Elevated activated partial thromboplastin time-based clot waveform analysis markers have strong positive association with acute venous thromboembolism

Introduction: A hypercoagulable state is a predisposition for venous thromboembolism (VTE). The activated partial thromboplastin time (aPTT)-based clot waveform analysis (CWA) is a global haemostatic measure but its role in assessment of hypercoagulability and thrombotic disorders is uncertain. We aimed to study the changes of CWA parameters in acute VTE. We hypothesized that patients with acute VTE would demonstrate higher CWA values than control patients without VTE and having elevated CWA parameters is associated with acute VTE. Materials and methods: Clot waveform analysis data from patients (N = 45) with objectively proven acute VTE who had an aPTT performed prior to initiation of anticoagulation were compared with controls (N = 111). The CWA parameters measured were min1, min2, max2 and delta change. Results: While the mean aPTT between VTE patients and controls did not differ (P = 0.830), the mean CWA parameters were significantly higher among VTE patients than controls (min1, P < 0.001; min2, P = 0.001; max2, P = 0.002; delta change, P < 0.001). There were significantly more cases within the VTE group exhibiting CWA values above their reference intervals than the control group (all P < 0.001), with the odds ratios for VTE of 8.0, 5.2, 4.8 and 18.6 for min1, min2, max2 and delta change, respectively (all P < 0.001). Conclusions: Patients with acute VTE had elevated aPTT-based CWA parameters than controls. Higher CWA parameters were significantly associated with acute VTE

Enforceability of Shrinkwrap and Clickwrap Agreements in Singapore.

This study examines The Enforceability of Shrinkwrap and Clickwrap Agreements in Singapore, and addresses the question of whether electronic commerce will ultimately replace the conventional systems of trading through supermarkets and retail stores. Shrinkwraps and clickwraps are devices used by software vendors or manufacturers that require the user of the program to do a specific act which will then constitute the user's acceptance to standard terms and conditions governing the use of the program

The Central Provident Fund investment schemes

110 p.The CPF Scheme is to enable CPF members to be financially independent after they retire. With statistics pointing to the ageing of the Singapore population, the CPF Scheme has a great significance and impact on Singapore. An important part of the CPF Scheme is the investment scheme whose main objective is to enable the CPF members to enhance their CPF savings. Since the inception of the CPF investment scheme, the CPF Board has twice revised the investment scheme, with the latest revision to CPFIS made on 1 January 1997. The purpose of the CPF Board is to encourage more CPF members to invest their CPF savings. This is in line with the government's objective to nurture Singaporeans to become a more sophisticated investing public.ACCOUNTANC

Perspectives of medical students on local medical education during COVID-19.

10.11622/smedj.2020105Singapore Medical Journa

Tumour infiltrating lymphocytes as a predictive and prognostic biomarker in rectal cancers treated with neoadjuvant chemoradiotherapy

Current literature documents conflicting results on the prognostic significance of tumour infiltrating lymphocytes (TIL) and the peritumoural lymphocytic reaction as a marker for recurrence and overall survival in patients with curative treatment-naive colorectal cancer. This may be related to the focus on phenotypic rather than functional characterisation of these lymphocytes. Several studies in rectal cancer have shown that lymphocyte density in pre-treatment biopsy samples correlate with treatment response while others have highlighted the contrasting relationship between different T helper subset expressions and prognosis. Peritumoural inflammation was not a significant prognostic factor for 5-year disease-free or overall survival in one rectal cancer cohort1, however preclinical studies have demonstrated the tumour controlling effect of inflammation induced by radiation. This study aims to examine the: (1) TIL subsets in rectal cancers before and after neoadjuvant chemoradiotherapy; (2) relationship between TIL and early tumour response as assessed histologically by the extent of tumour regression; (3) relationship between TIL and late tumour response as measured clinically by the 3-year disease-free survival (DFS)

Upregulated PLK1 expression confers radiation resistance and poor patient survival outcomes in rectal cancer

Background and aim: Colorectal cancers (CRC) are common in Western countries. Death due to colorectal malignancy is the second commonest cause of cancer related death in Australia. Preoperative radiotherapy is commonly used to downstage rectal cancers in order to improve clinical outcome. However, the effectiveness of radiotherapy is highly variable between individual patients. Currently there are no reliable predictive biomarkers of radiation sensitivity. Hypothesis: PLK1 (polo-like kinase 1), the serine/threonine protein kinase, has crucial roles in cell cycle regulation, such as centrosome maturation, mitotic spindle formation and cytokinesis. PLK1 expression in colorectal cancer cell lines and in rectal tumour tissues may be related to radiation sensitivity of these tumours. PLK1 may be a possible biomarker that predicts the histological changes and clinical outcome in rectal cancer after radiotherapy. Methods: Archived rectal cancer tissue samples from a patient cohort (Sydney South West Pathology Service, n = 352) were constructed into tissue microarray (TMA) blocks. TMA slides were immunohistochemically stained with monoclonal anti-PLK1 anbtibodies. TMA immunohistochemistry (IHC) results of PLK1 expression were correlated with both histological tumour regression seen in the surgically resected bowel and with clinical survival times. Statistical analyses were performed with SPSS (IBM, version 21). Results: Rectal cancer patients with low PLK1 expression in their tumours have longer overall survival (univariate Kaplan-Meier analysis), and this trend remains significant in multivariate Cox regression analysis [hazard ratio of 0.474 (95% CI 0.265-0.849, p = 0.012)]. PLK1 expression correlated significantly with tumour regression grade (TRG) (p = 0.039), with positive expression seen more commonly in poorly regressed tumours. Age and AJCC stage were other significant prognostic makers in our cohort. Conclusions: Current therapeutic management of rectal cancer can be improved with the availability of better predictive and efficient prognostic biomarkers. PLK1 expression appears to confer radiation resistance, with our results to date demonstrating a relationship between PLK1 immunostaining and treatment response in rectal cancers