Clinical benign prostatic hyperplasia(BPH)is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms(LUTS).The prevalence of BPH increases after the age of 40 years,with...Clinical benign prostatic hyperplasia(BPH)is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms(LUTS).The prevalence of BPH increases after the age of 40 years,with a prevalence of 8%-60% at age 90 years.Some data have suggested that there is decreased risk among the Asians compared to the western white population.Genetics,diet and life style may play a role here.Recent reports suggest the strong relationship of clinical BPH with metabolic syndrome and erectile dysfunction,as well as the possible role of inflammation as a cause of the prostatic hyperplasia.Lifestyle changes including exercise and diet are important strategies in controlling this common ailment.展开更多
Objective:Men with benign prostate hyperplasia(BPH)with good urinary flow may still have bladder outlet obstruction(BOO).Intravesical prostatic protrusion(IPP)has been shown to be able to predict BOO.We aim to investi...Objective:Men with benign prostate hyperplasia(BPH)with good urinary flow may still have bladder outlet obstruction(BOO).Intravesical prostatic protrusion(IPP)has been shown to be able to predict BOO.We aim to investigate the use of IPP to predict BOO in men with good urinary flow.Methods:One hundred and fourteen consecutive men(>50 years old)presenting with lower urinary tract symptoms suggestive of BPH were recruited in 2001 and 2002.They were evaluated with serum prostate specific antigen(PSA),uroflowmetry and transabdominal ultrasound measurement of IPP and prostate volume(PV).Pressure-flow urodynamic studies were performed on all men and BOO was defined by BOO index>40.Men with Qmax12.0 mL/s were considered to have good flow.Results:Among the 114 men,61 patients had good urinary flow.Their median age,PV and Qmax were 66 years,32.9 mm3 and 14.5 mL/s respectively.14/61(23.0%)patients had BOO and their distribution of IPP were as follows:Grade 1 e 0/20(0%)obstructed,Grade 2 e 6/22(27.3%)and Grade 3 e 8/19(42.1%).Sensitivity of Grade 2/3 IPP for BOO was 100% while specificity of Grade 3 IPP was 76.6%.The area-under-curve(AUC)for IPP was greater than that for PV(0.757 vs.0.696).Conclusion:Even in men with good flow,high grades of IPP were more likely to have BOO and hence,may be a useful adjunct to predict BOO.展开更多
Background Case-finding is a recommended approach for dementia early detection in the community.Aims To investigate the discriminant validity and cost-effectiveness of a stepwise dementia case-finding approach in a Si...Background Case-finding is a recommended approach for dementia early detection in the community.Aims To investigate the discriminant validity and cost-effectiveness of a stepwise dementia case-finding approach in a Singaporean older adult community.Methods The two-phase study was conducted in the community from 2009 to 2015 in Singapore.A total of 3780 participants(age≥60 years)completed phase I(a brief cognitive screening);918 completed phase II and were included in the final analysis.In phase I,all participants were administered the Abbreviated Mental Test(AMT)and the Progressive Forgetfulness Question(PFQ).Those who screened positive on either test were invited to phase II,whereby the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and a formal neuropsychological battery were administered,followed by the research diagnosis of no cognitive impairment,cognitive impairment no dementia(CIND)-Mild(≤2 impaired cognitive domains),CIND-Moderate(>2 impaired domains)or dementia.Receiver operating characteristic curve analyses were conducted for the different cognitive instruments.All discriminant indices were calculated,including sensitivity,specificity,positive and negative predictive values(NPV)and accuracy.Cost-effectiveness analysis was conducted by estimating the amount of screening time needed and the number of older adults requiring re-evaluation in two case-finding scenarios,ie,with or without preselection by the PFQ.Results The stepwise case-finding approach(preselection by the PFQ,then MMSE or MoCA or AMT)showed an excellent NPV(>99%)and accuracy(>86%)for excluding dementia-free cases.Without preselection by the PFQ,screening time for the three cognitive tools were 317.5,317.5 and 254 hours,with 159,302 and 175 screen-positive older adults involved in further evaluation.By adopting the stepwise case-finding approach,total screening time were 156.5,156.5 and 126.2 hours,which decreased by 50.7%,50.7% and 50.3% as compared with those without preselection.Furthermore,after preselection,only 98,167 and 145 screen-positive older adults required further evaluation,corresponding to a reduction of 38.4%,44.7% and 17.1% in the numbers compared with those without preselection.Conclusions A stepwise approach for dementia case-finding should be implemented in the community to minimise the time and resources needed for large-scale early detection of dementia.展开更多
BACKGROUND Cerebral venous sinus thrombosis(CVT)is rare cause of cerebrovascular disease.The incidence is 0.5%of all stroke.The majority of affected patients are young adults(mean age:35-40 years)with mild to moderate...BACKGROUND Cerebral venous sinus thrombosis(CVT)is rare cause of cerebrovascular disease.The incidence is 0.5%of all stroke.The majority of affected patients are young adults(mean age:35-40 years)with mild to moderate disabilities.Poor outcome with severe disability is seen in 13%of cases.Early diagnosis and treatment are important for good outcomes and preventing complications.Treatment options are limited and mostly based on consensus.NeuroAiD II™(MLC901;Moleac Pte,Ltd,Singapore)has a potential beneficial role in post-stroke recovery,by aiding the natural brain recovery process.CASE SUMMARY MLC901 consists of nine natural herbal ingredients.Studies have shown its safety profile and aid in post stroke recovery.The aim of this case series was to demonstrate the potential role of MLC901 in stroke recovery of patients with cerebral venous sinus thrombosis(CVST)who received MLC901 in addition to standard of care.The prescribed dose of MLC901 is 400 mg/cap two capsules,three times a day.Data from these patients were prospectively collected at baseline and at monthly visits,for a duration of 3 mo.Outcome measures included adherence to therapy,side effects,National Institutes of Health Stroke Scale,Glasgow Coma Scale,modified Rankin Scale,and the Short Orientation-Memory-Concentration Test.MLC901 was well tolerated and no side effects were reported.All patients were stable with improved condition.CONCLUSION This case series highlights the potential therapeutic effects of MLC901 on CVST and provides support for further studies.展开更多
Introduction: Insomnia is a common but often underdiagnosed and undertreated condition among cancer patients, significantly impacting their quality of life (QoL). Oncologists play a crucial role in managing insomnia, ...Introduction: Insomnia is a common but often underdiagnosed and undertreated condition among cancer patients, significantly impacting their quality of life (QoL). Oncologists play a crucial role in managing insomnia, yet their knowledge and practices in this area remain unclear. This study aims to assess the current practices of oncologists in Singapore regarding insomnia management and to identify areas where additional education may be needed. Methods: We conducted a cross-sectional survey of practicing medical and radiation oncologists in Singapore. The survey, based on the 2023 ESMO Clinical Practice Guideline for managing insomnia in adult cancer patients, included 12 multiple-choice, checkbox, and open-ended questions. Data were analyzed descriptively to identify trends in screening, assessment, and management of insomnia among oncologists. Results: A total of 25 oncologists responded to the survey. The majority (84%) do not routinely screen for sleep disturbances, and only a small fraction uses validated tools to assess insomnia severity. Time constraints and a lack of knowledge were identified as the primary barriers to comprehensive sleep assessments. Pharmacological treatments, particularly melatonin and Z-class drugs, were commonly initiated, with 32% of oncologists using them as first-line therapy. Non-pharmacological strategies, such as cognitive behavioral therapy for insomnia, were underutilized. Additionally, many oncologists expressed uncertainty about when to refer patients to sleep specialists, indicating a gap in their training and confidence in managing insomnia. Conclusion: This study reveals significant gaps in the routine screening and comprehensive management of insomnia among oncologists in Singapore. Despite the high prevalence of sleep disturbances in cancer patients, oncologists often prioritize other symptoms and lack the necessary tools and knowledge to address insomnia effectively. The findings underscore the need for targeted educational interventions to enhance oncologists’ competence in diagnosing and managing insomnia, ultimately improving patient care.展开更多
Background MLC1501,consisting of four herbs,that is,Radix Astragali,Radix Angelicae sinensis,Rhizoma Chuanxiong,Radix Polygalae,has the same pharmacological properties as its precursors MLC601 and MLC901 which contain...Background MLC1501,consisting of four herbs,that is,Radix Astragali,Radix Angelicae sinensis,Rhizoma Chuanxiong,Radix Polygalae,has the same pharmacological properties as its precursors MLC601 and MLC901 which contain extracts of nine herbs and showed neuroprotective,anti-inflammatory and neurorestorative properties in non-clinical models,as well as clinical benefits in improving functional and neurological recovery after brain injuries.Aims To determine the efficacy of MLC1501 on motor recovery as measured by Fugl-Meyer motor Assessment(FMA)total score at 24 weeks in patients with ischaemic stroke(IS).Design A total of 300 patients aged>18 years,diagnosed with IS in the prior 2-10 days,with National Institute of Health Stroke Scale(NIHSS)total score of 8-18 and a combined score of≥3 on NIHSS motor items 5A,5B,6A and/or 6B,will be randomised in a 1:1:1 ratio to receive oral placebo,MLC1501 low dose or MLC1501 high dose for 6 months.The study is governed by a Steering Committee.An independent Data Monitoring Committee oversees patient safety.Outcomes The primary outcome is mean change from baseline in FMA total score at 24 weeks.Efficacy outcomes evaluated in person at baseline,12 weeks and 24 weeks include the FMA(total,upper extremity and lower extremity motor scores),modified Rankin Scale(mRS),Patient-Reported Outcomes Measurement Information System-Global Health(PROMIS-10)and NIHSS.Additionally,telephone assessment at week 4 includes the simplified mRS and PROMIS-10.Safety will be evaluated by standard assessments and occurrence of adverse events over the duration of the study.Discussion Interventions that enhance recovery beyond the acute period of stroke are needed.MLC1501 has a good safety profile as well as potential to be a treatment for recovery after brain injury.The results of this study will provide objective level B evidence on the efficacy of MLC1501 on long-term recovery and safety of 24 weeks of treatment among patients with IS.展开更多
Objective To explore the additive effect of neurodegenerative diseases,measured by atrophy,on neurocognitive function in Asian dementia-free elderly with cerebrovascular disease(CeVD).Methods The present study employe...Objective To explore the additive effect of neurodegenerative diseases,measured by atrophy,on neurocognitive function in Asian dementia-free elderly with cerebrovascular disease(CeVD).Methods The present study employed a cross-sectional design and was conducted between 2010 and 2015 among community-dwelling elderly participants recruited into the study.Eligible participants were evaluated with an extensive neuropsychological battery and neuroimaging.The weighted CeVD burden scale comprising markers of both small-and large-vessel diseases was applied,with a score of≥2,indicating significant CeVD burden.Cortical atrophy(CA)and medial temporal atrophy(MTA)were graded using the global cortical atrophy scale and Schelten's scale,respectively.Global and domain-specific(attention,executive function,language,visuomotor speed,visuoconstruction,visual memory,and verbal memory)neurocognitive performance was measured using a locally validated neuropsychological battery(Vascular Dementia Battery,VDB).Results A total of 819 dementia-free participants were included in the analysis.Among none-mild CeVD subjects,there was no significant difference in the global cognitive performance across atrophy groups(no atrophy,CA,and CA+MTA).However,in moderate-severe CeVD subjects,CA+MTA showed significantly worse global cognitive performance compared with those with CA alone(mean difference=?0.35,95%CI?0.60 to?0.11,p=0.002)and those without atrophy(mean difference=?0.46,95%CI?0.74 to?0.19,p<0.001,p<0.001).In domain-specific cognitive performance,subjects with CA+MTA performed worse than other groups in visual memory(p=0.005),executive function(p=0.001)and visuomotor speed(p<0.001)in moderate-severe CeVD but not in none-mild CeVD.Conclusions and relevance Atrophy and moderate-severe CeVD burden showed an additive effect on global and domain-specific cognitive performance.This study highlights the importance of investigating the mechanisms of clinico-pathological interactions between neurodegenerative processes and vascular damage,particularly in the pre-dementia stage.展开更多
文摘Clinical benign prostatic hyperplasia(BPH)is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms(LUTS).The prevalence of BPH increases after the age of 40 years,with a prevalence of 8%-60% at age 90 years.Some data have suggested that there is decreased risk among the Asians compared to the western white population.Genetics,diet and life style may play a role here.Recent reports suggest the strong relationship of clinical BPH with metabolic syndrome and erectile dysfunction,as well as the possible role of inflammation as a cause of the prostatic hyperplasia.Lifestyle changes including exercise and diet are important strategies in controlling this common ailment.
文摘Objective:Men with benign prostate hyperplasia(BPH)with good urinary flow may still have bladder outlet obstruction(BOO).Intravesical prostatic protrusion(IPP)has been shown to be able to predict BOO.We aim to investigate the use of IPP to predict BOO in men with good urinary flow.Methods:One hundred and fourteen consecutive men(>50 years old)presenting with lower urinary tract symptoms suggestive of BPH were recruited in 2001 and 2002.They were evaluated with serum prostate specific antigen(PSA),uroflowmetry and transabdominal ultrasound measurement of IPP and prostate volume(PV).Pressure-flow urodynamic studies were performed on all men and BOO was defined by BOO index>40.Men with Qmax12.0 mL/s were considered to have good flow.Results:Among the 114 men,61 patients had good urinary flow.Their median age,PV and Qmax were 66 years,32.9 mm3 and 14.5 mL/s respectively.14/61(23.0%)patients had BOO and their distribution of IPP were as follows:Grade 1 e 0/20(0%)obstructed,Grade 2 e 6/22(27.3%)and Grade 3 e 8/19(42.1%).Sensitivity of Grade 2/3 IPP for BOO was 100% while specificity of Grade 3 IPP was 76.6%.The area-under-curve(AUC)for IPP was greater than that for PV(0.757 vs.0.696).Conclusion:Even in men with good flow,high grades of IPP were more likely to have BOO and hence,may be a useful adjunct to predict BOO.
基金funded by National Natural Science Foundation of China(72274170)Interdisciplinary Research Project of the Zhejiang University(519600*17222022201)+1 种基金National Medical Research Council(R-184-006-184-511)Dean’s Fund Research of the Zhejiang University(188021-171257702/004/010).
文摘Background Case-finding is a recommended approach for dementia early detection in the community.Aims To investigate the discriminant validity and cost-effectiveness of a stepwise dementia case-finding approach in a Singaporean older adult community.Methods The two-phase study was conducted in the community from 2009 to 2015 in Singapore.A total of 3780 participants(age≥60 years)completed phase I(a brief cognitive screening);918 completed phase II and were included in the final analysis.In phase I,all participants were administered the Abbreviated Mental Test(AMT)and the Progressive Forgetfulness Question(PFQ).Those who screened positive on either test were invited to phase II,whereby the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and a formal neuropsychological battery were administered,followed by the research diagnosis of no cognitive impairment,cognitive impairment no dementia(CIND)-Mild(≤2 impaired cognitive domains),CIND-Moderate(>2 impaired domains)or dementia.Receiver operating characteristic curve analyses were conducted for the different cognitive instruments.All discriminant indices were calculated,including sensitivity,specificity,positive and negative predictive values(NPV)and accuracy.Cost-effectiveness analysis was conducted by estimating the amount of screening time needed and the number of older adults requiring re-evaluation in two case-finding scenarios,ie,with or without preselection by the PFQ.Results The stepwise case-finding approach(preselection by the PFQ,then MMSE or MoCA or AMT)showed an excellent NPV(>99%)and accuracy(>86%)for excluding dementia-free cases.Without preselection by the PFQ,screening time for the three cognitive tools were 317.5,317.5 and 254 hours,with 159,302 and 175 screen-positive older adults involved in further evaluation.By adopting the stepwise case-finding approach,total screening time were 156.5,156.5 and 126.2 hours,which decreased by 50.7%,50.7% and 50.3% as compared with those without preselection.Furthermore,after preselection,only 98,167 and 145 screen-positive older adults required further evaluation,corresponding to a reduction of 38.4%,44.7% and 17.1% in the numbers compared with those without preselection.Conclusions A stepwise approach for dementia case-finding should be implemented in the community to minimise the time and resources needed for large-scale early detection of dementia.
文摘BACKGROUND Cerebral venous sinus thrombosis(CVT)is rare cause of cerebrovascular disease.The incidence is 0.5%of all stroke.The majority of affected patients are young adults(mean age:35-40 years)with mild to moderate disabilities.Poor outcome with severe disability is seen in 13%of cases.Early diagnosis and treatment are important for good outcomes and preventing complications.Treatment options are limited and mostly based on consensus.NeuroAiD II™(MLC901;Moleac Pte,Ltd,Singapore)has a potential beneficial role in post-stroke recovery,by aiding the natural brain recovery process.CASE SUMMARY MLC901 consists of nine natural herbal ingredients.Studies have shown its safety profile and aid in post stroke recovery.The aim of this case series was to demonstrate the potential role of MLC901 in stroke recovery of patients with cerebral venous sinus thrombosis(CVST)who received MLC901 in addition to standard of care.The prescribed dose of MLC901 is 400 mg/cap two capsules,three times a day.Data from these patients were prospectively collected at baseline and at monthly visits,for a duration of 3 mo.Outcome measures included adherence to therapy,side effects,National Institutes of Health Stroke Scale,Glasgow Coma Scale,modified Rankin Scale,and the Short Orientation-Memory-Concentration Test.MLC901 was well tolerated and no side effects were reported.All patients were stable with improved condition.CONCLUSION This case series highlights the potential therapeutic effects of MLC901 on CVST and provides support for further studies.
文摘Introduction: Insomnia is a common but often underdiagnosed and undertreated condition among cancer patients, significantly impacting their quality of life (QoL). Oncologists play a crucial role in managing insomnia, yet their knowledge and practices in this area remain unclear. This study aims to assess the current practices of oncologists in Singapore regarding insomnia management and to identify areas where additional education may be needed. Methods: We conducted a cross-sectional survey of practicing medical and radiation oncologists in Singapore. The survey, based on the 2023 ESMO Clinical Practice Guideline for managing insomnia in adult cancer patients, included 12 multiple-choice, checkbox, and open-ended questions. Data were analyzed descriptively to identify trends in screening, assessment, and management of insomnia among oncologists. Results: A total of 25 oncologists responded to the survey. The majority (84%) do not routinely screen for sleep disturbances, and only a small fraction uses validated tools to assess insomnia severity. Time constraints and a lack of knowledge were identified as the primary barriers to comprehensive sleep assessments. Pharmacological treatments, particularly melatonin and Z-class drugs, were commonly initiated, with 32% of oncologists using them as first-line therapy. Non-pharmacological strategies, such as cognitive behavioral therapy for insomnia, were underutilized. Additionally, many oncologists expressed uncertainty about when to refer patients to sleep specialists, indicating a gap in their training and confidence in managing insomnia. Conclusion: This study reveals significant gaps in the routine screening and comprehensive management of insomnia among oncologists in Singapore. Despite the high prevalence of sleep disturbances in cancer patients, oncologists often prioritize other symptoms and lack the necessary tools and knowledge to address insomnia effectively. The findings underscore the need for targeted educational interventions to enhance oncologists’ competence in diagnosing and managing insomnia, ultimately improving patient care.
文摘Background MLC1501,consisting of four herbs,that is,Radix Astragali,Radix Angelicae sinensis,Rhizoma Chuanxiong,Radix Polygalae,has the same pharmacological properties as its precursors MLC601 and MLC901 which contain extracts of nine herbs and showed neuroprotective,anti-inflammatory and neurorestorative properties in non-clinical models,as well as clinical benefits in improving functional and neurological recovery after brain injuries.Aims To determine the efficacy of MLC1501 on motor recovery as measured by Fugl-Meyer motor Assessment(FMA)total score at 24 weeks in patients with ischaemic stroke(IS).Design A total of 300 patients aged>18 years,diagnosed with IS in the prior 2-10 days,with National Institute of Health Stroke Scale(NIHSS)total score of 8-18 and a combined score of≥3 on NIHSS motor items 5A,5B,6A and/or 6B,will be randomised in a 1:1:1 ratio to receive oral placebo,MLC1501 low dose or MLC1501 high dose for 6 months.The study is governed by a Steering Committee.An independent Data Monitoring Committee oversees patient safety.Outcomes The primary outcome is mean change from baseline in FMA total score at 24 weeks.Efficacy outcomes evaluated in person at baseline,12 weeks and 24 weeks include the FMA(total,upper extremity and lower extremity motor scores),modified Rankin Scale(mRS),Patient-Reported Outcomes Measurement Information System-Global Health(PROMIS-10)and NIHSS.Additionally,telephone assessment at week 4 includes the simplified mRS and PROMIS-10.Safety will be evaluated by standard assessments and occurrence of adverse events over the duration of the study.Discussion Interventions that enhance recovery beyond the acute period of stroke are needed.MLC1501 has a good safety profile as well as potential to be a treatment for recovery after brain injury.The results of this study will provide objective level B evidence on the efficacy of MLC1501 on long-term recovery and safety of 24 weeks of treatment among patients with IS.
基金The Epidemiology of Dementia in Singapore study is supported by the NMRC Centre Grant-Memory Aging and Cognition Centre(MACC)-Theme 5(NMRC/CG/NUHS/2010-R-184-006-184-511)NUHS Bridging Fund(NUHSRO/2013/114/5+5 budget/01)+1 种基金NMRC Clinician Scientist Award(NMRC/CSA/038/2013)and NMRC Centre Grant-NUHS-Metabolic Medicine,Infectious Diseases,Neuroscience Enablers(MINE)(NMRC/CG/013/2013).
文摘Objective To explore the additive effect of neurodegenerative diseases,measured by atrophy,on neurocognitive function in Asian dementia-free elderly with cerebrovascular disease(CeVD).Methods The present study employed a cross-sectional design and was conducted between 2010 and 2015 among community-dwelling elderly participants recruited into the study.Eligible participants were evaluated with an extensive neuropsychological battery and neuroimaging.The weighted CeVD burden scale comprising markers of both small-and large-vessel diseases was applied,with a score of≥2,indicating significant CeVD burden.Cortical atrophy(CA)and medial temporal atrophy(MTA)were graded using the global cortical atrophy scale and Schelten's scale,respectively.Global and domain-specific(attention,executive function,language,visuomotor speed,visuoconstruction,visual memory,and verbal memory)neurocognitive performance was measured using a locally validated neuropsychological battery(Vascular Dementia Battery,VDB).Results A total of 819 dementia-free participants were included in the analysis.Among none-mild CeVD subjects,there was no significant difference in the global cognitive performance across atrophy groups(no atrophy,CA,and CA+MTA).However,in moderate-severe CeVD subjects,CA+MTA showed significantly worse global cognitive performance compared with those with CA alone(mean difference=?0.35,95%CI?0.60 to?0.11,p=0.002)and those without atrophy(mean difference=?0.46,95%CI?0.74 to?0.19,p<0.001,p<0.001).In domain-specific cognitive performance,subjects with CA+MTA performed worse than other groups in visual memory(p=0.005),executive function(p=0.001)and visuomotor speed(p<0.001)in moderate-severe CeVD but not in none-mild CeVD.Conclusions and relevance Atrophy and moderate-severe CeVD burden showed an additive effect on global and domain-specific cognitive performance.This study highlights the importance of investigating the mechanisms of clinico-pathological interactions between neurodegenerative processes and vascular damage,particularly in the pre-dementia stage.
