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Designing a neurofeedback device to quantify attention levels using coffee as a reward system

Cheng KS, Lee JX, Lee PF

Int J Occup Saf Ergon, 2021 Mar;27(1):258-266.
PMID: 29658406 DOI: 10.1080/10803548.2018.1459348

Purpose. Work performance is closely related to one's attention level. In this study, a brain-computer interface (BCI) device suitable for office usage was chosen to quantify the individual's attention levels. Methods. A BCI system was adopted to interface brainwave signals to a coffee maker via three ascending levels of laser detectors. The preliminary test with this prototype was to characterize the attention level through the collected coffee amount. Here, the preliminary testing was comparing the correlation between the attention level and the participants' cumulative grade point average (CGPA) and scores from the 21-item depression, anxiety, and stress scale (DASS-21) and the attentional control scale (ACS) using ordinal regression. It was assumed that a greater CGPA would generate a greater attention level. Result. The generated coffee amount from the BCI system had a significant positive correlation with the CGPA (p = 0.004), mild depression (p = 0.019) and mild and extremely severe anxiety (p = 0.044 and p = 0.019, respectively) and a negative correlation with the ACS score (p = 0.042). Conclusion. This simple and cost-effective prototype has the potential to enable everyone to know their immediate attention level and predict the possible correlation to their mental state.
Fulltext COVID-19 and Hemoglobinopathies: A Systematic Review of Clinical Presentations, Investigations, and Outcomes

Lee JX, Chieng WK, Lau SCD, Tan CE

Front Med (Lausanne), 2021;8:757510.
PMID: 34722593 DOI: 10.3389/fmed.2021.757510

This systematic review aimed to provide an overview of the clinical profile and outcome of COVID-19 infection in patients with hemoglobinopathy. The rate of COVID-19 mortality and its predictors were also identified. A systematic search was conducted in accordance with PRISMA guidelines in five electronic databases (PubMed, Scopus, Web of Science, Embase, WHO COVID-19 database) for articles published between 1st December 2019 to 31st October 2020. All articles with laboratory-confirmed COVID-19 cases with underlying hemoglobinopathy were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Thirty-one articles with data on 246 patients with hemoglobinopathy were included in this review. In general, clinical manifestations of COVID-19 infection among patients with hemoglobinopathy were similar to the general population. Vaso-occlusive crisis occurred in 55.6% of sickle cell disease patients with COVID-19 infection. Mortality from COVID-19 infection among patients with hemoglobinopathy was 6.9%. After adjusting for age, gender, types of hemoglobinopathy and oxygen supplementation, respiratory (adj OR = 89.63, 95% CI 2.514-3195.537, p = 0.014) and cardiovascular (adj OR = 35.20, 95% CI 1.291-959.526, p = 0.035) comorbidities were significant predictors of mortality. Patients with hemoglobinopathy had a higher mortality rate from COVID-19 infection compared to the general population. Those with coexisting cardiovascular or respiratory comorbidities require closer monitoring during the course of illness. More data are needed to allow a better understanding on the clinical impact of COVID-19 infections among patients with hemoglobinopathy. Clinical Trial Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020218200.
Fulltext NPHS Mutations in Pediatric Patients with Congenital and Steroid-Resistant Nephrotic Syndrome

Lee JX, Tan YJ, Ismail NAS

Int J Mol Sci, 2024 Nov 15;25(22).
PMID: 39596340 DOI: 10.3390/ijms252212275

NPHS1 and NPHS2 are kidney gene components that encode for nephrin and podocin, respectively. They play a role in the progression of congenital (CNS) and steroid-resistant (SRNS) nephrotic syndrome. Hence, this study aimed to determine the prevalence and renal outcomes of NPHS mutations among pediatric patients with CNS and SRNS. We also aimed to identify potential predictors of NPHS mutations in this patient cohort. Overall, this study included 33 studies involving 2123 patients screened for NPHS1, whereas 2889 patients from 40 studies were screened for NPHS2 mutations. The patients' mean age was 4.9 ± 1 years (ranging from birth to 18 years), and 56% of patients were male (n = 1281). Using the random-effects model, the pooled proportion of NPHS1 mutations among pediatric patients with CNS and SRNS was 0.15 (95% CI 0.09; 0.24, p < 0.001, I2 = 92.0%). The pooled proportion of NPHS2 mutations was slightly lower, at 0.11 (95% CI 0.08; 0.14, p < 0.001, I2 = 73.8%). Among the 18 studies that reported ESRF, the pooled proportion was 0.47 (95% CI 0.34; 0.61, p < 0.001, I2 = 75.4%). Our study showed that the NPHS1 (β = 1.16, p = 0.35) and NPHS2 (β = 5.49, p = 0.08) mutations did not predict ESRF in CNS and SRNS pediatric patients. Nevertheless, patients from the European continent who had the NPHS2 mutation had a significantly higher risk of developing ESRF (p < 0.05, β = 1.3, OR = 7.97, 95% CI 0.30; 2.30) compared to those who had the NPHS1 mutation. We recommend NPHS mutation screening for earlier diagnosis and to avoid unnecessary steroid treatments. More data are needed to better understand the impact of NPHS mutations among pediatric patients with CNS and SRNS.
Severe and rare neurological manifestations following COVID-19 infection in children: A Malaysian tertiary centre experience

Anuar MA, Lee JX, Musa H, Abd Hadi D, Majawit E, Anandakrishnan P, et al.

Brain Dev, 2023 Nov;45(10):547-553.
PMID: 37661525 DOI: 10.1016/j.braindev.2023.06.004

INTRODUCTION: Since the emergence of COVID-19, we have experienced potent variants and sub-variants of the virus with non-specific neurological manifestations. We observed a surge of the Omicron variant of COVID-19 patients with neurological manifestations where less cases of multisystem inflammatory syndrome in children (MIS-C) were reported. This article describes our experience of children with severe and rare neurological manifestations following COVID-19 infection.
METHODS: This is a retrospective observational case series of patients under 18 years old who fulfilled the WHO COVID-19 case definition and were referred to our paediatric neurology unit at Hospital Tunku Azizah Kuala Lumpur. Their demographic data, neurological symptoms, laboratory and supporting investigations, neuroimaging, treatment and outcomes were collected and analysed.
RESULTS: There were eleven patients with neurological manifestations who fulfilled the WHO COVID-19 case definition. Nine patients presented with seizures and/or encephalopathy, one patient with eye opsoclonus and another patient with persistent limbs myokymia. Based on the history, clinical, electrophysiological and radiological findings, two of them had febrile infection-related epilepsy syndrome, two had acute disseminated encephalomyelitis, two had acute necrotising encephalopathy of childhood, one each had hemiconvulsion-hemiplegia-epilepsy syndrome, acute encephalopathy with bilateral striatal necrosis, hemi-acute encephalopathy with biphasic seizures and reduced diffusion, infection-associated opsoclonus and myokymia.
CONCLUSIONS: This case series highlighted a wide spectrum of neurological manifestations of COVID-19 infection. Early recognition and prompt investigations are important to provide appropriate interventions. It is essential that these investigations should take place in a timely fashion and COVID-19 quarantine period should not hinder the confirmation of various presenting clinical syndromes.
Fulltext Curative Locoregional Therapy following Objective Response to Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma

Shao YY, Chen SC, Rau KM, Lee TY, Chan SL, Liu K, et al.

Liver Cancer, 2026 Aug 12.
PMID: 42923539 DOI: 10.1159/lic/admag004

INTRODUCTION: Atezolizumab plus bevacizumab (Atezo-Bev) is a standard first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). We aimed to explore the benefits of adding curative locoregional therapy (LRT) to patients who achieve a partial response (PR) to Atezo-Bev treatment.
METHODS: This multinational retrospective study enrolled patients who received Atezo-Bev as first-line systemic therapy for unresectable HCC and reached complete response (CR) or PR. Patients were categorized into three cohorts: patients who underwent curative LRT after PR, patients with PR but did not receive curative LRT, and patients achieving CR without LRT. Curative LRT included surgery, ablation, and definitive radiotherapy with imaging evidence showing disease-free status afterward.
RESULTS: A total of 243 patients were enrolled from 8 countries or regions; 31 patients received curative LRT after PR, 180 patients obtained PR but did not receive curative LRT, and 32 patients achieved CR without LRT. The curative-LRT group, compared with patients who did not receive curative LRT after PR, exhibited significantly longer PFS (median, 44.4 months vs. 18.2 months, p = 0.004) and overall survival (OS) (median, not reached vs. 34.3 months, p < 0.001). The differences remained significant after inverse probability of treatment weighting (IPTW) adjustment. By contrast, whether before or after IPTW adjustment, the curative-LRT group did not exhibit statistically significant difference in PFS, OS, and recurrence-free survival from patients who obtained CR without curative LRT.
CONCLUSION: Curative LRT may consolidate the efficacy of Atezo-Bev in patients achieving a PR, potentially prolonging survival compared to systemic therapy alone.