Browse publications by year: 2017

  1. Sinniah SK, Tan KW, Ng SW, Sim KS
    Anticancer Agents Med Chem, 2017;17(5):741-753.
    PMID: 27671302 DOI: 10.2174/1871520616666160926110929
    BACKGROUND: Thiosemicarbazone (TSC) is a Schiff base that has been receiving considerable attention owing to its promising biological implication and remarkable pharmacological properties. The most promising drug candidate of this class would be Triapine (3-aminopyridine-2-carboxaldehyde thiosemicarbazone) which has entered phase II clinical trials as a potent anti-cancer chemotherapeutic agent.

    OBJECTIVE: The current research aimed to synthesize several Schiff base ligands from (3-formyl-4-hydroxyphenyl) methyltriphenylphosphonium (T). Additionally, the current research aimed to study the growth inhibitory effect of triphenylphosphonium containing thiosemicarbazone derivatives on PC-3 cells by deciphering the mechanisms involved in cell death.

    METHOD: The compounds were characterized by various spectroscopic methods (infrared spectra, 1H NMR, 13C NMR, HRESIMS and X-ray crystallography) and the results were in conformity with the structure of the targeted compounds. Growth inhibitory effect of the compounds were performed against six human cell lines.

    RESULTS: DM(tsc)T displayed most potent activity against PC-3 cells with IC50 value of 2.64 ± 0.33 μM, surpassing that of the positive control cisplatin (5.47 ± 0.06 μM). There were marked morphological changes observed in DM(tsc)T treated cells stained with acridine orange and ethidium bromide which were indicative of cell apoptosis. Treatment with DM(tsc)T showed that the cell cycle is arrested in the G0/G1 phase after 72 hours. Mitochondrial membrane potential loss was observed in cells treated with DM(tsc)T, indicating the apoptosis could be due to mitochondria mediated pathway.

    CONCLUSION: This study indicates that DM(tsc)T would serve as a lead scaffold for rational anticancer agent development.

    MeSH terms: Antineoplastic Agents/chemical synthesis; Antineoplastic Agents/pharmacology*; Antineoplastic Agents/chemistry; Cell Cycle/drug effects; Dose-Response Relationship, Drug; Drug Screening Assays, Antitumor; Humans; Male; Mitochondria/drug effects*; Mitochondria/metabolism; Structure-Activity Relationship; Thiosemicarbazones/chemical synthesis; Thiosemicarbazones/pharmacology*; Thiosemicarbazones/chemistry; Molecular Structure; Apoptosis/drug effects*; Cell Line, Tumor; Cell Proliferation/drug effects
  2. Ibrahim NR, Kheng TH, Nasir A, Ramli N, Foo JLK, Syed Alwi SH, et al.
    Arch. Dis. Child. Fetal Neonatal Ed., 2017 May;102(3):F225-F229.
    PMID: 27671836 DOI: 10.1136/archdischild-2015-310246
    OBJECTIVE: To determine whether feeding with 2-hourly or 3-hourly feeding interval reduces the time to achieve full enteral feeding and to compare their outcome in very low birthweight preterm infants.

    DESIGN: Parallel-group randomised controlled trial with a 1:1 allocation ratio.

    SETTING: Two regional tertiary neonatal intensive care units.

    PATIENTS: 150 preterm infants less than 35 weeks gestation with birth weight between 1.0 and 1.5 kg were recruited.

    INTERVENTIONS: Infants were enrolled to either 2-hourly or 3-hourly interval feeding after randomisation. Blinding was not possible due to the nature of the intervention.

    MAIN OUTCOME MEASURES: The primary outcome was time to achieve full enteral feeding (≥100 mL/kg/day). Secondary outcomes include time to regain birth weight, episode of feeding intolerance, peak serum bilirubin levels, duration of phototherapy, episode of necrotising enterocolitis, nosocomial sepsis and gastro-oesophageal reflux.

    RESULTS: 72 infants were available for primary outcome analysis in each group as three were excluded due to death-three deaths in each group. The mean time to full enteral feeding was 11.3 days in the 3-hourly group and 10.2 days in the 2-hourly group (mean difference 1.1 days; 95% CI -0.4 to 2.5; p=0.14). The mean time to regain birth weight was shorter in 3-hourly group (12.9 vs 14.8 days, p=0.04). Other subgroup analyses did not reveal additional significant results. No difference in adverse events was found between the groups.

    CONCLUSION: 3-hourly feeding was comparable with 2-hourly feeding to achieve full enteral feeding without any evidence of increased adverse events.

    TRIAL REGISTRATION NUMBER: ACTRN12611000676910, pre-result.

    MeSH terms: Birth Weight; Enteral Nutrition/adverse effects; Enteral Nutrition/methods*; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Male; Parenteral Nutrition/adverse effects; Parenteral Nutrition/methods; Time Factors; Intensive Care, Neonatal/methods*; Treatment Outcome; Infant, Very Low Birth Weight*
  3. Zin CS, Rahman NA, Ismail CR, Choy LW
    Pain Pract, 2017 07;17(6):774-781.
    PMID: 27676695 DOI: 10.1111/papr.12525
    BACKGROUND: There are currently limited data available on the patterns of opioid prescribing in Malaysia. This study investigated the patterns of opioid prescribing and characterized the dosing and duration of opioid use in patients with noncancer and cancer pain.
    METHODS: This retrospective, cross-sectional study was conducted at an outpatient hospital setting in Malaysia. All prescriptions for opioids (dihydrocodeine, fentanyl, morphine, and oxycodone) issued between January 2013 and December 2014 were examined. The number of prescriptions and patients, the distribution of mean daily dose, annual total days covered with opioids, and annual total opioid dose at the individual level were calculated and stratified by noncancer and cancer groups.
    RESULTS: A total of 1015 opioid prescriptions were prescribed for 347 patients from 2013 to 2014. Approximately 41.5% of patients (N = 144/347) and 58.5% (N = 203/347) were associated with noncancer and cancer diagnosis, respectively. Oxycodone (38.0%) was the highest prescribed primarily for the noncancer group. The majority of patients in both noncancer (74.3%) and cancer (60.4%) groups were receiving mean daily doses of < 50 mg morphine equivalents. The chronic use of opioids (> 90 days per year) was associated with 21.8% of patients in the noncancer group and 17.5% in the cancer group.
    CONCLUSIONS: The finding from this study showed that 41.5% of opioid users at an outpatient hospital setting in Malaysia received opioids for noncancer pain and 21.8% of these users were using opioids for longer than 90 days. The average daily dose in the majority of patients in both groups of noncancer and cancer was modest.
    Study site: outpatient clinic, hospital, Malaysia
    MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid/administration & dosage*; Cross-Sectional Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fentanyl/administration & dosage; Hospitals, General; Humans; Malaysia/epidemiology; Male; Middle Aged; Morphine/administration & dosage; Neoplasms/drug therapy; Neoplasms/epidemiology; Outpatient Clinics, Hospital/trends*; Oxycodone/administration & dosage; Pain/drug therapy; Pain/epidemiology; Retrospective Studies; Young Adult; Cancer Pain/drug therapy*; Cancer Pain/epidemiology*
  4. Pramanik BK, Pramanik SK, Sarker DC, Suja F
    Environ Technol, 2017 Aug;38(15):1937-1942.
    PMID: 27666670 DOI: 10.1080/09593330.2016.1240716
    Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are the major polyfluoroalkyl substances (PFASs) contaminating global water environment. This study investigated the efficiency of granular activated carbon (GAC), ultrafiltration (UF) and nanofiltration (NF) treatment for removing PFOS and PFOA contaminants from lake water. NF gave greater removal of all contaminant types (in terms of organic matter, PFOS and PFOA) than GAC treatment which in turn was greater than UF treatment. The lower removal by UF was due to larger pore size of the membrane compared to the size of the target contaminants. For all treatment processes, lower pH (4) in the feedwater showed greater rejection of the organics and selected PFASs. This was likely due to increase in the electrostatic repulsion between solute and sorbent. It could be observed that on increasing the concentration of organics in the feed solution, the rejection of PFOA/PFOS decreased which was due to competition between organics and PFOS/PFOA for binding sites on the membrane/activated carbon surface. It was also noted that protein content led to greater influence for lower rejection of the PFOA/PFOS than carbohydrate or DOC content. This study demonstrated the potential use of membrane processes for removing emerging persistent organic pollutant removal from lake water.
    MeSH terms: Caprylates/chemistry*; Fluorocarbons/chemistry*; Water Pollutants, Chemical/chemistry*; Alkanesulfonic Acids/chemistry*; Water Purification; Lakes
  5. Nikpay F, Ahmad R, Yin Kia C
    Eval Program Plann, 2017 02;60:1-16.
    PMID: 27665066 DOI: 10.1016/j.evalprogplan.2016.09.001
    Enterprise Architecture (EA) implementation evaluation provides a set of methods and practices for evaluating the EA implementation artefacts within an EA implementation project. There are insufficient practices in existing EA evaluation models in terms of considering all EA functions and processes, using structured methods in developing EA implementation, employing matured practices, and using appropriate metrics to achieve proper evaluation. The aim of this research is to develop a hybrid evaluation method that supports achieving the objectives of EA implementation. To attain this aim, the first step is to identify EA implementation evaluation practices. To this end, a Systematic Literature Review (SLR) was conducted. Second, the proposed hybrid method was developed based on the foundation and information extracted from the SLR, semi-structured interviews with EA practitioners, program theory evaluation and Information Systems (ISs) evaluation. Finally, the proposed method was validated by means of a case study and expert reviews. This research provides a suitable foundation for researchers who wish to extend and continue this research topic with further analysis and exploration, and for practitioners who would like to employ an effective and lightweight evaluation method for EA projects.
    MeSH terms: Decision Making; Humans; Information Systems/organization & administration*; Information Systems/standards; Research Design*; Reproducibility of Results; Program Evaluation/methods*; Program Evaluation/standards
  6. Chew BL, Fisk ID, Fray R, Tucker GA, Bodi Z, Ferguson A, et al.
    Plant Cell Rep, 2017 Jan;36(1):81-87.
    PMID: 27662835 DOI: 10.1007/s00299-016-2058-z
    KEY MESSAGE: This study highlights the changes in umami-related nucleotide and glutamate levels when the AMP deaminase gene was elevated in transgenic tomato. Taste is perceived as one of a combination of five sensations, sweet, sour, bitter, salty, and umami. The umami taste is best known as a savoury sensation and plays a central role in food flavour, palatability, and eating satisfaction. Umami flavour can be imparted by the presence of glutamate and is greatly enhanced by the addition of ribonucleotides, such as inosine monophosphate (IMP) and guanosine monophosphate (GMP). The production of IMP is regulated by the enzyme adenosine monophosphate (AMP) deaminase which functions to convert AMP into IMP. We have generated transgenic tomato (Solanum lycopersicum) lines over expressing AMP deaminase under the control of a fruit-specific promoter. The transgenic lines showed substantially enhanced levels of AMP deaminase expression in comparison to the wild-type control. Elevated AMP deaminase levels resulted in the reduced accumulation of glutamate and increased levels of the umami nucleotide GMP. AMP concentrations were unchanged. The effects on the levels of glutamate and GMP were unexpected and are discussed in relation to the metabolite flux within this pathway.
    MeSH terms: Adenosine Monophosphate/metabolism; AMP Deaminase/metabolism*; Fruit/genetics; Fruit/metabolism; Guanosine Monophosphate/metabolism; Plant Proteins; Taste*; Genes, Plant; Gene Expression Regulation, Plant; Lycopersicon esculentum/enzymology*; Lycopersicon esculentum/genetics; Lycopersicon esculentum/metabolism; Glutamic Acid/metabolism; Transgenes; Plants, Genetically Modified; Real-Time Polymerase Chain Reaction
  7. Adnan LA, Sathishkumar P, Yusoff AR, Hadibarata T, Ameen F
    Bioprocess Biosyst Eng, 2017 Jan;40(1):85-97.
    PMID: 27663440 DOI: 10.1007/s00449-016-1677-7
    In this study, a newly isolated ascomycete fungus Trichoderma lixii F21 was explored to bioremediate the polar [Alizarin Red S (ARS)] and non-polar [Quinizarine Green SS (QGSS)] anthraquinone dyes. The bioremediation of ARS and QGSS by T. lixii F21 was found to be 77.78 and 98.31 %, respectively, via biosorption and enzymatic processes within 7 days of incubation. The maximum biosorption (ARS = 33.7 % and QGSS = 74.7 %) and enzymatic biodegradation (ARS = 44.1 % and QGSS = 23.6 %) were observed at pH 4 and 27 °C in the presence of glucose and yeast extract. The laccase and catechol 1,2-dioxygenase produced by T. lixii F21 were involved in the molecular conversions of ARS and QGSS to phenolic and carboxylic acid compounds, without the formation of toxic aromatic amines. This study suggests that T. lixii F21 may be a good candidate for the bioremediation of industrial effluents contaminated with anthraquinone dyes.
    MeSH terms: Anthraquinones/metabolism*; Biodegradation, Environmental; Coloring Agents/metabolism*; Trichoderma/metabolism*
  8. Deng YF, Liu YY, Zhang YT, Wang Y, Liang JB, Tufarelli V, et al.
    J Sci Food Agric, 2017 Jun;97(8):2382-2391.
    PMID: 27664398 DOI: 10.1002/jsfa.8050
    BACKGROUND: The efficacy and role of inulin in the mitigation of enteric sulfur-containing odor gases hydrogen sulfide (H2 S) and methyl mercaptan (CH3 SH) in pigs were examined in this study. Twelve Duroc × Landrace × Yorkshire male finisher pigs (60.7 ± 1.9 kg), housed individually in open-circuit respiration chambers, were randomly assigned to two dietary groups, namely basal diet (control) and basal diet supplemented with 1% (w/w) inulin. At the end of the 45 day experiment, pigs were slaughtered and volatile fatty acid (VFA) concentration, sulfate radical (SO42- ) concentration, population of sulfate-reducing bacteria (SRB) and expression of methionine gamma-lyase (MGL) gene were determined in contents from the caecum, colon (two segments) and rectum. Metabonomic analysis was used to compare differences in biochemical composition, and the Illumina MiSeq procedure to investigate differences in bacterial components, in the different parts of the large intestine between inulin-supplemented and inulin-free (control) groups.

    RESULTS: Inulin decreased (P < 0.05) the average daily enteric H2 S and CH3 SH production by 12.4 and 12.1% respectively. The concentrations of acetate, propionate and butyrate in the large intestinal content were significantly increased (P < 0.05) with inulin treatment, whereas valerate concentration and MGL mRNA expression decreased (P < 0.05). The growth of Lactobacillus, Butyrivibrio, Pseudobutyrivibrio, Bifidobacterium and Clostridium butyricum was stimulated, while that of Desulfovibrio, the dominant SRB, was inhibited, and there was an accumulation of SO42- in the large intestinal content of the inulin-supplemented pigs, suggesting that inulin mitigates H2 S generation from the SO42- reduction pathway by reducing the growth of SRB.

    CONCLUSION: The results showed that inulin mitigates CH3 SH generation via three methionine degradation metabolic pathways and H2 S generation from two cysteine degradation metabolic pathways, thus resulting in increased synthesis of these two sulfur-containing amino acids in the pig large intestine. © 2016 Society of Chemical Industry.

    MeSH terms: Animals; Animal Feed/analysis; Fatty Acids, Volatile/metabolism; Feces/microbiology; Feces/chemistry; Intestine, Large/drug effects; Intestine, Large/microbiology; Inulin/administration & dosage; Inulin/pharmacology*; Male; Odors/analysis*; RNA, Ribosomal, 16S; Sulfates/metabolism; Carbon-Sulfur Lyases/genetics; Carbon-Sulfur Lyases/metabolism; Sulfhydryl Compounds/metabolism; Sulfur-Reducing Bacteria/classification; Sulfur-Reducing Bacteria/genetics; Sulfur-Reducing Bacteria/growth & development*; Sus scrofa/growth & development*; Sus scrofa/metabolism; Sus scrofa/microbiology; Metabolome/drug effects*
  9. Behkami S, Zain SM, Gholami M, Bakirdere S
    Food Chem, 2017 Feb 15;217:438-444.
    PMID: 27664656 DOI: 10.1016/j.foodchem.2016.08.130
    The potential for the isotopic ratio analysis of cattle tail hair in determining the geographical origin of raw cow milk in Peninsular Malaysia had been investigated in this research using exploratory visualization. A significant positive correlation (p<0.0001) (n=54) was noticed between δ(13)C and δ(15)N in milk with that of hair which indicated that these matrices could be used in tracing the geographical origin of animal produce and tissues, and there is a possibility that hair could be used as a substitute in building the database for the geographical traceability of milk. It was also observed that both hair and milk isotopic ratio correlations exhibited separation between the northern and southern regions. The accuracy of using isotopic ratio in determining geographical discrimination had been clearly demonstrated when several commercial milk samples from the same regions under the study were correctly assigned to the appropriate geographical clusters.
    MeSH terms: Animals; Carbon Isotopes/analysis*; Cattle; Deuterium/analysis; Female; Geography; Hair/chemistry*; Malaysia; Male; Milk/chemistry*; Nitrogen Isotopes/analysis*
  10. Tilwani RK, Vessillier S, Pingguan-Murphy B, Lee DA, Bader DL, Chowdhury TT
    Inflamm Res, 2017 Jan;66(1):49-58.
    PMID: 27658702 DOI: 10.1007/s00011-016-0991-5
    OBJECTIVE AND DESIGN: Oxygen tension and biomechanical signals are factors that regulate inflammatory mechanisms in chondrocytes. We examined whether low oxygen tension influenced the cells response to TNFα and dynamic compression.

    MATERIALS AND METHODS: Chondrocyte/agarose constructs were treated with varying concentrations of TNFα (0.1-100 ng/ml) and cultured at 5 and 21 % oxygen tension for 48 h. In separate experiments, constructs were subjected to dynamic compression (15 %) and treated with TNFα (10 ng/ml) and/or L-NIO (1 mM) at 5 and 21 % oxygen tension using an ex vivo bioreactor for 48 h. Markers for catabolic activity (NO, PGE2) and tissue remodelling (GAG, MMPs) were quantified by biochemical assay. ADAMTS-5 and MMP-13 expression were examined by real-time qPCR. 2-way ANOVA and a post hoc Bonferroni-corrected t test were used to analyse data.

    RESULTS: TNFα dose-dependently increased NO, PGE2 and MMP activity (all p 

    MeSH terms: Animals; Cattle; Cells, Cultured; Glycosaminoglycans/metabolism; Nitric Oxide/metabolism; Oxygen/physiology*; Stress, Mechanical; Tumor Necrosis Factor-alpha/pharmacology*; Dinoprostone/metabolism; Chondrocytes/drug effects*; Chondrocytes/metabolism; Chondrocytes/physiology; Matrix Metalloproteinase 13/genetics; ADAMTS5 Protein/genetics
  11. Yousuf A, Khan MR, Islam MA, Wahid ZA, Pirozzi D
    Biotechnol Lett, 2017 Jan;39(1):13-23.
    PMID: 27659031 DOI: 10.1007/s10529-016-2217-x
    Microbial oils are considered as alternative to vegetable oils or animal fats as biodiesel feedstock. Microalgae and oleaginous yeast are the main candidates of microbial oil producers' community. However, biodiesel synthesis from these sources is associated with high cost and process complexity. The traditional transesterification method includes several steps such as biomass drying, cell disruption, oil extraction and solvent recovery. Therefore, direct transesterification or in situ transesterification, which combines all the steps in a single reactor, has been suggested to make the process cost effective. Nevertheless, the process is not applicable for large-scale biodiesel production having some difficulties such as high water content of biomass that makes the reaction rate slower and hurdles of cell disruption makes the efficiency of oil extraction lower. Additionally, it requires high heating energy in the solvent extraction and recovery stage. To resolve these difficulties, this review suggests the application of antimicrobial peptides and high electric fields to foster the microbial cell wall disruption.
    MeSH terms: Esterification/physiology; Electroporation; Biomass; Antimicrobial Cationic Peptides/pharmacology; Biofuels/microbiology*; Microalgae/drug effects; Microalgae/genetics; Microalgae/metabolism*
  12. Feroz FS, Leicht G, Steinmann S, Andreou C, Mulert C
    Brain Topogr, 2017 Jan;30(1):30-45.
    PMID: 27659288 DOI: 10.1007/s10548-016-0521-3
    Growing evidence from neuroimaging studies suggest that emotional and cognitive processes are interrelated. Anatomical key structures in this context are the dorsal and rostral-ventral anterior cingulate cortex (dACC and rvACC). However, up to now, the time course of activations within these regions during emotion-cognition interactions has not been disentangled. In the present study, we used event-related potentials (ERP) and standardized low-resolution electromagnetic tomography (sLORETA) region of interest (ROI) source localization analyses to explore the time course of neural activations within the dACC and rvACC using a modified emotional Stroop paradigm. ERP components related to Stroop conflict (N200, N450 and late negativity) were analyzed. The time course of brain activations in the dACC and rvACC was strikingly different with more pronounced initial responses in the rvACC followed by increased dACC activity mainly at the late negativity window. Moreover, emotional valence modulated the earlier N450 stage within the rvACC region with higher neural activations in the positive compared to the negative and neutral conditions. Emotional arousal modulated the late negativity stage; firstly in the significant arousal × congruence ERP effect and then the significant higher current density in the low arousal condition within the dACC. Using sLORETA source localization, substantial differences in the activation time courses in the dACC and rvACC could be found during the emotional Stroop task. We suggest that during late negativity, within the dACC, emotional arousal modulated the processing of response conflict, reflected in the correlation between the ex-Gaussian µ and the current density in the dACC.
    MeSH terms: Adult; Arousal/physiology; Attention/physiology*; Cognition/physiology; Emotions/physiology*; Evoked Potentials/physiology*; Female; Gyrus Cinguli/physiology*; Humans; Male; Middle Aged; Time Factors; Young Adult; Stroop Test*
  13. Ten ST, Hashim U, Gopinath SC, Liu WW, Foo KL, Sam ST, et al.
    Biosens Bioelectron, 2017 Jul 15;93:146-154.
    PMID: 27660016 DOI: 10.1016/j.bios.2016.09.035
    Surface acoustic wave mediated transductions have been widely used in the sensors and actuators applications. In this study, a shear horizontal surface acoustic wave (SHSAW) was used for the detection of food pathogenic Escherichia coli O157:H7 (E.coli O157:H7), a dangerous strain among 225 E. coli unique serotypes. A few cells of this bacterium are able to cause young children to be most vulnerable to serious complications. Presence of higher than 1cfu E.coli O157:H7 in 25g of food has been considered as a dangerous level. The SHSAW biosensor was fabricated on 64° YX LiNbO3 substrate. Its sensitivity was enhanced by depositing 130.5nm thin layer of SiO2 nanostructures with particle size lesser than 70nm. The nanostructures act both as a waveguide as well as a physical surface modification of the sensor prior to biomolecular immobilization. A specific DNA sequence from E. coli O157:H7 having 22 mers as an amine-terminated probe ssDNA was immobilized on the thin film sensing area through chemical functionalization [(CHO-(CH2)3-CHO) and APTES; NH2-(CH2)3-Si(OC2H5)3]. The high-performance of sensor was shown with the specific oligonucleotide target and attained the sensitivity of 0.6439nM/0.1kHz and detection limit was down to 1.8femto-molar (1.8×10(-15)M). Further evidence was provided by specificity analysis using single mismatched and complementary oligonucleotide sequences.
    MeSH terms: DNA, Bacterial/isolation & purification*; DNA, Bacterial/chemistry; DNA, Single-Stranded/isolation & purification*; DNA, Single-Stranded/chemistry; Food Microbiology; Gold/chemistry; Humans; Silicon Dioxide/chemistry; Sound; Biosensing Techniques/methods*; Escherichia coli O157/isolation & purification*; Escherichia coli O157/pathogenicity; Nanostructures/chemistry
  14. Leng CY, Low HC, Chua LL, Chong ML, Sulaiman H, Azwa I, et al.
    HIV Med, 2017 05;18(5):321-331.
    PMID: 27649852 DOI: 10.1111/hiv.12432
    OBJECTIVES: Human papillomavirus (HPV)-associated cancers disproportionately affect those infected with HIV despite effective combination antiretroviral therapy (cART). The primary aim of this study was to quantify HPV16 and HPV52 E6-specific interferon (IFN)-γ enzyme-linked immunospot (ELISPOT) T-cell responses, a correlate of protective immunity, in the first year following cART initiation and subsequently in those patients with suboptimal (sIR) and optimal (oIR) immune reconstitution.

    METHODS: Ninety-four HIV-infected patients were recruited to the study; a longitudinal cohort of patients recruited just prior to commencing cART and followed up for 48 weeks (n = 27), and a cross-sectional cohort (n = 67) consisting of patients with sIR (CD4 T-cell count < 350 cells/μL) and oIR (CD4 T-cell count > 500 cells/μL) after a minimum of 2 years on cART. Controls (n = 29) consisted of HIV-negative individuals. IFN-γ ELISPOT responses against HPV16 and HPV52 E6 were correlated to clinical characteristics, anal and oral HPV carriage, T-cell maturational subsets, markers of activation, senescence and T-regulatory cells.

    RESULTS: HPV16 and HPV52 E6-specific T-cell responses were detected in only one of 27 patients (3.7%) during the initial phase of immune recovery. After at least 2 years of cART, those who achieved oIR had significantly higher E6-specific responses (9 of 34; 26.5%) compared with those with sIR (2 of 32; 6.3%) (P = 0.029). Apart from higher CD4 T-cell counts and lower CD4 T-cell activation, no other immunological correlates were associated with the detection of HPV16 and HPV52 E6-specific responses.

    CONCLUSIONS: HPV16 and HPV52 E6-specific IFN-γ T-cell responses, a correlate of protective immunity, were detected more frequently among HIV-infected patients who achieved optimal immune recovery on cART (26.5%) compared with those with suboptimal recovery (6.3%).

    MeSH terms: Adult; Cross-Sectional Studies; Female; Genotype; Humans; Interferon-gamma/secretion; Leukocytes, Mononuclear/immunology; Longitudinal Studies; Male; Middle Aged; Oncogene Proteins, Viral/immunology*; HIV Infections/complications*; HIV Infections/drug therapy*; Antiretroviral Therapy, Highly Active*; Papillomaviridae/immunology*; Papillomavirus Infections/immunology*; Anti-Retroviral Agents/therapeutic use*; Enzyme-Linked Immunospot Assay
  15. Hirsch RE, Sibmooh N, Fucharoen S, Friedman JM
    Antioxid Redox Signal, 2017 May 10;26(14):794-813.
    PMID: 27650096 DOI: 10.1089/ars.2016.6806
    SIGNIFICANCE: Oxidative stress and generation of free radicals are fundamental in initiating pathophysiological mechanisms leading to an inflammatory cascade resulting in high rates of morbidity and death from many inherited point mutation-derived hemoglobinopathies. Hemoglobin (Hb)E is the most common point mutation worldwide. The βE-globin gene is found in greatest frequency in Southeast Asia, including Thailand, Malaysia, Indonesia, Vietnam, Cambodia, and Laos. With the wave of worldwide migration, it is entering the gene pool of diverse populations with greater consequences than expected.

    CRITICAL ISSUES: While HbE by itself presents as a mild anemia and a single gene for β-thalassemia is not serious, it remains unexplained why HbE/β-thalassemia (HbE/β-thal) is a grave disease with high morbidity and mortality. Patients often exhibit defective physical development, severe chronic anemia, and often die of cardiovascular disease and severe infections. Recent Advances: This article presents an overview of HbE/β-thal disease with an emphasis on new findings pointing to pathophysiological mechanisms derived from and initiated by the dysfunctional property of HbE as a reduced nitrite reductase concomitant with excess α-chains exacerbating unstable HbE, leading to a combination of nitric oxide imbalance, oxidative stress, and proinflammatory events.

    FUTURE DIRECTIONS: Additionally, we present new therapeutic strategies that are based on the emerging molecular-level understanding of the pathophysiology of this and other hemoglobinopathies. These strategies are designed to short-circuit the inflammatory cascade leading to devastating chronic morbidity and fatal consequences. Antioxid. Redox Signal. 26, 794-813.

    MeSH terms: Animals; Hemoglobin E/genetics; Hemoglobin E/metabolism*; Hemoglobinopathies/drug therapy*; Hemoglobinopathies/metabolism; Hemoglobinopathies/physiopathology*; Humans; beta-Thalassemia/genetics; beta-Thalassemia/metabolism*; Point Mutation; Oxidative Stress*
  16. Lee SW, Chaiyakunapruk N, Lai NM
    Br J Clin Pharmacol, 2017 01;83(1):211-212.
    PMID: 27650490 DOI: 10.1111/bcp.13091
    MeSH terms: Prunus persica/adverse effects; Anemia, Hemolytic/etiology; Anemia, Hemolytic/prevention & control*; Food/adverse effects*; Food Coloring Agents/adverse effects*; Food Coloring Agents/chemistry; Glucosephosphate Dehydrogenase Deficiency/blood; Glucosephosphate Dehydrogenase Deficiency/complications; Glucosephosphate Dehydrogenase Deficiency/diet therapy*; Humans; Menthol/adverse effects; Naphthalenes/chemistry; Pollen/adverse effects; Trigonella/adverse effects; Vicia faba/adverse effects; Asymptomatic Diseases/therapy
  17. Permsuwan U, Dilokthornsakul P, Thavorn K, Saokaew S, Chaiyakunapruk N
    J Med Econ, 2017 Feb;20(2):171-181.
    PMID: 27645706 DOI: 10.1080/13696998.2016.1238386
    OBJECTIVE: With a high prevalence of chronic kidney disease (CKD) in type 2 diabetes (T2DM) in Thailand, the appropriate treatment for the patients has become a major concern. This study aimed to evaluate long-term cost-effective of dipeptidyl peptidase-4 (DPP-4) inhibitor monothearpy vs sulfonylurea (SFU) monotherapy in people with T2DM and CKD.

    METHODS: A validated IMS CORE Diabetes Model was used to estimate the long-term costs and outcomes. The efficacy parameters were identified and synthesized using a systematic review and meta-analysis. Baseline characteristics and cost parameters were obtained from published studies and hospital databases in Thailand. Costs were expressed in 2014 US Dollars. Outcomes were presented as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to estimate parameter uncertainty.

    RESULTS: From a societal perspective, treatment with DPP-4 inhibitors yielded more quality-adjusted life years (QALYs) (0.024) at a higher cost (>66,000 Thai baht (THB) or >1,829.27 USD) per person than SFU, resulting in the ICER of >2.7 million THB/QALY (>74,833.70 USD/QALY). The cost-effectiveness results were mainly driven by differences in HbA1c reduction, hypoglycemic events, and drug acquisition cost of DPP-4 inhibitors. At the ceiling ratio of 160,000 THB/QALY (4,434.59 USD/QALY), the probability that DPP-4 inhibitors are cost-effective compared to SFU was less than 10%.

    CONCLUSIONS: Compared to SFU, DPP-4 inhibitor monotherapy is not a cost-effective treatment for people with T2DM and CKD in Thailand.

    MeSH terms: Aged; Cost-Benefit Analysis/methods*; Diabetes Mellitus, Type 2/drug therapy*; Female; Humans; Male; Markov Chains; Middle Aged; Sulfonylurea Compounds/administration & dosage; Sulfonylurea Compounds/economics*; Thailand; Comorbidity; Drug Costs/statistics & numerical data; Health Care Costs/statistics & numerical data; Renal Insufficiency, Chronic/drug therapy*; Dipeptidyl-Peptidase IV Inhibitors/administration & dosage; Dipeptidyl-Peptidase IV Inhibitors/economics*
  18. Lo TS, Shailaja N, Hsieh WC, Uy-Patrimonio MC, Yusoff FM, Ibrahim R
    Int Urogynecol J, 2017 Apr;28(4):575-582.
    PMID: 27647467 DOI: 10.1007/s00192-016-3144-z
    INTRODUCTION AND HYPOTHESIS: The objective of this study was to identify the predictors of postoperative voiding dysfunction in women following extensive vaginal pelvic reconstructive surgery.

    METHODS: We enrolled 1,425 women who had pelvic organ prolapse of POP-Q stage III or IV and had undergone vaginal pelvic reconstructive surgery with or without transvaginal mesh insertion from January 2006 to December 2014. All subjects were required to complete a 72-h voiding diary, and the IIQ-7, UDI-6, POPDI-6 and PISQ-12 questionnaires. Urodynamic study was performed preoperatively and postoperatively.

    RESULTS: Of the 1,425 women, 54 were excluded due to incomplete data, and 1,017 of the remaining 1,371 (74.2 %) had transvaginal mesh surgery and 247 (18 %) had concurrent midurethral sling insertion. Of 380 women (27.7 %) with preoperative voiding dysfunction, 37 (9.7 %) continued to have voiding dysfunction postoperatively. Of the remaining 991 women (72.3 %) with normal preoperative voiding function, 11 (1.1 %) developed de novo voiding dysfunction postoperatively. The overall incidence of postoperative voiding dysfunction was 3.5 % (48/1,371). Those with concurrent midurethral sling insertion were at higher risk of developing voiding dysfunction postoperatively (OR 3.12, 95 % CI 1.79 - 5.46, p 

    MeSH terms: Adult; Aged; Female; Humans; Middle Aged; Postoperative Complications/etiology*; Retrospective Studies; Gynecologic Surgical Procedures/adverse effects*; Urination Disorders/etiology*; Vagina/surgery; Pelvic Organ Prolapse/surgery*
  19. Guest GD, Scott DF, Xavier JP, Martins N, Vreede E, Chennal A, et al.
    ANZ J Surg, 2017 Jun;87(6):436-440.
    PMID: 27647706 DOI: 10.1111/ans.13768
    BACKGROUND: Timor-Leste suffered a destructive withdrawal by the Indonesian military in 1999, leaving only 20 Timorese-based doctors and no practising specialists for a population of 700 000 that has now grown to 1.2 million.

    METHODS: This article assesses the outcomes and impact of Royal Australasian College of Surgeons (RACS) specialist medical support from 2001 to 2015. Three programmes were designed collaboratively with the Timor-Leste Ministry of Health and Australian Aid. The RACS team began to provide 24/7 resident surgical and anaesthesia services in the capital, Dili, from July 2001. The arrival of the Chinese and Cuban Medical Teams provided a medical workforce, and the Cubans initiated undergraduate medical training for about 1000 nationals both in Cuba and in Timor-Leste, whilst RACS focused on specialist medical training.

    RESULTS: Australian Aid provided AUD$20 million through three continuous programmes over 15 years. In the first 10 years over 10 000 operations were performed. Initially only 10% of operations were done by trainees but this reached 77% by 2010. Twenty-one nurse anaesthetists were trained in-country, sufficient to cover the needs of each hospital. Seven Timorese doctors gained specialist qualifications (five surgery, one ophthalmology and one anaesthesia) from regional medical schools in Papua New Guinea, Fiji, Indonesia and Malaysia. They introduced local specialist and family medicine diploma programmes for the Cuban graduates.

    CONCLUSIONS: Timor-Leste has developed increasing levels of surgical and anaesthetic self-sufficiency through multi-level collaboration between the Ministry of Health, Universidade Nacional de Timor Lorosa'e, and sustained, consistent support from external donors including Australian Aid, Cuba and RACS.

  20. Su SC, Masters IB, Buntain H, Frawley K, Sarikwal A, Watson D, et al.
    Pediatr Pulmonol, 2017 04;52(4):480-486.
    PMID: 27641078 DOI: 10.1002/ppul.23606
    INTRODUCTION: Flexible bronchoscopy (FB) is the current gold standard for diagnosing tracheobronchomalacia. However, it is not always feasible and virtual bronchoscopy (VB), acquired from chest multi-detector CT (MDCT) scan is an alternative diagnostic tool. We determined the sensitivity, specificity, and positive and negative predictive values of VB compared to FB in diagnosing tracheobronchomalacia.

    METHODS: Children aged <18-years scheduled for FB and MDCT were recruited. FB and MDCT were undertaken within 30-min to 7-days of each other. Tracheobronchomalacia (mild, moderate, severe, very severe) diagnosed on FB were independently scored by two pediatric pulmonologists; VB was independently scored by two pairs (each pair = pediatric pulmonologist and radiologist), in a blinded manner.

    RESULTS: In 53 children (median age = 2.5 years, range 0.8-14.3) evaluated for airway abnormalities, tracheomalacia was detected in 37 (70%) children at FB. Of these, VB detected tracheomalacia in 20 children, with a sensitivity of 54.1% (95%CI 37.1-70.2), specificity = 87.5% (95%CI 60.4-97.8), and positive predictive value = 90.9% (95%CI 69.4-98.4). The agreement between pediatric pulmonologists for diagnosing tracheomalacia by FB was excellent, weighted κ = 0.8 (95%CI 0.64-0.97); but only fair between the pairs of pediatric pulmonologists/radiologists for VB, weighted κ = 0.47 (95%CI 0.23-0.71). There were 42 cases of bronchomalacia detected on FB. VB had a sensitivity = 45.2% (95%CI 30.2-61.2), specificity = 95.5% (95%CI 94.2-96.5), and positive predictive value = 23.2 (95%CI 14.9-34.0) compared to FB in detecting bronchomalacia.

    CONCLUSION: VB cannot replace FB as the gold standard for detecting tracheobronchomalacia in children. However, VB could be considered as an alternative diagnostic modality in children with symptoms suggestive of tracheobronchomalacia where FB is unavailable. Pediatr Pulmonol. 2017;52:480-486. © 2016 Wiley Periodicals, Inc.

    MeSH terms: Adolescent; Bronchoscopy/instrumentation*; Child; Child, Preschool; Female; Humans; Infant; Male; Sensitivity and Specificity; Tomography, X-Ray Computed; Tracheobronchomalacia/diagnosis*
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