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  1. An unusual case of diverticulitis protruding into sigmoid colon
    Lim JY, Lu CJ, Huang WF
    Am J Med Sci, 2024 Jan;367(1):e10-e11.
    PMID: 37716599 DOI: 10.1016/j.amjms.2023.09.010
  2. Splenic Pseudotumor-Like Follicular Dendritic Cell Sarcoma
    Lim JY, Hong SK, Huang WF
    J Gastrointest Surg, 2023 Jul;27(7):1486-1488.
    PMID: 36849606 DOI: 10.1007/s11605-023-05630-y
  3. An unusual endoscopic appearance of rectosigmoid endometriosis
    Lim JY, Yang WL, Huang WF
    Gastrointest Endosc, 2024 Apr;99(4):656-657.
    PMID: 37806405 DOI: 10.1016/j.gie.2023.10.015
  4. An unusual case of rapid death: Diffuse artery occlusion
    Lim JY, Lu CJ, Huang WF
    Am J Med Sci, 2024 Apr;367(4):e41-e42.
    PMID: 38072071 DOI: 10.1016/j.amjms.2023.12.002
  5. Fulltext Effects of Starter Defect on Energy Release Rate of Three-Point End-Notch Flexure Tested Unidirectional Carbon Fiber Reinforced Polymer Composite
    Nor FM, Lim JY, Tamin MN, Lee HY, Kurniawan D
    Polymers (Basel), 2020 Apr 14;12(4).
    PMID: 32295111 DOI: 10.3390/polym12040904
    The mechanics of damage and fracture process in unidirectional carbon fiber reinforced polymer (CFRP) composites subjected to shear loading (Mode II) were examined using the experimental method of the three-point end-notch flexure (3ENF) test. The CFRP composite consists of [0o]16 with an insert film in the middle plane for a starter defect. A 3ENF test sample with a span of 50 mm and interface delamination crack length of 12.5 mm was tested to yield the load vs. deformation response. A sudden load drop observed at maximum force value indicates the onset of delamination crack propagation. The results are used to extract the energy release rate, GIIC, of the laminates with an insert film starter defect. The effect of the starter defect on the magnitude of GIIC was examined using the CFRP composite sample with a Mode II delamination pre-crack. The higher magnitude of GIIC for the sample with insert film starter defect was attributed to the initial straight geometry of the notch/interface crack and the toughness of the resin at the notch front of the fabricated film insert. The fractured sample was examined using a micro-computerized tomography scanner to establish the shape of the internal delamination crack front. Results revealed that the interface delamination propagated in a non-uniform manner, leaving a curved-shaped crack profile.
  6. Blockchain as a frontier in biotechnology and bioenergy applications
    Loy ACM, Lim JY, How BS, Yoo CK
    Trends Biotechnol, 2022 Mar;40(3):255-258.
    PMID: 34629171 DOI: 10.1016/j.tibtech.2021.09.006
    The fourth Industrial Revolution is stimulating a fast-paced and resilient industrial internet of things (IIoT) ecosystem. Blockchain, a decentralized digital ledger technology, plays a crucial role in improvising, securing, and streamlining traditional biotechnology-related industrial processes with IoT and creates a sustainable nexus between social, economic, and environmental aspects.
  7. SCL: Self-supervised contrastive learning for few-shot image classification
    Lim JY, Lim KM, Lee CP, Tan YX
    Neural Netw, 2023 Aug;165:19-30.
    PMID: 37263089 DOI: 10.1016/j.neunet.2023.05.037
    Few-shot learning aims to train a model with a limited number of base class samples to classify the novel class samples. However, to attain generalization with a limited number of samples is not a trivial task. This paper proposed a novel few-shot learning approach named Self-supervised Contrastive Learning (SCL) that enriched the model representation with multiple self-supervision objectives. Given the base class samples, the model is trained with the base class loss. Subsequently, contrastive-based self-supervision is introduced to minimize the distance between each training sample with their augmented variants to improve the sample discrimination. To recognize the distant sample, rotation-based self-supervision is proposed to enable the model to learn to recognize the rotation degree of the samples for better sample diversity. The multitask environment is introduced where each training sample is assigned with two class labels: base class label and rotation class label. Complex augmentation is put forth to help the model learn a deeper understanding of the object. The image structure of the training samples are augmented independent of the base class information. The proposed SCL is trained to minimize the base class loss, contrastive distance loss, and rotation class loss simultaneously to learn the generic features and improve the novel class performance. With the multiple self-supervision objectives, the proposed SCL outperforms state-of-the-art few-shot approaches on few-shot image classification benchmark datasets.
  8. Fulltext Effect of nutritional intervention on nutritional status among children with disorders of amino acid and nitrogen metabolism (AANMDs): A scoping review
    Lim JY, Amit N, Ali NM, Leong HY, Mohamad M, Rajikan R
    Intractable Rare Dis Res, 2021 Nov;10(4):246-256.
    PMID: 34877236 DOI: 10.5582/irdr.2021.01124
    Disorders of amino acid and nitrogen metabolism (AANMDs) occur due to an enzyme deficiency in a normal biochemical pathway. Nutritional intervention is recognized as the mainstay of treatment for children diagnosed with AANMD. Hence, this scoping review aimed to identify the nutritional interventions available in managing AANMD disorders and their effects on nutritional status. A systematic search using PRISMA Extension for Scoping Reviews (PRISMA-ScR) method was conducted across 4 databases: PubMed, ScienceDirect (Elsevier), EBSCOhost and Cochrane Central Register of Controlled Trials (CENTRAL). Inclusion criteria for the study to be selected are: subjects aged less than 18-year-old, article published in English, utilized an experimental design and published within the past 20 years. A total of 22 articles were included in this review. The majority of the subjects are boys (55.6%) and employed a randomized controlled trial (RCT) study design (45.4%). Nutritional interventions were categorized into 4 categories which are: "protein substitute" (n = 5), "protein substitute with modified composition" (n = 6), "nutrient supplementation (n=8)", and "distribution and dosage of protein substitute (n = 3)". The most frequently assessed outcomes were biochemical parameters that gauge the effectiveness of metabolic control (68.2%). Overall, "protein substitute enriched with inhibitive amino acids", "long-chain polyunsaturated fatty acids supplementation", and "evenly distributed protein substitute" demonstrated beneficial effects towards the nutritional status, especially in terms of biochemical parameters. In summary, nutritional intervention plays a significant role in improving the nutritional status of AANMD patients. Further investigations of nutritional intervention among AANMD children using a meta-analysis approach are necessary for better comprehension of their impact in management of AANMD disorders.
  9. Rethinking of the future sustainable paradigm roadmap for plastic waste management: A multi-nation scale outlook compendium
    Loy ACM, Lim JY, How BS, Yiin CL, Lock SSM, Lim LG, et al.
    Sci Total Environ, 2023 Jul 10;881:163458.
    PMID: 37068680 DOI: 10.1016/j.scitotenv.2023.163458
    The myriad consumption of plastic regularly, environmental impact and health disquietude of humans are at high risk. Along the line, international cooperation on a global scale is epitomized to mitigate the environmental threats from plastic usage, not limited to implementing international cooperation strategies and policies. Here, this study aims to provide explicit insight into possible cooperation strategies between countries on the post-treatment and management of plastic. First, a thorough cradle-to-grave assessment in terms of economic, environmental, and energy requirements is conducted on the entire life cycle across different types of plastic polymers in 6 main countries, namely the United States of America, China, Germany, Japan, South Korea, and Malaysia. Subsequently, P-graph is introduced to identify the integrative plastic waste treatment scheme that minimizes the economic, environmental, and energy criteria (1000 sets of solutions are found). Furthermore, TOPSIS analysis is also being adapted to search for a propitious solution with optimal balance between the dominant configuration of economic, environmental, and energy nexus. The most sustainable configuration (i.e., integrated downcycle and reuse routes in a closed loop system except in South Korea, which proposed another alternative to treat the plastic waste using landfill given the cheaper cost) is reported with 4.08 × 108 USD/yr, 1.76× 108 kg CO2/yr, and 2.73 × 109 MJ/yr respectively. To attain a high precision result, Monte-Carlo simulation is introduced (10,000 attempts) to search for possible uncertainties, and lastly, a potential global plastic waste management scheme is proposed via the PESTLE approach.
  10. Need analysis of a dietary application among caregivers of patients with disorders of amino acid metabolism (AAMDs): A mixed-method approach
    Lim JY, Ali NM, Rajikan R, Amit N, Hamid HA, Leong HY, et al.
    Int J Med Inform, 2023 Sep;177:105120.
    PMID: 37295139 DOI: 10.1016/j.ijmedinf.2023.105120
    BACKGROUND: A dietary application can assist the caregivers of AAMDs children in auto-calculating the protein intake, hence improving dietary compliance. However, existing dietary application for patients with AAMDs only focus on delivering the nutritional content of food and monitoring the dietary intake but were lacking in other educational components.

    OBJECTIVE: To assess the uses, needs and preferences towards a dietary application among the caregivers of AAMDs patients.

    METHODS: We conducted a mixed-method study comprising focus group discussion (FGD) and a quantitative questionnaire survey among caregivers of patients aged between 6-month-old to 18-year-old with AAMDs who are receiving active treatment, both medical and dietetic treatment in the genetic clinic, Hospital Kuala Lumpur (HKL).

    RESULTS: A total of 76 and 20 caregivers participated in the survey and FGD respectively. All the caregivers (100%) possessed a smartphone and most of the caregivers (89.5%) had the experience of using smartphone or other technological devices to search for health or medical information. However, majority of the participants were not aware of the existence of any web-based or mobile application related to AAMDs (89.5%). While for the qualitative part, three themes emerged: (1) experience with current source of information; (2) needs for supporting self-management educational contents and needs for technological design application. Most of the caregivers used the nutritional booklet as sources of reference but some of them searched for web-based information. Features perceived by the caregivers included a digital food composition database, sharing diet recall with healthcare providers, self-monitoring diet intake as well as low protein recipes. Besides that, user-friendly and ease to use were also perceived as the important features by the caregivers.

    CONCLUSION: The identified features and needs by the caregivers should be integrated into the design of the apps to promote acceptance and usage.

  11. Smart solutions for clean air: An AI-guided approach to sustainable industrial pollution control in coal-fired power plant
    Lim JY, Teng SY, How BS, Loy ACM, Heo S, Jansen J, et al.
    Environ Pollut, 2023 Oct 15;335:122335.
    PMID: 37558197 DOI: 10.1016/j.envpol.2023.122335
    Conventional fossil fuels are relied on heavily to meet the ever-increasing demand for energy required by human activities. However, their usage generates significant air pollutant emissions, such as NOx, SOx, and particulate matter. As a result, a complete air pollutant control system is necessary. However, the intensive operation of such systems is expected to cause deterioration and reduce their efficiency. Therefore, this study evaluates the current air pollutant control configuration of a coal-powered plant and proposes an upgraded system. Using a year-long dataset of air pollutants collected at 30-min intervals from the plant's telemonitoring system, untreated flue gas was reconstructed with a variational autoencoder. Subsequently, a superstructure model with various technology options for treating NOx, SOx, and particulate matter was developed. The most sustainable configuration, which included reburning, desulfurization with seawater, and dry electrostatic precipitator, was identified using an artificial intelligence (AI) model to meet economic, environmental, and reliability targets. Finally, the proposed system was evaluated using a Monte Carlo simulation to assess various scenarios with tightened discharge limits. The untreated flue gas was then evaluated using the most sustainable air pollutant control configuration, which demonstrated a total annual cost, environmental quality index, and reliability indices of 44.1 × 106 USD/year, 0.67, and 0.87, respectively.
  12. A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country
    Ooi SH, Ng KP, Sthaneshwar P, Lim SK, Khor PY, Lim JY, et al.
    BMC Nephrol, 2024 Apr 05;25(1):122.
    PMID: 38580977 DOI: 10.1186/s12882-024-03498-x
    BACKGROUND: The commonest indication for hospitalization in COVID-19 patients is hypoxemia or severe respiratory symptoms. However, COVID-19 disease may result in extrapulmonary complications including kidney-related pathology. The reported incidence of renal involvement related to COVID infection varies based on geographical location.

    OBJECTIVE: This study aimed to assess the incidence rate of AKI in hospitalized COVID-19 patients and identify risk factors and prognostic predictors.

    METHOD: In this retrospective study, we recruited hospitalized COVID-19 patients from January 2021 until June 2021 at the University Malaya Medical Center. The inclusion criteria were hospitalized for ≥ 48 h with confirmed COVID-19 infection and at least 18 years old. Patient demographic and clinical data were collected from electronic medical records. The staging of AKI was based on criteria as per KDIGO guidelines.

    RESULTS: One thousand five hundred twenty-nine COVID patients fulfilled the inclusion criteria with a male-to-female ratio of 759 (49.6%) to 770 (50.3%). The median age was 55 (IQR: 36-66). 500 patients (32.7%) had diabetes, 621 (40.6%) had hypertension, and 5.6% (n = 85) had pre-existing chronic kidney disease (CKD). The incidence rate of AKI was 21.1% (n = 323). The percentage of COVID patients in different AKI stages of 1,2 and 3 were 16.3%, 2.1%, and 2.7%, respectively. Fifteen hospitalized patients (0.98%) required renal replacement therapy. 58.8% (n = 190) of AKI group had complete recovery of kidney function. Demographic factors included age (p 

  13. Rapamycin synergizes cisplatin sensitivity in basal-like breast cancer cells through up-regulation of p73
    Wong SW, Tiong KH, Kong WY, Yue YC, Chua CH, Lim JY, et al.
    Breast Cancer Res Treat, 2011 Jul;128(2):301-13.
    PMID: 20686837 DOI: 10.1007/s10549-010-1055-0
    Recent gene expression profiling studies have identified five breast cancer subtypes, of which the basal-like subtype is the most aggressive. Basal-like breast cancer poses serious clinical challenges as there are currently no targeted therapies available to treat it. Although there is increasing evidence that these tumors possess specific sensitivity to cisplatin, its success is often compromised due to its dose-limiting nephrotoxicity and the development of drug resistance. To overcome this limitation, our goal was to maximize the benefits associated with cisplatin therapy through drug combination strategies. Using a validated kinase inhibitor library, we showed that inhibition of the mTOR, TGFβRI, NFκB, PI3K/AKT, and MAPK pathways sensitized basal-like MDA-MB-468 cells to cisplatin treatment. Further analysis demonstrated that the combination of the mTOR inhibitor rapamycin and cisplatin generated significant drug synergism in basal-like MDA-MB-468, MDA-MB-231, and HCC1937 cells but not in luminal-like T47D or MCF-7 cells. We further showed that the synergistic effect of rapamycin plus cisplatin on basal-like breast cancer cells was mediated through the induction of p73. Depletion of endogenous p73 in basal-like cells abolished these synergistic effects. In conclusion, combination therapy with mTOR inhibitors and cisplatin may be a useful therapeutic strategy in the treatment of basal-like breast cancers.
  14. The effect of 5-min mindfulness of love on suffering and spiritual quality of life of palliative care patients: A randomized controlled study
    Lim MA, Ang BT, Lam CL, Loh EC, Zainuddin SI, Capelle DP, et al.
    Eur J Cancer Care (Engl), 2021 Sep;30(5):e13456.
    PMID: 33913192 DOI: 10.1111/ecc.13456
    OBJECTIVE: Suffering is a common experience in palliative care. In our study, we aimed to determine the effect of 5-min mindfulness of love on suffering and the spiritual quality of life of palliative care patients.

    METHODS: We conducted a parallel-group, blinded, randomized controlled study at the University of Malaya Medical Centre (UMMC), Malaysia from February 2019 to April 2019. Sixty adult palliative care patients with an overall suffering score of 4/10 or above based on the Suffering Pictogram were recruited and randomly assigned to either the 5-min mindfulness of love group (N = 30) or the 5-min supportive listening group (N = 30).

    RESULTS: There were statistically significant improvements in the overall suffering score (mean difference = -2.9, CI = -3.7 to -2.1, t = -7.268, p = 0.000) and the total FACIT-Sp-12 score (mean difference = 2.9, CI = 1.5 to 4.3, t = 4.124, p = 0.000) in the intervention group compared to the control group.

    CONCLUSION: The results provided evidence that 5-min mindfulness of love could affect the actual state of suffering and the spiritual quality of life of palliative care patients.

  15. Practical Considerations for Using RNA Sequencing in Management of B-Lymphoblastic Leukemia: Malaysia-Singapore Acute Lymphoblastic Leukemia 2020 Implementation Strategy
    Ni Chin WH, Li Z, Jiang N, Lim EH, Suang Lim JY, Lu Y, et al.
    J Mol Diagn, 2021 10;23(10):1359-1372.
    PMID: 34365011 DOI: 10.1016/j.jmoldx.2021.07.013
    Despite the immense genetic heterogeneity of B-lymphoblastic leukemia [or precursor B-cell acute lymphoblastic leukemia (B-ALL)], RNA sequencing (RNA-Seq) could comprehensively interrogate its genetic drivers, assigning a specific molecular subtype in >90% of patients. However, study groups have only started to use RNA-Seq. For broader clinical use, technical, quality control, and appropriate performance validation are needed. We describe the development and validation of an RNA-Seq workflow for subtype classification, TPMT/NUDT15/TP53 variant discovery, and immunoglobulin heavy chain (IGH) disease clone identification for Malaysia-Singapore acute lymphoblastic leukemia (ALL) 2020. We validated this workflow in 377 patients in our preceding Malaysia-Singapore ALL 2003/Malaysia-Singapore ALL 2010 studies and proposed the quality control measures for RNA quality, library size, sequencing, and data analysis using the International Organization for Standardization 15189 quality and competence standard for medical laboratories. Compared with conventional methods, we achieved >95% accuracy in oncogene fusion identification, digital karyotyping, and TPMT and NUDT15 variant discovery. We found seven pathogenic TP53 mutations, confirmed with Sanger sequencing, which conferred a poorer outcome. Applying this workflow prospectively to the first 21 patients in Malaysia-Singapore ALL 2020, we identified the genetic drivers and IGH disease clones in >90% of patients with concordant TPMT, NUDT15, and TP53 variants using PCR-based methods. The median turnaround time was 12 days, which was clinically actionable. In conclusion, RNA-Seq workflow could be used clinically in management of B-cell ALL patients.
  16. A Report on Ten Asia Pacific Countries on Current Status and Future Directions of the Genetic Counseling Profession: The Establishment of the Professional Society of Genetic Counselors in Asia
    Laurino MY, Leppig KA, Abad PJ, Cham B, Chu YWY, Kejriwal S, et al.
    J Genet Couns, 2018 02;27(1):21-32.
    PMID: 28699126 DOI: 10.1007/s10897-017-0115-6
    The Professional Society of Genetic Counselors in Asia (PSGCA) was recently established as a special interest group of the Asia Pacific Society of Human Genetics. Fostering partnerships across the globe, the PSGCA's vision is to be the lead organization that advances and mainstreams the genetic counseling profession in Asia and ensures individuals have access to genetic counseling services. Its mission is to promote quality genetic counseling services in the region by enhancing practice and curricular standards, research and continuing education. The PSGCA was formally launched during the Genetic Counseling Pre-Conference Workshop held at the 11th Asia-Pacific Conference on Human Genetics in Hanoi, Viet Nam, September 16, 2015. The pre-conference workshop provided an opportunity for medical geneticists and genetic counselors from across 10 Asia Pacific countries to learn about the varied genetic counseling practices and strategies for genetic counseling training. This paper provides an overview of the current status and challenges in these countries, and proposed course of unified actions for the future of the genetic counseling profession.
  17. Fulltext Diagnosis and outcomes of cachexia in Asia: Working Consensus Report from the Asian Working Group for Cachexia
    Arai H, Maeda K, Wakabayashi H, Naito T, Konishi M, Assantachai P, et al.
    J Cachexia Sarcopenia Muscle, 2023 Oct;14(5):1949-1958.
    PMID: 37667992 DOI: 10.1002/jcsm.13323
    Chronic diseases often lead to metabolic disorders, causing anabolic resistance and increased energy consumption, which result in cachexia. Cachexia, in turn, can lead to major clinical consequences such as impaired quality of life, shortened life expectancy, and increased healthcare expenditure. Existing international diagnostic criteria for cachexia employ thresholds derived from Western populations, which may not apply to Asians due to differing body compositions. To address this issue, the Asian Working Group for Cachexia (AWGC) was initiated. The AWGC comprises experts in cachexia research and clinical practice from various Asian countries and aims to develop a consensus on diagnostic criteria and significant clinical outcomes for cachexia in Asia. The AWGC, composed of experts in cachexia research and clinical practice from several Asian countries, undertook three-round Delphi surveys and five meetings to reach a consensus. Discussions were held on etiological diseases, essential diagnostic items for cachexia, including subjective and objective symptoms and biomarkers, and significant clinical outcomes. The consensus highlighted the importance of multiple diagnostic factors for cachexia, including chronic diseases, either or both weight loss or low body mass index, and at least one of the following: anorexia, decreased grip strength (<28 kg in men and <18 kg in women), or elevated C-reactive protein levels (>5 mg/L [0.5 mg/dL]). The AWGC proposed a significant weight change of 2% or more over a 3-6 month period and suggested a tentative cut-off value of 21 kg/m2 for low body mass index in diagnosing cachexia. Critical clinical outcomes were determined to be mortality, quality of life as assessed by tools such as EQ-5D or the Functional Assessment of Anorexia/Cachexia Therapy, and functional status as measured by the Clinical Frailty Scale or Barthel Index, with significant emphasis on patient-reported outcomes. The AWGC consensus offers a comprehensive definition and user-friendly diagnostic criteria for cachexia, tailored specifically for Asian populations. This consensus is set to stimulate future research and enhance the multidisciplinary approach to managing cachexia. With plans to develop further guidelines for the optimal treatment, prevention, and care of cachexia in Asians, the AWGC criteria are expected to drive research across chronic co-morbidities and cancer in Asia, leading to future refinement of diagnostic criteria.
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