Characteristics of patients with tuberculosis and the associated factors with TB-related mortality in a rural setting in Sarawak, Malaysia: A single-centre study.

INTRODUCTION: Tuberculosis (TB) in Malaysia has estimated incidence and mortality rates of 81 cases per 100,000 people-year and 4.9 per 100,000 populations, respectively. This study aimed to study the characteristics of rural TB patients and their mortality outcomes. MATERIALS AND METHODS: This is a retrospective observational study involving real-world data analysis, looking into TB patients in Lubok Antu Health Clinic by obtaining data through clinic cards, from 1 January 2019 till 31 December 2020. Statistical significance was p < 0.05. RESULTS: Eighty-four patients were included. Fifty-two (61.9%) were male. Median age was 58.5 (39-67). Forty-six (54.8%) had smear-positive TB. Seventy-eight (92.9%) were alive at treatment completion. Fifteen (17.9%) experienced adverse drug reactions. Estimated prevalence and mortality rate were 7.1% and 10.7 per 100,000 populations, respectively. Regression analyses revealed that drug reaction was significantly associated with compliance [OR = 8.38 (95% CI: 1.26, 55.53), p = 0.029]. Patients compliant with treatment were more likely to survive [OR = 12.5 (95% CI: 1.61, 97.34), p = 0.028]. CONCLUSION: Compliance with TB treatment should be emphasised to reduce TB-related mortality.

Methylprednisolone in severe COVID-19 with acute respiratory distress syndrome - less is more?

INTRODUCTION: Corticosteroids, particularly methylprednisolone, are part of the treatment for severe COVID-19 with acute respiratory distress syndrome (ARDS). In this study, we aimed to compare the mortalities of patients treated with higher versus lower doses of methylprednisolone. Secondary outcomes included oxygenation, need for mechanical ventilation, length of stay in intensive care unit (ICU), secondary infection, improvement of PaO2/FiO2 (PF) ratio, and inflammatory response as expressed by C-reactive protein (CRP). MATERIALS AND METHODS: A retrospective cohort study conducted at Sarawak General Hospital from 1st June to 30th September 2021. Patients who received intravenous methylprednisolone for severe COVID-19 in the ICU were identified and divided into two groups: higher dose (cumulative dose more than 10 mg per kg) and lower dose (cumulative dose less than 10 mg per kg). RESULTS: Out of a total of 165 patients, 40 (24.2%) patients received higher dose methylprednisolone. There was no significant difference in socio-demographic characteristics (age, gender, body mass index), COVID-19 vaccination status, laboratory parameters (lymphocyte count, CRP, lactate dehydrogenase, D-dimer), or usage of immunomodulator therapy between the groups. Overall mortality was 23.6%. Mortality in the higher dose group was twice as high compared to lower dose group (37.5% versus 19.2%) (OR 3.79, 95% CI 1.24-11.59, p<0.05). In addition, the higher dose cohort developed more secondary infections (87.5%) and had longer stays in ICU (median 11 days, IQR 8- 15). No significant difference was found between both cohorts in terms of CRP reduction, improvement of PF ratio, or the need for mechanical ventilation post methylprednisolone. CONCLUSION: In this study, the use of higher dose methylprednisolone in COVID-19 with ARDS was not associated with better clinical outcomes. A lower dose of methylprednisolone might be sufficient in treating severe COVID-19 with ARDS.

Identifying barriers to care for complex airway disease and multidisciplinary solutions to optimize therapy in Canada.

BACKGROUND: Complex airway disease such as Chronic Rhinosinusitis with Asthma or Aspirin Exacerbated Respiratory Disease requires a multidisciplinary approach to management and treatment. Many centers in the USA have created collaborative multidisciplinary clinics to support the management of these patients; however, similar structures do not appear to exist in Canada. METHODS: This mixed methods study used a combination of structured interviews and a cross-sectional national survey. Interviewees included members of the Canadian Rhinology Working Group and survey participants were a combination of academic and community Rhinologists, Respirologists and Allergists. All participation was voluntary and selection criteria was based on their involvement in treating complex airway disease. Our objective was to identify the current state of diagnosis and treatment of complex airway patients in Canada between Rhinology, Respirology and Allergy and understand the barriers, challenges and propose solutions to establishing a multidisciplinary airway clinic in Canada. RESULTS: Four Rhinologists participated in qualitative interviews and a convenience sample of 42 specialists through our known network responded to our quantitative survey. From our survey, 54.8% believed multidisciplinary clinics were necessary in the management of complex airway disease, providing better outcomes and cost-savings (69%, 45.2%). Most specialties agreed that history, physical, pulmonary function and skin prick testing was important for diagnosis (92.9%, 92.9%, 88.1%). If clinicians were to participate in a multidisciplinary clinic, they would be willing to forego an average of 14.2% of their mean daily income for that clinic. The ideal clinic location was split between a neutral shared location vs. a Rhinology clinic space (38.1%, 45.2%). CONCLUSIONS: Complex airway diseases are currently managed in subspecialty silos resulting in fragmented care. Our study highlights gaps in management, areas for improvement and support for establishing multidisciplinary complex airway disease clinics in Canada to better treat this population.

A 10-min novel technique for involutional entropion: Mini-incisional continuous ligation everting sutures.

PURPOSE: To introduce a novel technique of mini-incisional continuous ligation everting sutures for correction of involutional entropion and report the surgical outcome. METHODS: A retrospective case series. Eighty-five eyelids of 77 patients who underwent correction of involutional lower lid entropion using mini-incisional continuous ligation everting sutures were included in this study. The medical records of patients with at least 24 months of follow-up after surgery were reviewed. We collected information on demographic and clinical characteristics, including sex, age at surgery, duration of follow-up, horizontal lid laxity, surgical outcomes, and complications. Main outcome measures were success of surgery, recurrence rate, time to recurrence, and risk factors for recurrence. RESULTS: The median (interquartile range) age at the time of surgery was 72.0 (65.5-78.0) years and the median (interquartile range) follow-up duration was 24.0 (24.0-42.5) months. Thirty-seven eyelids (43.5%) showed horizontal eyelid laxity on a lid distraction test The surgical outcome was successful in the majority of patients (94.1%) with a recurrence rate of 5.9% in the 2 years after surgery. Only female sex was significantly correlated with recurrence of entropion (odds ratio 9.466, 95% confidence interval 1.022 to 87.670, P = 0.048). CONCLUSION: This novel technique is a promising surgical modality for correction of lower lid involutional entropion because of its ease of application, simplicity, compatibility with anticoagulants, and low recurrence rate.

Multi-Scale Binary Pattern Encoding Network for Cancer Classification in Pathology Images.

Multi-scale approaches have been widely studied in pathology image analysis. These offer an ability to characterize tissues in an image at various scales, in which the tissues may appear differently. Many of such methods have focused on extracting multi-scale hand-crafted features and applied them to various tasks in pathology image analysis. Even, several deep learning methods explicitly adopt the multi-scale approaches. However, most of these methods simply merge the multi-scale features together or adopt the coarse-to-fine/fine-to-coarse strategy, which uses the features one at a time in a sequential manner. Utilizing the multi-scale features in a cooperative and discriminative fashion, the learning capabilities could be further improved. Herein, we propose a multi-scale approach that can identify and leverage the patterns of the multiple scales within a deep neural network and provide the superior capability of cancer classification. The patterns of the features across multiple scales are encoded as a binary pattern code and further converted to a decimal number, which can be easily embedded in the current framework of the deep neural networks. To evaluate the proposed method, multiple sets of pathology images are employed. Under the various experimental settings, the proposed method is systematically assessed and shows an improved classification performance in comparison to other competing methods.

The Effects of Stocking Density and Distances on Electroencephalographic Changes and Cortisol as Welfare Indicators in Brahman Crossbred Cattle.

The objective of the current study was to investigate the effects of stocking density and distances on electroencephalographic changes and cortisol as welfare indicators in Brahman crossbred cattle. Sixty Brahman crossbred heifers were subjected to road transport from a cattle feedlot farm located in Universiti Putra Malaysia (UPM), Serdang to a commercial ruminant abattoir in Shah Alam, Selangor. Animals were assigned to long (850 km) and short (450 km) distances and high (600 sqm), medium (400 sqm), and low (200 sqm) stocking densities. Results revealed that the intensity of cortisol responses and EEG parameters (such as alpha <0.001, beta < 0.001, delta < 0.001, theta < 0.001, MF < 0.001 and Ptot < 0.001) increased significantly. Long-distance transport also resulted in significantly more intense (<0.001) responses to nociception during slaughter than animals that had been transported over a shorter distance, as indicated by EEG and cortisol.

Effects of Stocking and Transport Conditions on Physicochemical Properties of Meat and Acute-Phase Proteins in Cattle.

This study's objective was to evaluate the effects of distance and stocking density on physicochemical properties and oxidative stability of meat and acute-phase proteins in Brahman crossbred cattle transported by road under hot and humid tropical conditions. Sixty Brahman crossbred heifers were subjected to road transport from a cattle feedlot farm located in Universiti Putra Malaysia (UPM), Serdang, to a commercial ruminant abattoir in Shah Alam, Selangor. Animals were assigned to long and short distances and high, medium, and low stocking densities. The results revealed that the intensity of response significantly increased in meat samples from animals subjected to long-distance transportation and higher stocking density. Alpha-1-acid glycoprotein and serum amyloid-A values increased considerably and were different from the baseline values recorded at preload. In conclusion, the current results revealed that the color, pH, shear force values, water holding capacity (WHC), glycogen level, and malondilaldehyde assay (MDA) concentrations in meat and acute-phase proteins (APP) were affected by both distances and stocking densities, as evidenced by the significant changes recorded from the parameters above.

Prospective evaluation of the utility of magnetic resonance imaging in patients with non-MRI-conditional pacemakers and defibrillators.

BACKGROUND: Magnetic resonance imaging (MRI) in patients with legacy cardiovascular implantable electronic devices (CIEDs) in situ is likely underutilized. We hypothesized the clinical benefit of MRI would outweigh the risks in legacy CIED patients. METHODS: This is a single-center retrospective study that evaluated and classified the utility of MRI using a prospectively maintained database. The outcomes were classified as aiding in diagnosis, treatment, or both for the patients attributable to the MRI. We then assessed the incidence of adverse effects (AE) when the MRI was performed. RESULTS: In 668, MRIs performed on 479 patients, only 13 (1.9%) MRIs did not aid in the diagnosis or treatment of the patient. Power-on reset events without clinical sequelae in three scans (0.45%) were the only AE. The probability of an adverse event happening without any benefit from the MRI scan was 1.1 × 10-4 . A maximum benefit in diagnosis using MRI was obtained in ruling out space-occupying lesions (121/185 scans, 65.4%). Scans performed in patients for elucidating answers to queries in treatment were most frequently done for disease staging at long term follow-up (167/470 scans, 35.5%). Conservative treatment (184/470 scans, 39%) followed by medication changes (153/470 scans, 28.7%) were the most common treatment decisions made. CONCLUSIONS: The utility of MRI in patients with non-MRI-conditional CIEDs far outweighs the risk of adverse events when imaging is done in the context of a multidisciplinary program that oversees patient safety.

Selective laser trabeculoplasty vs. topical medications for step-up treatment in primary open angle glaucoma: comparing clinical effectiveness, quality of life and cost-effectiveness.

INTRODUCTION: The aim of this study was to investigate the clinical effectiveness, health related quality of life (HRQoL) and cost effectiveness of selective laser trabeculoplasty (SLT) compared to topical anti-glaucoma medications in step-up treatment of patients with primary open angle glaucoma (POAG). METHODS: Seventeen POAG patients with suboptimal IOP control despite pre-existing topical medications were subjected to adjunct SLT (50 applications 180 degrees) or second line medical therapy. Current medications were continued, and patients were followed up for 6 months for degree of intraocular pressure (IOP) lowering. HRQoL was assessed using Glaucoma Quality of Life 36-item (GlauQoL-36), Assessment of Quality of Life-7D (AQoL-7D) and Vision related Quality of Life (VisQoL). Costs involved were calculated and compared to the effect (IOP reduction) achieved in each arm. RESULTS: Ten patients were in the SLT group and 7 in the topical medication (MED) group. Mean baseline intraocular pressure (IOP) was 18.90±3.48mmHg in SLT group and 15.57±2.23mmHg in MED group. Mean reduction of IOP was 4.30±1.64mmHg in SLT group and 2.71±2.56 mmHg in MED group at 6 months which was not statistically significant (p=0.14) between two groups. All the HRQoL questionnaires did not show significant changes in the groups or between groups when compared baseline with 6-month post treatment (p-values ranging from 0.247 to 0.987). For every 1mmHg reduction in IOP, cost involved in MED group (RM53.61) was 165% of the cost involved in SLT group (RM32.56). DISCUSSION AND CONCLUSION: This study has shown that SLT was as effective clinically and tolerable as topical anti glaucoma medications and was possibly more cost effective in the step-up treatment of patients with POAG at 6 months follow- up.

Diagnostic yield of medical thoracoscopy in exudative pleural effusions in a region with high tuberculosis burden.

INTRODUCTION: Pleural effusion is frequently encountered in respiratory medicine. However, despite thorough assessment including closed pleural biopsy, the cause of around 20% of pleural effusions remains undetermined. Medical thoracoscopy (MT) is the investigation of choice in these circumstances especially if malignancy is suspected. The aim of this study is to evaluate the diagnostic yield of MT in exudative pleural effusions in a single center from East Malaysia. METHODS: Retrospective chart review of all adult patients who underwent MT for undiagnosed exudative pleural effusion in a 24-month duration. RESULTS: Our cohort comprised of 209 patients with a median age of 61 years old (IQR 48.5-69.5). There were 92 (44%) patients with malignant pleural effusion (MPE) and 117 (56%) benign effusions; which included 85 tuberculous pleural effusion (TBE) and 32 cases of non-tuberculous exudative pleural effusion. Conclusive pathological diagnosis was made in 79.4% of the cases. For diagnosis of MPE, MT had a sensitivity of 89.1% (95% CI 80.4-94.3), specificity of 100% (95% CI 96.0-100.0), and positive predictive value (PPV) of 100% (95% CI 94.4-100) and negative predictive value (NPV) of 92.1% (95% CI 85.6-95.9). For TBE, MT had a sensitivity of 90.5% (95% CI 81.8-95.6), specificity of 100% (95% CI 96.3- 100.0) PPV of 100% (95% CI 94.1-100) and NPV of 93.9% (95% CI 88.0-97.2). Overall complication rate was 3.3%. CONCLUSIONS: MT showed excellent sensitivity and specificity in the diagnosis of exudative pleural effusion in this region. It reduces empirical therapy by providing histological evidence of disease when initial non-invasive investigations were inconclusive.

A Converging Strategy for the Generation of a Virtually Sequenced cDNA Library from Unreferenced Pacific Oysters.

The access to biological material of reference species, which were used previously in key experiments such as in the development of novel cell lines or genome sequencing projects, are often difficult to provide for further studies or third parties due to the consumptive nature of the samples. Although now widely distributed over the Pacific coasts of Asia, Australia and North America, individual Pacific oyster specimens are genetically quite diverse and are therefore not directly suitable as the starting material for gene libraries. In this article, we demonstrate the use of unreferenced Pacific oyster specimens obtained from regional seafood markets to generate cDNA libraries. These libraries were then compared to the publicly available oyster genome, and the closest related library was selected using the mitochondrial reference genes Cytochrome C Oxidase subunit I (COX1) and NADH Dehydrogenase (ND). The suitability of the generated cDNA library is also demonstrated by cloning and expression of two genes encoding the enzymes UDP-glucuronic acid dehydrogenase (UGD) and UDP-xylose synthase (UXS), which are responsible for the biosynthesis of UDP-xylose from UDP-glucose.

The importance of both CYP2C19 and CYP2B6 germline variations in cyclophosphamide pharmacokinetics and clinical outcomes.

Cyclophosphamide is an alkylating agent used in the treatment of solid and haematological malignancies and as an immunosuppressive agent. As a prodrug, it is dependent on bioactivation to the active phosphoramide mustard metabolite to elicit its therapeutic effect. This focused review will highlight the evidence for the role of germline pharmacogenetic variation in both plasma pharmacokinetics and clinical outcomes. There is a substantial indication from 13 pharmacokinetic and 17 therapeutic outcome studies, in contexts as diverse as haematological malignancy, breast cancer, systemic lupus erythematosus and myeloablation, that pharmacogenetic variation in both CYP2C19 and CYP2B6 influence the bioactivation of cyclophosphamide. An additional role for pharmacogenetic variation in ALDH1A1 has also been reported. Future studies should comprehensively assess these 3 pharmacogenes and undertake appropriate statistical analysis of gene-gene interactions to confirm these findings and may allow personalised treatment regimens.

Adjuvant Chemotherapy plus Radiation for Locally Advanced Endometrial Cancer.

BACKGROUND: Stage III or IVA endometrial cancer carries a significant risk of systemic and locoregional recurrence. METHODS: In this randomized phase 3 trial, we tested whether 6 months of platinum-based chemotherapy plus radiation therapy (chemoradiotherapy) is associated with longer relapse-free survival (primary end point) than six cycles of combination chemotherapy alone in patients with stage III or IVA endometrial carcinoma. Secondary end points included overall survival, acute and chronic toxic effects, and quality of life. RESULTS: Of the 813 patients enrolled, 736 were eligible and were included in the analysis of relapse-free survival; of those patients, 707 received the randomly assigned intervention (346 received chemoradiotherapy and 361 received chemotherapy only). The median follow-up period was 47 months. At 60 months, the Kaplan-Meier estimate of the percentage of patients alive and relapse-free was 59% (95% confidence interval [CI], 53 to 65) in the chemoradiotherapy group and 58% (95% CI, 53 to 64) in the chemotherapy-only group (hazard ratio, 0.90; 90% CI, 0.74 to 1.10). Chemoradiotherapy was associated with a lower 5-year incidence of vaginal recurrence (2% vs. 7%; hazard ratio, 0.36; 95% CI, 0.16 to 0.82) and pelvic and paraaortic lymph-node recurrence (11% vs. 20%; hazard ratio, 0.43; 95% CI, 0.28 to 0.66) than chemotherapy alone, but distant recurrence was more common in association with chemoradiotherapy (27% vs. 21%; hazard ratio, 1.36; 95% CI, 1.00 to 1.86). Grade 3, 4, or 5 adverse events were reported in 202 patients (58%) in the chemoradiotherapy group and 227 patients (63%) in the chemotherapy-only group. CONCLUSIONS: Chemotherapy plus radiation was not associated with longer relapse-free survival than chemotherapy alone in patients with stage III or IVA endometrial carcinoma. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00942357.).

The Effects of Sea and Road Transport on Physiological and Electroencephalographic Responses in Brahman Crossbred Heifers.

The objective of the current study was to evaluate the effects of sea and road transport on the acute phase proteins (APP), cortisol, metabolic, haematological and electroencephalographic (EEG) responses of Brahman crossbred heifers. Sixty Brahman crossbred heifers were subjected to 14 d of transportation by sea from Darwin Port, Australia, to Pasir Gudang Port, Johor, Malaysia, and 330 km of road transportation. Results revealed that the intensity of response for most blood biochemical parameters increased significantly and were different from the baseline values taken while the animals were in Darwin Port, Australia. Haematological results obtained also revealed a significant increase and were different from the baseline values. Cortisol and APP (bovine alpha 1-acid glycoprotein and serum amyloid-A) values increased significantly and were different from the baseline values. Haematological parameters, APP, cortisol and EEG data (alpha, beta, delta and theta waves, total power and median frequency) decreased significantly following 4 and 7 days post-transport, suggesting a recovery of the animals from the stressfulness of transport. In conclusion, the current results revealed that the concentrations of biochemical and haematological parameters, cortisol, APP and EEG data were affected by both sea and road transport as evidenced by the significant changes recorded from the parameters above.

Incidence and Prevention of Biliary Leakage after Partial Liver Resection in a Tertiary Level Hospital.

Biliary leakage is a postoperative complication of liver resection which may have considerable consequences. The aim of this study is to evaluate the incidence of post hepatectomy biliary leakage and to find out the preventive measures by systemic literature reviews. This observational study was conducted on 500 patients who required various forms of hepatic resection at the Department of Hepatic Surgery - 4, Eastern Hepatobiliary Surgery Hospital of The Second Military Medical University, Shanghai, China from September 2014 to July 2016. Out of 500 cases 413(82.6%) were males and 87(17.4%) females with female to male ratio 1:4.75. A total 23(4.6%) patients developed biliary leakage after surgery. Incidence of biliary leakage was more 21/440 (4.8%) in malignant diseases. Intrahepatic cholangio carcinoma had highest 4/23 (17.4%) incidence of biliary leakage among malignant diseases. It was lowest 2/60 (3.3%) in benign diseases. Non anatomical resection found to have higher incidence 5/17 (29.4%) of biliary leakage. Among the anatomical resection left extended hepatectomy found more porn 2/6 (33.3%) to develop biliary leakage. No biliary leakage test was done in 111(22.2%) patients to prevent biliary leakage. In other patients biliary leakage tests were carried out and there was not much variation in incidence of biliary leakage. Maximum patients 380(76%) were discharged from the hospital within 11-15 days after operation. Patients with biliary leakage had higher hospital stay. There are still no standardized methods to prevent biliary leakage because of the lack of clear evidence that support their use. Therefore, the development of novel technical strategies to reduce biliary leakage is required.

Dietary supplementation of different parts of Andrographis paniculata affects the fatty acids, lipid oxidation, microbiota, and quality attributes of longissimus muscle in goats.

The effects of dietary supplementation of different parts of Andrographis paniculata on fatty acids, lipid oxidation, microbiota and quality attributes of Longissimus thoracis et lumborum (LTL) muscle in goats were assessed. Twenty four, entire Boer bucks (4 months old; 20.18 ±â€¯0.19 kg BW) were randomly allotted to either a basal diet without additive (AP0), a basal diet + 1.5% Andrographis paniculata leaves (APL) or a basal diet + 1.5% Andrographis paniculata whole plant (APW). The bucks were fed the diets for 100 d and slaughtered. The LTL muscle was subjected to a 7 d chill storage. The AP0 meat had higher (p < .05) concentration of C16:0 and C18:0 than the APW and APL meat. The concentrations of total C18:1trans, total CLA, C18:1n-9, C18:2n-6, C18:3n-3 and C20:5n-3 were higher (p < .05) in APL and APW meat than the AP0 meat. Diets had no effect (p > .05) on muscle glycogen, pH, drip loss, chemical composition and lactic acid bacteria count. Cooking loss, shear force, and TBARS values were lower (p < .05) in APL (23.98%, 0.76 kg, 0.12 mg MDA/kg) and APW (24.53%, 0.80 kg, 0.15 mg MDA/kg) meat compared with AP0 (26.49%, 1.13 kg, 0.23 mg MDA/kg) meat. Meat redness was higher (p < .05) in APL (13.49) and APW (12.98) than AP0 (10.86). Sensory scores for juiciness, tenderness, and overall acceptability of APL (7.92, 7.88, 7.89) and APW (7.90, 7.08, 7.77) meat were higher (p < .05) than that of the AP0 (5.38, 5.95, 5.41) meat. Total viable counts and populations of Pseudomonas spp, Escherichia coli and Enterobacteriacea were higher (p < .05) in AP0 meat than in APL and APW meat. The APL exhibited higher (p < .05) antimicrobial potential than the APW. Chill storage affected (p < .05) the physicochemical properties, lipid oxidation and microbial counts in chevon. Dietary APL and APW enhanced the beneficial fatty acids, quality attributes and oxidative stability, and reduced microbial counts in chevon.

Drainage of multiloculated tuberculous pleural effusion by medical thoracoscopy: When and why should it be considered?

Tuberculous pleural effusion (TBE) is a common encounter in our region. Up to 50% of patients with TBE will develop residual pleural thickening (RPT) which can lead to functional impairment. However, the need of drainage remains controversial. We report a case of end-stage renal failure patient who presented with right multiloculated tuberculous pleural effusion which was drained via a medical thoracoscope. Patient reports immediate relief of breathlessness post procedure and one month follow up shown significant improvement of RPT. We also discussed the current perspective on the rationale of TBE drainage and the role of medical thoracoscope in TBE management.

Effect of ozonation on minocycline degradation and N-Nitrosodimethylamine formation.

The objective of this study was to assess reactivity of Minocycline (MNC) towards ozone and determine the effects of ozone dose, pH value, and water matrix on MNC degradation as well as to characterize N-Nitrosodimethylamine (NDMA) formation from MNC ozonation. The MNC initial concentration of the solution was set in the range of 2-20 mg/L to investigate NDMA formation during MNC ozonation. Four ozone doses (22.5, 37.2, 58.0, and 74.4 mg/min) were tested to study the effect of ozone dose. For the evaluation of effects of pH value, pH was adjusted from 5 to 9 in the presence of phosphate buffer. MNC ozonation experiments were also conducted in natural water to assess the influence of water matirx. The influence of the typical component of natural water was also investigated with the addition of HA and NaHCO3 solution. Results indicated that ozone was effective in MNC removal. Consequently, NDMA and dimethylamine (DMA) were generated from MNC oxidation. Increasing pH value enhanced MNC removal but led to greater NDMA generation. Water matrices, such as HCO3- and humic acid, affected MNC degradation. Conversely, more NDMA accumulated due to the inhibition of NDMA oxidation by oxidant consumption. Though ⋅OH can enhance MNC degradation, ozone molecules were heavily involved in NDMA production. Seven transformation products were identified. However, only DMA and the unidentified tertiary amine containing DMA group contributed to NDMA formation.