Lower Kent Ridge Road Research Articles

Simulation of cardiopulmonary bypass management: an approach to resident training.

From the *Department of Anesthesia; and †Yong Loo Lin School of Medicine, National University Healthcare System, Singapore, Singapore. Address reprint requests to Rex J. Morais, Department of Anesthesia, National University Healthcare System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. E-mail: rex_joseph_morais@nuhs.edu.sg © 2014 Elsevier Inc. All rights reserved. 1053-0770/2601-0001$36.00/0 http://dx.doi.org/10.1053/j.jvca.2014.05.026

Implications of Morbid Obesity and Surgery for the Obese

1University Surgical Cluster, National University Hospital, Singapore Address for Correspondence: A/Prof So Bok Yan, University Surgical Cluster, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. Email: jimmy_so@nuhs.edu.sg Since the dawn of mankind, the survival of the species theory mandates the adaptation of complex mammalian bodies to harsh climates and unfavourable environments. With abundant nutrition, sedentary lifestyle and modern transportation amongst many other comforts of urbanisation, many of the overweight and obese men today would be unrecognisable from the common man in the days of Socrates, Leonardo Da Vinci and even Thomas Edison. Modern healthcare facilities are plagued with diseases of the metabolic syndrome as the rate of obesity in Singapore and most developed countries rises unchecked. This is now a global public health problem, a pandemic plaguing the rich and the poor, the young and the old, the movers and shakers and even the downtrodden. According to the Ministry of Health, Singapore, the overall prevalence of obesity in 2010 is 11%, with 1.7 million of Singaporeans being at risk of obesity-related health problems.1 Body mass index (BMI) is commonly used to objectively measure the status of weight. BMI is calculated as weight in kilograms divided by the height in meters squared (m2). According to the WHO classifi cation of overweight and obese in Asian countries, an overweight individual has a BMI between 23 and 27.5 kg/m2. In Singapore and Asia-Pacifi c countries, an obese person is defi ned as a person with BMI of 27.5 kg/m2 or more.2 Obesity is classifi ed by WHO as a chronic disease, a multisystemic disease resulting from complex interaction between the human genotype and the environment. Morbid obesity is defi ned as patients whose weight is more than twice their ideal body weight and/or 100 pounds or more overweight. As part of the 1998 National Health Survey in Singapore, a study by Deurenberg-Yap et al from the Ministry of Health was published. It showed that for the same amount of body fat as Caucasians, the BMI in Chinese, Malays or Indians would be lower. For example, the BMI cut-off points for obesity would have to be about 27 kg/m2 for Chinese and Malays and 26 kg/m2 for Indians compared to the BMI of 30 kg/m2 in Caucasians (cut-off for obesity as defi ned by WHO). This is the paradox of low BMI and high body fat percentage among Chinese, Malays and Indians in Singapore.3 Morbid obesity may affect every organ system such as the cardiovascular, respiratory, metabolic, musculoskeletal, gastrointestinal, urological, endocrine and reproductive, dermatological, neurological and psychological systems, thus increasing the risks of developing many diseases. High BMI is on average associated with about 30% higher overall mortality — 40% increased mortality rate for vascular mortality, 60% to 120% for diabetic, renal, and hepatic mortality, 10% for neoplastic mortality and 20% for respiratory and for all other mortality.4 Various comorbid conditions coexist or are common in the obese such as: • hypertension, atherosclerotic heart and peripheral vascular disease with myocardial infarction and cerebral vascular accidents, peripheral venous insuffi ciency, thrombophlebitis, pulmonary embolism • asthma, obstructive sleep apnea, obesityhypoventilation syndrome • type 2 diabetes, impaired glucose tolerance, dyslipidemia • cholelithiasis, gastroesophageal refl ux disease • non-alcoholic fatty liver disease or steatohepatitis, hepatic cirrhosis • hepatic carcinoma, colorectal carcinoma, cancer of the endometrium, breast, ovary, prostate, pancreas • back strain, disc disease, osteoarthritis of the hips, knees, ankles, feet • polycystic ovary syndrome, increased risk of pregnancy and foetal abnormalities, male hypogonadism • intertriginous dermatitis • pseudotumour cerebri • carpal tunnel syndrome • depression, eating disorders, body image disturbance.

Capsular Warning Syndrome-Better Observation or a New Disease?

Prakash R Paliwal1 and Vijay K Sharma1,2* 1Division of Neurology, National University Hospital, Singapore 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore *Corresponding author: Dr. Vijay K Sharma, Division of Neurology, Department of Medicine, National University Hospital 5 Lower Kent Ridge Road, Singapore 119074, Tel: 65-67724126; Fax: 65-68723566; E-mail: drvijay@singnet.com.sg

Cerebral Venous Thrombosis: A Path Less Travelled and making a Difference

Joy Vijayan1 and Vijay K Sharma1,2* 1Division of Neurology, National University Hospital, Singapore 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore *Corresponding author: Dr. Vijay K Sharma, Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Tel: 6567724126; Fax: 65-68723566; E-mail: drvijay@singnet.com.sg

Noninvasive Ventilation in Acute Ischemic Stroke

Amanda Chee Yun Chan1 and Vijay K Sharma1,2* 1Division of Neurology, National University Hospital, Singapore 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore *Corresponding author: Dr. Vijay K Sharma, Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Tel: 65-67724126; Fax: 65-68723566; E-mail: drvijay@singnet.com.sg

Thyroglobulin and thyroglobulin autoantibodies: interpret with care

A middle-aged lady with a past history of hyperlipidemia presented to our institution with worsening of a lower back pain that has been present for a year. The back pain radiated down her left lower limb and was associated with left foot numbness and nocturnal pain. On examination, a mass was palpated in the left iliac fossa. A full body CT scan revealed a soft tissue lesion with central necrosis and bony destruction of the left iliac bone, a similar bony lesion in the left 6th rib, and a thyroid mass. An ultrasound of thyroid gland showed a cystic nodule with interrupted calcified rim. A biopsy of the left iliac fossa mass was reported as metastatic follicular thyroid carcinoma. She underwent total thyroidectomy and was given four courses of radioiodine after a failed debulking surgery. During follow up, she was comanaged with another institution where she received the radioiodine therapy. Her thyroglobulin autoantibodies (TgAb) and thyroglobulin (Tg) concentrations were measured by both institutions. Interestingly, at our institution, her TgAb were always undetectable and her Tg showed rapidly decreasing trend (both Immulite 2000, Siemens). At the other institution, her TgAb were strongly positive and her Tg concentrations showed a different trend and were closely mirrored by TgAb concentrations (both Kryptor, B R A H M S) (Fig. 1). The Immulite 2000 TgAb method employs a chemiluminescence sequential immunometric format. On the other hand, the Kryptor TgAb method is a fluorescence competitive immunoassay. This report was exempted from local institutional board review. This case illustrated several important points about interpretation of Tg and TgAb. Tg is produced by the thyroid gland and is a tumor marker for differentiated thyroid cancers (DTC). TgAb are autoantibodies that may develop in autoimmune thyroid diseases or DTC. TgAb must be simultaneously measured with Tg as they may interfere with and falsely lower Tg measurements. When TgAb are positive, the Tg results should be interpreted with care and the TgAb may be used as surrogate tumor marker, as detailed in this clinical review [1]. Rising or stable TgAb trends are associated with increased risk of residual disease, metastasis, or recurrence, while a declining trend suggests the risks are low [1]. This approach remains controversial and more evidence is needed to establish its role in routine clinical care. An emerging and promising alternative is the use of mass spectrometric methods to measure Tg that may avoid the interference from TgAb. TgAb have been shown to be heterogeneous and have different epitopes between individuals, and are associated with histologic features of lymphocytic thyroiditis [2]. They are detected variably using different laboratory assays and may be classified differently in nearly 40 % of patients with papillary thyroid cancer with lymphocytic thyroiditis [3]. In patients with lymphocytic thyroiditis, it is probably prudent to confirm a negative TgAb with an alternate assay when Tg is unexpectedly undetectable [2, 3]. This patient did not have histologic evidence of lymphocytic thyroiditis yet showed highly discrepant TgAb results. The discrepancy may be accounted for by the use T. P. Loh (&) Department of Laboratory Medicine, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore, Singapore e-mail: lohtp@yahoo.com

Advances in simulation optimization and its applications

Advances in simulation optimization and its applications Loo Hay Lee a , Ek Peng Chew a , Peter I. Frazier b , Qing-Shan Jia c & Chun-Hung Chen d e a Department of Industrial & Systems Engineering, National University of Singapore, 21 Lower Kent Ridge Road, 119077, Singapore b School of Operations Research and Information Engineering, Cornell University, Ithaca, NY, 14853, USA c Department of Automation, Tsinghua University, Beijing, China d Department of Systems Engineering & Operations Research, George Mason University, Fairfax, VA, 22030, USA e Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan Published online: 10 Apr 2013.

Anaplastic large cell lymphoma of the vertebra masquerading as tuberculous spondylitis: potential pitfalls of conventional imaging

A 26-year-old woman presented with a 6-month history of progressive neck pain associated with a 1-month history of fever, cough, and weight loss. Physical examination revealed a febrile patient with a temperature of 39.1 C. There were localized tenderness and reduced range of motion at the cervicothoracic region of the spine. There was no neurological deficit. Laboratory findings revealed a raised white blood cell count of 21.6 9 10/L. There was elevation of inflammatory markers such as erythrocyte sedimentation rate (79 mm/hr) and C-reactive protein (137 mg/L). Serum lactate dehydrogenase and tumor markers such as alpha-fetoprotein, beta-human chorionic gonadotropin, carcinoembryonic antigen, and CA-125 levels were normal. Radiographs of the cervical spine and chest revealed bony erosions in the C7 and T1 vertebrae (Fig. 1, arrowhead), and right upper lobe consolidation with air bronchograms (Fig. 1, arrow). Contrast-enhanced computed tomography (CT) scan showed bony erosions with pathological fractures involving the C7 to T3 vertebrae (Fig. 2a, b, arrows). An adjacent large paravertebral thick-walled rim-enhancing lesion was seen (Fig. 2c, arrow). There was lung consolidation in the posterior segment of the right upper lobe (Fig. 2d, arrow) as well as prominent mediastinal and retroperitoneal (Fig. 2e, arrow) lymph nodes. Gadolinium-enhanced magnetic resonance imaging (MRI) of the spine was performed to evaluate the soft tissues and spinal cord. MRI revealed altered marrow signal and abnormal enhancement in the C7 to T4 vertebrae with adjacent enhancing subligamentous and epidural masses as well as mild kyphosis (Fig. 3, arrows). There was relative sparing of most of the intervertebral disks. The radiographic, CT, and MRI findings were typical of pulmonary tuberculosis (TB) with tuberculosis spondylitis. The clinical findings further corroborated this presumptive diagnosis. However, multiple induced sputum specimens were negative for acid-fast bacilli smears and molecular TB tests. Moreover, the vertebral destruction seemed more extensive than expected for TB that had been symptomatic for only 6 months. Hence the possibility of an alternative diagnosis was entertained. [F]fluorodeoxyglucose positron emission tomography/ computed tomography (FDG-PET/CT) scan (Biograph mCT 64-slice, Siemens AG, Erlangen, Germany) was subsequently performed to assess the extent and pattern of disease, and to determine the most suitable site for biopsy. The PET/CT scan showed FDG-avid vertebral and paravertebral masses (standardized uptake value, SUVmax 28.3) extending from the C7 to T4 vertebrae (Fig. 4a, arrow), FDG-avid lung consolidation with air bronchograms (SUVmax 7.9) in the right upper lobe (Fig. 4b, arrows), FDG-avid lesions in both kidneys (SUVmax 11.1) (Fig. 4c, arrows), and FDG-avid retroperitoneal (SUVmax 7.6) lymphadenopathy (Fig. 4d, arrows). In addition, the spleen (SUVmax 8.3) and bone marrow (SUVmax 5) showed diffusely increased FDG uptake (Fig. 4a, e, arrowheads). The pattern of disease demonstrated on L. K. Khor (&) S.-J. Lu Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore e-mail: superkhor@hotmail.com

Distributed Mobile Sensor Networks for Hazardous Applications

1Research Department for Underwater Acoustics and Marine Geophysics, Bundeswehr Technical Centre for Ships and Naval Weapons, Naval Technology and Research (WTD 71), Klausdorfer Weg 2, 24148 Kiel, Germany 2Navy Center for Applied Research in Artificial Intelligence, Naval Research Laboratory, 4555 Overlook Avenue S.W., Washington, DC 20375, USA 3Acoustic Research Laboratory, National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077 4 Systems Technology Department, NATO Undersea Research Centre (NURC), Viale S. Bartolomeo 400, 19126 La Spezia, Italy

Redefining “amok” and other rampage‐type culture‐bound syndromes

Asia-Pacific PsychiatryVolume 3, Issue 4 p. 241-245 YOUNG PSYCHIATRISTS' FORUM Redefining “amok” and other rampage-type culture-bound syndromes Kundadak Ganesh Kudva MBBS, Corresponding Author Kundadak Ganesh Kudva MBBS Department of Psychological Medicine, National University Hospital, Singapore, SINGAPORE Correspondence Kundadak Ganesh Kudva MBBS, Department of Psychological Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. Tel: +97384351 Email: [email protected]Search for more papers by this author Kundadak Ganesh Kudva MBBS, Corresponding Author Kundadak Ganesh Kudva MBBS Department of Psychological Medicine, National University Hospital, Singapore, SINGAPORE Correspondence Kundadak Ganesh Kudva MBBS, Department of Psychological Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. Tel: +97384351 Email: [email protected]Search for more papers by this author First published: 29 November 2011 https://doi.org/10.1111/j.1758-5872.2011.00151.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume3, Issue4December 2011Pages 241-245 RelatedInformation

Ectopic gastric mucosa in “ectopic” Meckel’s diverticulum

A previously healthy 11-year-old boy presented with an acute onset of hematochezia, right abdominal pain and syncope. On admission, he was found to be hypotensive with a blood pressure of 90/60 mmHg, and tachycardic with a pulse rate of 100 beats/min. The hemoglobin level was 8.1 g/dL. The boy was promptly resuscitated responding with a blood pressure of 110/70 mmHg, and a pulse rate of 80 beats/min. The physical examination was otherwise unremarkable. The abdomen was soft with no guarding or rebound tenderness. The rectal examination was unremarkable apart from traces of fresh blood. The platelet count of 307 9 10/L was normal, and he did not have a coagulopathy. Erect chest radiograph and abdominal radiograph studies were unremarkable with no evidence of pneumoperitoneum or other abnormality. An abdominal ultrasound scan was normal with no intussusception detected. A Meckel’s scan was performed to evaluate for a Meckel’s diverticulum containing ectopic gastric mucosa. After intravenous administration of 155 MBq (4.19 mCi) of Technetium pertechnetate, images of the abdomen were acquired with a dual-head gamma camera (ECAM, Siemens, Erlangen, Germany). The Meckel’s scan showed an abnormal focus of tracer activity in the right upper abdomen that appeared early with gastric activity, indicative of ectopic gastric mucosa (Fig. 1, arrow). The abnormal tracer was persistent and unchanged in position over 60 min, distinguishing it from physiological bowel activity. Despite the unusual location, a Meckel’s diverticulum containing ectopic gastric mucosa was thought probable. The boy underwent a laparoscopy. Intraoperatively, a 4 cm long inflamed Meckel’s diverticulum was found arising from the ileum, approximately 15 cm from the ileocecal junction, and this was located ‘‘ectopically’’ in the right hypochondrium (Fig. 2, arrow). Dark bluish colored blood from a recent hemorrhage was seen through the bowel wall (Fig. 2, arrowheads). The Meckel’s diverticulum was resected, and histology confirmed that the diverticulum contained the gastric mucosa. The patient recovered swiftly after the surgery. A Meckel’s diverticulum is the most common congenital abnormality of the gastrointestinal tract, and is found in 1–3% of the population [1]. It is a result of a failure of regression of the omphalomesenteric duct, and is frequently located within 100 cm proximal from the ileocecal valve, and hence, symptoms typically involved the lower abdomen [1]. It is most frequently asymptomatic, with symptoms being present in approximately 25% of the cases [2, 3]. The symptoms arise from the complications of a Meckel’s diverticulum, which include bleeding, intestinal obstruction, diverticulitis, vesicodiverticular fistula and tumor [2, 3]. Bleeding secondary to ectopic gastric mucosa is the most common complication of a Meckel’s diverticulum, and is most often seen in the pediatric population, particularly in patients younger than 2 years of age [3]. In adults, the most common complication of a Meckel’s diverticulum is intestinal obstruction, which may be secondary to intussusception, volvulus or internal herniation S.-J. Lu (&) A. Sinha Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore e-mail: suat_jin_lu@yahoo.com

Depression and cognitive behavioral therapy

Asia-Pacific PsychiatryVolume 1, Issue 3 p. 161-165 Depression and cognitive behavioral therapy Li Fang Neo BSocSci, Li Fang Neo BSocSci Department of Paediatrics, Adolescent Medicine Service, National University Hospital, SingaporeSearch for more papers by this author Li Fang Neo BSocSci, Li Fang Neo BSocSci Department of Paediatrics, Adolescent Medicine Service, National University Hospital, SingaporeSearch for more papers by this author First published: 30 November 2009 https://doi.org/10.1111/j.1758-5872.2009.00042.x Li Fang Neo BSocSci. 5, Lower Kent Ridge Road Main Building, Level 4 Department of Paediatrics Office Singapore 119074 Tel: +65 6779 5555 Fax: +65 6779 5678 Email: li_fang_neo@nuhs.edu.sg Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume1, Issue3December 2009Pages 161-165 RelatedInformation

Ross River Virus Disease in a Traveler to Australia

A 42‐year‐old Singaporean man was admitted to the National University Hospital on November 29, 2005. He presented with a 2‐day history of fever, myalgias, severe arthralgias, and a rash. He had first noticed that his left ankle was swollen and painful on movement. A day later he developed a generalized non‐pruritic rash. There was no significant past medical history. He had traveled to western Australia from November 14 to 20, 2005 where he had mainly visited lakes, parks, and rivers in and around Perth. There was no travel to any developing country in the past 6 months. On clinical examination his left ankle was swollen, erythematous with periarticular tenderness. There was full range of movement. He had a generalized maculopapular rash which was more prominent over his lower limbs. Full blood count, urinalysis, liver enzymes, and serum creatinine were all normal. His C‐reactive protein (CRP) was raised to 17 mg/L (normal value: less than 10 mg/L) and his ALT was raised to 101 U/L (normal range: 5–60 IU/L), but all other liver parameters were normal. Dengue PCR and dengue serology were negative. Parvovirus and rubella serologies were negative. Because of his recent travel history to Australia and the triad of fever, arthritis, and rash, we considered various arboviral diseases, and in particular, alpha virus infections. Further screening for arboviral diseases was performed by the Queensland Health Pathology and Science Services in Brisbane, Australia. Ross River IgM [enzyme immunoassay (EIA)] was found to be reactive while Ross River IgG (EIA) was negative. All other investigations including testing for Barmah Forest were negative. Unfortunately, chikungunya PCR was not done routinely in 2005; however, chikungunya is epidemiologically highly unlikely in this case as local transmission of chikungunya had not been reported in 2005 either in Singapore or in Australia. Chikungunya was only imported … Corresponding Author: Annelies Wilder‐Smith, MD, PhD, DTM&H Director, Travellers' Screening and Vaccination Clinic, Associate Professor, Department of Medicine, National University Singapore, Singapore, 5 Lower Kent Ridge Road, Singapore 119074. E‐mail: epvws{at}pacific.net.sg

Interactive Play and Learning for Children

1Mixed Reality Lab, Interactive and Digital Media Institute (IDMI), National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077 2Graduate School of Media Design, Keio University, Kanagawa-ken 223-8522, Japan 3MIT Media Lab, School of Architecture and Planning, Massachusetts Institute of Technology, Cambridge, MA 02139-4307, USA 4NEC Design, Ltd., Shinagawa-Ku, Tokyo 141-0031, Japan

Continuing Professional Development: Microsurgery Training for Orthopaedic Hand Surgeons

Microsurgical training is essential for those embarking on a career in hand surgery. Training courses in the UK are generally oversubscribed with long waiting lists and fees are now in excess of £1000 for a five day basic microsurgery training course. With meagre study leave budgets already stretched beyond breaking point, trainees may decide to look further a field for cheaper alternatives. Singapore has a world-renowned expertise in microsurgery reconstruction techniques and the Department of Hand and Reconstructive Microsurgery at the National University Hospital (NUH) Singapore (figure 1) runs regular training courses for surgeons working within their unit and throughout the rest of Asia. The NUH website describes the courses available. They run microsurgery training courses throughout the year. There are two Basic Courses per month and Advanced, Refresher, Free Flap and Replant courses are available on request. The Basic Course costs $800 Singapore (about £270 or US $600). The course administrator may be contacted via email and places reserved. Helpful information regarding hostel accommodation is also provided. Figure 1 Figure 1: NUH Singapore The courses are conducted in the Microsurgery Training Laboratory on the NUH campus (figure 2). The courses are limited to three participants. There is one technician, a former theatre sister, who is highly skilled and is always on hand to offer advice and assistance. The laboratory is small but well equipped and most importantly, air-conditioned. The courses are run to worldwide recognised standards. There are video presentations that are followed by practical sessions. Continuing Professional Development: Microsurgery Training for Orthopaedic Hand Surgeons 2 of 4 Figure 2 Figure 2: Microsurgery Training Laboratory THE BASIC MICROSURGERY COURSE AND CERTIFICATION EXAMINATION Day 1 concentrates on the mental and physical preparation necessary for good microsurgical practice. It also covers instrumentation and instrument care, basic suture techniques and principle of vascular anastomosis. The afternoon session culminates with vessel repair in a chicken thigh. Day 2 each candidate is provided with an anaesthetised albino rat and performs a dissection of the tail vessels under the microscope and then at least 3 anastomoses of the tail vessels before lunch. The afternoon session involves a groin dissection and preparation, division and anastomosis of the femoral arteries. Day 3 there is another rat and bilateral femoral artery and vein anastomoses with an inferior epigastric vein interposition graft to one of the arteries (figure 3). Day 4 there is an arterial end to side anastomosis and creation of AV fistula. Day 5 there is a formal practical examination with a timed exercise to perform a rat groin dissection and mobilisation of the femoral vessels, resection of a small segment and repair of both artery and vein with satisfactory and sustained flow all in less than 2 hours. Figure 3 Figure 3: Testing Patency in Rat Femoral Artery Repair Although the course timetable is full, there is ample time for free practice. Arrangements are informal and breaks can be taken at any time – very important when performing microsurgical procedures. The courses at NUH are usually attended by trainee surgeons from throughout Asia. European surgeons may be put off by the distance involved and the cost of travel, but even with flights, accommodation, food and taxis the European trainee will spend far less than the equivalent course fee closer to home. We would recommend the NUH courses to any UK trainees considering a microsurgery instructional course. FOR MORE INFORMATION CONTACT Department of Hand and Reconstructive Microsurgery National University Hospital 5 Lower Kent Ridge Road Singapore 119074 Email: AWYongLC@nuh.com.sg Continuing Professional Development: Microsurgery Training for Orthopaedic Hand Surgeons 3 of 4 References Continuing Professional Development: Microsurgery Training for Orthopaedic Hand Surgeons 4 of 4 Author Information Dominic Power Birmingham Hand Service, Selly Oak Hospital Simon Tan Birmingham Hand Service, Selly Oak Hospital

Co‐transplantation of autologous adult stem cells together with differentiated derivatives of human embryonic stem cells. A novel strategy to enhance the efficacy of autologous cell‐transplantation therapy?

Wound Repair and RegenerationVolume 13, Issue 3 p. 353-356 Co-transplantation of autologous adult stem cells together with differentiated derivatives of human embryonic stem cells. A novel strategy to enhance the efficacy of autologous cell-transplantation therapy? Boon Chin Heng PhD, Boon Chin Heng PhD Stem Cell Laboratory, Faculty of Dentistry, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074. Fax: + 65-6778-5742; Email: dencaot@nus.edu.sg.Search for more papers by this authorTong Cao DDS, PhD, Tong Cao DDS, PhD Stem Cell Laboratory, Faculty of Dentistry, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074. Fax: + 65-6778-5742; Email: dencaot@nus.edu.sg.Search for more papers by this author Boon Chin Heng PhD, Boon Chin Heng PhD Stem Cell Laboratory, Faculty of Dentistry, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074. Fax: + 65-6778-5742; Email: dencaot@nus.edu.sg.Search for more papers by this authorTong Cao DDS, PhD, Tong Cao DDS, PhD Stem Cell Laboratory, Faculty of Dentistry, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074. Fax: + 65-6778-5742; Email: dencaot@nus.edu.sg.Search for more papers by this author First published: 13 June 2005 https://doi.org/10.1111/j.1067-1927.2005.130320.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume13, Issue3May 2005Pages 353-356 RelatedInformation

DIAGRAMMATIC INSTRUCTIONS TO NURSING STAFF

Division of Plastic Surgery Department of Surgery National University Hospital 5, Lower Kent Ridge Road Singapore 119074 [email protected]

Neuromuscular compartments in the long head of triceps: a morphological study in rabbits.

Muscle & NerveVolume 20, Issue 7 p. 897-899 Short Report Neuromuscular compartments in the long head of triceps: A morphological study in rabbits Jie Liu MD, Jie Liu MD Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260Search for more papers by this authorV. Prem Kumar MBBS, FRCS, V. Prem Kumar MBBS, FRCS Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260Search for more papers by this authorHui-King Lau BEng, Hui-King Lau BEng Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260Search for more papers by this authorBarry P. Pereira MEng, Barry P. Pereira MEng Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260Search for more papers by this authorYan Shen MD, Yan Shen MD Department of Hand & Reconstructive Microsurgery, National University Hospital, SingaporeSearch for more papers by this authorRobert W. H. Pho MBBS, FRCS, Robert W. H. Pho MBBS, FRCS Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260Search for more papers by this author Jie Liu MD, Jie Liu MD Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260Search for more papers by this authorV. Prem Kumar MBBS, FRCS, V. Prem Kumar MBBS, FRCS Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260Search for more papers by this authorHui-King Lau BEng, Hui-King Lau BEng Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260Search for more papers by this authorBarry P. Pereira MEng, Barry P. Pereira MEng Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260Search for more papers by this authorYan Shen MD, Yan Shen MD Department of Hand & Reconstructive Microsurgery, National University Hospital, SingaporeSearch for more papers by this authorRobert W. H. Pho MBBS, FRCS, Robert W. H. Pho MBBS, FRCS Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260Search for more papers by this author First published: 07 December 1998 https://doi.org/10.1002/(SICI)1097-4598(199707)20:7<897::AID-MUS18>3.0.CO;2-PCitations: 4 Dr. V. Prem Kumar, Department of Orthopaedic Surgery, National University of Singapore, Lower Kent Ridge Road, Singapore 119260 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume20, Issue7July 1997Pages 897-899 RelatedInformation

Listeria Septicaemia in a Young Healthy Pregnant Woman

Australian and New Zealand Journal of Obstetrics and GynaecologyVolume 35, Issue 3 p. 316-317 Listeria Septicaemia in a Young Healthy Pregnant Woman A. Kurup, A. Kurup Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Singapore Senior Resident.Search for more papers by this authorG. Kumarasinghe, G. Kumarasinghe Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Singapore Consultant Bacteriologist.Search for more papers by this authorS. Arulkumaran, Corresponding Author S. Arulkumaran Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Singapore Professor.Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Lower Kent Ridge Road, Singapore 0511.Search for more papers by this authorS. S. Ratnam, S. S. Ratnam Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Singapore Professor and Head.Search for more papers by this author A. Kurup, A. Kurup Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Singapore Senior Resident.Search for more papers by this authorG. Kumarasinghe, G. Kumarasinghe Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Singapore Consultant Bacteriologist.Search for more papers by this authorS. Arulkumaran, Corresponding Author S. Arulkumaran Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Singapore Professor.Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Lower Kent Ridge Road, Singapore 0511.Search for more papers by this authorS. S. Ratnam, S. S. Ratnam Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Singapore Professor and Head.Search for more papers by this author First published: August 1995 https://doi.org/10.1111/j.1479-828X.1995.tb01991.xCitations: 1 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume35, Issue3August 1995Pages 316-317 RelatedInformation

Cytotoxic properties of a novel marine toxin MTX1 on human blood cells: L. Sun, 1P. Gopalakrishnakone2 and K. S. Khoo3 ( 1Department of Paediatrics, Venom and Toxin Research Group; 2Department of Anatomy, and 3Department of Biochemistry, National University of Singapore, Lower Kent Ridge Road, Singapore 0511)

Cytotoxic properties of a novel marine toxin MTX1 on human blood cells: L. Sun, 1P. Gopalakrishnakone2 and K. S. Khoo3 ( 1Department of Paediatrics, Venom and Toxin Research Group; 2Department of Anatomy, and 3Department of Biochemistry, National University of Singapore, Lower Kent Ridge Road, Singapore 0511)