Effect of Defatted Dabai Pulp Extract in Urine Metabolomics of Hypercholesterolemic Rats

A source of functional food can be utilized from a source that might otherwise be considered waste. This study investigates the hypocholesterolemic effect of defatted dabai pulp (DDP) from supercritical carbon dioxide extraction and the metabolic alterations associated with the therapeutic effects of DDP using ¹H NMR urinary metabolomic analysis. Male-specific pathogen-free Sprague–Dawley rats were fed with a high cholesterol diet for 30 days to induce hypercholesterolemia. Later, the rats were administered with a 2% DDP treatment diet for another 30 days. Supplementation with the 2% DDP treatment diet significantly reduced the level of total cholesterol (TC), triglyceride, low-density lipoprotein (LDL), and inflammatory markers (C-reactive protein (CRP), interleukin 6 (IL6) and tumour necrosis factor-α (α-TNF)) and significantly increased the level of antioxidant profile (total antioxidant status (TAS), superoxide dismutase (SOD), glutathione peroxide (GPX), and catalase (CAT)) compared with the positive control group (PG) group (p < 0.05). The presence of high dietary fibre (28.73 ± 1.82 g/100 g) and phenolic compounds (syringic acid, 4-hydroxybenzoic acid and gallic acid) are potential factors contributing to the beneficial effect. Assessment of ¹H NMR urinary metabolomics revealed that supplementation of 2% of DDP can partially recover the dysfunction in the metabolism induced by hypercholesterolemia via choline metabolism. ¹H-NMR-based metabolomic analysis of urine from hypercholesterolemic rats in this study uncovered the therapeutic effect of DDP to combat hypercholesterolemia.     

Laparoscopic appendicectomy: the ideal procedure for laparoscopic skill training for surgical registrars

OBJECTIVE: Appendicectomy is a very common surgical procedure performed by registrars. It is mainly carried out by surgical registrars as an open procedure in many government hospitals. We aimed to evaluate laparoscopic appendicectomy as a laparoscopic training skill in a clinical setting for our registrars. METHODS: A retrospective analysis of all attempted laparoscopic appendicectomies over 12 months by experienced surgeons and registrars was done. Factors evaluated were operating time, conversion rate, postoperative hospital stay, morbidity and mortality. RESULTS: There was no statistically significant difference in operating time for surgeons and registrars (mean, 53 minutes vs. 60 minutes), conversion rate (10% vs. 11%). Mean hospital stay for patients operated on by surgeons was 3.1 days and 3.2 days for registrars. Morbidity was equal with both surgeons and registrars. CONCLUSION: We conclude that laparoscopic appendicectomy is a safe laparoscopic training tool for registrars with basic laparoscopic knowledge who have had a proper apprenticeship, and can be done in a clinical setting.     

Cotard delusion in a depressed patient: “My throat is missing!”

Cotard's syndrome is a rare neuropsychiatric disorder characterized by marked nihilistic delusions. This report describes an Indonesian woman from a small town in Malaysia who was diagnosed with depression and Cotard's delusion. The diagnosis was confirmed after thorough history-taking, clinical examination, and relevant laboratory tests. Herein, we highlight the unique psychopathology of a possible Cotard's syndrome subtype and efficacy of pharmacological combination strategies, rather than monotherapy and electroconvulsive therapy, for its treatment.     

The clinical utility window for acute kidney injury biomarkers in the critically ill

Introduction

Acute Kidney Injury (AKI) biomarker utility depends on sample timing after the onset of renal injury. We compared biomarker performance on arrival in the emergency department (ED) with subsequent performance in the intensive care unit (ICU).

Methods

Urinary and plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL), and urinary Cystatin C (CysC), alkaline phosphatase, γ-Glutamyl Transpeptidase (GGT), α- and π-Glutathione S-Transferase (GST), and albumin were measured on ED presentation, and at 0, 4, 8, and 16 hours, and days 2, 4 and 7 in the ICU in patients after cardiac arrest, sustained or profound hypotension or ruptured abdominal aortic aneurysm. AKI was defined as plasma creatinine increase ≥26.5 μmol/l within 48 hours or ≥50% within 7 days.

Results

In total, 45 of 77 patients developed AKI. Most AKI patients had elevated urinary NGAL, and plasma NGAL and CysC in the period 6 to 24 hours post presentation. Biomarker performance in the ICU was similar or better than when measured earlier in the ED. Plasma NGAL diagnosed AKI at all sampling times, urinary NGAL, plasma and urinary CysC up to 48 hours, GGT 4 to 12 hours, and π-GST 8 to 12 hours post insult. Thirty-one patients died or required dialysis. Peak 24-hour urinary NGAL and albumin independently predicted 30-day mortality and dialysis; odds ratios 2.87 (1.32 to 6.26), and 2.72 (1.14 to 6.48), respectively. Urinary NGAL improved risk prediction by 11% (IDI_event of 0.06 (0.002 to 0.19) and IDI_non-event of 0.04 (0.002 to 0.12)).

Conclusion

Early measurement in the ED has utility, but not better AKI diagnostic performance than later ICU measurement. Plasma NGAL diagnosed AKI at all time points. Urinary NGAL best predicted mortality or dialysis compared to other biomarkers.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12610001012066. Registered 12 February 2010     

Shape-based interpolation method in measuring intracranial volume for pre- and post-operative decompressive craniectomy using open source software

IntroductionIntracranial volume (ICV) is an important tool in the management of patients undergoing decompressive craniectomy (DC) surgery. The aim of this study was to validate ICV measurement applying the shape-based interpolation (SBI) method using open source software on computed tomography (CT) images.MethodsThe pre- and post-operative CT images of 55 patients undergoing DC surgery were analyzed. The ICV was measured by segmenting every slice of the CT images, and compared with estimated ICV calculated using the 1-in-10 sampling strategy and processed using the SBI method. An independent t test was conducted to compare the ICV measurements between the two different methods. The calculation using this method was repeated three times for reliability analysis using the intraclass correlations coefficient (ICC). The Bland–Altman plot was used to measure agreement between the methods for both pre- and post-operative ICV measurements.ResultsThe mean ICV (±SD) were 1341.1 ± 122.1 ml (manual) and 1344.11 ± 122.6 ml (SBI) for the preoperative CT data. The mean ICV (±SD) were 1396.4 ± 132.4 ml (manual) and 1400.53 ± 132.1 ml (SBI) for the post-operative CT data. No significant difference was found in ICV measurements using the manual and the SBI methods (p = .983 for pre-op, and p = .960 for post-op). The intrarater ICC showed a significant correlation; ICC = 1.00. The Bland–Altman plot showed good agreement between the manual and the SBI method.ConclusionThe shape-based interpolation method with 1-in-10 sampling strategy gave comparable results in estimating ICV compared to manual segmentation. Thus, this method could be used in clinical settings for rapid, reliable and repeatable ICV estimations.     

Warpage Optimisation on the Moulded Part with Straight Drilled and Conformal Cooling Channels Using Response Surface Methodology (RSM), Glowworm Swarm Optimisation (GSO) and Genetic Algorithm (GA) Optimisation Approaches

It is quite challenging to control both quality and productivity of products produced using injection molding process. Although many previous researchers have used different types of optimisation approaches to obtain the best configuration of parameters setting to control the quality of the molded part, optimisation approaches in maximising the performance of cooling channels to enhance the process productivity by decreasing the mould cycle time remain lacking. In this study, optimisation approaches namely Response Surface Methodology (RSM), Genetic Algorithm (GA) and Glowworm Swarm Optimisation (GSO) were employed on front panel housing moulded using Acrylonitrile Butadiene Styrene (ABS). Each optimisation method was analysed for both straight drilled and Milled Groove Square Shape (MGSS) conformal cooling channel moulds. Results from experimental works showed that, the performance of MGSS conformal cooling channels could be enhanced by employing the optimisation approach. Therefore, this research provides useful scientific knowledge and an alternative solution for the plastic injection moulding industry to improve the quality of moulded parts in terms of deformation using the proposed optimisation approaches in the used of conformal cooling channels mould.     

Quantification techniques to minimize the effects of native T1 variation and B1 inhomogeneity in dynamic contrast‐enhanced MRI of the breast at 3 T

The variation of the native T₁ (T₁₀) of different tissues and B₁ transmission‐field inhomogeneity at 3 T are major contributors of errors in the quantification of breast dynamic contrast‐enhanced MRI. To address these issues, we have introduced new enhancement indices derived from saturation‐recovery snapshot‐FLASH (SRSF) images. The stability of the new indices, i.e., the SRSF enhancement factor (EF_SRSF) and its simplified version (EF′_SRSF) with respect to differences in T₁₀ and B₁ inhomogeneity was compared against a typical index used in breast dynamic contrast‐enhanced MRI, i.e., the enhancement ratio (ER), by using computer simulations. Imaging experiments with Gd‐DTPA‐doped gel phantoms and a female volunteer were also performed. A lower error was observed in the new indices compared to enhancement ratio in the presence of typical T₁₀ variation and B₁ inhomogeneity. At changes of relaxation rate (ΔR₁) of 8 s^?1, the differences between a T₁₀ of 1266 and 566 ms are <1, 12, and 58%, respectively, for EF_SRSF, EF′_SRSF, and ER, whereas differences of 20, 8, and 51%, respectively, result from a 50% B₁ field reduction at the same ΔR₁. These quantification techniques may be a solution to minimize the effect of T₁₀ variation and B₁ inhomogeneity on dynamic contrast‐enhanced MRI of the breast at 3 T. Magn Reson Med, 2012. © 2011 Wiley Periodicals, Inc.     

Survival and prognostic factors in Malaysian acute myeloid leukemia patients after allogeneic haematopoietic stem cell transplantation

Studies of survival outcomes in acute myeloid leukemia (AML) patients treated with allogeneic haematopoietic stem cell transplantation (HSCT) are essential for planning patient care. The objectives of the present study were to determine overall survival (OS) and disease-free survival (DFS) in AML patients treated with allogeneic HSCT, and to identify prognostic factors associated with poor outcome. This study was conducted retrospectively, using data from the Blood and Bone Marrow Transplant, National Transplant Registry, Malaysia. All cases of AML treated with allogeneic HSCT registered at the registry between 1st January 1987 and 31st December 2010 were included in the study. A total of 300 patients were included for final analysis. The Kaplan–Meier method and Cox proportional hazard regression were used for statistical analysis. The overall 10-year OS and DFS for Malaysian AML patients after allogeneic HSCT were 63 and 67 %, respectively. Donor gender, marrow status, and conditioning intensity were identified as important prognostic factors for overall survival, whereas the significant prognostic factors for disease-free survival were ethnic group, donor gender, marrow status, and conditioning intensity. In conclusion, the survival outcomes for Malaysian AML patients treated with allogeneic HSCT were good, and this treatment should be considered the standard therapeutic approach for suitable candidates.     

Skin-sparing mastectomy

Skin-sparing mastectomy is still in its infancy in Malaysia. The option of skin-sparing mastectomy is rarely given to patients as many general surgeons perform the conventional mastectomy. This could also be compounded by the lack of awareness amongst the local surgeons on the safety, surgical technique and treatment outcome of this relatively new procedure. This case report demonstrates the feasibility of this procedure performed on a Malaysian patient with a comparable outcome of those reported in the Western countries.