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Article ; Online: Dual Antiplatelet Therapy for the Acute Management and Long-term Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack, An Updated Review.

Chan, Bernard P L / Wong, Lily Y H / Tan, Benjamin Y Q / Yeo, Leonard L L / Venketasubramanian, Narayanaswamy

Journal of cardiovascular development and disease

2024 Volume 11, Issue 2

Abstract: To improve the efficacy over antiplatelet monotherapy, dual antiplatelet therapy (DAPT) has been increasingly adopted in the management of non-cardioembolic stroke. For minor ischemic stroke and high-risk transient ischemic attack, the aspirin- ... ...

Abstract	To improve the efficacy over antiplatelet monotherapy, dual antiplatelet therapy (DAPT) has been increasingly adopted in the management of non-cardioembolic stroke. For minor ischemic stroke and high-risk transient ischemic attack, the aspirin-clopidogrel combination is now recommended for acute short-term treatment, whereas aspirin-ticagrelor combination may be considered in selected patients, especially those with resistance to clopidogrel. For long-term stroke prevention, aspirin-dipyridamole combination has been used as an alternative to antiplatelet monotherapy, and aspirin or clopidogrel combined with cilostazole may be prescribed for added protection in high-risk patients. In this paper, we review the development of DAPT from a historical perspective and describe the findings from major clinical trials published up until the end of 2023. Using the 2021 American Heart Association guideline for secondary stroke prevention as a basis for our recommendations, we further discuss areas of controversy and more recent developments to provide an updated review for clinicians to consider in their daily practice.
Language	English
Publishing date	2024-01-31
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2777082-5
ISSN	2308-3425 ; 2308-3425
ISSN (online)	2308-3425
ISSN	2308-3425
DOI	10.3390/jcdd11020048
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Multiomics reveals glutathione metabolism as a driver of bimodality during stem cell aging.

Benjamin, Daniel I / Brett, Jamie O / Both, Pieter / Benjamin, Joel S / Ishak, Heather L / Kang, Jengmin / Kim, Soochi / Chung, Mingyu / Arjona, Marina / Nutter, Christopher W / Tan, Jenna H / Krishnan, Ananya K / Dulay, Hunter / Louie, Sharon M / de Morree, Antoine / Nomura, Daniel K / Rando, Thomas A

Cell metabolism

2023 Volume 35, Issue 3, Page(s) 472–486.e6

Abstract: With age, skeletal muscle stem cells (MuSCs) activate out of quiescence more slowly and with increased death, leading to defective muscle repair. To explore the molecular underpinnings of these defects, we combined multiomics, single-cell measurements, ... ...

Abstract	With age, skeletal muscle stem cells (MuSCs) activate out of quiescence more slowly and with increased death, leading to defective muscle repair. To explore the molecular underpinnings of these defects, we combined multiomics, single-cell measurements, and functional testing of MuSCs from young and old mice. The multiomics approach allowed us to assess which changes are causal, which are compensatory, and which are simply correlative. We identified glutathione (GSH) metabolism as perturbed in old MuSCs, with both causal and compensatory components. Contrary to young MuSCs, old MuSCs exhibit a population dichotomy composed of GSH
MeSH term(s)	Mice ; Animals ; Muscle, Skeletal/metabolism ; Multiomics ; Stem Cells/metabolism ; Cellular Senescence ; Aging/physiology
Language	English
Publishing date	2023-02-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2176834-1
ISSN	1932-7420 ; 1550-4131
ISSN (online)	1932-7420
ISSN	1550-4131
DOI	10.1016/j.cmet.2023.02.001
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Article: Influence of body composition measures on chyle leak after oesophagectomy.

Halle-Smith, James M / Siddaiah-Subramanya, Manjunath / Ghoneim, Abdulrahman / Almonib, Ahmed / Tan, Benjamin H L

Journal of thoracic disease

2022 Volume 14, Issue 4, Page(s) 877–883

Abstract: Background: Chyle leak (CL) is an infrequent but potentially serious complication of oesophagectomy. Sarcopenia is an increasingly recognised prognostic factor in oesophageal cancer surgery. The aim of this study was to identify the influence of body ... ...

Abstract	Background: Chyle leak (CL) is an infrequent but potentially serious complication of oesophagectomy. Sarcopenia is an increasingly recognised prognostic factor in oesophageal cancer surgery. The aim of this study was to identify the influence of body composition measures on CL following oesophagectomy. Methods: Patients who developed CL after oesophagectomy between January 2006-December 2020 were identified retrospectively from a prospectively maintained dataset. A control group of patients undergoing oesophagectomy, who did not experience chyle leak during the same time period, was also collected. Relationships between CL and demographics, operative factors and body composition measures were investigated as primary outcomes. Risk factors for severe CL were evaluated as a secondary outcome. Results: There were 26 patients who developed a CL following an oesophagectomy. On univariate analysis, preoperative body mass index (BMI) (P=0.001), subcutaneous fat index (P=0.001) and total fat index (P=0.004) were significantly associated with CL. On multivariate analysis, a lower preoperative subcutaneous fat index was a significant independent predictor of CL (P=0.003). Sarcopenia, as an overall measure, was not found to be a significant predictor of developing CLs. No significant predictors of severe CL were identified. Conclusions: A reduced preoperative BMI and body fat composition are risk factors for CL after oesophagectomy. Sarcopenia does not predict either the occurrence or severity of CL. This presents potentially modifiable risk factors for CL after oesophagectomy and emphasises the importance of physiological and nutritional optimisation before oesophagectomy.
Language	English
Publishing date	2022-04-28
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-21-1580
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Article ; Online: Correction to: Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis.

Kamarajah, Sivesh K / Bundred, James / Tan, Benjamin H L

Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association

2019 Volume 22, Issue 3, Page(s) 645–650

Abstract: In the original publication of this article, most of the reference citations in Tables 1 and 2 were published incorrectly. The corrected tables are given in this correction. ...

Abstract	In the original publication of this article, most of the reference citations in Tables 1 and 2 were published incorrectly. The corrected tables are given in this correction.
Language	English
Publishing date	2019-03-01
Publishing country	Japan
Document type	Journal Article ; Published Erratum
ZDB-ID	1463526-4
ISSN	1436-3305 ; 1436-3291
ISSN (online)	1436-3305
ISSN	1436-3291
DOI	10.1007/s10120-019-00939-7
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Article ; Online: Meta-analysis: Prevalence of significant or advanced fibrosis in adults with alpha-1-antitrypsin deficiency.

Huang, Daniel Q / Chan, Kai En / Tan, Caitlyn / Zeng, Rebecca Wenling / Koh, Benjamin / Ong, Elden Yen Hng / Ong, Charlotte Chung Hui / Ong, Christen En Ya / Tan, Darren J H / Lim, Wen Hui / Cho, Elina / Tan, Eunice X X / Teng, Margaret L P / Ng, Cheng Han / Nah, Benjamin / Lim, Mei Chin / Muthiah, Mark / Clark, Virginia C / Loomba, Rohit

Alimentary pharmacology & therapeutics

2023 Volume 58, Issue 2, Page(s) 152–158

Abstract: Background: The prevalence of liver fibrosis detected by non-invasive imaging in alpha-1-antitrypsin (AAT) deficiency has not been systematically assessed.: Aims: We conducted a systematic review and meta-analysis to determine the prevalence of ... ...

Abstract	Background: The prevalence of liver fibrosis detected by non-invasive imaging in alpha-1-antitrypsin (AAT) deficiency has not been systematically assessed. Aims: We conducted a systematic review and meta-analysis to determine the prevalence of significant fibrosis and advanced fibrosis in AAT deficiency based on non-invasive imaging. Methods: Medline and Embase electronic databases were searched for studies from inception to 13 November 2022 that provided data for the prevalence of fibrosis in adults with AAT deficiency. A generalised linear mixed model with Clopper-Pearson intervals was used to pool single-arm outcomes. Results: Of the 214 records identified, 8 studies were included. Five studies assessed fibrosis using vibration-controlled transient elastography. The prevalence of significant fibrosis (defined as ≥7.1 kPA) in Z homozygosity, Z heterozygosity and non-carrier status was 22.10% (five studies, 95% CI: 17.07-28.12), 9.24% (three studies, 95% CI: 4.68-17.45) and 5.38% (one study, 95% CI: 3.27-8.73), respectively, p < 0.0001, and the prevalence of advanced fibrosis (defined as ≥9.5 kPa) was 8.13% (five studies, 95% CI: 4.60-13.96), 2.96% (three studies, 95% CI: 1.49-5.81) and 1.08% (one study, 95% CI: 0.35-3.28), respectively, p = 0.003. There were limited data regarding the use of magnetic resonance elastography or acoustic radiation force impulse to assess for fibrosis. Conclusion: More than one in five adult individuals with AAT deficiency and Z homozygosity harbour significant fibrosis, and nearly 1 in 10 harbours advanced fibrosis. The risk of fibrosis increases incrementally with the frequency of Pi*Z mutations.
MeSH term(s)	Adult ; Humans ; Prevalence ; alpha 1-Antitrypsin Deficiency/complications ; alpha 1-Antitrypsin Deficiency/diagnosis ; alpha 1-Antitrypsin Deficiency/epidemiology ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/epidemiology ; Liver Cirrhosis/etiology
Language	English
Publishing date	2023-04-23
Publishing country	England
Document type	Systematic Review ; Meta-Analysis ; Journal Article ; Review ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	639012-2
ISSN	1365-2036 ; 0269-2813 ; 0953-0673
ISSN (online)	1365-2036
ISSN	0269-2813 ; 0953-0673
DOI	10.1111/apt.17516
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Zs.A 2206: Show issues

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Article ; Online: Clustering of Environmental Parameters and the Risk of Acute Ischaemic Stroke.

Koo, Geraldine P Y / Zheng, Huili / Aik, Joel C L / Tan, Benjamin Y Q / Sharma, Vijay K / Sia, Ching Hui / Ong, Marcus E H / Ho, Andrew F W

International journal of environmental research and public health

2023 Volume 20, Issue 6

Abstract: Acute ischaemic stroke (AIS) risk on days with similar environmental profiles remains unknown. We investigated the association between clusters of days with similar environmental parameters and AIS incidence in Singapore. We grouped calendar days from ... ...

Abstract	Acute ischaemic stroke (AIS) risk on days with similar environmental profiles remains unknown. We investigated the association between clusters of days with similar environmental parameters and AIS incidence in Singapore. We grouped calendar days from 2010 to 2015 with similar rainfall, temperature, wind speed, and Pollutant Standards Index (PSI) using k-means clustering. Three distinct clusters were formed 'Cluster 1' containing high wind speed, 'Cluster 2' having high rainfall, and 'Cluster 3' having high temperatures and PSI. We aggregated the number of AIS episodes over the same period with the clusters and analysed their association using a conditional Poisson regression in a time-stratified case-crossover design. Comparing the three clusters, Cluster 3 had the highest AIS occurrence (IRR 1.09; 95% confidence interval (CI) 1.05-1.13), with no significant difference between Clusters 1 and 2. Subgroup analyses in Cluster 3 showed that AIS risk was amplified in the elderly (≥65 years old), non-smokers, and those without a history of ischaemic heart disease/atrial fibrillation/vascular heart disease/peripheral vascular disease. In conclusion, we found that AIS incidence may be higher on days with higher temperatures and PSI. These findings have important public health implications for AIS prevention and health services delivery during at-risk days, such as during the seasonal transboundary haze.
MeSH term(s)	Aged ; Humans ; Air Pollution/analysis ; Brain Ischemia/epidemiology ; Cluster Analysis ; Environmental Pollutants ; Ischemic Stroke ; Seasons ; Stroke/epidemiology ; Stroke/etiology ; Cross-Over Studies
Chemical Substances	Environmental Pollutants
Language	English
Publishing date	2023-03-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20064979
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Article ; Online: The use of colchicine as an anti-inflammatory agent for stroke prevention in patients with coronary artery disease: a systematic review and meta-analysis.

Goh, Claire X Y / Tan, Ying Kiat / Tan, Choon Han / Leow, Aloysius S T / Ho, Jamie S Y / Tan, Natalie H W / Goh, Sherill / Ho, Andrew F W / Sharma, Vijay K / Chan, Bernard P L / Yeo, Leonard L L / Tan, Benjamin Y Q

Journal of thrombosis and thrombolysis

2022 Volume 54, Issue 1, Page(s) 183–190

Abstract: Objective: The primary objective is to evaluate the use of colchicine as an anti-inflammatory agent for stroke prevention in patients with coronary artery disease.: Background: There has been a rising number of randomized controlled trials conducted ... ...

Abstract	Objective: The primary objective is to evaluate the use of colchicine as an anti-inflammatory agent for stroke prevention in patients with coronary artery disease. Background: There has been a rising number of randomized controlled trials conducted in patients with coronary artery disease on the use of colchicine in reducing cardiovascular complications. Recent publications suggest colchicine reduces the risk of stroke and other cardiovascular events. Methods: We performed a systematic review of known trials in the current literature to characterize the clinical characteristics and outcomes of colchicine treatment in patients with coronary artery disease. A literature search was performed in PubMed, Embase and SCOPUS using a suitable keyword search strategy from inception to 4 June 2021. All studies evaluating cardiovascular outcomes of colchicine treatment in patients with coronary artery disease were included. Results: The systemic review included 5 randomized controlled trials assessing a total of 11,790 patients. Majority of studies used a colchicine dosing regimen of 0.5 mg once daily, with the median follow-up duration ranging from 6 to 36 months. Meta-analytic estimates for stroke incidence highlighted a statistically significant benefit for patients that were administered colchicine compared to placebo (OR 0.47, 95% CI 0.27-0.81, p = 0.006), and a non-significant benefit for myocardial infarction. There was no significant association between colchicine treatment and the adverse effects of gastrointestinal symptoms and myopathy/myalgia. Conclusions: The use of colchicine reduces the risk of stroke in patients with a history of coronary artery disease, without a significant increase in gastrointestinal and myopathy/myalgia adverse effects.
MeSH term(s)	Anti-Inflammatory Agents/therapeutic use ; Colchicine/therapeutic use ; Coronary Artery Disease/complications ; Coronary Artery Disease/drug therapy ; Humans ; Myalgia/chemically induced ; Myalgia/drug therapy ; Stroke/chemically induced ; Stroke/prevention & control
Chemical Substances	Anti-Inflammatory Agents ; Colchicine (SML2Y3J35T)
Language	English
Publishing date	2022-05-10
Publishing country	Netherlands
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1230645-9
ISSN	1573-742X ; 0929-5305
ISSN (online)	1573-742X
ISSN	0929-5305
DOI	10.1007/s11239-022-02659-9
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Zs.A 4352: Show issues

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Article ; Online: Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis.

Kamarajah, Sivesh K / Bundred, James / Tan, Benjamin H L

Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association

2018 Volume 22, Issue 1, Page(s) 10–22

Abstract: Introduction: There has recently been increased interest in the assessment of body composition in patients with gastric cancer for the purpose of prognostication. This systematic review and meta-analysis aim to evaluate the current literature on body ... ...

Abstract	Introduction: There has recently been increased interest in the assessment of body composition in patients with gastric cancer for the purpose of prognostication. This systematic review and meta-analysis aim to evaluate the current literature on body composition assessment in patients with gastric cancer and its impact on peri-operative outcomes. Methods: A systematic literature search was conducted for studies reporting assessment of body composition in patients with gastric cancers. Meta-analysis of postoperative outcomes (overall and major complications, anastomotic leaks, pulmonary complications) and survival was performed using random effects models. Results: Thirty-nine studies reported the assessment of body composition in 8402 patients. Methods used to assess body composition in patients with gastric cancers were computerized tomography (n = 26), bioelectrical impedance analysis (n = 9), and dual-energy-X-ray-absorptiometry (n = 3). Only 21 studies reported the impact of pre-operative sarcopenia on post-operative outcomes. Sarcopenic patients have significantly higher rates of postoperative major complications (n = 12, OR 1.67, CI Conclusions: Assessment of body composition has the potential to become a clinically useful tool that could support decision-making in patients with gastric cancer. However, variation in methods of assessing and reporting body composition in this patient group limits assessment of current post-operative outcomes.
MeSH term(s)	Body Composition ; Humans ; Prognosis ; Risk Factors ; Sarcopenia/diagnostic imaging ; Sarcopenia/etiology ; Stomach Neoplasms/complications ; Stomach Neoplasms/mortality
Language	English
Publishing date	2018-10-01
Publishing country	Japan
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1463526-4
ISSN	1436-3305 ; 1436-3291
ISSN (online)	1436-3305
ISSN	1436-3291
DOI	10.1007/s10120-018-0882-2
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Article ; Online: Clustering of Environmental Parameters and the Risk of Acute Ischaemic Stroke

Geraldine P. Y. Koo / Huili Zheng / Joel C. L. Aik / Benjamin Y. Q. Tan / Vijay K. Sharma / Ching Hui Sia / Marcus E. H. Ong / Andrew F. W. Ho

International Journal of Environmental Research and Public Health, Vol 20, Iss 4979, p

2023 Volume 4979

Abstract	Acute ischaemic stroke (AIS) risk on days with similar environmental profiles remains unknown. We investigated the association between clusters of days with similar environmental parameters and AIS incidence in Singapore. We grouped calendar days from 2010 to 2015 with similar rainfall, temperature, wind speed, and Pollutant Standards Index (PSI) using k-means clustering. Three distinct clusters were formed ‘Cluster 1’ containing high wind speed, ‘Cluster 2’ having high rainfall, and ‘Cluster 3’ having high temperatures and PSI. We aggregated the number of AIS episodes over the same period with the clusters and analysed their association using a conditional Poisson regression in a time-stratified case-crossover design. Comparing the three clusters, Cluster 3 had the highest AIS occurrence (IRR 1.09; 95% confidence interval (CI) 1.05–1.13), with no significant difference between Clusters 1 and 2. Subgroup analyses in Cluster 3 showed that AIS risk was amplified in the elderly (≥65 years old), non-smokers, and those without a history of ischaemic heart disease/atrial fibrillation/vascular heart disease/peripheral vascular disease. In conclusion, we found that AIS incidence may be higher on days with higher temperatures and PSI. These findings have important public health implications for AIS prevention and health services delivery during at-risk days, such as during the seasonal transboundary haze.
Keywords	ischaemic stroke ; cerebrovascular disease ; air pollution ; environmental epidemiology ; clustering ; haze ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Intra-Arterial Adjunctive Medications for Acute Ischemic Stroke During Mechanical Thrombectomy: A Meta-Analysis.

Chen, Vanessa H E / Lee, Grace K H / Tan, Choon-Han / Leow, Aloysius S T / Tan, Ying-Kiat / Goh, Claire / Gopinathan, Anil / Yang, Cunli / Chan, Bernard P L / Sharma, Vijay K / Tan, Benjamin Y Q / Yeo, Leonard L L

Stroke

2021 Volume 52, Issue 4, Page(s) 1192–1202

Abstract: Background and purpose: In patients with acute ischemic stroke with large vessel occlusion, the role of intra-arterial adjunctive medications (IAMs), such as urokinase, tPA (tissue-type plasminogen activator), or glycoprotein IIb/IIIa inhibitors, during ...

Abstract	Background and purpose: In patients with acute ischemic stroke with large vessel occlusion, the role of intra-arterial adjunctive medications (IAMs), such as urokinase, tPA (tissue-type plasminogen activator), or glycoprotein IIb/IIIa inhibitors, during mechanical thrombectomy (MT) has not been clearly established. We aim to evaluate the efficacy and safety of concomitant or rescue IAM for acute ischemic stroke with large vessel occlusion patients undergoing MT. Methods: We searched Medline, Embase, and Cochrane Stroke Group Trials Register databases from inception until March 13, 2020. We analyzed all studies with patients diagnosed with acute ischemic stroke with large vessel occlusion in the anterior or posterior circulation that provided data for the two treatment arms, (1) MT+IAM and (2) MT only, and also reported on at least one of the following efficacy outcomes, recanalization and 90-day modified Rankin Scale, or safety outcomes, symptomatic intracranial hemorrhage and 90-day mortality. Data were collated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Sixteen nonrandomized observational studies with a total of 4581 patients were analyzed. MT only was performed in 3233 (70.6%) patients, while 1348 (29.4%) patients were treated with both MT and IAM. As compared with patients treated with MT alone, patients treated with combination therapy (MT+IAM) had a higher likelihood of achieving good functional outcome (risk ratio, 1.13 [95% CI, 1.03-1.24]) and a lower risk of 90-day mortality (risk ratio, 0.82 [95% CI, 0.72-0.94]). There was no significant difference in successful recanalization (risk ratio, 1.02 [95% CI, 0.99-1.06]) and symptomatic intracranial hemorrhage between the two groups (risk ratio, 1.13 [95% CI, 0.87-1.46]). Conclusions: In acute ischemic stroke with large vessel occlusion, the use of IAM together with MT may achieve better functional outcomes and lower mortality rates. Randomized controlled trials are warranted to establish the safety and efficacy of IAM as adjunctive treatment to MT.
MeSH term(s)	Fibrinolytic Agents/therapeutic use ; Humans ; Ischemic Stroke/therapy ; Thrombectomy/methods ; Thrombolytic Therapy/methods
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2021-02-22
Publishing country	United States
Document type	Journal Article ; Meta-Analysis
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.120.031738
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