26 results on '"Pwee KH"'
Search Results
2. Rapid Health Technology Assessment – Valveless Trocar System for Advanced Laparoscopic / Robotic Surgery
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Pwee, KH, primary
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- 2016
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3. Enhancing the process and practice of guideline development in developing countries: What can G-I-N do to facilitate the process?
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Mathew, J and Pwee, KH
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Background: Health-care systems in developing countries often lack robust guideline development systems. In some settings, external guidelines are simply extrapolated to local settings; sometimes they are adapted to the local context and then adopted. In contrast several health-care systems have limited[for full text, please go to the a.m. URL], G-I-N Conference 2012
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- 2012
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4. Toward a Framework for International Guideline Collaboration
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Koster, M, Schunemann, H, Qaseem, A, Cluzeau, F, Pwee, KH, Koster, M, Schunemann, H, Qaseem, A, Cluzeau, F, and Pwee, KH
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- 2012
5. Health technology assessment for integrated care pathways and transition of care services
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Pwee, KH, Bettger, JAP, Sheppard, LM, Chalkidou, K, Pwee, KH, Bettger, JAP, Sheppard, LM, and Chalkidou, K
- Published
- 2012
6. PHP106 - Health Technology Assessment Supports Evidence-Based Decision-Making in The Changi General Hospital Marketplace Exercise
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Pwee, KH, Tong, SC, and Chow, WL
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- 2016
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7. PMD28 - Rapid Health Technology Assessment – Valveless Trocar System for Advanced Laparoscopic / Robotic Surgery.
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Pwee, KH
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- 2016
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8. A systematic review of economic evaluations of cardiac rehabilitation.
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Wong WP, Feng J, Pwee KH, and Lim J
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- Adult, Comparative Effectiveness Research, Cost of Illness, Cost-Benefit Analysis, Databases, Bibliographic, Home Care Services economics, Humans, Male, Patient-Centered Care economics, Singapore, Heart Failure economics, Heart Failure rehabilitation, Myocardial Infarction economics, Myocardial Infarction rehabilitation
- Abstract
Background: Cardiac rehabilitation (CR), a multidisciplinary program consisting of exercise, risk factor modification and psychosocial intervention, forms an integral part of managing patients after myocardial infarction (MI), revascularization surgery and percutaneous coronary interventions, as well as patients with heart failure (HF). This systematic review seeks to examine the cost-effectiveness of CR for patients with MI or HF and inform policy makers in Singapore on published cost-effectiveness studies on CR., Methods: Electronic databases (EMBASE, MEDLINE, NHS EED, PEDro, CINAHL) were searched from inception to May 2010 for published economic studies. Additional references were identified through searching bibliographies of included studies. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using Drummond's checklist., Results: A total of 22 articles were selected for review. However five articles were further excluded because they were cost-minimization analyses, whilst one included patients with stroke. Of the final 16 articles, one article addressed both centre-based cardiac rehabilitation versus no rehabilitation, as well as home-based cardiac rehabilitation versus no rehabilitation. Therefore, nine studies compared cost-effectiveness between centre-based supervised CR and no CR; three studies examined that between centre- and home based CR; one between inpatient and outpatient CR; and four between home-based CR and no CR. These studies were characterized by differences in the study perspectives, economic study designs and time frames, as well as variability in clinical data and assumptions made on costs. Overall, the studies suggested that: (1) supervised centre-based CR was highly cost-effective and the dominant strategy when compared to no CR; (2) home-based CR was no different from centre-based CR; (3) no difference existed between inpatient and outpatient CR; and (4) home-based programs were generally cost-saving compared to no CR., Conclusions: Overall, all the studies supported the implementation of CR for MI and HF. However, comparison across studies highlighted wide variability of CR program design and delivery. Policy makers need to exercise caution when generalizing these findings to the Singapore context.
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- 2012
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9. Cost-effectiveness of conjugate pneumococcal vaccination in Singapore: comparing estimates for 7-valent, 10-valent, and 13-valent vaccines.
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Tyo KR, Rosen MM, Zeng W, Yap M, Pwee KH, Ang LW, and Shepard DS
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Cost-Benefit Analysis, Female, Health Care Costs statistics & numerical data, Heptavalent Pneumococcal Conjugate Vaccine, Humans, Infant, Infant, Newborn, Male, Middle Aged, Models, Statistical, Pneumococcal Infections economics, Pneumococcal Vaccines administration & dosage, Singapore epidemiology, Vaccination statistics & numerical data, Vaccines, Conjugate administration & dosage, Vaccines, Conjugate economics, Young Adult, Pneumococcal Infections epidemiology, Pneumococcal Infections prevention & control, Pneumococcal Vaccines economics
- Abstract
Introduction: Although multiple studies of cost-effectiveness of pneumococcal conjugate vaccines have been conducted, no such study has examined Singapore's situation nor compared the licensed conjugate vaccines in an Asian population. This paper estimates the costs and public health impacts of pneumococcal conjugate vaccine programs, varying estimates of serotype replacement and herd immunity effects as key parameters in the analysis. Based in part on a 2008 analysis also presented here, Singapore has approved the PCV-7, PHiD-10, and PCV-13 pneumococcal conjugate vaccines as part of its National Childhood Immunisation Programme., Methods: An economic evaluation was performed using a Markov simulation model populated with Singapore-specific population parameters, vaccine costs, treatment costs, and disease incidence data. The vaccinated infant and child cohort of 226,000 was 6% of the Singapore resident population of 3.8 million. Vaccine efficacy estimates were constructed for PCV-7, PHiD-10, and PCV-13 vaccines based on their serotype coverage in Singapore and compared to 'no vaccination'. The model estimated impacts over a five-year time horizon with 3% per year discounting of costs and health effects. Costs were presented in 2010 U.S. dollars (USD) and Singapore dollars (SGD). Sensitivity analyses included varying herd immunity, serotype replacement rates, vaccine cost, and efficacy against acute otitis media., Results: Under base case assumptions for the revised analysis (i.e., herd effects in the unvaccinated population equivalent to 20% of direct effects) PCV-13 prevented 834 cases and 7 deaths due to pneumonia, meningitis, and bacteremia in the vaccinated population, and 952 cases and 191 deaths in the unvaccinated population over the 5-year time horizon. Including herd effects, the cost-effectiveness ratio for PCV-13 was USD $37,644 (SGD $51,854) per QALY. Without herd effects, however, the ratio was USD $204,535 (SGD $281,743) per QALY. The PCV-7 cost per QALY including herd effects was USD $43,275 (SGD $59,610) and for PHiD-10 the ratios were USD $45,100 (SGD $62,125). The original 2008 analysis, which had higher estimates of pneumonia prevention due to herd immunity and lower estimates of cost per dose, had found a cost-effectiveness ratio of USD $5562 (SGD $7661) per QALY for PCV-7., Conclusions: When compared to cost-effectiveness thresholds recommended by the World Health Organization (WHO), our 2008 analysis found that vaccination of infants in Singapore with PCV-7 was very cost-effective if herd immunity effects were present. However, knowledge on herd immunity and serotype replacement that emerged subsequent to this analysis changed our expectations about indirect effects. Given these changed inputs, our current estimates of infant vaccination against pneumococcal disease in Singapore find such programs to be moderately cost-effective compared to WHO thresholds. The different findings from the 2008 and 2011 analyses suggest that the dynamic issue of serotype replacement should be monitored post-licensure and, as changes occur, vaccine effectiveness and cost-effectiveness analyses should be re-evaluated., (Copyright © 2011 Elsevier Ltd. All rights reserved.)
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- 2011
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10. Singapore ministry of health clinical practice guidelines on stroke and transient ischemic attacks.
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Venketasubramanian N, Pwee KH, and Chen CP
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- Humans, Angioplasty, Anticoagulants therapeutic use, Blood Pressure physiology, Cerebral Infarction therapy, Endarterectomy, Carotid, Evidence-Based Medicine, Fever complications, Fever drug therapy, Hospitals, Private, Hospitals, Public, Hyperglycemia complications, Hyperglycemia drug therapy, Hypoglycemia complications, Hypoglycemia drug therapy, Neurosurgical Procedures, Platelet Aggregation Inhibitors therapeutic use, Quality Improvement, Risk Management, Singapore, Stents, Venous Thromboembolism complications, Venous Thromboembolism drug therapy, Ischemic Attack, Transient epidemiology, Ischemic Attack, Transient surgery, Ischemic Attack, Transient therapy, Stroke epidemiology, Stroke surgery, Stroke therapy
- Abstract
The primary aim of these guidelines is to assist individual clinicians, hospital departments, and hospital administrators to produce local protocols for the: • assessment, investigation and immediate management of individuals with a transient ischemic attack or acute stroke (other than sub-arachnoid hemorrhage), and • secondary prevention and risk factor management following a transient ischemic attack or acute stroke. The secondary aim of these guidelines is to suggest methods for implementation and clinical audit. The workgroup preparing these guidelines was formed by the Ministry of Health, Singapore. It comprised healthcare workers from relevant specialties, family medicine, nursing, occupational therapy, and a lay patient advocate. The Scottish Intercollegiate Guidelines Network's Clinical Practice Guidelines on the Management of Patients with Stroke were reviewed, updated, and modified to meet local needs. The final guidelines are made up of evidence-based recommendations covering the following areas - assessment, investigation, immediate management, secondary prevention, rehabilitation, and implications for service delivery. The guidelines were sent to professional organizations for comments and endorsements. The final version was circulated to all medical practitioners in Singapore. It is hoped that the guidelines will improve the care of patients with stroke and transient ischemic attack. Clinical quality improvement measures are proposed., (© 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.)
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- 2011
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11. Singapore Armed Forces Medical Corps-Ministry of Health clinical practice guidelines: management of heat injury.
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Lee L, Fock KM, Lim CL, Ong EH, Poon BH, Pwee KH, O'Muircheartaigh CR, Seet B, Tan CL, and Teoh CS
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- Body Temperature, Evidence-Based Medicine, Humans, Military Personnel, Practice Guidelines as Topic, Singapore, Heat Exhaustion diagnosis, Heat Exhaustion prevention & control, Heat Stroke diagnosis, Heat Stroke prevention & control, Hot Temperature
- Abstract
The Singapore Armed Forces (SAF) Medical Corps and the Ministry of Health (MOH) have published clinical practice guidelines on Management of Heat Injury to provide doctors and patients in Singapore with evidence-based guidance on the prevention and clinical management of exertional heat injuries. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the SAF Medical Corps-MOH clinical practice guidelines on Management of Heat Injury, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/mohcorp/publications.aspx?id=25178. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
- Published
- 2010
12. Health technology assessment in Singapore.
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Pwee KH
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- Delivery of Health Care economics, Delivery of Health Care organization & administration, Singapore, Technology Assessment, Biomedical
- Abstract
The Republic of Singapore is an island city-state in Southeast Asia. Its population enjoys good health and the Singapore Ministry of Health's mission is to promote good health and reduce illness, ensure access to good and affordable health care, and pursue medical excellence. This is achieved through a healthcare system that includes both private and public sector elements. The financing philosophy of Singapore's healthcare delivery system is based on individual responsibility and community support. Health care in Singapore is financed by a combination of taxes, employee medical benefits, compulsory health savings, insurance, and out-of-pocket payment. The capability for health technology assessment in Singapore was developed concurrently with its medical device regulation system in the 1990s. The first formal unit with health technology assessment (HTA) functions was established in September 1995. Today, HTA features in decision making for the Standard Drug List, licensing of medical clinics, the Health Service Development Programme, healthcare subsidies, and policy development. The public sector healthcare delivery clusters have also recently started health services research units with HTA functions. Singapore is organizing the 6th Health Technology Assessment International (HTAi) Annual Meeting in June 2009. Bringing this prestigious international conference to Asia for the first time will help raise awareness of HTA in the region.
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- 2009
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13. How hard should we look for the evidence?
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Pwee KH
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- Humans, Databases, Bibliographic standards, Databases, Bibliographic statistics & numerical data, Evidence-Based Medicine methods, Review Literature as Topic
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- 2004
14. What is this thing called EBM?
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Pwee KH
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- Evidence-Based Medicine
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- 2004
15. Conservation of class C function of floral organ development during 300 million years of evolution from gymnosperms to angiosperms.
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Zhang P, Tan HT, Pwee KH, and Kumar PP
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- Amino Acid Sequence, Arabidopsis genetics, Arabidopsis growth & development, Arabidopsis metabolism, Cloning, Molecular, Cycadopsida chemistry, Cycadopsida genetics, Cycadopsida metabolism, Cycas genetics, Cycas growth & development, Cycas metabolism, DNA, Plant chemistry, DNA, Plant genetics, Flowers genetics, Gene Expression Regulation, Developmental, Gene Expression Regulation, Plant, MADS Domain Proteins metabolism, Magnoliopsida genetics, Magnoliopsida metabolism, Molecular Sequence Data, Mutation, Phylogeny, Plant Proteins metabolism, Sequence Analysis, DNA, Sequence Homology, Amino Acid, Cycadopsida growth & development, Evolution, Molecular, Flowers growth & development, MADS Domain Proteins genetics, Magnoliopsida growth & development, Plant Proteins genetics
- Abstract
Flower development in angiosperms is regulated by the family of MADS-box transcription factors. MADS-box genes have also been reported from gymnosperms, another major group of seed plants. AGAMOUS (AG) is the class C MADS-box floral organ identity gene controlling the stamen and carpel development in Arabidopsis. We report the characterization of an ortholog of the AG gene, named Cycas AGAMOUS (CyAG), from the primitive gymnosperm Cycas edentata. The expression pattern of CyAG in Cycas parallels that of AG in Arabidopsis. Additionally, the gene structure, including the number and location of the introns, is conserved in CyAG and other AG orthologs known. Most importantly, functional analysis shows that CyAG driven by the AG promoter can rescue the loss-of-function ag mutant of Arabidopsis. However, the ectopic expression of CyAG in ag mutant Arabidopsis cannot produce the carpeloid and stamenoid organs in the first and second whorls, although the stamen and carpel are rescued in the third and fourth whorls of the transformants. These observations show that the molecular mechanism of class C function controlling reproductive organ identity (stamen and carpel of angiosperms or microsporophyll and megasporophyll of gymnosperms) arose before the divergence of angiosperms and gymnosperms, and has been conserved during 300 million years of evolution thereafter.
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- 2004
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16. Cloning and characterization of rice HMGB1 gene.
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Wu Q, Zhang W, Pwee KH, and Kumar PP
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- 5' Flanking Region genetics, Amino Acid Sequence, Base Sequence, Cloning, Molecular, DNA, Complementary chemistry, DNA, Complementary genetics, DNA, Plant chemistry, DNA, Plant genetics, Exons, Gene Expression Regulation, Plant, Glucuronidase genetics, Glucuronidase metabolism, Introns, Molecular Sequence Data, Plant Proteins genetics, Promoter Regions, Genetic genetics, RNA, Plant genetics, RNA, Plant metabolism, Recombinant Fusion Proteins genetics, Recombinant Fusion Proteins metabolism, Sequence Alignment, Sequence Analysis, DNA, Sequence Homology, Amino Acid, HMGB1 Protein genetics, Oryza genetics
- Abstract
We isolated a 918 bp long full-length rice HMGB1 cDNA, which has an open reading frame of 471 bp encoding 157 amino acids, with a central domain of high sequence similarity to the HMG-box domain of other plant HMGB1 proteins. RNA gel blot analysis indicated that rice HMGB1 gene is constitutively expressed in various tissues and organs. Southern hybridization and sequence analyses suggested that a single copy of the HMGB1 gene composed of seven exons and six introns exists in rice. We have also cloned a 1755 bp long 5' flanking region of the rice HMGB1 gene, which can be regarded as its promoter. 5' deletion analysis of this promoter indicated that positive cis-elements residing between -1400 and -1115 are important to enhance quantitative expression, whereas negative cis-elements between -1755 and -1400 and between -1115 and -351 inhibit expression.
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- 2003
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17. Characterization of the interaction of wheat HMGa with linear and four-way junction DNAs.
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Zhang W, Wu Q, Pwee KH, Jois SD, and Kini RM
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- Amino Acid Sequence, Circular Dichroism, DNA metabolism, Gene Deletion, Histones chemistry, Kinetics, Molecular Sequence Data, Mutation, Plasmids metabolism, Protein Binding, Protein Conformation, Protein Structure, Tertiary, Structure-Activity Relationship, Surface Plasmon Resonance, Time Factors, DNA chemistry, High Mobility Group Proteins chemistry, Plant Proteins, Triticum metabolism
- Abstract
Wheat HMGa protein is a typical member of the plant HMGA family. It has four AT hooks and a histone H1-like region. A panel of deletion mutants of HMGa was generated to study the role of different regions of HMGa in its binding to 4H (a synthetic DNA that mimics the in vivo structure of intermediates of homologous recombination and DNA repair) and linear DNAs. Although the histone H1-like region of HMGa does not bind to 4H or linear DNAs, it does enhance the binding. Mutants with any two adjacent AT hooks show specific binding to both 4H and linear P268 (and P31) with different binding affinities, which is partly due to the flanking regions between AT hooks. Conformational studies indicate that the alpha-helical content of HMGa increases significantly when it binds to 4H compared to that after binding to P31, linear DNA. In contrast, linear DNA, but not 4H, undergoes substantial conformational change when it binds to HMGa, indicating that linear DNA is relatively more flexible than 4H. A more significant difference in the affinities of binding of the mutants of HMGa to 4H was observed compared to their affinities of binding to linear DNA, P31. These differences could be due to the rigidity of the DNA and the characters of the AT hook regions in the mutants.
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- 2003
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18. Rice HMGB1 protein recognizes DNA structures and bends DNA efficiently.
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Wu Q, Zhang W, Pwee KH, and Kumar PP
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- Base Sequence, Circular Dichroism, DNA drug effects, DNA, Complementary chemistry, HMGB1 Protein pharmacology, Plant Proteins chemistry, Plant Proteins pharmacology, Polymerase Chain Reaction, DNA chemistry, HMGB1 Protein chemistry, Nucleic Acid Conformation, Oligodeoxyribonucleotides chemistry, Oryza chemistry
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We analyzed the DNA-binding and DNA-bending properties of recombinant HMGB1 proteins based on a rice HMGB1 cDNA. Electrophoretic mobility shift assay demonstrated that rice HMGB1 can bind synthetic four-way junction (4H) DNA and DNA minicircles efficiently but the binding to 4H can be completed out by HMGA and histone H1. Conformational changes were detected by circular dichroism analysis with 4H DNA bound to various concentrations of HMGB1 or its truncated forms. T4 ligase-mediated circularization assays with short DNA fragments of 123 bp showed that the protein is capable of increasing DNA flexibility. The 123-bp DNA formed closed circular monomers efficiently in its presence, similar to that in an earlier study on maize HMG. Additionally, our results show for the first time that the basic N-terminal domain enhances the affinity of the plant HMGB1 protein for 4H DNA, while the acidic C-terminal domain has the converse effects.
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- 2003
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19. Multislice/spiral computed tomography for screening for coronary artery disease.
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Pwee KH
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- Canada, Clinical Trials as Topic, Costs and Cost Analysis, Device Approval, Humans, Sensitivity and Specificity, Technology Assessment, Biomedical, Tomography, X-Ray Computed adverse effects, Tomography, X-Ray Computed economics, Tomography, X-Ray Computed instrumentation, Coronary Disease diagnosis, Tomography, X-Ray Computed methods
- Abstract
Multislice computed tomography (MSCT) and spiral (or helical) computed tomography (CT) are designed to provide faster images with better resolution than conventional CT scanning. MSCT and spiral CT have been used to quantify calcification in the coronary arteries, in an effort to link this to coronary artery disease. Long-term studies on clinical outcomes of people screened with MSCT or spiral CT are lacking, as are comparisons with established screening modalities like risk factor algorithms. Low specificity gives rise to concern over false positive results. False positives may cause harm (and expense) due to inappropriate and invasive follow-up. One study was identified in which spiral CT was compared with electron beam CT (EBCT) to evaluate coronary calcifications in 33 asymptomatic individuals, giving a sensitivity of 74% and a specificity of 70%. There is insufficient evidence at this time to suggest that asymptomatic people derive clinical benefit from undergoing coronary calcification screening using MSCT or spiral CT scanning.
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- 2003
20. Interaction of wheat high-mobility-group proteins with four-way-junction DNA and characterization of the structure and expression of HMGA gene.
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Zhang W, Wu Q, Pwee KH, and Manjunatha Kini R
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- AT-Hook Motifs, Amino Acid Sequence, Base Sequence, Cell Division, DNA, Plant chemistry, DNA-Binding Proteins drug effects, DNA-Binding Proteins metabolism, Dose-Response Relationship, Drug, Exons, HMGA Proteins drug effects, HMGA Proteins isolation & purification, HMGA Proteins metabolism, HMGB Proteins drug effects, HMGB Proteins metabolism, High Mobility Group Proteins isolation & purification, High Mobility Group Proteins metabolism, Histones drug effects, Histones metabolism, Introns, Magnesium pharmacology, Molecular Sequence Data, Nuclear Proteins isolation & purification, Nuclear Proteins metabolism, Plant Proteins isolation & purification, Plant Proteins metabolism, Protein Binding drug effects, Protein Structure, Tertiary, Sodium pharmacology, Spermidine pharmacology, DNA, Plant metabolism, Gene Expression Regulation, Plant, HMGA Proteins chemistry, HMGA Proteins genetics, High Mobility Group Proteins genetics, Nuclear Proteins genetics, Plant Proteins genetics, Triticum genetics, Triticum metabolism
- Abstract
Plant high-mobility-group (HMG) chromosomal proteins are the most abundant and ubiquitous nonhistone proteins found in the nuclei of higher eukaryotes. There are only two families of HMG proteins, namely, HMGA and HMGB in plants. The cDNA encoding wheat HMGa protein was isolated and characterized. Wheat HMGA cDNA encodes a protein of 189 amino acid residues. At its N terminus, there is a histone H1-like structure, which is a common feature of plant HMGA proteins, followed by four AT-hook motifs. Polymerase chain reaction results show that the gene contains a single intron of 134 bp. All four AT-hook motifs are encoded by the second exon. Northern blot results show that the expression of HMGA gene is much higher in organs undergoing active cell proliferation. Gel retardation analysis show that wheat HMGa, b, c and histone H1 bind to four-way-junction DNA with high binding affinity, but affinity is dramatically reduced with increasing Mg(2+) and Na(+) ion concentration. Competition binding studies show that proteins share overlapping binding sites on four-way-junction DNA. HMGd does not bind to four-way-junction DNA.
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- 2003
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21. Cloning and characterization of Fortune-1, a novel gene with enhanced expression in male reproductive organs of Cycas edentata.
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Zhang P, Pwee KH, Tan HT, and Kumar PP
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- Amino Acid Sequence, Base Sequence, Blotting, Southern, Cloning, Molecular, DNA, Complementary metabolism, In Situ Hybridization, Molecular Sequence Data, RNA, Messenger metabolism, Sequence Homology, Amino Acid, Ferns genetics, Plant Physiological Phenomena, Plant Proteins biosynthesis, Plant Proteins genetics
- Abstract
To better understand the molecular mechanisms controlling development of sexual characters in Cycas edentata, we attempted to clone genes expressed differentially in male or female reproductive organs. We report a novel gene, named Fortune-1 (Ft-1), with enhanced expression in male reproductive organs. The 593-base-pair Ft-1 cDNA is predicted to encode a 77-amino-acid protein, and exists as a single copy gene in the C. edentata genome. Ft-1 expression is enhanced in male cones, including the cone axis, microsporophylls and microsporangia, but is reduced in ovules and undetectable in megasporophylls. Ft-1 is also weakly detectable in leaves. In roots and stems of C. edentata, Ft-1 transcripts are undetectable. The secondary structure prediction and homology search of Ft-1 protein show that it has a helix-loop-helix motif, and is without any homologue in the database., (Copyright 2002 Elsevier Science Ireland Ltd.)
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- 2002
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22. Influenza in Singapore: assessing the burden of illness in the community.
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Ng TP, Pwee KH, Niti M, and Goh LG
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- Adult, Aged, Female, Hospitalization statistics & numerical data, Humans, Influenza Vaccines therapeutic use, Influenza, Human mortality, Male, Middle Aged, Respiratory Tract Infections epidemiology, Singapore epidemiology, Cost of Illness, Influenza, Human epidemiology
- Abstract
Introduction: Influenza infection has significant morbidity and mortality. The social and economic costs from work absence in the working population and from hospitalisations in the elderly are considerable. Meta-analyses of cohort and randomised controlled studies indicate that influenza vaccination is effective in preventing respiratory illness, hospitalization, pneumonia and death in 50% to 68% of cases. In Singapore, data on the disease burden from influenza are sparse and no official recommendation on influenza vaccination exists., Method: We estimated the disease burden of influenza-like illness (ILI), influenza infection in the general adult population, and hospitalisations and deaths from pneumonia and influenza, from routine official and published sources, and hoc community sample surveys, national virological surveillance, hospitalization and mortality data., Results: In a resident population of 3 million people, there were 4.2 million cases of ILI in a typical non-epidemic year, 3.5 million visits to the doctor and 2.1 million days of work absence due to ILI. Data from the National Influenza Surveillance Programme indicated that about 15% of patients with ILI were positive for influenza isolates. We therefore estimated 630,000 cases of influenza virus infection cases a year, giving rise to 520,000 sick visits and 315,000 days of sick absence from work. About 4200 elderly (65+) persons were hospitalised for pneumonia and influenza, resulting in about 1450 deaths every year. The literature suggests a vaccine efficacy of about 50% of preventing influenza and its complications, including hospitalizations and deaths. This indicates that at least 315,000 cases of influenza virus infection, 258,000 sick visits, and 157,000 lost days from work in the whole population, and 2100 hospitalisations and 600 deaths from pneumonia in the elderly are potentially preventable by vaccination each year., Conclusion: Influenza poses a considerable burden of illness in the community and the potential benefits from influenza vaccination are substantial.
- Published
- 2002
23. DNA binding mediated by the wheat HMGa protein: a novel instance of selectivity against alternating GC sequence.
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Chua YL, Pwee KH, and Kini RM
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- Base Sequence, Chromatography, High Pressure Liquid, DNA Primers, Electrophoresis, Polyacrylamide Gel, Kinetics, Promoter Regions, Genetic, Protein Binding, Surface Plasmon Resonance, Triticum genetics, DNA, Plant metabolism, High Mobility Group Proteins metabolism, Triticum metabolism
- Abstract
The high-mobility-group (HMG) chromosomal protein wheat HMGa was purified to homogeneity and tested for its binding characteristics to double-stranded DNA. Wheat HMGa was able to bind to P268, an A/T-rich fragment derived from the pea plastocyanin gene promoter, producing a small mobility shift in gel retardation assays where the bound complex was sensitive to addition of proteinase K but resistant to heat treatment of the protein, consistent with the identity of wheat HMGa as a putative HMG-I/Y protein. Gel retardation assays and southwestern hybridization analysis revealed that wheat HMGa could selectively interact with the DNA polynucleotides poly(dA).poly(dT), poly(dAdT).poly(dAdT), and poly(dG).poly(dC), but not with poly(dGdC).poly(dGdC). Surface plasmon resonance analysis determined the kinetic and affinity constants of sensor chip-immobilized wheat HMGa for double-stranded DNA 10-mers, revealing a good affinity of the protein for various dinucleotide combinations, except that of alternating GC sequence. Thus contrary to prior reports of a selectivity of wheat HMGa for A/T-rich DNA, the protein appears to be able to interact with sequences containing guanine and cytosine residues as well, except where G/C residues alternate directly in the primary sequence.
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- 2001
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24. High mobility group proteins HMG-1 and HMG-I/Y bind to a positive regulatory region of the pea plastocyanin gene promoter.
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Webster CI, Packman LC, Pwee KH, and Gray JC
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- Amino Acid Sequence, Base Sequence, Binding Sites genetics, DNA Footprinting, DNA Primers genetics, DNA, Complementary genetics, DNA, Plant genetics, Distamycins pharmacology, Escherichia coli genetics, Genes, Plant, HMGA1a Protein, High Mobility Group Proteins genetics, Molecular Sequence Data, Plant Proteins genetics, Plastocyanin genetics, Promoter Regions, Genetic, Protein Binding drug effects, High Mobility Group Proteins metabolism, Pisum sativum genetics, Pisum sativum metabolism, Plant Proteins metabolism
- Abstract
A 268 bp region (P268) of the pea plastocyanin gene promoter responsible for high-level expression has been shown to interact with the high mobility group proteins HMG-1 and HMG-I/Y isolated from pea shoot chromatin. cDNAs encoding an HMG-1 protein of 154 amino acid residues containing a single HMG-box and a C-terminal acidic tail and an HMG-I/Y-like protein of 197 amino acid residues containing four AT-hooks have been isolated and expressed in Escherichia coli to provide large amounts of full-length proteins. DNase I footprinting identified eight binding sites for HMG-I/Y and six binding sites for HMG-1 in P268. Inhibition of binding by the antibiotic distamycin, which binds in the minor groove of A/T-rich DNA, revealed that HMG-I/Y binding was 400-fold more sensitive than HMG-1 binding. Binding-site selection from a pool of random oligonucleotides indicated that HMG-I/Y binds to oligonucleotides containing stretches of five or more A/T bp and HMG-1 binds preferentially to oligonucleotides enriched in dinucleotides such as TpT and TpG.
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- 1997
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25. HMG protein binding to an A/T-rich positive regulatory region of the pea plastocyanin gene promoter.
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Pwee KH, Webster CI, and Gray JC
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- Base Composition, Base Sequence, Cell Nucleus chemistry, DNA, Plant metabolism, DNA-Binding Proteins isolation & purification, DNA-Binding Proteins metabolism, Deoxyribonuclease I metabolism, High Mobility Group Proteins isolation & purification, Molecular Sequence Data, Protein Binding, Subcellular Fractions chemistry, Genes, Plant genetics, High Mobility Group Proteins metabolism, Pisum sativum genetics, Plastocyanin genetics, Promoter Regions, Genetic genetics
- Abstract
Gel retardation assays using pea nuclear extracts have detected specific binding to regions of the promoter of the pea plastocyanin gene (petE). Several complexes which differ in sensitivity to competition with unlabelled promoter fragments and various DNA alternating copolymers, to heat treatment and to digestion with proteinase K have been detected. A protein factor, PCF1, forming one of these complexes was heat-stable and most sensitive to competition with poly(dAdT).poly(dAdT) compared to other alternating copolymers. DNase I footprinting assays showed that tracts of A/T-rich sequence within the -444 to -177 positive regulatory region of the petE promoter were protected in the presence of the pea nuclear extract. The factor PCF1 copurified with a high-mobility-group (HMG) protein preparation from pea chromatin. DNase I footprinting with the HMG protein preparation demonstrated that similar tracts of A/T-rich sequences within the promoter were protected. Southwestern-blot analysis of pea HMG proteins purified by gel filtration through Superose 12 detected a single DNA-binding species of 21 kDa. The properties of the factor PCF1 suggest that it is likely to be an HMG I protein.
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- 1994
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26. The pea plastocyanin promoter directs cell-specific but not full light-regulated expression in transgenic tobacco plants.
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Pwee KH and Gray JC
- Subjects
- Base Sequence, Genes, Reporter, Glucuronidase biosynthesis, Glucuronidase genetics, Histocytochemistry, Light, Molecular Sequence Data, Plants, Genetically Modified, Plants, Toxic, Plastocyanin biosynthesis, Recombinant Fusion Proteins biosynthesis, Sequence Analysis, DNA, Sequence Deletion, Tissue Distribution, Nicotiana genetics, Fabaceae genetics, Gene Expression Regulation radiation effects, Plants, Medicinal, Plastocyanin genetics, Promoter Regions, Genetic genetics
- Abstract
A series of 5' deletions of the pea plastocyanin gene (petE) promoter fused to the beta-glucuronidase (GUS) reporter gene has been examined for expression in transgenic tobacco plants. Strong positive and negative cis-elements which modulate quantitative expression of the transgene in the light and the dark have been detected within the petE promoter. Disruption of a negative regulatory element at -784 bp produced the strongest photosynthesis-gene promoter so far described. Histochemical analysis demonstrated that all petE-GUS constructs directed expression in chloroplast-containing cells, and that a region from -176 bp to +4 bp from the translation start site was sufficient for such cell-specific expression. The petE-promoter fusions were expressed at high levels in etiolated transgenic tobacco seedlings but there was no marked induction of GUS activity in the light. The endogenous tobacco plastocyanin genes and the complete pea plastocyanin gene in transgenic tobacco plants were also expressed in the dark, but showed a three- to sevenfold increase in the light. This indicates a requirement for sequences 3' to the promoter for the full light response of the petE gene.
- Published
- 1993
- Full Text
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