Health
INAUGURAL NUHS SCIENTIFIC & INNOVATION SUMMIT CHAMPIONS PREDICTIVE, PRECISE AND PERSONALISED CARE
Innovation Summit
From digital twin technology to leveraging AI in tackling obesity, the NUHS Scientific & Innovation Summit is a congregation of the brightest minds in cutting-edge medicine – with patients’ utmost care at heart
SINGAPORE, Aug. 3, 2024 /PRNewswire/ — Hepatocellular carcinoma (HCC) is one of the most lethal cancers, but Mr Ang Chin Chay, 70, was in the dark about his dire condition, until he experienced a bout of fever following a vacation to Vietnam. He quickly sought medical attention for what turned out to be a Hepatitis A infection, transmitted through contaminated food he had consumed overseas.
It was a fortuitous encounter, as routine tests revealed abnormal liver function results. Mr Ang subsequently underwent scans, which uncovered HCC, a largely asymptomatic cancer in its early stages. This was unexpected as Mr Ang was known to have fatty liver, but not cirrhosis, the most advanced form of liver scarring.
“Patients with fatty liver – but without cirrhosis – are not routinely recommended to undergo liver cancer screening,” Dr Huang explained. “But in reality, we have discovered that nearly 40 percent of HCC cases related to fatty liver occur in the absence of cirrhosis.”
Mr Ang’s prognosis would have been poor if his condition had not been detected early, as patients who are diagnosed at a late stage have an overall five-year survival rate of less than 20 percent.
Improving the screening process for patients like Mr Ang through non-invasive tests and advanced imaging is the crux of Dr Huang’s work that he will be presenting at the NUHS Scientific & Innovation Summit, on 3 August 2024.
“We aim to risk stratify people with fatty liver into those who have a high risk of liver cancer and those who do not, and to pre-emptively develop better ways to identify these people early so that they can receive some form of curative treatment,” Dr. Huang explained.
Personalising care with the digital twin
Another project pushing the frontiers of medicine with digital innovations, is the Digital Twin programme led by Dr Gao Yujia, Assistant Group Chief Technology Officer, National University Health System.
The digital twin, which is based on imaging and other data from a patient’s own tests, is a virtual 3D anatomical replica of a patient’s organs, like the liver. The digital twin will allow clinicians to transform what is usually a static scan image (such as an MRI scan), into a dynamic model that precisely recreates the shape and structural behaviour of the organ it replicates, enabling enhanced pre-surgery planning and more accurate intra-operative navigation.
Together with Holomedicine, which is a mixed reality (MR) based technology, this represents a significant leap forward in the surgeons’ ability to predict how organs will behave during a surgery, and predict how internal structures will move and change as the surgery is being performed.
“Holomedicine leverages mixed reality to interact with virtual objects superimposed onto the real world, allowing for unparalleled accuracy in pre-surgical planning,” explained Dr Gao, who will be presenting his work in mixed reality technology at the NUHS Scientific & Innovation Summit.
With this near-pinpoint precision, surgeons can minimise the risk of injuring other structures, thereby reducing potential complications and operating time, ultimately improving the patient’s overall recovery outcomes.
Innovation Summit: Tackling diseases with precision
Dr Anand Jeyasekharan, a senior consultant at the Department of Haematology-Oncology in the National University Cancer Institute, Singapore (NCIS), likens the human body’s reaction to cancer cells, to an intense battle between two warring armies.
It was a battle that became personal in 2023 for Mr Soegianto Nagaria, Dr Jeyasekharan’s patient. He had a large tumour in his liver excised by surgeons in Taiwan. Initially thought to be liver cancer, the reports indicated it to be a Stage 4 diffuse large B-cell lymphoma instead. The situation worsened when the doctors discovered the presence of a second lymphoma in his bone marrow.
Diagnosing and treating two concurrent cancers presented significant challenges, requiring precise and coordinated medical intervention. It was important to know if the two cancers were related, as the treatment would be very different if they were.
Upon recommendations by his cousins, who are doctors, Mr Nagaria decided to continue the rest of his treatment at NCIS, under Dr Jeyasekharan’s care.
Mr Nagaria flew to Singapore in September 2023, and underwent a molecular profiling under an NUHS programme for precision oncology (IMAC – integrated molecular analysis of cancer) to get his tumour sequenced. Following the sequencing, the NCIS team discovered that the two lymphomas were not related and drew up the vital treatment plans, providing life-saving ammunition in the cancer battle.
Mr Nagaria completed multiple rounds of chemotherapy over six months, and is now on close monitoring while in remission.
Besides sequencing, which Mr Nagaria underwent, Dr Jeyasekharan is developing a new tool in his arsenal of weapons against deadly cancers – spatial phenotyping, where advanced imaging equipment is used to analyse cancer with high molecular detail.
Spatial phenotyping represents the next frontier of cancer research, and is especially useful for solid tumours. “We are trying to draw [battle] maps of cancer at a high resolution and in great detail, in order to understand how to fight it,” Dr Jeyasekharan explained. “Spatial phentoyping’s ability to dive deep into molecular detail allows us to be more precise in diagnostics, treatment and care.”
With cancer being a leading cause of death globally, spatial phenotyping can mean a world of difference for patients afflicted with cancer. “We are never happy with just delivering standard treatment, because standard treatment simply isn’t good enough,” Dr Jeyasekharan said. “Some people get cured, some people don’t – we are trying to understand what we can do to improve the chances of curing more people.”
For A/Prof Su Xinyi, who is a senior consultant with the Department of Ophthalmology at NUH, precision medicine may be the key to restoring the vision of patients suffering from currently untreatable and blinding retinal diseases. “Every patient with retinal disease has a unique gene mutation, so the treatment that we provide is tailored specifically to the mutations that they have,” A/Prof Su explained.
Besides gene therapy, A/Prof Su also explores innovations in cell therapy, which are last options for patients with end-stage age-related macular degeneration (AMD) – the third leading cause of blindness globally. In AMD, retinal pigment epithelium (RPE) cells in the retina degenerate with age. By growing these cells in a petri dish, and then injecting them into the eye, they can replace lost cells and help patients regain vision.
While this method of treatment is not new, what makes it unique is the source of cells A/Prof Su uses in its development – cells derived from the umbilical cord. By doing so, this greatly reduces the chance of rejection or the need to use immunosuppressants.
Predicting risk factors, a step ahead
Predictive care affords patients and clinicians the precious gift of time, in preventing the onset, or minimising the severity, of diseases. For Dr Jocelyn Chew, who is an assistant professor at the NUS Alice Lee Centre for Nursing Studies and Yong Loo Lin School of Medicine (NUS Medicine), adopting a predictive approach to tackling a person’s dietary triggers can curb overeating and obesity.
Dr Chew has been working on an app called the Eating Trigger-Response Inhibition Program (eTRIP), which is designed to help patients identify moments where they are prone to overeating. These include emotional eating, or even ingrained habits such as over-ordering during family gatherings.
eTRIP will be used in tandem with Adipoview, an AI-based dashboard that Dr Chew has created with the team from the NUHS Group Chief Technology Office. Adipoview will gather patient data throughout NUHS to generate insights, such as the diagnosis rate of obesity and treatment rate, to proactively predict who may need further support.
At the Innovation Summit
More than 60 clinician-scientists will be presenting their work at the NUHS Scientific & Innovation Summit, which will be graced by guest-of-honour Professor Tan Chorh Chuan, Permanent Secretary for National Research and Development as well as for Public Sector Science and Technology Policy and Plans Office, Prime Minister’s Office.
Themed “Tomorrow’s Health Today – Predictive, Precise and Personalised”, the summit will bring together over 500 international and local healthcare experts, opinion leaders and scientists to shape the future of healthcare.
Over the past decade, the NUHS academic health system has secured more than $1 billion in competitive grants (cumulative from FY2011 to FY2021). These funds have fuelled scientific innovations in predictive, precise and personalised care, ensuring improved health outcomes for patients now and in the future.
About National University Health System
The National University Health System (NUHS) is an integrated Academic Health System and Regional Health System in Singapore that delivers value-driven, innovative, and sustainable healthcare.
As Singapore’s only academic health system, we are uniquely positioned to draw on the academic, research and creative capabilities residing within the National University of Singapore (NUS). This collaboration allows us to develop solutions for existing and emerging health and healthcare needs of the Singapore population.
We also work in close collaboration with community hospitals, general practitioners, family medicine clinics, nursing homes and other community and social partners to provide integrated care to the wider community.
With member institutions ranging from community hospitals to academic centres, NUHS creates synergies as a fully integrated cluster to provide seamless care, develop solutions for Singapore’s healthcare challenges and nurture the next generation of healthcare professionals.
National University Health System (NUHS)
SOURCE National University Health System (NUHS)
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(Family Features) Some women may be unaware they’re living with risks for heart disease, kidney disease and metabolic conditions like diabetes, which drive risk for cardiovascular disease.
The interplay among these conditions is called cardiovascular-kidney-metabolic (CKM) syndrome, according to the scientific experts at the American Heart Association. Consider these facts women should know about CKM syndrome.
Cardiovascular Disease is the No. 1 Killer of Women
Cardiovascular disease (CVD), which includes heart disease and stroke, affects nearly 45% of women ages 20 and older, and 1 in 3 women will die from it, according to the association.
“Despite heart disease being the leading cause of death for women, most women are not aware of their risk for heart disease,” said Sadiya S. Khan, M.D., M.Sc., FAHA, American Heart Association volunteer and a member of the science advisory group for the association’s CKM Health Initiative, supported by founding sponsors Novo Nordisk and Boehringer Ingelheim and champion sponsor DaVita.
Women may develop heart disease differently than men and experience symptoms uncommon in men. Women are more likely to have blockage in smaller blood vessels around the heart and, while chest pain is the most common heart attack symptom, women are more likely than men to experience pain in the arms, jaw and neck, too.
Early Action is Key
According to a study presented at an American Heart Association scientific conference, women with either Type 2 diabetes or chronic kidney disease are predicted to reach elevated risk for CVD 8-9 years earlier than women with neither condition while women with both conditions may reach high risk 26 years earlier.
Risk Factors are Connected
The health factors that comprise CKM syndrome are connected. They include high blood pressure, abnormal cholesterol, excess weight, high blood glucose sugar and low kidney function. If something goes wrong in one area, it affects others.
“Knowing your health numbers is critical to optimize your CKM health and prioritize prevention of heart, kidney and metabolic disease,” said Khan, who is also the Magerstadt professor of cardiovascular epidemiology and an associate professor of cardiology and preventive medicine at Northwestern School of Medicine.
Since high blood pressure and early stages of kidney disease and diabetes often don’t have symptoms, regular screening is necessary to be aware of your risk.
Pregnancy and Menopause Affect Women’s CKM Health
Each pregnancy is a window into later heart and kidney health, according to Janani Rangaswami, M.D., FAHA, professor of medicine at the George Washington University School of Medicine and Health Sciences and co-chair of the scientific advisory group for the American Heart Association’s presidential advisory that defined CKM syndrome.
Pregnancy complications such as pre-eclampsia, gestational diabetes and gestational hypertension are risk factors for future chronic kidney disease and cardiovascular disease, Rangaswami said.
Changes during menopause also influence long-term heart and metabolic health. This includes declining estrogen levels, increased body fat around the organs, increased cholesterol levels and stiffening or weakening of blood vessels, per the American Heart Association. Early menopause (before age 45) is linked to a higher risk for kidney disease, Type 2 diabetes and CVD.
“Women can mitigate those risks by getting appropriate treatment for their menopause symptoms,” Rangaswami said.
Social Factors Affect Women’s Health
Negative economic, environmental and psychosocial factors are associated with lower levels of preventive health behaviors like physical activity and healthy eating and higher levels of conditions like obesity and diabetes. Some factors affect women differently than men. For example, marriage is associated with worse health for women, and women are more likely than men to delay medical care because of costs, according to an American Heart Association scientific statement. Women are also more likely to have their health concerns dismissed, Khan said.
Women should know their risk and self-advocacy is critical. They should request thorough screenings that assess heart, kidney and metabolic health at visits with their health care providers. Visit heart.org/myCKMhealth to learn more.
Photos courtesy of Shutterstock
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(Family Features) These days, wellness information is practically everywhere you turn. Do this; don’t do that. Eat more of this; eat less of that. This is good for you; that is bad.
It can be hard to cut through all the noise, but the reality is, when it comes to something as serious as your heart health and LDL cholesterol – the “bad” cholesterol – ignoring it can be downright dangerous for your health.
According to the American Heart Association, about every 40 seconds, someone in the United States has a heart attack, and strokes occur at about the same frequency.
High LDL cholesterol, often called “bad” cholesterol, significantly increases your risk of heart disease.
A poll conducted by The Harris Poll for the American Heart Association revealed 75% of heart attack and stroke survivors reported having high cholesterol. Yet nearly half (47%) of heart attack and stroke survivors are unaware of their LDL cholesterol number. This lack of awareness shows more knowledge is needed to help survivors proactively manage their health.
In fact, knowledge is key to reducing your risk of heart disease. Understanding the impact of LDL cholesterol and knowing your LDL number can help you make informed decisions.
Cholesterol: The Good and The Bad
Cholesterol is a waxy, fat-like substance your body needs to build cells and produce hormones. However, not all cholesterol is created equal:
- LDL (low-density lipoprotein) Cholesterol: This is the “bad” cholesterol. When too much LDL cholesterol circulates in the blood, it can build up in the inner walls of the arteries that feed the heart and brain, forming plaque that can narrow and eventually block these arteries, leading to heart attack or stroke.
- HDL (high-density lipoprotein) Cholesterol: Known as the “good” cholesterol, HDL helps remove the “bad” cholesterol from the arteries, protecting against heart attack and stroke.
A Silent Threat
Many people think high cholesterol has obvious signs, but that’s not always the case. In fact, about half of U.S. adults and 42% of heart attack and stroke survivors mistakenly believe high cholesterol has clear symptoms. However, high LDL cholesterol typically doesn’t show any signs, which is why it’s known as a silent threat to your heart.
People who have had a heart attack or stroke are at higher risk of future cardiovascular problems, which is why it’s important to monitor your cholesterol regularly to help prevent future events.
It’s also important to know high LDL cholesterol can be genetic, meaning someone who eats a healthy diet and exercises regularly can still have high cholesterol. Additionally, the risk of high LDL cholesterol increases with age.
That’s why the American Heart Association’s “Lower Your LDL Cholesterol Now” initiative, nationally sponsored by Amgen, emphasizes the importance of regular cholesterol checks regardless of your weight, diet and physical activity levels. Knowing your LDL cholesterol number – and understanding the target levels based on your health history – gives you the opportunity to manage your health proactively. This enables you to make informed decisions to prevent future heart issues.
Know Your Number
You can reduce your risk of a heart attack or stroke by knowing and addressing your LDL cholesterol number.
Working closely with your doctor allows you to actively manage high LDL cholesterol – often a key risk factor you can help control – and together, you can develop a personalized treatment plan. Ask your doctor or health care provider for a cholesterol test to know your LDL number. Understanding your cholesterol number is the first step toward managing it effectively. If necessary, appropriate management of your LDL cholesterol can help reduce your risk of a heart attack or stroke.
Your doctor may also talk with you about your personal and family medical history; previous heart-related medical events such as a heart attack or stroke; lifestyle habits such as tobacco use, obesity, unhealthy living or aging; racial and ethnic backgrounds; and reproductive health.
Lower is Better
When it comes to your cholesterol, guidelines from the American Heart Association and the American College of Cardiology recommend “lower is better” to reduce your risk. Studies show that an LDL number or below 100 mg/dL is ideal for healthy adults.
If you have a history of heart attack or stroke and are already on a cholesterol-lowering medication, your doctor may aim for your LDL to be 70 mg/dL or lower.
Talk to your doctor about the right treatment plan for you. Positive lifestyle habits, such as exercising and eating a healthy diet, may also help.
However, if you’ve had a heart attack or stroke before, lifestyle changes alone may not be enough to lower your risk of another event. Your doctor may recommend cholesterol-lowering medications to protect your heart health.
Learn more about LDL (bad) cholesterol by visiting heart.org/LDL.
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(Family Features) Throughout history, humans’ ability to rely on one another has been crucial to survival. Despite modern developments that help individuals live with minimal human engagement, the human need to connect remains.
However, in many parts of America, a trend toward isolation is emerging. Over the past two decades, people are spending more time alone and less time engaging with others in person, according to data from the Office of the U.S. Surgeon General. One segment of Americans at particular risk of social isolation, loneliness and their negative impacts are select populations who live in rural areas.
“There is an urgent need to take action and improve mental health in rural America,” said Jeff Winton, dairy farmer and founder and chairman of Rural Minds, a nonprofit mental health advocacy organization that partnered with Pfizer to raise awareness about the physical and mental risks of social isolation. “Challenges to mental health can be inherent in a rural lifestyle, including a belief in self-reliance as a virtue, fear of judgment and difficulty getting an appointment with a limited number of mental health professionals, among others.”
Many Americans are increasingly spending more time alone according to the American Time Use Survey. They are increasingly more likely to take meetings, shop, eat and enjoy entertainment at home, making it easier for them to stay within their own four walls and avoid social interactions.
Authentic human connection is a basic but often unacknowledged necessity for health, “as essential to survival as food, water and shelter,” according to the U.S. Surgeon General’s Advisory on the Health Effects of Social Connection and Community.
Understanding Social Isolation
According to the Centers for Disease Control and Prevention (CDC), about one-third of U.S. adults reported feeling lonely and about one-fourth said they don’t have social and emotional support (the basis of social isolation).
The concepts of social isolation and loneliness can go hand-in-hand, but the two are actually quite different.
Social isolation is defined by an absence of relationships or contact with others. Someone experiencing loneliness may or may not have social connections, but lacks feelings of closeness, support or belonging. Despite the distinction, both can have a negative impact on a person’s mental and even physical health.
Several factors can influence a person’s risk for social isolation and loneliness.
“Social connection is a dynamic that changes over time,” said Nikki Shaffer, senior director, occupational health and wellness, Pfizer. “Transient feelings of loneliness or solitude may be beneficial because they can serve as motivation to reconnect. However, chronic loneliness (even if someone is not isolated) and isolation (even if someone is not lonely) can represent significant health concerns.”
Isolation in Rural America
Compared to people who live in urban areas, many rural Americans experience higher rates of depression and suicide but are less likely to access mental health care services, according to the “Health Disparities in Rural America: Current Challenges and Future Solutions” study published in “Clinical Advisor.” What’s more, CDC data shows suicide rates among people living in rural areas can be 64-68% higher than those in large urban areas.
Rural areas have 20% fewer primary care providers compared to urban areas, according to a report in JAMA, and the Health Resources and Services Administration reports more than 25 million rural Americans, more than half of rural residents, live in mental health professional shortage areas.
Among rural counties, 65% lack a psychiatrist. Nearly 30% of rural Americans don’t have internet access in their homes, which complicates the option for telehealth. These figures from Rural Minds exemplify the challenges facing rural America.
“Some people in rural communities still don’t understand or accept that mental illness is a disease,” said Winton, who grew up on a rural farm. “Rather, a mental illness can often be viewed as a personal weakness or character flaw. A lot of the stigma around mental illness results in unwarranted shame, which adds to the burden for someone already suffering from mental illness.”
Health Impacts of Social Isolation
Loneliness is far more than just a bad feeling; it harms both individual and societal health. In fact, loneliness and social isolation can increase the risk for premature death by 26% and 29%, respectively.
Lacking social connection can increase the risk for premature death as much as smoking up to 15 cigarettes a day or drinking six alcoholic drinks daily.
In addition, poor or insufficient social connection is associated with increased risk of disease, including a 29% increased risk of heart disease and a 32% increased risk of stroke.
Social isolation is also associated with increased risk for anxiety, depression and dementia. Additionally, a lack of social connection may increase susceptibility to viruses and respiratory illness.
Learn more about the impact of social isolation, especially on residents of rural areas, and the steps you can take to reduce isolation and loneliness by visiting ruralminds.org.
Boost Your Social Connections
Take a proactive approach to combatting social isolation and loneliness with these everyday actions that can promote stronger social ties.- Invest time in nurturing your relationships through consistent, frequent and high-quality engagement with others. Take time each day to reach out to a friend or family member.
- Minimize distractions during conversation to increase the quality of the time you spend with others. For instance, don’t check your phone during meals with friends, important conversations and family time.
- Seek out opportunities to serve and support others, either by helping your family, co-workers, friends or people in your community or by participating in community service.
- Be responsive, supportive and practice gratitude. As you practice these behaviors, others are more likely to reciprocate, strengthening social bonds, improving relationship satisfaction and building social capital.
- Participate in social and community groups such as religious, hobby, fitness, professional and community service organizations to help foster a sense of belonging, meaning and purpose.
- Seek help during times of struggle with loneliness or isolation by reaching out to a family member, friend, counselor, health care provider or the 988 crisis line.
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