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  1. Zolkeflee NKZ, Wong PL, Maulidiani M, Ramli NS, Azlan A, Mediani A, et al.
    Biochem Biophys Res Commun, 2024 May 14;708:149778.
    PMID: 38507867 DOI: 10.1016/j.bbrc.2024.149778
    The increasing prevalence of lean diabetes has prompted the generation of animal models that mimic metabolic disease in humans. This study aimed to determine the optimum streptozotocin-nicotinamide (STZ-NA) dosage ratio to elicit lean diabetic features in a rat model. It also used a proton nuclear magnetic resonance (1H NMR) urinary metabolomics approach to identify the metabolic effect of metformin treatment on this novel rat model. Three different STZ-NA dosage regimens (by body weight: Group A: 110 mg/kg NA and 45 mg/kg STZ; Group B: 180 mg/kg NA and 65 mg/kg STZ and Group C: 120 mg/kg NA and 60 mg/kg STZ) were administered to Sprague-Dawley rats along with oral metformin. Group A diabetic rats (A-DC) showed favorable serum biochemical analyses and a more positive response toward oral metformin administration relative to the other STZ-NA dosage ratio groups. Orthogonal partial least squares-discriminant analysis (OPLS-DA) revealed that glucose, citrate, pyruvate, hippurate, and methylnicotinamide differentiating the OPLS-DA of A-MTF rats (Group A diabetic rats treated with metformin) and A-DC model rats. Subsequent metabolic pathway analyses revealed that metformin treatment was associated with improvement in dysfunctions caused by STZ-NA induction, including carbohydrate metabolism, cofactor metabolism, and vitamin and amino acid metabolism. In conclusion, our results identify the best STZ-NA dosage ratio for a rat model to exhibit lean type 2 diabetic features with optimum sensitivity to metformin treatment. The data presented here could be informative to improve our understanding of non-obese diabetes in humans through the identification of possible activated metabolic pathways in the STZ-NA-induced diabetic rats model.
    Matched MeSH terms: Metabolomics/methods
  2. Shen XF, Khoo SS
    Hand Clin, 2024 May;40(2):237-248.
    PMID: 38553095 DOI: 10.1016/j.hcl.2023.10.004
    Microsurgery is undoubtedly the pinnacle of hand surgery. Significant advancement in recent years has stretched the indications for toe-to-hand transfer in both acquired and congenital hand defects to restore function, esthetics, and motion, with minimal morbidity to the donor site. There is no one fixed microsurgical transfer technique but a surgeon's versatility and innovation in using what one could spare because each case is unique. Esthetic refinements and reducing donor site morbidities have taken a front seat in recent years. We present a few cases to put forward the senior author's preferred techniques with this objective in mind.
    Matched MeSH terms: Microsurgery/methods
  3. Munian K, Ramli FF, Othman N, Mahyudin NAA, Sariyati NH, Abdullah-Fauzi NAF, et al.
    Mol Ecol Resour, 2024 May;24(4):e13936.
    PMID: 38419264 DOI: 10.1111/1755-0998.13936
    The approach of combining cost-effective nanopore sequencing and emerging environmental DNA (eDNA) metabarcoding could prove to be a promising tool for biodiversity documentation, especially in Malaysia. Given the substantial funding constraints in recent years, especially in relation to the country's biodiversity, many researchers have been limited to conduct restricted research without extended monitoring periods, potentially hindering comprehensive surveys and could compromise the conservation efforts. Therefore, the present study aimed to evaluate the application of eDNA metabarcoding on freshwater fish using short reads generated through nanopore sequencing. This assessment focused on species detection in three selected rivers within the Endau Rompin Landscape in Malaysia. Additionally, the study compared levels of species detection between eDNA metabarcoding and conventional sampling methods, examined the effectiveness of primer choice, and applied both metabarcoding and shotgun sequencing to the eDNA approach. We successfully identified a total of 22 and 71 species with an identification threshold of >97% and >90%, respectively, through the MinION platform. The eDNA metabarcoding approach detected over 13% more freshwater fish species than when the conventional method was used. Notably, the distinction in freshwater fish detection between eDNA primers for 12S rRNA and cytochrome oxidase I was insignificant. The cost for eDNA metabarcoding proved to be more effective compared to conventional sampling with cost reduction at 33.4%. With favourable cost-effectiveness and increased species detection, eDNA metabarcoding could complement existing methods, enhance holistic diversity documentation for targeted habitats and facilitate effective conservation planning.
    Matched MeSH terms: Environmental Monitoring/methods; DNA Barcoding, Taxonomic/methods
  4. Zhao J, Yu L, Newbold T, Shen X, Liu X, Hua F, et al.
    Sci Total Environ, 2024 Apr 20;922:171296.
    PMID: 38423324 DOI: 10.1016/j.scitotenv.2024.171296
    Largely driven by agricultural pressures, biodiversity has experienced great changes globally. Exploring biodiversity responses to agricultural practices associated with agricultural intensification can benefit biodiversity conservation in agricultural landscapes. However, the effects of agricultural practices may also extend to natural habitats. Moreover, agricultural impacts may also vary with geographical region. We analyze biodiversity responses to landscape cropland coverage, cropping frequency, fertiliser and yield, among different land-use types and across geographical regions. We find that species richness and total abundance generally respond negatively to increased landscape cropland coverage. Biodiversity reductions in human land-use types (pasture, plantation forest and cropland) were stronger in tropical than non-tropical regions, which was also true for biodiversity reductions with increasing yield in both human and natural land-use types. Our results underline substantial biodiversity responses to agricultural practices not only in cropland but also in natural habitats, highlighting the fact that biodiversity conservation demands a greater focus on optimizing agricultural management at the landscape scale.
    Matched MeSH terms: Agriculture/methods
  5. Perrone G, Giuffrida M, Abu-Zidan F, Kruger VF, Livrini M, Petracca GL, et al.
    World J Emerg Surg, 2024 Apr 16;19(1):14.
    PMID: 38627831 DOI: 10.1186/s13017-024-00543-w
    BACKGROUND: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA.

    METHODS: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up.

    RESULTS: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P 

    Matched MeSH terms: Anastomosis, Surgical/methods
  6. Leong N, Yaacob MH, Md Zain AR, Tengku Abdul Aziz TH, Christianus A, Chong CM, et al.
    PMID: 38377639 DOI: 10.1016/j.saa.2024.123974
    Fish epidermal mucus is an important reservoir of antipathogenic compounds which serves as the first line of the immune defence. Despite its significant role in the physiology and health of fish, detailed profiling of fish epidermal mucus has yet to be explored. Therefore, this study investigates a label-free colloidal surface-enhanced Raman spectroscopic (SERS) method for profiling grouper mucus. Gold nanoparticles were first synthesised using the standard citrate reduction and characterised using ultraviolet-visible spectroscopy, transmission electron microscopy and dynamic light scattering. The influence of acidified sodium sulphate (Na2SO4) at pH 3 as the aggregating agent on the enhancement of the SERS spectrum of different analyte samples including rhodamine 6G (R6G) dye, lysozyme solution and hybrid grouper (Epinephelus fuscoguttatus × Epinephelus lanceolatus) mucus was observed. Based on the results, an optimal Na2SO4 concentration of 1 M was recorded to achieve the highest enhancement of the SERS signal for R6G and grouper mucus, while the optimal concentration for lysozyme was 0.1 M. The results indicated a higher degree of aggregation induced by lysozyme than R6G and grouper mucus. A few overlapping peaks of the SERS spectra of lysozyme and grouper mucus made it possible to confirm the presence of lysozyme as potential biomarkers.
    Matched MeSH terms: Spectrum Analysis, Raman/methods
  7. Mustapa MA, Yuzir A, Latif AA, Ambran S, Abdullah N
    PMID: 38310743 DOI: 10.1016/j.saa.2024.123977
    A rapid, simple, sensitive, and selective point-of-care diagnosis tool kit is vital for detecting the coronavirus disease (COVID-19) based on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain. Currently, the reverse transcriptase-polymerase chain reaction (RT-PCR) is the best technique to detect the disease. Although a good sensitivity has been observed in RT-PCR, the isolation and screening process for high sample volume is limited due to the time-consuming and laborious work. This study introduced a nucleic acid-based surface-enhanced Raman scattering (SERS) sensor to detect the nucleocapsid gene (N-gene) of SARS-CoV-2. The Raman scattering signal was amplified using gold nanoparticles (AuNPs) possessing a rod-like morphology to improve the SERS effect, which was approximately 12-15 nm in diameter and 40-50 nm in length. These nanoparticles were functionalised with the single-stranded deoxyribonucleic acid (ssDNA) complemented with the N-gene. Furthermore, the study demonstrates method selectivity by strategically testing the same virus genome at different locations. This focused approach showcases the method's capability to discern specific genetic variations, ensuring accuracy in viral detection. A multivariate statistical analysis technique was then applied to analyse the raw SERS spectra data using the principal component analysis (PCA). An acceptable variance amount was demonstrated by the overall variance (82.4 %) for PC1 and PC2, which exceeded the desired value of 80 %. These results successfully revealed the hidden information in the raw SERS spectra data. The outcome suggested a more significant thymine base detection than other nitrogenous bases at wavenumbers 613, 779, 1219, 1345, and 1382 cm-1. Adenine was also less observed at 734 cm-1, and ssDNA-RNA hybridisations were presented in the ketone with amino base SERS bands in 1746, 1815, 1871, and 1971 cm-1 of the fingerprint. Overall, the N-gene could be detected as low as 0.1 nM within 10 mins of incubation time. This approach could be developed as an alternative point-of-care diagnosis tool kit to detect and monitor the COVID-19 disease.
    Matched MeSH terms: Spectrum Analysis, Raman/methods
  8. Lau EPM, Ing M, Vekaria S, Tan AL, Charlesworth C, Fysh E, et al.
    Trials, 2024 Apr 10;25(1):249.
    PMID: 38594766 DOI: 10.1186/s13063-024-08065-1
    BACKGROUND: Malignant pleural effusion (MPE) is a debilitating condition as it commonly causes disabling breathlessness and impairs quality of life (QoL). Indwelling pleural catheter (IPC) offers an effective alternative for the management of MPE. However, IPC-related infections remain a significant concern and there are currently no long-term strategies for their prevention. The Australasian Malignant PLeural Effusion (AMPLE)-4 trial is a multicentre randomised trial that evaluates the use of topical mupirocin prophylaxis (vs no mupirocin) to reduce catheter-related infections in patients with MPE treated with an IPC.

    METHODS: A pragmatic, multi-centre, open-labelled, randomised trial. Eligible patients with MPE and an IPC will be randomised 1:1 to either regular topical mupirocin prophylaxis or no mupirocin (standard care). For the interventional arm, topical mupirocin will be applied around the IPC exit-site after each drainage, at least twice weekly. Weekly follow-up via phone calls or in person will be conducted for up to 6 months. The primary outcome is the percentage of patients who develop an IPC-related (pleural, skin, or tract) infection between the time of catheter insertion and end of follow-up period. Secondary outcomes include analyses of infection (types and episodes), hospitalisation days, health economics, adverse events, and survival. Subject to interim analyses, the trial will recruit up to 418 participants.

    DISCUSSION: Results from this trial will determine the efficacy of mupirocin prophylaxis in patients who require IPC for MPE. It will provide data on infection rates, microbiology, and potentially infection pathways associated with IPC-related infections.

    ETHICS AND DISSEMINATION: Sir Charles Gairdner and Osborne Park Health Care Group Human Research Ethics Committee has approved the study (RGS0000005920). Results will be published in peer-reviewed journals and presented at scientific conferences.

    TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ACTRN12623000253606. Registered on 9 March 2023.

    Matched MeSH terms: Pleurodesis/methods
  9. Lai MY, Abdul Hamid MH, Jelip J, Mudin RN, Lau YL
    Am J Trop Med Hyg, 2024 Apr 03;110(4):648-652.
    PMID: 38412548 DOI: 10.4269/ajtmh.23-0572
    Loop-mediated isothermal amplification (LAMP) is a nucleic acid amplification technique that can amplify specific nucleic acids at a constant temperature (63-65°C) within a short period (<1 hour). In this study, we report the utilization of recombinase-aided LAMP to specifically amplify the 18S sRNA of Plasmodium knowlesi. The method was built on a conventional LAMP assay by inclusion of an extra enzyme, namely recombinase, into the master mixture. With the addition of recombinase into the LAMP assay, the assay speed was executed within a time frame of less than 28 minutes at 65°C. We screened 55 P. knowlesi samples and 47 non-P. knowlesi samples. No cross-reactivity was observed for non-P. knowlesi samples, and the detection limit for recombinase-aided LAMP was one copy for P. knowlesi after LAMP amplification. It has been reported elsewhere that LAMP can be detected through fluorescent readout systems. Although such systems result in considerable limits of detection, the need for sophisticated equipment limits their use. Hence, we used here a colorimetric detection platform for the evaluation of the LAMP assay's performance. This malachite green-based recombinase-aided LAMP assay enabled visualization of results with the naked eye. Negative samples were observed by a change in color from green to colorless, whereas positive samples remained green. Our results demonstrate that the LAMP assay developed here is a convenient, sensitive, and useful diagnostic tool for the rapid detection of knowlesi malaria parasites. This method is suitable for implementation in remote healthcare settings, where centralized laboratory facilities, funds, and clinicians are in short supply.
    Matched MeSH terms: Nucleic Acid Amplification Techniques/methods; Molecular Diagnostic Techniques/methods
  10. Rosenthal VD, Jin Z, Yin R, Sahu S, Rajhans P, Kharbanda M, et al.
    J Crit Care, 2024 Apr;80:154500.
    PMID: 38128216 DOI: 10.1016/j.jcrc.2023.154500
    BACKGROUND: Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.

    METHODS: We implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods.

    RESULTS: 174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58-0.65; P 

    Matched MeSH terms: Infection Control/methods
  11. Imron MF, Hestianingsi WOA, Putranto TWC, Citrasari N, Abdullah SRS, Hasan HA, et al.
    Chemosphere, 2024 Apr;353:141595.
    PMID: 38438021 DOI: 10.1016/j.chemosphere.2024.141595
    Increasing aquaculture cultivation produces large quantities of wastewater. If not handled properly, it can have negative impacts on the environment. Constructed wetlands (CWs) are one of the phytoremediation methods that can be applied to treat aquaculture effluent. This research was aimed at determining the performance of Cyperus rotundus in removing COD, BOD, TSS, turbidity, ammonia, nitrate, nitrite, and phosphate from the batch CW system. Treatment was carried out for 30 days with variations in the number of plants (10, 15, and 20) and variations in media height (10, 12, and 14 cm). The result showed that aquaculture effluent contains high levels of organic compounds and nutrients, and C. rotundus can grow and thrive in 100% of aquaculture effluent. Besides that, the use of C. rotundus in CWs with the effect of numbers of plants and media height showed performance of COD, BOD, TSS, turbidity, ammonia, nitrate, nitrite, and phosphate with 70, 79, 90, 96, 64, 82, 92, and 48% of removal efficacy, respectively. There was no negative impact observed on C. rotundus growth after exposure to aquaculture effluent, as indicated by the increase in wet weight, dry weight, and growth rate when compared to the control. Thus, adding aquaculture effluent to CWs planted with C. rotundus supports the growth and development of plants while also performing phytoremediation.
    Matched MeSH terms: Waste Disposal, Fluid/methods
  12. Hong J, Raghavan S, Siti Nordiana A, Saaid R, Vallikkannu N, Tan PC
    Int J Gynaecol Obstet, 2024 Apr;165(1):265-274.
    PMID: 37846154 DOI: 10.1002/ijgo.15199
    OBJECTIVES: To evaluate expectant compared to immediate return to hospital upon outpatient Foley catheter expulsion predicated on maternal satisfaction and amniotomy-titrated oxytocin infusion to delivery interval.

    METHODS: This randomized trial was conducted in a tertiary university hospital in Malaysia from September 2020 to February 2022. A total of 330 nulliparous women at term with unripe cervices (Bishop score ≤5), singleton viable fetus in cephalic presentation, reassuring preinduction fetal heart rate tracing and intact membranes who underwent planned outpatient Foley catheter induction of labor (IOL) were included. Women were randomized to expectant or immediate return to hospital if the Foley was spontaneously expelled at home before their scheduled hospital admission the following day. Primary outcomes were amniotomy-titrated oxytocin infusion to delivery interval and maternal satisfaction on the induction process (assessed by 0-10 visual numerical rating scale [VNRS]).

    RESULTS: Amniotomy-titrated oxytocin infusion to delivery interval was 8.7 ± 4.1 versus 8.9 ± 3.9 h, P = 0.605 (mean difference - 0.228 95% CI: -1.1 to +0.6 h) and maternal satisfaction VNRS score was median (interquartile range) 8 (7-9) versus 8 (7-9), P = 0.782. Early return to hospital rates were 37/165 (22.4%) versus 72/165 (43.6%), RR 0.51 (95% CI: 0.37-0.72), P ≤ 0.001, Cesarean delivery rates were 80/165 (48.5%) versus 80/165 (48.5%), RR 1.00 (95% CI: 0.80-1.25), P = 1.00 and duration of hospital stay was 54.4 ± 22.9 versus 56.7 ± 22.8 h, P = 0.364 for the expectant versus immediate return groups respectively.

    CONCLUSION: In outpatient Foley catheter IOL, expectant compared to immediate return to hospital following Foley dislodgement results in similarly high maternal satisfaction. The amniotomy-titrated oxytocin to delivery duration is non-inferior with expectant management.

    Matched MeSH terms: Labor, Induced/methods
  13. Patil PG, Seow LL, Uddanwadikar R, Pau A, Ukey PD
    J Prosthet Dent, 2024 Apr;131(4):675-682.
    PMID: 35667890 DOI: 10.1016/j.prosdent.2022.04.018
    STATEMENT OF PROBLEM: The edentulous mandible is commonly treated with a 2-implant overdenture. A change in diameter of the implants may affect the biomechanical behavior of the overdenture, but information on these effects is lacking.

    PURPOSE: The purpose of this 3D finite element analysis study was to evaluate the biomechanical behavior of 2-implant mandibular overdentures (2IMO) and their individual components by using implants of different diameters.

    MATERIAL AND METHODS: A 3D mandibular model was obtained from the cone beam computed tomography (CBCT) images of a 59-year-old edentulous man, and a 3D denture model was developed from intraoral scanning files in the Mimics software program. A 3D model of different diameters of implants (2.5 mm, 3.0 mm, 3.5 mm, and 4.0 mm) with a LOCATOR attachment was developed in the Solidworks software program. Two same-sized implants were inserted in the mandibular model at 10 mm from the midline in the 3Matics software program. A vertical load of 100 N was applied on the first molar region on the right side or both sides in the ANSYS software program. The maximum von Mises stresses and strains were recorded and analyzed.

    RESULTS: Stresses within the implants decreased with an increase in diameter (from 2.5 mm to 3 mm, 3.5 mm, and 4.0 mm) of the implants. The highest stresses were observed with 2.5-mm-diameter implants (0.949 MPa under unilateral and 0.915 MPa under bilateral loading) and the lowest with Ø4-mm implants (0.710 MPa under unilateral and 0.703 MPa under bilateral loading). The strains on the implants ranged between 0.0000056 and 0.0000097, and those on the mandible ranged between 0.0000513 and 0.0000566 across all diameters of the implants without following a specific trend.

    CONCLUSIONS: In 2IMO, the stresses in the implants and mandible decreased with an increase in the diameter of the implants. The implants of lesser diameter (2.5 mm) exhibited the highest stresses and strains, and the implants of the largest diameter (4 mm) exhibited the lowest stresses and strains under unilateral and bilateral loading conditions.

    Matched MeSH terms: Dental Stress Analysis/methods
  14. Gong J, Hou L, Ching YC, Ching KY, Hai ND, Chuah CH
    Int J Biol Macromol, 2024 Apr;264(Pt 2):130525.
    PMID: 38431004 DOI: 10.1016/j.ijbiomac.2024.130525
    To realize the maximum therapeutic activity of medicine and protect the body from the adverse effects of active ingredients, drug delivery systems (DDS) featured with targeted transportation sites and controllable release have captured extensive attention over the past decades. Hydrogels with unique three-dimensional (3D) porous structures present tunable capacity, controllable degradation, various stimuli sensitivity, therapeutic agents encapsulation, and loaded drugs protection properties, which endow hydrogels with bred-in-the-bone advantages as vehicles for drug delivery. In recent years, with the impressive consciousness of the "back-to-nature" concept, biomass materials are becoming the 'rising star' as the hydrogels building blocks for controlled drug release carriers due to their biodegradability, biocompatibility, and non-toxicity properties. In particular, cellulose and its derivatives are promising candidates for fabricating hydrogels as their rich sources and high availability, and various smart cellulose-based hydrogels as targeted carriers under exogenous such as light, electric field, and magnetic field or endogenous such as pH, temperature, ionic strength, and redox gradients. In this review, we summarized the main synthetic strategies of smart cellulose-based hydrogels including physical and chemical cross-linking, and illustrated the detailed intelligent-responsive mechanism of hydrogels in DDS under external stimulus. Additionally, the ongoing development and challenges of cellulose-based hydrogels in the biomedical field are also presented.
    Matched MeSH terms: Drug Delivery Systems/methods
  15. Olunusi SO, Ramli NH, Fatmawati A, Ismail AF, Okwuwa CC
    Int J Biol Macromol, 2024 Apr;264(Pt 2):130682.
    PMID: 38460636 DOI: 10.1016/j.ijbiomac.2024.130682
    Tropical fruits, predominantly cultivated in Southeast Asia, are esteemed for their nutritional richness, distinctive taste, aroma, and visual appeal when consumed fresh. However, postharvest challenges have led to substantial global wastage, nearly 50 %. The advent of edible biopolymeric nanoparticles presents a novel solution to preserve the fruits' overall freshness. These nanoparticles, being edible, readily available, biodegradable, antimicrobial, antioxidant, Generally Recognized As Safe (GRAS), and non-toxic, are commonly prepared via ionic gelation owing to the method's physical crosslinking, simplicity, and affordability. The resulting biopolymeric nanoparticles, with or without additives, can be employed in basic formulations or as composite blends with other materials. This study aims to review the capabilities of biopolymeric nanoparticles in enhancing the physical and sensory aspects of tropical fruits, inhibiting microbial growth, and prolonging shelf life. Material selection for formulation is crucial, considering coating materials, the fruit's epidermal properties, internal and external factors. A variety of application techniques are covered such as spraying, and layer-by-layer among others, including their advantages, and disadvantages. Finally, the study addresses safety measures, legislation, current challenges, and industrial perspectives concerning fruit edible coating films.
    Matched MeSH terms: Food Preservation/methods
  16. Sun C, Lee WG, Ma Q, Zhang X, Song F, Cai X
    Arch Orthop Trauma Surg, 2024 Apr;144(4):1781-1792.
    PMID: 38147077 DOI: 10.1007/s00402-023-05168-3
    BACKGROUND: Positioning implant components and restoring patient anatomy during total hip arthroplasty (THA) are essential for joint stability, polyethylene liner wear, and range of motion. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during the posterior or posterolateral approach have reported conflicting results. This meta-analysis evaluated if intraoperative fluoroscopy improves component positioning and femoral component position compared to no fluoroscopy during posterior or posterolateral approach total hip arthroplasty.

    METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed when conducting the systematic review. We searched Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving Intraoperative fluoroscopy versus no fluoroscopy during posterior or posterolateral approach total hip arthroplasty. Finally, we identified 1133 patients (1145 hips) assessed in seven studies.

    RESULTS: There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.43), ACIA within safe zone rate (P = 0.58), acetabular cup anteversion angle (ACAA, P = 0.46); ACAA within safe zone rate (P = 0.72), Combined safe zone rate (P = 0.28), dislocation rate (P = 0.64) and infection rate (P = 0.94) between two groups. Compared with the no fluoroscopy group, the intraoperative fluoroscopy group had more operation time (P 

    Matched MeSH terms: Fluoroscopy/methods
  17. Ferdowsi M, Kwan BH, Tan MP, Saedon NI, Subramaniam S, Abu Hashim NFI, et al.
    Biomed Eng Online, 2024 Mar 30;23(1):37.
    PMID: 38555421 DOI: 10.1186/s12938-024-01229-9
    BACKGROUND: The diagnostic test for vasovagal syncope (VVS), the most common cause of syncope is head-up tilt test (HUTT) assessment. During the test, subjects experienced clinical symptoms such as nausea, sweating, pallor, the feeling of palpitations, being on the verge of passing out, and fainting. The study's goal is to develop an algorithm to classify VVS patients based on physiological signals blood pressure (BP) and electrocardiography (ECG) obtained from the HUTT.

    METHODS: After 10 min of supine rest, the subject was tilted at a 70-degree angle on a tilt table for approximately a total of 35 min. 400 µg of glyceryl trinitrate (GTN) was administered sublingually after the first 20 min and monitoring continued for another 15 min. Mean imputation and K-nearest neighbors (KNN) imputation approaches to handle missing values. Next, feature selection techniques were implemented, including genetic algorithm, recursive feature elimination, and feature importance, to determine the crucial features. The Mann-Whitney U test was then performed to determine the statistical difference between two groups. Patients with VVS are categorized via machine learning models including Support Vector Machine (SVM), Gaussian Naïve Bayes (GNB), Multinomial Naïve Bayes (MNB), KNN, Logistic Regression (LR), and Random Forest (RF). The developed model is interpreted using an explainable artificial intelligence (XAI) model known as partial dependence plot.

    RESULTS: A total of 137 subjects aged between 9 and 93 years were recruited for this study, 54 experienced clinical symptoms were considered positive tests, while the remaining 83 tested negative. Optimal results were obtained by combining the KNN imputation technique and three tilting features with SVM with 90.5% accuracy, 87.0% sensitivity, 92.7% specificity, 88.6% precision, 87.8% F1 score, and 95.4% ROC (receiver operating characteristics) AUC (area under curve).

    CONCLUSIONS: The proposed algorithm effectively classifies VVS patients with over 90% accuracy. However, the study was confined to a small sample size. More clinical datasets are required to ensure that our approach is generalizable.

    Matched MeSH terms: Tilt-Table Test/methods
  18. Daelman B, Van Bulck L, Luyckx K, Kovacs AH, Van De Bruaene A, Ladouceur M, et al.
    J Am Coll Cardiol, 2024 Mar 26;83(12):1149-1159.
    PMID: 38508848 DOI: 10.1016/j.jacc.2024.01.021
    BACKGROUND: Life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies have shown that older people with CHD have higher morbidity, health care use, and mortality. To maintain longevity and quality of life, understanding their evolving medical and psychosocial challenges is essential.

    OBJECTIVES: The authors describe the frailty and cognitive profile of middle-aged and older adults with CHD to identify predictor variables and to explore the relationship with hospital admissions and outpatient visits.

    METHODS: Using a cross-sectional, multicentric design, we included 814 patients aged ≥40 years from 11 countries. Frailty phenotype was determined using the Fried method. Cognitive function was assessed by the Montreal Cognitive Assessment.

    RESULTS: In this sample, 52.3% of patients were assessed as robust, 41.9% as prefrail, and 5.8% as frail; 38.8% had cognitive dysfunction. Multinomial regression showed that frailty was associated with older age, female sex, higher physiologic class, and comorbidities. Counterintuitively, patients with mild heart defects were more likely than those with complex lesions to be prefrail. Patients from middle-income countries displayed more prefrailty than those from higher-income countries. Logistic regression demonstrated that cognitive dysfunction was related to older age, comorbidities, and lower country-level income.

    CONCLUSIONS: Approximately one-half of included patients were (pre-)frail, and more than one-third experienced cognitive impairment. Frailty and cognitive dysfunction were identified in patients with mild CHD, indicating that these concerns extend beyond severe CHD. Assessing frailty and cognition routinely could offer valuable insights into this aging population.

    Matched MeSH terms: Geriatric Assessment/methods
  19. Manoharan A, Harris MM, Chin BH, Ming KW, Asmuee Z, Salamon N, et al.
    BMC Prim Care, 2024 Mar 22;25(1):95.
    PMID: 38519908 DOI: 10.1186/s12875-024-02342-3
    BACKGROUND: Inquiring conservative Asian women about their menopausal symptoms is often challenging in crowded primary healthcare clinics. Furthermore, the subject matter is culturally sensitive to most Malaysian women. Hence, the translation of MQ6 into Malay is crucial to enable self-administration, eliminating the necessity for interviewers and mitigating potential respondent shyness.

    METHODS: The Menopause Quick 6 (MQ6) questionnaire was translated into the Malay language with an addition of an item, henceforth termed MQ6 (M). Forward and backward translation was performed. Face and content validity were conducted. MQ6 (M) was self-administered to 400 women aged between 40 and 60 attending six primary healthcare clinics in Malaysia. To ascertain the reliability for MQ6 (M), corrected Item-Total Correlation, Squared Multiple Correlation, Cronbach's Alpha if the Item is Deleted, and Kuder-Richardson Reliability Coefficients (KR20). Exploratory factor analysis was done to determine its' construct validity.

    RESULTS: The outcome of the validation was satisfactory. By the Lawshe method, the content validity ratios ranged from 0.6 to 1.0 and the content validity index was 0.914. The Internal consistency for MQ6(M) Cronbach's alpha was 0.711 while Kuder-Richardson Reliability Coefficients KR20 was 0.676. Factor loading of all four items is above 0.70, indicating a well-defined structure. Whereas factor loading for three items fell within the range of 0.50-0.69 indicating a practically significant threshold for a new questionnaire.

    CONCLUSION: MQ6 (M) has acceptable reliability and construct validity to be considered as a self-administered screening tool in primary care clinics in Malaysia.

    Matched MeSH terms: Psychometrics/methods
  20. Mohamed FS, Lokman FL, Mansoor WNBW, Shakri NBM, Hussain RI, Abdullah A
    Int Tinnitus J, 2024 Mar 21;27(2):242-246.
    PMID: 38512871 DOI: 10.5935/0946-5448.20230037
    A cholesteatoma is an expansion of keratinizing squamous epithelium that enters the middle ear cleft from the outer layer of the tympanic membrane or ear canal. Choleatomas are always treated surgically. Recurrence of the illness presents another challenge for the patient and the surgeon, though. There have been reports of recurrence rates as high as 30% in adults and as high as 70% in children. Here, we describe a case of persistent recurrent otorrhea following revision surgery, along with acquired recurrent cholesteatoma following canal wall down surgery. A 38-year -male with underlying Diabetes Mellitus and Hypertension presented with left scanty and foul-smelling ear discharge for 2 years and left reduced hearing. He was diagnosed with left chronic active otitis media with cholesteatoma for which he underwent left modified radical mastoidectomy, meatoplasty and tympanoplasty in 2017. Five months post operatively, he presented with left otorrhea. However, he defaulted followed up and presented in April 2018 for similar complaints. Otoscopy examination revealed left tympanic membrane perforation at poster superior quadrant of pars tensa and bluish discoloration behind pars flacida. He was diagnosed as recurrent left cholesteatoma and subsequently he underwent left mastoid exploration under general anesthesia in June 2018. Postsurgery, he developed recurrent ear discharge which was treated with topical antibiotics and ear toileting. We report a case of recurrent Cholesteatoma despite canal wall down procedure requiring a second redo procedure and with persistent recurrent otorrhea after the redo procedure.However, this case demonstrates the need for regular follow ups even after a canal wall down procedure for detecting recurrence of disease. Moreover, this case denotes some of the patient factors and surgeon factors involved in disease recurrence. Furthermore, importance of opting for an imaging study in case of high suspicion of the disease.
    Matched MeSH terms: Tympanoplasty/methods
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