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An evaluation of knowledge and skill on cricoid pressure among emergency personnel

Hanizah N, Affirul CA, Fadzlon MY

Clin Ter, 2014;165(5):e336-41.
PMID: 25366949 DOI: 10.7417/CT.2014.1759

BACKGROUND: Cricoid pressure (CP) is a step during rapid sequence induction. Previous studies showed a poor clinical application of CP despite a reasonable theoretical knowledge of CP. This study aims to evaluate the proficiency and knowledge retention on CP among the emergency staff in the Emergency Department, Universiti Kebangsaan Malaysia Medical Centre.
MATERIALS AND METHODS: This is questionnaire-based observational comparative study. Once the questionnaire is filled, the application of CP is tested on an airway model and competency level is documented. An education hand out is passed to all participants after the procedure. The improvement and knowledge retention were assess after 2 month.
RESULTS: A total of 81 completed surveys were returned comprises of of 34 medical officers, 23 staff nurses and 24 assistant medical officers. 75.3% subjects have work experience more than a year but only 59.3% of them were trained in CP application. A total of 69.1% participants passed the pre educational handout test and 100% passed the post educational handout test. However, for pre educational handout phase, 81.5% participants passed the theory part while only 42% passed the practical component. In post educational handout phase, the number of respondents who passed both components was 97.5% and 63% respectively. There are positive correlation between designation and working experience with overall passes in this study.
CONCLUSIONS: The theoretical knowledge of CP is satisfactory but clinical application is poor especially in the pre educational handout phase. The educational handout is proved to improve the knowledge transfer and retention with regards to CP.

Matched MeSH terms: Cricoid Cartilage/metabolism*
Interactive knee cartilage extraction using efficient segmentation software: data from the osteoarthritis initiative

Gan HS, Tan TS, Wong LX, Tham WK, Sayuti KA, Abdul Karim AH, et al.

Biomed Mater Eng, 2014;24(6):3145-57.
PMID: 25227024 DOI: 10.3233/BME-141137

In medical image segmentation, manual segmentation is considered both labor- and time-intensive while automated segmentation often fails to segment anatomically intricate structure accordingly. Interactive segmentation can tackle shortcomings reported by previous segmentation approaches through user intervention. To better reflect user intention, development of suitable editing functions is critical. In this paper, we propose an interactive knee cartilage extraction software that covers three important features: intuitiveness, speed, and convenience. The segmentation is performed using multi-label random walks algorithm. Our segmentation software is simple to use, intuitive to normal and osteoarthritic image segmentation and efficient using only two third of manual segmentation's time. Future works will extend this software to three dimensional segmentation and quantitative analysis.

Matched MeSH terms: Cartilage, Articular/pathology*
Breakage of an intramedullary rod after bone union in congenital pseudoarthrosis of the tibia: a report of two cases

Sulaiman AR, Simbak N, Wan Ismail WF, Wan Z, Halim AS

J Orthop Surg (Hong Kong), 2011 Aug;19(2):250-3.
PMID: 21857057

We report 2 patients with congenital pseudoarthrosis of the tibia who underwent intramedullary Rush rod transfixation through the ankle joint following refracture and nonunion of vascularised fibular grafting 6 and 8 months earlier. After 9 and 5 years, both Rush rods were broken at the level of the ankle joints, while the reconstructed area was solidly united. The growth of the distal tibia increased the distance of the tips of the broken rod and hence the ankle joint motion. The broken tips may damage the articular cartilage and result in valgus deformity of the ankle and limb length discrepancy.

Matched MeSH terms: Cartilage, Articular/injuries*
Fulltext Myoid hamartoma of breast with chondroid metaplasia: a case report

Khoo JJ, Alwi RI, Abd-Rahman I

Malays J Pathol, 2009 Jun;31(1):77-80.
PMID: 19694319 MyJurnal

Breast hamartoma is an uncommon poorly recognised benign breast neoplasm. Hamartoma displaying marked smooth muscle components known as myoid hamartoma of the breast is a much rarer entity. We present a case of myoid hamartoma of breast with chondroid differentiation in a 46-year-old woman. The painless breast lump was circumscribed and mammography showed a well-encapsulated large, dense mass with no calcification. Core needle biopsy was reported as fibroadenoma. The lesion was excised. Microscopically, it composed of many groups of mammary glandular components with dense fibrous stroma, adipose tissue and marked groups of smooth muscle fibres. Foci of chondroid differentiation were noted in the lesion. The smooth muscle cells showed strong and diffuse immunoreactivity for vimentin, myogloblin, alpha-smooth muscle actin, desmin and CD34 and failed to express pan-cytokeratin or S100 protein. The ducts lined by epithelial cells were reactive to pan-cytokeratin while the myoepithelial cells were reactive to S100 protein. The various immuno-histochemical staining as well as the cyto-histological changes encountered in myoid hamartomas are discussed with clinical, radiological and pathological correlation to differentiate it from other benign and malignant breast lesions.

Matched MeSH terms: Cartilage/pathology
Autologous versus pooled human serum for articular chondrocyte growth

Munirah S, Ruszymah BH, Samsudin OC, Badrul AH, Azmi B, Aminuddin BS

J Orthop Surg (Hong Kong), 2008 Aug;16(2):220-9.
PMID: 18725677

To evaluate the effect of autologous human serum (AHS) versus pooled human serum (PHS) versus foetal bovine serum (FBS) for growth of articular chondrocytes and formation of chondrocytefibrin constructs.

Matched MeSH terms: Cartilage, Articular/cytology
Autologous human fibrin as the biomaterial for tissue engineering

Ruszymah BH

Med J Malaysia, 2004 May;59 Suppl B:30-1.
PMID: 15468804

Patient own fibrin may act as the safest, cheapest and immediate available biodegradable scaffold material in clinical 1 tissue engineering. This study investigated the feasibility of using patient own fibrin isolated from whole blood to construct a new human cartilage, skin and bone. Constructed in vitro tissues were implanted on the dorsal part of the nude mice for in vivo maturation. After 8 weeks of implantation, the engineered tissues were removed for histological analysis. Our results demonstrated autologous fibrin has great potential as clinical scaffold material to construct various human tissues.

Matched MeSH terms: Cartilage/transplantation*
Interaction between insulin-like growth factor-1 with other growth factors in serum depleted culture medium for human cartilage engineering

Chua KH, Aminuddin BS, Fuzina NH, Ruszymah BH

Med J Malaysia, 2004 May;59 Suppl B:7-8.
PMID: 15468792

The regulation roles of insulin-like growth factor-1 (IGF-1) with basic fibroblast growth factor (bFGF) and transforming growth factor beta 2 (TGFbeta2) in human nasal septum chondrocytes monolayer culture and cartilage engineering was investigated in this study. The role of IGF-1 with bFGF and TGFbeta2 was investigated by measuring chondrocyte growth kinetic and collagen genes expression. IGF-1 together with bFGF and TGFbeta2 promote cartilage tissue engineering, increase type II collagen expression and enhance the histological features of engineered cartilage.

Matched MeSH terms: Cartilage/transplantation*
Using tissue engineering techniques for osteochondral repair and regeneration

Goh JC, Shao XX, Hutmacher D, Lee EH

Med J Malaysia, 2004 May;59 Suppl B:17-8.
PMID: 15468797
Matched MeSH terms: Cartilage, Articular/pathology
The effect of TGF-beta1 and beta-estradiol on glycosaminoglycan and type II collagen distribution in articular chondrocyte cultures

Ab-Rahim S, Selvaratnam L, Kamarul T

Cell Biol Int, 2008 Jul;32(7):841-7.
PMID: 18479947 DOI: 10.1016/j.cellbi.2008.03.016

Articular cartilage extracellular matrix (ECM) plays a crucial role in regulating chondrocyte functions via cell-matrix interaction, cytoskeletal organization and integrin-mediated signaling. Factors such as interleukins, basic fibroblast growth factor (bFGF), bone morphogenic proteins (BMPs) and insulin-like growth factor (IGF) have been shown to modulate the synthesis of extracellular matrix in vitro. However, the effects of TGF-beta1 and beta-estradiol in ECM regulation require further investigation, although there have been suggestions that these factors do play a positive role. To establish the role of these factors on chondrocytes derived from articular joints, a study was conducted to investigate the effects of TGF-beta1 and beta-estradiol on glycosaminoglycan secretion and type II collagen distribution (two major component of cartilage ECM in vivo). Thus, chondrocyte cultures initiated from rabbit articular cartilage were treated with 10ng/ml of TGF-beta1, 10nM of beta-estradiol or with a combination of both factors. Sulphated glycosaminoglycan (GAG) and type II collagen levels were then measured in both these culture systems. The results revealed that the synthesis of GAG and type II collagen was shown to be enhanced in the TGF-beta1 treated cultures. This increase was also noted when TGF-beta1 and beta-estradiol were both used as culture supplements. However, beta-estradiol alone did not appear to affect GAG or type II collagen deposition. There was also no difference between the amount of collagen type II and GAG being expressed when chondrocyte cultures were treated with TGF-beta1 when compared with cultures treated with combined factors. From this, we conclude that although TGF-beta1 appears to stimulate chondrocyte ECM synthesis, beta-estradiol fails to produce similar effects. The findings of this study confirm that contrary to previous claims, beta-estradiol has little or no effect on chondrocyte ECM synthesis. Furthermore, the use of TGF-beta1 may be useful in future studies looking into biological mechanisms by which ECM synthesis in chondrocyte cultures can be augmented, particularly for clinical application.

Matched MeSH terms: Cartilage, Articular/cytology
Fulltext Analysis of cricoid pressure application: anaesthetic trainee doctors vs. nursing anaesthetic assistants

Yahaya NH, Teo R, Izaham A, Tang S, Mohamad Yusof A, Abdul Manap N

Braz J Anesthesiol, 2016 May-Jun;66(3):283-8.
PMID: 27108826 DOI: 10.1016/j.bjane.2014.10.008

BACKGROUND AND OBJECTIVE: To evaluate the ability of anaesthetic trainee doctors compared to nursing anaesthetic assistants in identifying the cricoid cartilage, applying the appropriate cricoid pressure and producing an adequate laryngeal inlet view.

METHODS: Eighty-five participants, 42 anaesthetic trainee doctors and 43 nursing anaesthetic assistants, were asked to complete a set of questionnaires which included the correct amount of force to be applied to the cricoid cartilage. They were then asked to identify the cricoid cartilage and apply the cricoid pressure on an upper airway manikin placed on a weighing scale, and the pressure was recorded. Subsequently they applied cricoid pressure on actual anaesthetized patients following rapid sequence induction. Details regarding the cricoid pressure application and the Cormack-Lehane classification of the laryngeal view were recorded.

RESULTS: The anaesthetic trainee doctors were significantly better than the nursing anaesthetic assistants in identifying the cricoid cartilage (95.2% vs. 55.8%, p=0.001). However, both groups were equally poor in the knowledge about the amount of cricoid pressure force required (11.9% vs. 9.3% respectively) and in the correct application of cricoid pressure (16.7% vs. 20.9% respectively). The three-finger technique was performed by 85.7% of the anaesthetic trainee doctors and 65.1% of the nursing anaesthetic assistants (p=0.03). There were no significant differences in the Cormack-Lehane view between both groups.

CONCLUSION: The anaesthetic trainee doctors were better than the nursing anaesthetic assistants in cricoid cartilage identification but both groups were equally poor in their knowledge and application of cricoid pressure.

Matched MeSH terms: Cricoid Cartilage*
Cartilage oligomeric matrix protein (COMP) in rheumatoid arthritis and its correlation with sonographic knee cartilage thickness and disease activity

Sakthiswary R, Rajalingam S, Hussein H, Sridharan R, Asrul AW

Clin Rheumatol, 2017 Dec;36(12):2683-2688.
PMID: 28889184 DOI: 10.1007/s10067-017-3817-0

The aim of the study is to investigate the correlation of serum cartilage oligomeric matrix protein (COMP) levels with articular cartilage damage based on sonographic knee cartilage thickness (KCT) and disease activity in rheumatoid arthritis (RA). A total of 61 RA patients and 27 healthy controls were recruited in this study. Serum samples were obtained from all subjects to determine the serum COMP levels. All subjects had bilateral ultrasound scan of their knees. The KCT was based on the mean of measurements at three sites: the medial condyle, lateral condyle and intercondylar notch. Besides, the RA patients were assessed for their disease activity based on 28-joint-based Disease Activity Score (DAS 28). Serum COMP concentrations were significantly elevated in the RA patients compared to the controls (p = 0.001). The serum COMP levels had an inverse relationship with bilateral KCT in RA subjects and the healthy controls. COMP correlated significantly with disease activity based on DAS 28 (r = 0.299, p = 0.010), disease duration (r = 0.439, p =

Matched MeSH terms: Cartilage Oligomeric Matrix Protein/blood*
Fulltext Shelf Life Evaluation of Clinical Grade Chondrogenic Induced Aged Adult Stem Cells for Cartilage Regeneration

Ude CC, Seet WT, Sharen Aini S, Aminuddin BS, Ruszymah BHI

Sci Rep, 2018 03 12;8(1):4345.
PMID: 29531282 DOI: 10.1038/s41598-018-22748-1

The study objectives include, enhancing the proliferations of aged bone marrow stem cells (BMSCs) and adipose stem cells (ADSCs); and evaluating the shelf lives of clinical grade chondrogenically induced cells from both samples. ADSCs and BMSCs from 56 patients (76 ± 8 yrs) were proliferated using basal medium (FD) and at (5, 10, 15, 20 and 25) ng/ml of basal fibroblast growth factor (bFGF). They were induced to chondrogenic lineage and stored for more than 120 hrs in FD, serum, Dulbecco's phosphate buffered saline (DPBS) and saline at 4 °C. In FD, cells stagnated and BMSCs' population doubling time (PDT) was 137 ± 30 hrs, while ADSCs' was 129.7 ± 40 hrs. bFGF caused PDT's decrease to 24.5 ± 5.8 hrs in BMSCs and 22.0 ± 6.5 hrs in ADSCs (p = 0.0001). Both cells were positive to stem cell markers before inductions and thereafter, expressed significantly high chondrogenic genes (p = 0.0001). On shelf life, both cells maintained viabilities and counts above 70% in FD and serum after 120 hrs. BMSCs' viabilities in DPBS fell below 70% after 96 hrs and saline after 72 hrs. ADSCs' viability fell below 70% in DPBS after 24 hrs and saline within 24 hrs. Concentrations between 20 ng/ml bFGF is ideal for aged adult cells' proliferation and delivery time of induced BMSCs and ADSCs can be 120 hrs in 4 °C serum.

Matched MeSH terms: Cartilage/physiology*
Fulltext Basic fibroblast growth factor with human serum supplementation: enhancement of human chondrocyte proliferation and promotion of cartilage regeneration

Chua KH, Aminuddin BS, Fuzina NH, Ruszymah BH

Singapore Med J, 2007 Apr;48(4):324-32.
PMID: 17384880

The objectives of this study were to determine the optimum concentration of basic fibroblast growth factor (bFGF) in foetal bovine serum (FBS) or human serum (HS) supplemented medium for adult human nasal septum chondrocyte culture and to evaluate the potential of cartilage regeneration.

Matched MeSH terms: Cartilage, Articular/cytology
Fulltext Cartilage regeneration by chondrogenic induced adult stem cells in osteoarthritic sheep model

Ude CC, Sulaiman SB, Min-Hwei N, Hui-Cheng C, Ahmad J, Yahaya NM, et al.

PLoS One, 2014;9(6):e98770.
PMID: 24911365 DOI: 10.1371/journal.pone.0098770

In this study, Adipose stem cells (ADSC) and bone marrow stem cells (BMSC), multipotent adult cells with the potentials for cartilage regenerations were induced to chondrogenic lineage and used for cartilage regenerations in surgically induced osteoarthritis in sheep model.

Matched MeSH terms: Cartilage/pathology; Cartilage/physiopathology*; Cartilage/surgery
Articular cartilage regeneration with autologous peripheral blood progenitor cells and hyaluronic acid after arthroscopic subchondral drilling: a report of 5 cases with histology

Saw KY, Anz A, Merican S, Tay YG, Ragavanaidu K, Jee CS, et al.

Arthroscopy, 2011 Apr;27(4):493-506.
PMID: 21334844 DOI: 10.1016/j.arthro.2010.11.054

PURPOSE: The purpose of this study was to evaluate the quality of articular cartilage regeneration after arthroscopic subchondral drilling followed by postoperative intraarticular injections of autologous peripheral blood progenitor cells (PBPCs) in combination with hyaluronic acid (HA).
METHODS: Five patients underwent second-look arthroscopy with chondral core biopsy. These 5 patients are part of a larger pilot study in which 180 patients with International Cartilage Repair Society grade III and IV lesions of the knee joint underwent arthroscopic subchondral drilling followed by postoperative intra-articular injections. Continuous passive motion was used on the operated knee 2 hours per day for 4 weeks. Partial weight bearing was observed for the first 6 to 8 weeks. Autologous PBPCs were harvested 1 week after surgery. One week after surgery, 8 mL of the harvested PBPCs in combination with 2 mL of HA was injected intra-articularly into the operated knee. The remaining PBPCs were divided into vials and cryopreserved. A total of 5 weekly intra-articular injections were given.
RESULTS: Second-look arthroscopy confirmed articular cartilage regeneration, and histologic sections showed features of hyaline cartilage. Apart from the minimal discomfort of PBPC harvesting and localized pain associated with the intra-articular injections, there were no other notable adverse reactions.
CONCLUSIONS: Articular hyaline cartilage regeneration is possible with arthroscopic subchondral drilling followed by postoperative intraarticular injections of autologous PBPCs in combination with HA.
LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Matched MeSH terms: Cartilage, Articular/injuries; Cartilage, Articular/pathology; Cartilage, Articular/physiology*
Modification of palm oil for anti-inflammatory nutraceutical properties

Zainal Z, Longman AJ, Hurst S, Duggan K, Hughes CE, Caterson B, et al.

Lipids, 2009 Jul;44(7):581-92.
PMID: 19449050 DOI: 10.1007/s11745-009-3304-8

Palm oil is one of the most important edible oils in the world. Its composition (rich in palmitate and oleate) make it suitable for general food uses but its utility could be increased if its fatty acid quality could be varied. In this study, we have modified a palm olein fraction by transesterification with the n-3 polyunsaturated fatty acids, alpha-linolenate or eicosapentaenoic acid (EPA). Evaluation of the potential nutritional efficacy of the oils was made using chondrocyte culture systems which can be used to mimic many of the degenerative and inflammatory pathways involved in arthritis. On stimulation of such cultures with interleukin-1alpha, they showed increased expression of cyclooxygenase-2, the inflammatory cytokines tumour necrosis factor-alpha (TNF-alpha), IL-1alpha and IL-1beta and the proteinase ADAMTS-4. This increased expression was not affected by challenge of the cultures with palm olein alone but showed concentration-dependent reduction by the modified oil in a manner similar to EPA. These results show clearly that it is possible to modify palm oil conveniently to produce a nutraceutical with effective anti-inflammatory properties.

Matched MeSH terms: Cartilage/drug effects; Cartilage/metabolism; Cartilage/pathology
Fulltext Edible Bird's nest extract as a chondro-protective agent for human chondrocytes isolated from osteoarthritic knee: in vitro study

Chua KH, Lee TH, Nagandran K, Md Yahaya NH, Lee CT, Tjih ET, et al.

BMC Complement Altern Med, 2013;13:19.
PMID: 23339380 DOI: 10.1186/1472-6882-13-19

Osteoarthritis (OA) is a degenerative joint disease that results in the destruction of cartilage. Edible Bird's Nest (EBN) extract contains important components, which can reduce the progression of osteoarthritis and helps in the regeneration of the cartilage. The present study aimed to investigate the effect of EBN extract on the catabolic and anabolic activities of the human articular chondrocytes (HACs) isolated from the knee joint of patients with OA.

Matched MeSH terms: Cartilage, Articular/cytology; Cartilage, Articular/drug effects*; Cartilage, Articular/metabolism
Fulltext The Effects of Annatto Tocotrienol Supplementation on Cartilage and Subchondral Bone in an Animal Model of Osteoarthritis Induced by Monosodium Iodoacetate

Chin KY, Wong SK, Japar Sidik FZ, Abdul Hamid J, Abas NH, Mohd Ramli ES, et al.

Int J Environ Res Public Health, 2019 08 13;16(16).
PMID: 31412648 DOI: 10.3390/ijerph16162897

Osteoarthritis is a degenerative joint disease which primarily affects the articular cartilage and subchondral bones. Since there is an underlying localized inflammatory component in the pathogenesis of osteoarthritis, compounds like tocotrienol with anti-inflammatory properties may be able to retard its progression. This study aimed to determine the effects of oral tocotrienol supplementation on the articular cartilage and subchondral bone in a rat model of osteoarthritis induced by monosodium iodoacetate (MIA). Thirty male Sprague-Dawley rats (three-month-old) were randomized into five groups. Four groups were induced with osteoarthritis (single injection of MIA at week 0) and another served as the sham group. Three of the four groups with osteoarthritis were supplemented with annatto tocotrienol at 50, 100 and 150 mg/kg/day orally for five weeks. At week 5, all rats were sacrificed, and their tibial-femoral joints were harvested for analysis. The results indicated that the groups which received annatto tocotrienol at 100 and 150 mg/kg/day had lower histological scores and cartilage remodeling markers. Annatto tocotrienol at 150 mg/kg/day significantly lowered the osteocalcin levels and osteoclast surface of subchondral bone. In conclusion, annatto tocotrienol may potentially retard the progression of osteoarthritis. Future studies to confirm its mechanism of joint protection should be performed.

Matched MeSH terms: Cartilage, Articular
Fulltext Osteochondromyxoma of Talus

Balakrishnan, Yogambigai, Nor Hasnina Mohd Hassan, Wan Najwa Zaini Wan Mohamed

Borneo Journal of Medical Sciences, 2019;13(3):65-70.
MyJurnal

Osteochondromyxoma is a rare bone tumour. Bone tumours of the talus are also uncommon, and accounts to be between 8% to 23% in tumours of the foot. A 28-year-old man presented with chronic right ankle pain. He had underlying left knee ligament and meniscal injury. Special examination tests for ligament injury were negative. Magnetic Resonance Imaging (MRI) revealed a benign bone lesion of talus with reactive oedema of sinus tarsi. Excision of lesion was done and subsequent histopathological examination confirmed the diagnosis of ostechondromyxoma.

Matched MeSH terms: Cartilage Diseases
TENS for surgical stabilisation of acetabular fracture in the skeletally immature: A novel technique

Razak KAA, Ghani KHA, Musa AA

Injury, 2021 Jan;52(1):90-94.
PMID: 33168201 DOI: 10.1016/j.injury.2020.11.004

BACKGROUND: Acetabular fractures in childhood are rare and the literature is scarce to describe a standard protocol in surgical management of these injuries. As the patient is still growing, it warrants a detailed assessment with a sound surgical plan if operative intervention is deemed necessary to prevent late complications. Throughout literature, most fixation rely on using pins, screws, plates or combination of the three which require large surgical exposure and risk of secondary physeal injury, hence we come up with a method of using the Titanium Elastic Nail System (TENS) to overcome this issue. We describe a novel technique in managing acetabular fractures in this group of patients using the TENS.
METHOD: An 8 year old girl with a diagnosis of right anterior column posterior hemitransverse acetabular fracture was fixed with 3 TENS for supra-acetabular, anterior column and posterior column fragments. Surgery was performed in a minimally invasive manner. No drilling was performed during the surgery and implant insertion is done manually.
RESULTS: Advantages of this procedure include minimally invasive surgery with smaller wounds, minimal intraoperative bleeding and theoretically reduces the risk of premature fusion of the triradiate cartilage. Patient is allowed early rehabilitation with this method.
CONCLUSION: This novel method provides an alternative to traditional usage of wires, pins, plates and screws as is described in most literature. However, it requires the surgeon to appreciate that the safe corridors for the implant are much narrower than adults. We recommend this technique for fractures that are deemed suitable for intramedullary fixation and further research in the future will be needed.

Matched MeSH terms: Cartilage

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