Natural compounds such as curcumin that contain high amounts of polyphenols can have a chemosensitivity effect that sensitises CSCs to cytotoxic agents such as cisplatin. This study was designed to investigate the efficacy of curcumin as a chemo-sensitiser in CSCs subpopulation of non-small cell lung cancer (NSCLC) using the lung cancer adenocarcinoma human alveolar basal epithelial cells A549 and H2170. The ability of curcumin to sensitise lung CSCs to cisplatin was determined by evaluating stemness characteristics, including proliferation activity, colony formation, and spheroid formation of cells treated with curcumin alone, cisplatin alone, or the combination of both at 24, 48, and 72 h. The mRNA level of genes involved in stemness was analysed using quantitative real-time polymerase chain reaction. Liquid chromatography-mass spectrometry was used to evaluate the effect of curcumin on the CSC niche. A combined treatment of A549 subpopulations with curcumin reduced cellular proliferation activity at all time points. Curcumin significantly (p < 0.001) suppressed colonies formation by 50% and shrank the spheroids in CSC subpopulations, indicating inhibition of their self-renewal capability. This effect also was manifested by the down-regulation of SOX2, NANOG, and KLF4. Curcumin also regulated the niche of CSCs by inhibiting chemoresistance proteins, aldehyde dehydrogenase, metastasis, angiogenesis, and proliferation of cancer-related proteins. These results show the potential of using curcumin as a therapeutic approach for targeting CSC subpopulations in non-small cell lung cancer.
  5. Kamarudin R, Ang YZ, Topare NS, Ismail MN, Mustafa KF, Gunnasegaran P, et al.
    Heliyon, 2024 Mar 15;10(5):e26597.
    PMID: 38434285 DOI: 10.1016/j.heliyon.2024.e26597
    The generation of power and fuel sustainability that contributes to a cleaner output of exhaust gases is one of the most important objectives the world seeks. In this paper, oxyhydrogen gas is used to retrofit into a two-stroke engine. The water was electrolysed and generated a mixture of oxygen (O2) and hydrogen (H2) or known as oxyhydrogen (HHO) gas via an electrolytic dry cell generator. The HHO was retrofitted experimentally to investigate the engine emissions and exhaust gas temperature from a 1.5 kW gasoline engine. The engine was tested with different power ratings (84-720 W) to investigate the performance and emissions of the engine using gasoline followed by the addition of HHO. The emissions of CO and NOx were measured with different amounts of HHO added. The exhaust temperature was calculated as one of the variables to be considered in relation to pollution. The air-fuel ratios are varied from 12 to 20% in the experiment. The most appropriate air-fuel ratio needed to start the generator with the most environmentally friendly gas emission was analysed. The results showed that the addition of HHO to the engine is successful in reducing fuel consumption up to 8.9%. A higher percentage of HHO added also has improved the emissions and reduced exhaust gas temperature. In this study, the highest quantity of HHO added at 0.15% of the volume fraction reduced CO gas emission by up to 9.41%, NOx gas up to 4.31%, and exhaust gas temperature by up to 2.02%. Generally, adding oxyhydrogen gas has significantly reduced the emissions, and exhaust temperature and provided an eco-friendly environment.
  6. Azmy SN, Sah SA, Shafie NJ, Ariffin A, Majid Z, Ismail MN, et al.
    Sci Rep, 2012;2:524.
    PMID: 22826802 DOI: 10.1038/srep00524
    Population surveys and species recognition for roosting bats are either based on capture, sight or optical-mechanical count methods. However, these methods are intrusive, are tedious and, at best, provide only statistical estimations. Here, we demonstrated the successful use of a terrestrial Light Detection and Ranging (LIDAR) laser scanner for remotely identifying and determining the exact population of roosting bats in caves. LIDAR accurately captured the 3D features of the roosting bats and their spatial distribution patterns in minimal light. The high-resolution model of the cave enabled an exact count of the visibly differentiated Hipposideros larvatus and their roosting pattern within the 3D topology of the cave. We anticipate that the development of LIDAR will open up new research possibilities by allowing researchers to study roosting behaviour within the topographical context of a cave's internal surface, thus facilitating rigorous quantitative characterisations of cave roosting behaviour.
  7. Ong D, Ismail MN, Shahrudin S
    Int J Pept Res Ther, 2021;27(3):2125-2133.
    PMID: 34177403 DOI: 10.1007/s10989-021-10240-w
    The skin secretion of amphibians is known for its high content of bioactive compounds. These bioactive compounds are essential for the advancement of biomedical industries. Four wild green paddy frogs, Hylarana erythraea, were collected from various habitat types within the Langkawi Archipelago. These frogs' skin secretions were collected, extracted, and analysed for their protein compounds together with biomedical potentials using liquid chromatography-mass spectrometry (LC-MS). The total protein concentration of H. erythraea skin secretions was determined as 0.269 mg/mL. Based on the UniProt (Anura) database, we identified 29 proteins. These proteins were categorised as antimicrobial (AMP) (38%), followed by hormone (17%), enzyme (17%), unreviewed proteins (17%), structural proteins (7%), and regulatory proteins (4%). The AMPs identified were from the family of esculentin-1, esculentin-2, brevinin-1, and frenatin-4, while the hormones belonged to the cholecystokinin group. The enzymes detected were adenylate cyclase 9, the suppressor of tumorigenicity 14 protein homolog, and the HGF activator. The structural proteins belonged to toe pad keratin 2 and Krt5.7 proteins, while the single regulatory protein is CCR4-NOT transcription complex subunit 6-like. These proteins have a wide range of biomedical importance, such as wound healings, facilitate digestions, anti-tumours, and anti-cancer effect.
  8. Salim SA, Sukor R, Ismail MN, Selamat J
    Toxins (Basel), 2021 04 15;13(4).
    PMID: 33920815 DOI: 10.3390/toxins13040280
    Rice bran, a by-product of the rice milling process, has emerged as a functional food and being used in formulation of healthy food and drinks. However, rice bran is often contaminated with numerous mycotoxins. In this study, a method to simultaneous detection of aflatoxins (AFB1, AFB2, AFG1, and AFG2), ochratoxin A (OTA), deoxynivalenol (DON), fumonisins (FB1 and FB2), sterigmatocystin (STG), T-2 toxin, HT-2 toxin, diacetoxyscirpenol (DAS) and zearalenone (ZEA) in rice bran was developed, optimized and validated using dispersive liquid-liquid microextraction (DLLME) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). In DLLME, using a solvent mixture of methanol/water (80:20, v/v) as the dispersive solvent and chloroform as the extraction solvent with the addition of 5% salt improved the extraction recoveries (63-120%). The developed method was further optimized using the response surface methodology (RSM) combined with Box-Behnken Design (BBD). Under the optimized experimental conditions, good linearity was obtained with a correlation coefficient (r2) ≥ 0.990 and a limit of detection (LOD) between 0.5 to 50 ng g-1. The recoveries ranged from 70.2% to 99.4% with an RSD below 1.28%. The proposed method was successfully applied to analyze multi-mycotoxin in 24 rice bran samples.
  9. Firouzi S, Poh BK, Ismail MN, Sadeghilar A
    Obes Res Clin Pract, 2014 Jan-Feb;8(1):e70-8.
    PMID: 24548579 DOI: 10.1016/j.orcp.2012.12.001
    This study aimed to determine the association between sleep habits (including bedtime, wake up time, sleep duration, and sleep disorder score) and physical characteristics, physical activity level, and food pattern in overweight and obese versus normal weight children.
  10. Drewnowski A, Mognard E, Gupta S, Ismail MN, Karim NA, Tibère L, et al.
    Nutrients, 2020 May 25;12(5).
    PMID: 32466102 DOI: 10.3390/nu12051530
    Countries in South East Asia are undergoing a nutrition transition, which typically involves a dietary shift from plant to animal proteins. To explore the main drivers of protein consumption, the SCRiPT (Socio Cultural Research in Protein Transition) study recruited a population sample in Malaysia (N = 1604). Participants completed in-person 24 h dietary recalls and socio-demographic surveys. Energy and nutrient intakes were estimated using Nutritionist Pro. A novel recipe-based frequency count coded protein sources as meat (chicken, beef, pork, and mutton), fish, eggs, dairy, and plants (cereals, pulses, tubers). Dietary intakes and frequencies were examined by gender, age, income, education, ethnicity, religion, and family status, using ANOVAs and general linear models. Energy intakes were 1869 kcal/d for men and 1699 kcal/d for women. Protein intakes were 78.5 g/d for men and 72.5 g/d for women. Higher energy and protein intakes were associated with Chinese ethnicity, higher education and incomes. Frequency counts identified plant proteins in 50% of foods, followed by meat (19%), fish (12%), eggs (12%), and dairy (7%). Most frequent source of meat was chicken (16%) rather than pork or beef (1.5% each). In bivariate analyses, animal protein counts were associated with younger age, higher education and incomes. In mutually adjusted multivariate regression models, animal proteins were associated with education and ethnicity; plant proteins were associated with ethnicity and religion. Protein choices in Malaysia involve socio-cultural as well as economic variables.
  11. Fournier T, Tibère L, Laporte C, Mognard E, Ismail MN, Sharif SP, et al.
    Appetite, 2016 12 01;107:362-371.
    PMID: 27521166 DOI: 10.1016/j.appet.2016.08.009
    The Malaysian society is experiencing and coping with a fast modernization process, which is characterized by a rapid urbanization and rural exodus, an important reduction of the size of households, and the emergence of a new middle class. The Malaysian Food Barometer launched in 2013 has provided better understanding how these macro issues have affected the lifestyles and especially the food habits of the Malaysians. The country has indeed undergone a transition period from under-nutrition to over-nutrition in a few decades, with the prevalence of overweight and obesity having markedly and rapidly increased. A quantitative survey (n = 2000), elaborated from a qualitative preliminary phase, was carried out with the aim of analyzing the transformation of food habits at the national level. The present article focuses on the BMI issue in Malaysia, and investigates its relationships with the socio-demographic variables of the population, as well as their eating patterns. The mean BMI is 23.64 kg/m2, with 9.5% of the sample being obese, and 22% overweight. Strong statistical associations have been identified between BMI and independent variables such as size of the living area, ethnicity, level of education, gender, and age. Contrary to general believe, overweight and obesity were neither associated with the number of food intakes taken per day (including snacks) nor with the frequency of eating out. Nonetheless, obesity is over-represented in people who have dissonant eating behaviors, i.e. who declare having fewer food intakes a day (food norms) than they do actually (food practices). This process testifies that the Malaysians are experiencing a "food transition", which is linked with socio-economic development.
  12. Mognard E, Sanubari TPE, Alem Y, Yuen JL, Ragavan NA, Ismail MN, et al.
    Nutrients, 2023 May 05;15(9).
    PMID: 37432390 DOI: 10.3390/nu15092197
    Breakfast is often referred to as the "most important meal of the day" in shaping diet quality. This study established the patterns of breakfast consumption in Malaysia and assessed its contribution to the overall quality of the diet based on the 24 h recall data from the nationally representative and cross-sectional Malaysian Food Barometer (MFB, second data collection, 2018) to assess breakfast intake among adults (n = 1604). Diet quality was measured using the Nutrient Rich Food index (NRF) 9.3. The nutritional profile of breakfast was compared across tertiles of NRF 9.3. Overall, 89% of Malaysians consume breakfast. Breakfast was found to provide 474 kcal on average. The Malaysian daily diet was found to be rich in fats, saturated fats, total sugars, and sodium, with breakfast making a significant contribution to the daily intakes of these nutrients. Intakes of fiber, potassium, calcium, vitamins C and D, folate, iron, zinc, and magnesium were low. Breakfast was related to the overall diet quality measured by the NRF index. This study revealed that the breakfasts consumed by Malaysian adults were found to be nutritionally unbalanced. This analysis could serve as a basis for nutrient recommendations grounded in existing social and cultural breakfast patterns.
  13. Lee ST, Wong JE, Shanita SN, Ismail MN, Deurenberg P, Poh BK
    Int J Environ Res Public Health, 2015 Jan;12(1):146-61.
    PMID: 25546277 DOI: 10.3390/ijerph120100146
    Childhood obesity is related to low physical activity level and a sedentary lifestyle. The aim of this study was to assess the physical activity level and sedentary behaviour of Malaysian children aged 7 to 12 years and to examine their association with body mass index (BMI), BMI-for-age Z-score (BAZ), body fatness (%BF) and waist circumference (WC). A total of 1736 children, representing all ethnic groups were recruited from six regions of Malaysia. Anthropometric measurements included body weight, height and waist circumference. Body fat percentage (%BF) was assessed using bioelectrical impedance. Physical activity was assessed by a physical activity questionnaire (PAQ) in all children and by pedometers in a subsample (n = 514). PAQ score and pedometer step counts were negatively associated with BMI, BAZ, %BF and WC after adjusting for covariates. Screen time was positively associated with BAZ and WC. However, other sedentary activities were not significantly related with any anthropometric indicators. Strategies to promote active living among children in Malaysia should focus not only on increasing physical activity but also emphasise reduction in sedentary behaviours.
    MESH: screen time
  14. Noradilah MJ, Ang YN, Kamaruddin NA, Deurenberg P, Ismail MN, Poh BK
    Asia Pac J Public Health, 2016 Jul;28(5 Suppl):74S-84S.
    PMID: 27073201 DOI: 10.1177/1010539516641505
    This study aims to validate skinfold (SKF) and bioelectrical impedance analysis (BIA) against dual-energy X-ray absorptiometry (DXA) in determining body fat percentage (BF%) of Malay children aged 7 to 11 years. A total of 160 children had their BF% assessed using SKF and BIA, with DXA as the criterion method. Four SKF equations (SKFBray, SKFJohnston, SKFSlaughter, and SKFGoran) and 4 BIA equations (BIAManufacturer, BIAHoutkooper, BIARush, and BIAKushner) were used to estimate BF%. Mean age, weight, and height were 9.4 ± 1.1years, 30.5 ± 9.9 kg, and 131.3 ± 8.4 cm. All equations significantly underestimated BF% (P < .05). BIA equations had reasonable agreement with DXA and were independent of BF% with BIAManufacturer being the best equation. Although BIA underestimates BF% as compared with DXA, BIA was more suitable to measure BF% in a population that is similar to this study sample than SKF, suggesting a need to develop new SKF equations that are population specific.
  15. Lee ST, Wong JE, Ong WW, Ismail MN, Deurenberg P, Poh BK
    Asia Pac J Public Health, 2016 07;28(5 Suppl):21S-34S.
    PMID: 27026634 DOI: 10.1177/1010539516638155
    Children's physical activity has been correlated with child characteristics and social or physical environment. This study aimed to compare preschoolers' physical activity among various sociodemographic characteristics and to determine barriers, motivators, and environmental factors for active play. A total of 835 preschoolers were included in this analysis. Time spent on active play, quiet play, and screen time was reported by parents. Boys spent significantly more time on active play and screen time than girls. Time spent on quiet play was highest in East Coast Peninsular Malaysia and lowest in Sarawak. Some 40% of children achieved active play recommendation while 27% exceeded daily screen time recommendation. Most parents reported that their child played actively in the house area; and that the main barrier and motivator to active play were safety and child's enjoyment, respectively. These findings demonstrate that sociodemographic characteristics and environment should be considered in designing physical activity intervention programs.
    MESH: screen time
  16. Tan SY, Poh BK, Chong HX, Ismail MN, Rahman J, Zarina AL, et al.
    Leuk. Res., 2013 Jan;37(1):14-20.
    PMID: 23099236 DOI: 10.1016/j.leukres.2012.09.005
    This study aimed to assess the physical activity levels of pediatric patients with acute leukemia undergoing chemotherapy. Thirty-eight pediatric patients and matched controls, aged 3-12 years old, were measured for weight, height, and other anthropometric parameters. Physical activity was assessed using actical accelerometer and activity log book. Patients recorded significantly lower mean total activity counts (26.2±30.2 cpm vs. 192.2±68.8 cpm; p<0.01) and spent more time in sedentary activities (1301±121 min vs. 1020±101 min; p<0.001) compared to controls. They also achieved fewer 1-5-min bouts of moderate-vigorous physical activity (MVPA) compared to controls (1.50±5.95 vs. 37.38±40.36; p<0.001). In conclusion, patients had lower physical activity level and intensity; and simple exercise intervention programs may be needed to minimize the detrimental effects of prolonged sedentary behaviors.
  17. Paul A, Ismail MN, Tang TH, Ng SK
    Mol Biol Rep, 2023 Apr;50(4):3909-3917.
    PMID: 36662450 DOI: 10.1007/s11033-023-08253-3
    BACKGROUND: IRF9 is a transcription factor that mediates the expression of interferon-stimulated genes (ISGs) through the Janus kinase-Signal transducer and activator of transcription (JAK-STAT) pathway. The JAK-STAT pathway is regulated through phosphorylation reactions, in which all components of the pathway are known to be phosphorylated except IRF9. The enigma surrounding IRF9 regulation by a phosphorylation event is intriguing. As IRF9 plays a major role in establishing an antiviral state in host cells, the topic of IRF9 regulation warrants deeper investigation.

    METHODS: Initially, total lysates of 2fTGH and U2A cells (transfected with recombinant IRF9) were filter-selected and concentrated using phosphoprotein enrichment assay. The phosphoprotein state of IRF9 was further confirmed using Phos-tag™ assay. All protein expression was determined using Western blotting. Tandem mass spectrometry was conducted on immunoprecipitated IRF9 to identify the phosphorylated amino acids. Finally, site-directed mutagenesis was performed and the effects of mutated IRF9 on relevant ISGs (i.e., USP18 and Mx1) was evaluated using qPCR.

    RESULTS: IRF9 is phosphorylated at S252 and S253 under IFNβ-induced condition and R242 under non-induced condition. Site-directed mutagenesis of S252 and S253 to either alanine or aspartic acid has a modest effect on the upregulation of USP18 gene-a negative regulator of type I interferon (IFN) response-but not Mx1 gene.

    CONCLUSION: Our preliminary study shows that IRF9 is phosphorylated and possibly regulates USP18 gene expression. However, further in vivo studies are needed to determine the significance of IRF9 phosphorylation.

  18. Ismail MN, Zawiah H, Chee S, Ng K
    Malays J Nutr, 1995 Mar;1(1):1-9.
    PMID: 22692009 MyJurnal
    Anthropometry is the single most portable, easily applied, inexpensive and non-invasive method of assessing body composition. It reflects both health and nutrition and predicts performance, health and survival. The use of body mass index (BMI) as a measure of obesity has been widespread and has recently been promoted for assessment of chronic energy deficiency (CED) in adults. This report provides BMI values of 2636 adult males and 2111 adult females from the three main ethnic groups residing in urban areas and BMI of adult Malay and Dayak (380 males and 496 females) residing in rural areas in Peninsular Malaysia, Sabah and Sarawak. The percent prevalence of obesity and CED in males for the three ethnic groups were apparently quite similar. However, in the females, CED were higher in the Malays and Chinese while overweight problems were more serious in the Indians. Among the Malays, prevalence of CED for males and females were 7% and 11% in urban areas and 11% and 14% in rural areas, respectively. In the males, it is interesting to note that there is a two-fold difference between urban and rural, while a high prevalence of overweight women (20%) even in the rural areas should be viewed as a potential health problem of the future.
  19. Kumarasamy G, Mohd Salim NH, Mohd Afandi NS, Hazlami Habib MA, Mat Amin ND, Ismail MN, et al.
    Future Oncol, 2023 Nov;19(34):2313-2332.
    PMID: 37937446 DOI: 10.2217/fon-2023-0704
    Colorectal cancer (CRC) signifies a significant healthcare challenge in Southeast Asia. Despite advancements in screening approaches and treatment modalities, significant medical gaps remain, ranging from prevention and early diagnosis to determining targeted therapy and establishing personalized approaches to managing CRC. There is a need to expand more validated biomarkers in clinical practice. An advanced technique incorporating high-throughput mass spectrometry as a liquid biopsy to unravel a repertoire of glycoproteins and glycans would potentially drive the development of clinical tools for CRC screening, diagnosis and monitoring, and it can be further adapted to the existing standard-of-care procedure. Therefore this review offers a perspective on glycoproteomics-driven liquid biopsy and its potential integration into the clinical care of CRC in the southeast Asia region.
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