Publications by authors named "Alan Lam"

Background: Although longer surgical times in primary total hip arthroplasty (THA) are associated with higher complication rates, this has yet to be explored in conversion THA. The purpose of this study is to investigate the relationship between surgical time and complications in the setting of conversion THA with implant removal. We aim to establish a length of surgery after which the risk of complications increases.

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Background: As the demand for total hip arthroplasty (THA) and total knee arthroplasty (TKA) continues to grow exponentially, the economic burden on practices and healthcare payers simultaneously increases. Medicare accounts for over 60% of total joint arthroplasty (TJA) cases nationwide, and the reimbursements are worsening despite alternative payment models. Trending the active payers at an institution provides invaluable insight into the financial health of a practice and projects if annual run rates are sustainable.

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Aims: The Raising Awareness Tool for Endometriosis (RATE) was developed to facilitate discussions with health providers regarding endometriosis-associated symptoms. We aim to evaluate the acceptability of the RATE by general practitioners (GP), including determining the prevalence of symptoms of women presenting to general practice and immediate management of symptoms.

Methods: A mixed-methods study was undertaken using a combination of quantitative and qualitative data in Western Australian General Practices from 2021 to 2022.

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Stem cells are specialised cells characterised by their unique ability to both self-renew and transform into a wide array of specialised cell types. The widespread interest in stem cells for regenerative medicine and cultivated meat has led to a significant demand for these cells in both research and practical applications. Despite the growing need for stem cell manufacturing, the industry faces significant obstacles, including high costs for equipment and maintenance, complicated operation, and low product quality and yield.

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Background And Objectives: To reduce diagnostic delay for women with endometriosis-related symptoms, we need to understand general practitioners' (GPs) perspectives on the challenges they face in diagnosing and managing endometriosis.

Method: Qualitative interviews were conducted with nine Western Australian GPs to explore their knowledge, experiences and challenges with the diagnosis and management of endometriosis.

Results: Three themes were identified as challenges: eliciting symptoms, with subthemes of multiple and complex symptoms, clinician experience and awareness, time constraints and screening opportunities; delivering patient-centred care, with subthemes of cultural factors and health literary, perceived gender biases and women's choices and priorities; and system and service, which included learning on the job, clearer diagnostic pathways, access to services and collaborative care models.

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Human mesenchymal stem cells (hMSCs) are currently being explored as a promising cell-based therapeutic modality for various diseases, with more market approvals for clinical use expected over the next few years. To facilitate this transition, addressing the bottlenecks of scale, lot-to-lot reproducibility, cost, regulatory compliance, and quality control is critical. These challenges can be addressed by closing the process and adopting automated manufacturing platforms.

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Microcarriers (MCs) are adaptable therapeutic instruments that may be adjusted to specific therapeutic uses, making them an appealing alternative for regenerative medicine and drug delivery. MCs can be employed to expand therapeutic cells. MCs can be used as scaffolds for tissue engineering, as well as providing a 3D milieu that replicates the original extracellular matrix, facilitating cell proliferation and differentiation.

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Objective: To evaluate the efficacy of upper cervical joint mobilization and/or manipulation on reducing pain and improving maximal mouth opening (MMO) and pressure pain thresholds (PPTs) in adults with temporomandibular joint (TMJ) dysfunction compared with sham or other intervention.

Data Sources: MEDLINE, CINAHL, EMBASE, and Cochrane Library from inception to June 3, 2022, were searched.

Study Selection: Eight randomized controlled trials with 437 participants evaluating manual therapy (MT) vs sham and MT vs other intervention were included.

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Objectives: Induced pluripotent stem cells (iPSCs) generated by monolayer cultures is plagued by low efficiencies, high levels of manipulation and operator unpredictability. We have developed a platform, reprogramming, expansion, and differentiation on Microcarriers, to solve these challenges.

Materials And Methods: Five sources of human somatic cells were reprogrammed, selected, expanded and differentiated in microcarriers suspension cultures.

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Objectives: To improve our understanding of patients' perspectives regarding: (1) the decision-making and prehabilitation before lumbar spinal stenosis (LSS) surgery and (2) their postoperative experiences.

Design: Qualitative research with semi-structured interviews.

Setting: General community.

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Fracture of the tibial baseplate in total knee arthroplasty is a rare occurrence, particularly in short- and mid-term follow-up. This case series documents the first known report in the literature of fatigue fracture of a cementless, 3D-printed, highly porous titanium tibial component. We recommend regular follow-up visits with radiographs to confirm adequate total knee arthroplasty component positioning and alignment.

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Article Synopsis
  • - The study aimed to assess the morcellation practices of Fellows from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) through an online survey.
  • - Out of 2,300 Fellows, 438 responded, with a notable decrease in the use of uncontained power morcellation post-2014, dropping from 39.39% to 17.58% after FDA warnings about safety risks.
  • - The shift in practices included a significant increase in clinicians who never use uncontained power morcellation (up 36%) and a decrease in those who always used it (down 80.65%), primarily due to concerns raised by regulatory warnings.
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Agitated behaviour among elderly people with dementia is a challenge in clinical management. Wrist accelerometry could be a versatile tool for making objective, quantitative, and long-term assessments. The objective of this review was to summarise the clinical application of wrist accelerometry to agitation assessments and ways of analysing the data.

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Article Synopsis
  • This study reviews surgical complications and mesh erosion in women who underwent Elevate™ mesh repair for pelvic organ prolapse between 2006 and 2016, focusing on a cohort of 350 patients.
  • Results showed a low mesh exposure rate of 1.1% and a low surgical complication rate, with only 2% classified as Dindo grade 3, indicating mostly self-limiting issues.
  • The study supports using Elevate™ mesh as a viable alternative for treating pelvic organ prolapse, especially in light of concerns regarding transvaginal mesh safety raised by the FDA and ongoing medico-legal scrutiny.
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Objectives: Large-scale generation of universal red blood cells (RBCs) from O-negative (O-ve) human induced pluripotent stem cells (hiPSCs) holds the potential to alleviate worldwide shortages of blood and provide a safe and secure year-round supply. Mature RBCs and reticulocytes, the immature counterparts of RBCs generated during erythropoiesis, could also find important applications in research, for example in malaria parasite infection studies. However, one major challenge is the lack of a high-density culture platform for large-scale generation of RBCs in vitro.

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Therapies using mesenchymal stromal cells (MSCs) to treat immune and inflammatory conditions are now at an exciting stage of development, with many MSC-based products progressing to phase II and III clinical trials. However, a major bottleneck in the clinical translation of allogeneic MSC therapies is the variable immunomodulatory properties of MSC products due to differences in their tissue source, donor heterogeneity and processes involved in manufacturing and banking. This variable functionality of MSC products likely contributes to the substantial inconsistency observed in the clinical outcomes of phase III trials of MSC therapies; several trials have failed to reach the primary efficacy endpoint.

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The global outbreak of the SARS-Cov-2 virus in 2020 has killed millions of people worldwide and forced large parts of the world into lockdowns. While multiple vaccine programs are starting to immunize the global population, there is no direct cure for COVID-19, the disease caused by the SARS-Cov-2 infection. A common symptom in patients is a decrease in T cells, called lymphopenia.

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Human-induced pluripotent stem cells are known for their high proliferation capacity as well as their ability to differentiate to different lineages (Ban et al., Theranostics 7(7):2067-2077, 2017; Chen et al., Stem Cell Res 15(2):365-375, 2015; Serra et al.

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As the coronavirus disease (COVID-19) outbreak is the first pandemic to occur in the modern smartphone era, people universally rely on their electronic devices to stay current on the rapidly evolving circumstances. The objective of this study was to examine how daily screen time levels affect the mental health of health care workers attempting to stay up to date on the ever-changing COVID-19-related information available to them. Health care workers at an academic teaching hospital were asked to participate in a 12-question online-based survey between the dates of May 30, 2020, and June 3, 2020.

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Objective: Evidence for an association between uterine leiomyoma and increased risk of endometriosis is limited by small sample sizes and short follow-up periods. We assessed this association in a large nationwide sample with 14 years of data.

Design: Data were sourced from Taiwan's Longitudinal Health Insurance Database 2000 (LHID2000).

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Mesenchymal stem cells (MSCs) are of great clinical interest as a form of allogenic therapy due to their excellent regenerative and immunomodulatory effects for various therapeutic indications. Stirred suspension bioreactors using microcarriers (MC) have been used for large-scale production of MSCs compared to planar cultivation systems. Previously, we have demonstrated that expansion of MSCs in MC-spinner cultures improved chondrogenic, osteogenic, and cell migration potentials as compared to monolayer-static cultures.

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Universal red blood cells (RBCs) differentiated from O-negative human induced pluripotent stem cells (hiPSCs) could find applications in transfusion medicine. Given that each transfusion unit of blood requires 2 trillion RBCs, efficient bioprocesses need to be developed for large-scale in vitro generation of RBCs. We have developed a scalable suspension agitation culture platform for differentiating hiPSC-microcarrier aggregates into functional RBCs and have demonstrated scalability of the process starting with 6 well plates and finally demonstrating in 500 mL spinner flasks.

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Background: The production of large quantities of cardiomyocyte is essential for the needs of cellular therapies. This study describes the selection of a human-induced pluripotent cell (hiPSC) line suitable for production of cardiomyocytes in a fully integrated bioprocess of stem cell expansion and differentiation in microcarrier stirred tank reactor.

Methods: Five hiPSC lines were evaluated first for their cardiac differentiation efficiency in monolayer cultures followed by their expansion and differentiation compatibility in microcarrier (MC) cultures under continuous stirring conditions.

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Articular cartilage defects are one of the major challenges in orthopedic and trauma surgery. However, the poor ability of cartilage to self-repair has motivated efforts to engineer replacement tissues, and human mesenchymal stem cells (MSC), which have an extensive proliferation potential and can undergo chondrogenesis, have emerged as a promising cell source. In this review, we attempt to provide a brief overview of MSC isolation, characterization, current manufacturing platforms using various bioreactors, in vitro differentiation, and sealant-based or scaffold-based implantation.

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Objectives: To evaluate the safety, feasibility and efficacy of trans-vaginal fractional micro-ablative CO laser therapy in combination with platelet rich plasma (PRP) for the treatment of stress urinary incontinence (SUI) in women.

Study Design: Participants with SUI underwent three sessions of transvaginal CO laser and PRP treatment, administered at 4-6-week intervals. Outcomes were assessed using the bladder function section of the Australian Pelvic Floor Questionnaire (APFQ).

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