MATERIALS AND METHODS: Thirty two patients with metastatic bone disease of the proximal femur undergoing LHR were recruited and randomized. Conventional technique was used in 16 cases and distal decompression of the medullary canal was carried out for the other 16 patients. The decompression was carried out through a trocar inserted into the distal medullary canal, connected to a vacuum suction. Quantity of emboli was detected through A4 chambers transesophageal echocardiography; the blood pressure and oxygen saturation readings were also recorded.
RESULTS: The decompression group experienced significantly lower Grade 2 and Grade 3 embolic events compared to the conventional group (11 vs. 26), and the duration of the embolic phenomena was shorter. Insertion of the stem and relocating the hip gave the highest amount embolic events. There was a significant drop in systolic blood pressure (SBP) in 12 out of 16 patients (75.0%) in the conventional group and 5 out of 16 patients in the decompression group (31.3%). This is statically significant (P = 0.0124). The average drop in SBP for the conventional group is 45.8 mmHg and the decompression group was 32.9 mmHg. Oxygen saturation remained at above 96% in the decompression group. However, in the conventional group, 25% of the patients had their oxygen saturation drop to below 96% during the insertion of stem and relocation of hip joint.
CONCLUSION: Distal femoral canal decompression is an effective method in reducing the risk of cardiopulmonary embolic events associated with LHR.
Materials and Methods: We examined RANKL expression in 39 patients (21 males, 18 females) by immunohistochemistry. Four patients (10%) were presented with tumor recurrence, eight patients (20%) were complicated with lung metastasis, and two patients (5%) were presented with both recurrence and lung metastasis. Positive RANKL expression was assessed according to a scoring system evaluating the percentage of the immunostained epithelial area and the staining intensity. The cumulative score was calculated to determine the final score value. Data were analyzed using PASW version 18.0 and independent t-test between nonrecurrence/recurrence groups, and nonlung metastasis/lung metastasis groups. Significance was set at P < 0.05.
Results: Thirty-two patients (82%) scored 3 in RANKL-staining percentage from whole stromal cell population (>75%), 6 patients scored 2, and 1 patient scored 1. Nine patients (23%) scored 3 in RANKL-staining intensity (most intense), 19 patients (48%) scored 2, and 11 patients (29%) scored 1. Twenty six patients (67%) had strong RANKL expression (total score of 5-6), 12 patients (31%) showed moderate score (3-4) whereas only 1 patient (2%) showed weak RANKL expression. Together, the mean value of RANKL-staining percentage was 2.79, intensity 1.95 and the total score 4.77. The mean RANKL-staining percentage between recurrence and nonrecurrence groups was statistically significant (P = 0.009). There was no significant difference in the mean staining intensity and total score between nonrecurrence and recurrence groups, and staining percentage staining intensity and a total cumulative score of RANKL expression between lung metastasis and nonlung metastasis groups.
Conclusion: RANKL expression is generally high in Stage III GCT and is a reliable prognostic marker in predicting the risk of local recurrence however not in lung metastasis.
Materials and Methods: Gait analysis was performed in 20 patients with endoprosthesis replacement around the knee. The temporal parameters assessed during gait analysis were walking velocity, stride length, duration of stance, and goniometry of the knee. These parameters were compared with the functional outcome score of the MSTS.
Results: The mean free-paced walking velocity was 0.91 m/s (normal is 1.33 m/s), which was 68% lower than normal gait. The stride length and stance phase were shorter for the affected limb compared to normal (P < 0.05). However, the gait was symmetrical with no difference in stride length (P = 0.148), velocity (P = 0.918), knee flexion (P = 0.465), and knee extension (P = 0.321) between the affected and unaffected limbs. Sixteen patients demonstrated stiff knee gait, two had a flexed knee gait, and only two patients had normal gait during the stance phase. The mean MSTS score was 21. There was significant correlation between overall MSTS scores (P = 0.023), function (P = 0.039), and walking scores (P = 0.007).
Conclusion: Limb salvage surgery with endoprosthesis reconstruction around the knee gives good functional outcome, both objectively and subjectively, as evidenced by the symmetrical gait pattern and significant correlation with MSTS score. Despite decreased walking velocity, stride length, and stance phase of the operated limb, the patient still has a symmetrical gait.
Objective: To investigate the validity and pattern of DSM-5-defined BQ use disorder (BUD) and its association with oral potentially malignant disorder (OPMD) among Asian populations.
Design, Setting, and Participants: In-person interviews were conducted from January 1, 2009, to February 28, 2010, among a random sample of 8922 noninstitutionalized adults from the Asian Betel-quid Consortium study, an Asian representative survey of 6 BQ-endemic populations. Statistical analysis was performed from January 1, 2015, to December 31, 2016.
Main Outcomes and Measures: Participants were evaluated for BUD using DSM-5 criteria for substance use disorder and for OPMD using a clinical oral examination. Current users of BQ with 0 to 1 symptoms were classified as having no BUD, those with 2 to 3 symptoms as having mild BUD, those with 4 to 5 symptoms as having moderate BUD, and those with 6 or more symptoms as having severe BUD.
Results: Among the 8922 participants (4564 women and 4358 men; mean [SD] age, 44.2 [0.2] years), DSM-5 symptoms showed sufficient unidimensionality to act as a valid measure for BUD. The 12-month prevalence of DSM-5-defined BUD in the 6 study populations was 18.0% (mild BUD, 3.2%; moderate BUD, 4.3%; and severe BUD, 10.5%). The 12-month proportion of DSM-5-defined BUD among current users of BQ was 86.0% (mild BUD, 15.5%; moderate BUD, 20.6%; and severe BUD, 50.0%). Sex, age, low educational level, smoking, and drinking were significantly associated with BUD. Among individuals who used BQ, family use, high frequency of use, and amount of BQ used were significantly linked to moderate to severe BUD. Compared with individuals who did not use BQ, those who used BQ and had no BUD showed a 22.0-fold (95% CI, 4.3-112.4) risk of OPMD (P
RESULTS: The results of the study show that total phenolic content (TPC) in soil and leaves of three species of Macaranga were highest in TPSF followed by freshwater swamp forest and flooded limestone forest, then dry land sites. Highest TPC values were associated with acidity (in TPSF) and waterlogging (in flooded forests). Moreover, phenolic compounds are rapidly leached from fallen senescent leaves, and could be reabsorbed by tree roots and converted into more complex phenolics within the leaves.
CONCLUSIONS: Extreme conditions-waterlogging and acidity-may facilitate uptake and synthesis of protective phenolic compounds which are essential for impeded decomposition of organic matter in TPSF. Conversely, the ongoing drainage and degradation of TPSF, particularly for conversion to oil palm plantations, reverses the conditions necessary for peat accretion and carbon sequestration.
RESULTS: The primary screening of phytochemicals showed that P. speciosa seeds contain alkaloids, terpenoids, flavonoids, and phenolics. Samples collected from Perak contained the highest levels of the phytochemical constituents, with highest DPPH and FRAP activity followed by Negeri sembilan and Johor. From the identified compounds, quercetin and gallic acid were identified as the most abundant compounds. Seeds collected from the Perak location exhibited potent antibacterial activity, against both Gram-positive and Gram-negative bacteria strains. Staphylococcus aureus and Bacillus subtilis were recorded as the bacterial strains most sensitive to P. speciosa seed extracts. Correlation analysis showed that flavonoid compounds are responsible for the antioxidant activities of the P. speciosa seeds studied, while antibacterial activity showed a high correlation with the levels of gallic acid.
CONCLUSIONS: Parkia speciosa seed grown in Perak exhibit the highest concentrations of phytochemicals, as well as the highest biological activity. It may also be recommended for the food industry to use seeds from this area for their products, which are going to compete in the expanding functional food markets.
METHOD: Air interface biofilm was cultured onto Snapwell inserts incorporated into a modified pharmacopeia deposition apparatus, the Anderson Cascade Impactor (ACI). Three different formulations including mannitol only, ciprofloxacin only and combined ciprofloxacin and mannitol were nebulised onto the P. aeruginosa biofilm using the modified ACI. Antibacterial effectiveness was evaluated using colony-forming units counts, biofilm penetration and scanning electron microscopy.
RESULTS: Nebulised mannitol promotes the dispersion of bacteria from the biofilm and demonstrated a synergistic enhancement of the antibacterial efficacy of ciprofloxacin compared to delivery of antibiotic alone.
CONCLUSIONS: The combination of ciprofloxacin and mannitol may provide an important new strategy to improve antibiotic therapy for the treatment of chronic lung infections. Furthermore, the development of a representative lung model of bacterial biofilm could potentially be used as a platform for future new antimicrobial pre-clinical screening.
METHODS: Overall, 307 male and female adolescents (aged 13-18 y old) living in 9 private orphanages located in Klang Valley, Malaysia, participated in this cross-sectional study. Brief COPE scale and Depression, Anxiety and Stress Scale-21 were used as the main instruments in the current study.
RESULTS: The results of the current study showed female adolescents and participants with a higher level of education were more likely to experience stress. The results also showed significant differences between boys and girls in using of coping mechanisms in self-distraction (t = -2.39, P = .01), substance use (t = 2.12, P = .03), use of emotional support (t = -2.70, P = .001), humor (t = 2.28, P = .02), and religion (t = -2.19, P = .02). Denial, venting, religion, humor, planning, and active coping were identified as predictors of stress among participants.
DISCUSSION: The results showed a high prevalence of stress and a negative coping pattern among participants. The finding of the current study also showed the urgency of taking immediate action to reduce stress and improve coping methods among Malaysian institutional adolescents.
OBJECTIVES: To identify the risk factors associated with mortality for each gender and compare differences, if any, among ST-elevation myocardial infarction (STEMI) patients.
DESIGN: Retrospective analysis.
SETTINGS: Hospitals across Malaysia.
PATIENTS AND METHODS: We analyzed data on all STEMI patients in the National Cardiovascular Database-Acute coronary syndrome (NCVD-ACS) registry for the years 2006 to 2013 (8 years). We collected demographic and risk factor data (diabetes mellitus, hypertension, smoking status, dyslipidaemia and family history of CAD). Significant variables from the univariate analysis were further analysed by a multivariate logistic analysis to identify risk factors and compare by gender.
MAIN OUTCOME MEASURES: Differential risk factors for each gender.
RESULTS: For the 19484 patients included in the analysis, the mortality rate over the 8 years was significantly higher in females (15.4%) than males (7.5%) (P < .001). The univariate analysis showed that the majority of male patients < 65 years while females were >=65 years. The most prevalent risk factors for male patients were smoking (79.3%), followed by hypertension (54.9%) and diabetes mellitus (40.4%), while the most prevalent risk factors for female patients were hypertension (76.8%), followed by diabetes mellitus (60%) and dyslipidaemia (38.1%). The final model for male STEMI patients had seven significant variables: Killip class, age group, hypertension, renal disease, percutaneous coronary intervention and family history of CVD. For female STEMI patients, the significant variables were renal disease, smoking status, Killip class and age group.
CONCLUSION: Gender differences existed in the baseline characteristics, associated risk factors, clinical presentation and outcomes among STEMI patients. For STEMI females, the rate of mortality was twice that of males. Once they reach menopausal age, when there is less protection from the estrogen hormone and there are other risk factors, menopausal females are at increased risk for STEMI.
LIMITATION: Retrospective registry data with inter-hospital variation.