Search results for: Mei Li Khong

Authors: Rita Gill Singh, Alex Chun Koon, Cindy Sing Bik Ngai, Joanna Wen Ying Ho, Mei Li Khong, Enoch Chan, Terrence Lau

Abstract:

Although humour is viewed as a beneficial element in teaching, there has been little attempt to systematize humour in teaching, possibly because it is difficult to teach someone to be humorous. This study integrated planned humour pedagogical approach into teaching and learning activities and examined the effect of systematically planned humour on students’ engagement and learning in different courses. Specifically, appropriate types of humour (i.e. analogy, absurdity and wordplay) and incorporation methods and frequency were systematically integrated into the lessons of courses at some higher education institutions in Hong Kong. The results showed that the planned humour pedagogical approach increased student engagement, as well as enhanced learning and motivation while reducing students’ stress. The pedagogical implications of this study will be useful for researchers, practitioners, and educators.

Keywords: higher education, pedagogy, humour, student engagement, learning, motivation

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Authors: Li Lin Ong, Duc Thinh Khong, Zaher M. A. Judeh

Abstract:

Phenylpropanoid sucrose esters (PSEs) are natural compounds found in various medicinal plants which exhibit important biological activities such as antiproliferation and α- and β-glucosidase inhibitory activities. Despite their potential as new therapeutics, total synthesis of PSEs has been very limited as their inherent structures contain one or more (substituted) cinnamoyl groups randomly allocated on the sucrose core via ester linkage. Since direct acylation of unprotected sucrose would be complex and tedious due to the presence of eight free hydroxyl groups, partially protected 2,1’:4,6-di-O-diisopropylidene sucrose was used as the starting material instead. However, similar reactivity between the remaining four hydroxyl groups still pose a challenge in the total synthesis of PSEs as the lack of selectivity can restrict customisation where acylation at specific OH is desired. To overcome this problem, a 4-step orthogonal protection scheme was developed. In this scheme, the remaining four hydroxyl groups on 2,1’:4,6-di-O-diisopropylidene sucrose, 6’-OH, 3’-OH, 4’-OH, and 3-OH, were protected with different protecting groups with an overall yield of > 40%. This orthogonally protected intermediate would provide a convenient and divergent access to a wider range of natural and synthetic PSEs as (substituted) cinnamoyl groups can be selectively introduced at desired positions. Using this scheme, three different series of monosubstituted PSEs were successfully synthesized where (substituted) cinnamoyl groups were introduced selectively at O-3, O-3’, and O-4’ positions, respectively. The expanded library of PSEs would aid in structural-activity relationship study of PSEs for identifying key components responsible for their biological activities.

Keywords: orthogonal protection, phenylpropanoid sucrose esters, selectivity, sucrose

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Authors: Sean Yao Zu Kong, Khong Yik Chew

Abstract:

Introduction: We described a case report of the successful use of advanced surgical techniques in a patient with recurrent breast cancer who underwent a wide resection including the hemi-sternum, clavicle, multiple ribs, and a lobe of the lung due to tumor involvement. This extensive resection exposed critical structures, requiring a creative approach to reconstruction. To address this complex chest wall reconstruction, a free fibula flap and a 4-zone rectus abdominis musculocutaneous flap were successfully utilized. The use of a free vascularized bone flap allowed for rapid osteointegration and resistance against osteoradionecrosis after adjuvant radiation, while a four-zone tram flap allowed for reconstruction of both the chest wall and breast mound. Although limited recipient vessels made free flaps challenging, the free fibula flap served as both a bony reconstruction and vascular conduit, supercharged with the distal peroneal artery and veins of the peroneal artery from the fibula graft. Our approach highlights the potential of advanced surgical techniques to improve outcomes in complex cases of chest wall reconstruction in patients with recurrent breast cancer, which is becoming increasingly relevant as breast cancer incidence rates increases. Case presentation: This report describes a successful reconstruction of a patient with recurrent breast cancer who required extensive resection, including the anterior chest wall, clavicle, and sternoclavicular joint. Challenges arose due to the loss of accessory muscles and the non-rigid rib cage, which could lead to compromised ventilation and instability. A free fibula osteocutaneous flap and a four-zone TRAM flap with vascular supercharging were utilized to achieve long-term stability and function. The patient has since fully recovered, and during the review, both flaps remained viable, and chest mound reconstruction was satisfactory. A planned nipple/areolar reconstruction was offered pending the patient’s decision after adjuvant radiotherapy. Conclusion: In conclusion, this case report highlights the successful use of innovative surgical techniques in addressing a complex case of recurrent breast cancer requiring extensive resection and radical reconstruction. Our approach, utilized a combination of a free fibula flap and a 4-zone rectus abdominis musculocutaneous flap, demonstrates the potential for advanced techniques in chest wall reconstruction to minimize complications and ensure long-term stability and function. As the incidence of breast cancer continues to rise, it is crucial that healthcare professionals explore and utilize innovative techniques to improve patient outcomes and quality of life.

Keywords: free fibula flap, rectus abdominis musculocutaneous flap, post-adjuvant radiotherapy, reconstructive surgery, malignancy

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Authors: Divya SY. Ang, Mark B. Tan, Nicholas EM. Yeo, Siti RB. Sudirman, Khong Yik Chew

Abstract:

Introduction: The importance of the amalgamation of technological and engineering advances with surgical principles of reconstruction cannot be overemphasized. With earlier detection of cancer, consequences of high-speed living and neglect, like traumatic injuries and infection, resulting in increasingly younger patients with bone defects. This may result in malformations and suboptimal function that is more noticeable and palpable in the younger, active demographic. Our team proposes a technique that encapsulates a mesh of multidisciplinary effort, tissue engineering and reconstructive principles. Methods/Materials: Our patient was a young competitive footballer in his early 30s who was diagnosed with submandibular adenoid cystic carcinoma with bony involvement. He was thus counselled for a right hemi mandibulectomy, the floor of mouth resection, right selective neck dissection, tracheostomy, and free fibular flap reconstruction of his mandible and required post-operative radiotherapy. Being young and in his prime sportsman years, he was unable to accept the morbidities associated with using his fibula to reconstruct his mandible despite it being the gold standard reconstructive option. The fibula is an ideal vascularized bone flap because it’s reliable and easily shaped with relatively minimal impact on functional outcomes. The fibula contributes to 30% of weightbearing and is the attachment for the lateral compartment muscles; it is stronger in footballers concerning lateral bending. When harvesting the fibula, the distal 6-8cm and up to 10% of the total length is preserved to maintain the ankle’s stability, thus, minimizing the impact on daily activities. There are studies that have noted gait variability post-operatively. Therefore, returning to a premorbid competitive level may be doubtful. To improve his functional outcomes, the decision was made to try and restore the fibula's form and function. Using the concept of Fused Deposition Modelling (FDM), our team comprising of Plastics, Otolaryngology, Orthopedics and Radiology, worked with Osteopore to design a 3D bioresorbable implant to regenerate the fibula defect (14.5cm). Bone marrow was harvested via reaming the contralateral hip prior to the wide resection. 30mls of his blood was obtained for extracting platelet rich plasma. These were packed into the Osteopore 3D-printed bone scaffold. This was then secured into the fibula defect with titanium plates and screws. The flexor hallucis longus and soleus were anchored along the construct and intraosseous membrane, done in a single setting. Results: He was reviewed closely as an outpatient over 10 months post operatively. He reported no discernable loss or difference in ankle function. He is satisfied and back in training and our team has video and photographs that substantiate his progress. Conclusion: FDM allows regeneration of long bone defects. However, we aimed to also restore his eversion and inversion that is imperative for footballers and hence reattached his previously dissected muscles along the length of the Osteopore implant. We believe that the reattachment of the muscle stabilizes not only the construct but allows optimum muscle tensioning when moving his ankle. This is a simple but effective technique in restoring complete function and form in a young patient whose minute muscle control is imperative to life.

Keywords: fused deposition modelling, functional reconstruction, lower limb bony defects, regenerative surgery, 3D printing, tissue engineering

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