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  1. Lee YH, Pang SW, Revai Lechtich E, Shah K, Simon SE, Ponnusamy S, et al.
    J Cancer Res Clin Oncol, 2020 Jul;146(7):1751-1764.
    PMID: 32377840 DOI: 10.1007/s00432-020-03231-9
    PURPOSE: Although important for apoptosis, the signaling pathway involving MOAP-1(Modulator of Apoptosis 1), RASSF1A (RAS association domain family 1A), and Bax (Bcl-2 associated X protein) is likely to be dysfunctional in many types of human cancers due to mechanisms associated with gene mutation and DNA hyper-methylation. The purpose of the present study was to assess the potential impact of generating physiologically relevant signaling pathway mediated by MOAP-1, Bax, and RASSF1A (MBR) in cancer cells and chemo-drug resistant cancer cells.

    METHODS: The tricistronic expression construct that encodes MOAP-1, Bax, and RASSF1A (MBR) or its mutant, MOAP-1∆BH3L, Bax and RASSF1A (MBRX) was expressed from an IRES (Internal Ribosome Entry Site)-based tricistronic expression vector in human breast cancer cells, including MCF-7, MCF-7-CR (cisplatin resistant) and triple negative breast cancer cells, BMET05, for functional characterization through in vitro and in vivo models.

    RESULTS: Transient expression of MBR potently promoted dose-dependent apoptotic signaling and chemo-sensitization in the cancer cells, as evidenced by loss of cell viability, nuclei condensation and Annexin-V positive staining while stable expression of MBR in MCF-7 cells significantly reduced the number of MBR stable clone by 86% and the stable clone exhibited robust chemo-drug sensitivity. In contrast, MBRX stable clone exhibited chemo-drug resistance while transiently over-expressed MOAP-1ΔBH3L inhibited the apoptotic activity of MBR. Moreover, the spheroids derived from the MBR stable clone displayed enhanced chemo-sensitivity and apoptotic activity. In mouse xenograft model, the tumors derived from MBR stable clone showed relatively high level of tumor growth retardation associated with the increase in apoptotic activity, leading to the decreases in both tumor weight and volume.

    CONCLUSIONS: Expression of MBR in cancer cells induces apoptotic cell death with enhanced chemo-sensitization requiring the BH3L domain of MOAP-1. In animal model, the expression of MBR significantly reduces the growth of tumors, suggesting that MBR is a potent apoptotic sensitizer with potential therapeutic benefits for cancer treatment.

  2. Wan Ismail WS, Sim ST, Tan KA, Bahar N, Ibrahim N, Mahadevan R, et al.
    Perspect Psychiatr Care, 2020 Oct;56(4):949-955.
    PMID: 32363648 DOI: 10.1111/ppc.12517
    PURPOSE: This cross-sectional study examined the cyber-psychological correlates of depression, anxiety, stress, and suicidality among public university students in Klang Valley, Malaysia.

    DESIGN AND METHODS: Participants were randomly selected using multi-stage sampling methods from three public universities in the study location. Participants completed measures of internet and smartphone addictions, depression, anxiety, stress, and suicidality, along with sociodemographic items.

    FINDINGS: At bivariate level, both internet and smartphone addictions were found to have significant positive correlations with depression, anxiety, stress, and suicidality. At multivariate level, only internet addiction emerged as a consistent significant predictor for depression, anxiety, stress, and suicidality.

    PRACTICE IMPLICATIONS: The present findings have implications for mental health professionals to routinely screen for psychological disturbance in young adults who have potential risks for internet addiction.

  3. Sathiya Seelan JS, Shu Yee C, She Fui F, Dawood M, Tan YS, Kim MJ, et al.
    Mycobiology, 2020;48(2):95-103.
    PMID: 32363037 DOI: 10.1080/12298093.2020.1738743
    The genus Termitomyces (Lyophyllaceae, Basidiomycota) is often associated with fungus-feeding termites (Macrotermitinae) due to their strong symbiotic relationships. The genus is widely found exclusively in certain regions of Africa and Asia. They are recognized as edible mushroom within Southeast Asia as well. But it is often misidentified based on morphology by the local communities especially in Malaysia for Chlorophyllum molybdites which is a highly poisonous mushroom. Thus, it is necessary to study the genus for Malaysia with the synergy of using both morphological and molecular identification. In this study, we aim to describe another new species as an addition to the genus Termitomyces found within Sabah, Malaysia. We generated two new sequences (nrLSU and mtSSU) for the new species and a total of 28 nrLSU and mtSSU sequences were retrieved from GenBank for the phylogenetic analysis using maximum likelihood and Bayesian inferences. We identified that the new collection from Sabah province is a new species and named as Termitomyces gilvus based on the termites found in the mound. A phylogeny tree made from the concatenated genes of LSU and mtSSU suggests that T. gilvus is closely related to T. bulborhizus from China. According to our results, the combination of molecular and morphology proved to be a robust approach to re-evaluate the taxonomic status of Termitomyces species in Malaysia. Additional surveys are needed to verify the species diversity and clarify their geographic distribution.
  4. Tan NC, Koong Ying Leng A, Phoon Kwong Yun I, Wang Zhen S, Paulpandi M, Lee YK, et al.
    BMJ Open, 2020 03 08;10(3):e033791.
    PMID: 32152165 DOI: 10.1136/bmjopen-2019-033791
    INTRODUCTION: Patient decision-aids (PDAs) support patients in selecting evidence-based treatment options. PDA is useful only if the user understands the content to make personalised decisions. Cultural adaptation is a process of adjusting health messages so that the information is accurate, relevant and understandable to users from a different population. A PDA has been developed to assist Malaysian patients with secondary drug failure to initiate insulin therapy to control their type 2 diabetes mellitus (T2DM). Likewise, patients with T2DM in neighbouring Singapore face similar barriers in commencing insulin treatment, which a PDA may facilitate decision-making in selecting personalised therapy.

    OBJECTIVE: The study aimed to explore the views and perceptions of Singaporean primary care providers on the Malaysia PDA to initiate insulin therapy and described the cultural adaptation process used in the design and development of a new PDA, which would be trialled in a Singapore primary healthcare institution.

    METHOD: Qualitative research method was deployed to conduct one-to-one in-depth interviews of the healthcare providers at the trial site (SingHealth Polyclinics-SHP), including six primary care physicians and four nurses to gather their views and feedbacks on the Malaysian PDA. The interviews were transcribed, audited and analysed (standard content analysis) to identify themes relating to the content, layout, concerns of the original PDA and suggestions to the design of the new SHP PDA.

    RESULTS: Cultural adaptation of the new PDA includes change to the overall design, graphics (including pictograms), presentation styles, additional contextualised content (personalisation, subheadings, cost and treatment option), modified phrasing of the subtitles and concerns (choice of words) relevant to the new users.

    CONCLUSION: A PDA on insulin therapy underwent cultural adaptation before its implementation in another population in a neighbouring country. Its relevance and effectiveness will be evaluated in future research.

  5. Carlsohn MR, Groth I, Tan GYA, Schütze B, Saluz HP, Munder T, et al.
    Int J Syst Evol Microbiol, 2007 Jul;57(Pt 7):1640-1646.
    PMID: 17625209 DOI: 10.1099/ijs.0.64903-0
    Three actinomycetes isolated from the surfaces of rocks in a medieval slate mine were examined in a polyphasic taxonomic study. Chemotaxonomic and morphological characteristics of the isolates were typical of strains of the genus Amycolatopsis. The isolates had identical 16S rRNA gene sequences and formed a distinct phyletic line towards the periphery of the Amycolatopsis mediterranei clade, being most closely related to Amycolatopsis rifamycinica. The organisms shared a wide range of genotypic and phenotypic markers that distinguished them from their closest phylogenetic neighbours. On the basis of these results, a novel species, Amycolatopsis saalfeldensis sp. nov., is proposed. The type strain is HKI 0457(T) (=DSM 44993(T)=NRRL B-24474(T)).
  6. Lim QL, Tan YL, Ng WL, Yong CSY, Ismail A, Rovie-Ryan JJ, et al.
    Sci Rep, 2020 03 04;10(1):3973.
    PMID: 32132572 DOI: 10.1038/s41598-020-60552-y
    A molecular sexing method by polymerase chain reaction (PCR) amplification of a portion of the sex-determining region Y (SRY) and the zinc finger (ZF) gene, as well as six equine Y-chromosome-specific microsatellite markers, were tested in the Malayan tapir (Tapirus indicus). While the microsatellite markers did not yield any male-specific amplicons for sex-typing, the SRY/ZF marker system produced reliable molecular sexing results by accurately sex-typing 31 reference Malayan tapirs, using whole blood, dried blood spot (DBS), or tissue samples as materials for DNA extraction. The marker system was also tested on 16 faecal samples, and the results were in general consistent with the pre-determined sexes of the animals, despite some amplification failures. A preliminary estimation of wild Malayan tapir population sex ratio was estimated from the Wildlife Genomic Resource Bank (WGRB) database of the Malaysian Department of Wildlife and National Parks (PERHILITAN), zoos, and the Sungai Dusun Wildlife Conservation Centre (WCC), as well as from the results of molecular sexing 12 samples of unknown sex. The overall sex ratio favoured females, but the deviation from parity was statistically not significant when tested using the binomial test (p > 0.05), which may be due to reduced statistical power caused by small sample sizes.
  7. Abdul Rahman SF, Muniandy K, Soo YK, Tiew EYH, Tan KX, Bates TE, et al.
    Biochem Biophys Rep, 2020 Jul;22:100756.
    PMID: 32346617 DOI: 10.1016/j.bbrep.2020.100756
    Development of resistance to chemo- and radiotherapy in patients suffering from advanced cervical cancer narrows the therapeutic window for conventional therapies. Previously we reported that a combination of the selective BCL-2 family inhibitors ABT-263 and A-1210477 decreased cell proliferation in C33A, SiHa and CaSki human cervical cancer cell lines. As ABT-263 binds to both BCL-2 and BCL-XL with high affinity, it was unclear whether the synergism of the drug combination was driven either by singly inhibiting BCL-2 or BCL-XL, or inhibition of both. In this present study, we used the BCL-2 selective inhibitor ABT-199 and the BCL-XL selective inhibitor A1331852 to resolve the individual antitumor activities of ABT-263 into BCL-2 and BCL-XL dependent mechanisms. A-1210477 was substituted for the orally bioavailable S63845. Four cervical cancer cell lines were treated with the selective BCL-2 family inhibitors ABT-199, A1331852 and S63845 alone and in combination using 2-dimensional (2D) and 3-dimensional (3D) cell culture models. The SiHa, C33A and CaSki cell lines were resistant to single agent treatment of all three drugs, suggesting that none of the BCL-2 family of proteins mediate survival of the cells in isolation. HeLa cells were resistant to single agent treatment of ABT-199 and A1331852 but were sensitive to S63845 indicating that they depend on MCL-1 for survival. Co-inhibition of BCL-2 and MCL-1 with ABT-199 and S63845, inhibited cell proliferation of all cancer cell lines, except SiHa. However, the effect of the combination was not as pronounced as combination of A1331852 and S63845. Co-inhibition of BCL-XL and MCL-1 with A1331852 and S63845 significantly inhibited cell proliferation of all four cell lines. Similar data were obtained with 3-dimensional spheroid cell culture models generated from two cervical cancer cell lines in vitro. Treatment with a combination of A1331852 and S63845 resulted in inhibition of growth and invasion of the 3D spheroids. Collectively, our data demonstrate that the combination of MCL-1-selective inhibitors with either selective inhibitors of either BCL-XL or BCL-2 may be potentially useful as treatment strategies for the management of cervical cancer.
  8. Feng Y, Ping Tan C, Zhou C, Yagoub AEA, Xu B, Sun Y, et al.
    Food Chem, 2020 Sep 15;324:126883.
    PMID: 32344350 DOI: 10.1016/j.foodchem.2020.126883
    Freeze-thaw cycles (FTC) pretreatment was employed before the vacuum freeze-drying of garlic slices, aimed at improving the drying process and the quality of the end product. Cell viability, water status, internal structure, flavor, chemical composition and thermogravimetric of garlic samples were evaluated. The results indicated that FTC pretreatment reduced the drying time (22.22%-33.33%) and the energy consumption (14.25%-15.50%), owing to the water loss, the increase in free water, and the formation of porous structures. The FTC pretreatment improved thermal stability, flavor and chemical composition content of dried products. The antioxidant activity of polysaccharides extracted from FTC pretreated dried products was higher than that of the unpretreated dried product due to the reduction in polysaccharide molecular weight. This research could pave a route for future production of dried garlic slices having good quality by using the FTC pretreatment, with lower energy consumption and shorter drying time.
  9. Binti Kamaruddin NA, Fong LY, Tan JJ, Abdullah MNH, Singh Cheema M, Bin Yakop F, et al.
    Molecules, 2020 May 29;25(11).
    PMID: 32485974 DOI: 10.3390/molecules25112534
    Endothelial cell injury caused by reactive oxygen species (ROS) plays a critical role in the pathogenesis of cardiovascular diseases. Omentin, an adipocytokine that is abundantly expressed in visceral fat tissue, has been reported to possess anti-inflammatory and antidiabetic properties. However, endothelial protective effects of omentin against oxidative stress remain unclear. This study aimed to evaluate the protective effect of omentin against hydrogen peroxide (H2O2)-induced cell injury in human umbilical vein endothelial cells (HUVECs). Cytotoxicity and cytoprotective effects of omentin were evaluated using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The apoptotic activity of HUVECs was detected using Annexin-V/PI and Hoechst 33258 staining methods. Antioxidant activity of omentin was evaluated by measuring both reactive oxygen species (ROS) levels and glutathione peroxidase (GPx) activity. No cytotoxicity effect was observed in HUVECs treated with omentin alone at concentrations of 150 to 450 ng/ml. MTT assay showed that omentin significantly prevented the cell death induced by H2O2 (p < 0.001). Hoechst staining and flow cytometry also revealed that omentin markedly prevented H2O2-induced apoptosis. Moreover, omentin not only significantly inhibited ROS production (p < 0.01) but also significantly (p < 0.01) increased GPx activity in HUVECs. In conclusion, our data suggest that omentin may protect HUVECs from injury induced by H2O2.
  10. Hue YL, Lum LCS, Ahmad SH, Tan SS, Wong SY, Nathan AM, et al.
    Singapore Med J, 2020 Jun 02.
    PMID: 32480437 DOI: 10.11622/smedj.2020084
    INTRODUCTION: Chest physiotherapy (CPT) may benefit children aged < 5 years who suffer from lower respiratory tract infection (LRTI). However, its effects are technique-dependent. This study aimed to determine whether mechanical CPT using the LEGA-Kid® mechanical percussion device is superior to manual CPT in children with LRTI.

    METHODS: Children aged 5 months to 5 years who were admitted and referred for CPT from January to April 2017 were randomised to either manual CPT or mechanical CPT with LEGA-Kid®. Outcomes measured at pre-intervention and 2 hours post-intervention were respiratory rate (RR), oxygen saturation and modified Respiratory Distress Assessment Instrument (mRDAI) score.

    RESULTS: All 30 enrolled patients had significant reduction in post-intervention RR and mRDAI scores. There was an 8% reduction in RR for the manual CPT group (p = 0.002) and a 16.5% reduction in the mechanical CPT group (p = 0.0001), with a significantly greater reduction in the latter (p = 0.024). mRDAI scores decreased by 2.96 in the manual group (p = 0.0001) and 3.62 in the mechanical group (p = 0.002), with no significant difference between the groups. There was no significant improvement in oxygen saturation, and no adverse events were observed after CPT.

    CONCLUSION: Children receiving either manual or mechanical CPT showed improvements in respiratory distress symptoms with no adverse effects. A combined strategy of nebulised hypertonic saline followed by CPT for LRTI removes airway secretions and results in improvements of moderately severe respiratory distress. The LEGA-Kid mechanical CPT method was superior in reducing RR.

  11. Tan CW, Rukayadi Y, Hasan H, Thung TY, Lee E, Rollon WD, et al.
    Saudi J Biol Sci, 2020 Jun;27(6):1602-1608.
    PMID: 32489301 DOI: 10.1016/j.sjbs.2020.01.002
    Vibrio parahaemolyticus is a foodborne bacterial pathogen that may cause gastroenteritis in humans through the consumption of seafood contaminated with this microorganism. The emergence of antimicrobial and multidrug-resistant bacteria is another serious public health threat worldwide. In this study, the prevalence and antibiotic susceptibility test of V. parahaemolyticus in blood clams, shrimps, surf clams, and squids were determined. The overall prevalence of V. parahaemolyticus in seafood was 85.71% (120/140), consisting of 91.43% (32/35) in blood clam, 88.57% (31/35) in shrimps, 82.86% (29/35) in surf clams, and 80% (28/35) in squids. The majority of V. parahaemolyticus isolates from the seafood samples were found to be susceptible to most antibiotics except ampicillin, cefazolin, and penicillin. The MAR indices of V. parahaemolyticus isolates ranged from 0.04 to 0.71 and about 90.83% of isolates were found resistant to more than one antibiotic. The high prevalence of V. parahaemolyticus in seafood and multidrug-resistant isolates detected in this study could pose a potential risk to human health and hence appropriate control methods should be in place to minimize the potential contamination and prevent the emergence of antibiotic resistance.
  12. Sim BI, Khor YP, Lai OM, Yeoh CB, Wang Y, Liu Y, et al.
    Food Chem, 2020 Oct 30;328:127147.
    PMID: 32497897 DOI: 10.1016/j.foodchem.2020.127147
    The reduction of the 3-monochloropropane-1,2-diol esters (3-MCPDE) and glycidyl esters (GE) was successfully achieved by the optimization of four processing parameters: phosphoric acid dosage, degumming temperature, bleaching earth dosage, and deodorization temperature by response surface methodology without the need for additional processing steps. The optimized processing conditions were 0.31% phosphoric acid dosage, 50 °C degumming temperature, 3% bleaching earth dosage, and 240 °C deodorization temperature. The optimization resulted in more than 80% and 65% reduction of 3-MCPDE and GE levels, respectively with color and FFA contents maintained in the acceptable range specified by Palm Oil Refiners Association of Malaysia. The optimized refining condition was transferred to macro scale refining units of 1 kg and 3 kg capacities to investigate its successful application during scale-up process.
  13. Taib MAA, Alias N, Jaafar M, Razak KA, Tan WK, Shahbudin IP, et al.
    Nanotechnology, 2020 Oct 23;31(43):435605.
    PMID: 32640434 DOI: 10.1088/1361-6528/aba3d8
    Arrays of TiO2 nanotubes (TiO2 NTs) with grassy surfaces were observed on titanium foil anodised at 60 V in fluorinated ethylene glycol (EG) with added hydrogen peroxide (H2O2). The grassy surface was generated by the chemical etching and dissolution of the surface of the TiO2 NTs walls, which was accelerated by the temperature increase on the addition of H2O2 . Upon annealing at 600 °C, the grassy part of the TiO2 NTs was found to consist of mostly anatase TiO2 whereas the bottom part of the anodic oxide comprised a mixture of anatase and rutile TiO2. The TiO2 NTs were then used to reduce hexavalent chromium (Cr(VI)) under ultraviolet radiation. They exhibited a rather efficient photocatalytic effect, with 100% removal of Cr(VI) after 30 min of irradiation. The fast removal of Cr(VI) was due to the anatase dominance at the grassy part of the TiO2 NTs as well as the higher surface area the structure may have. This work provides a novel insight into the photocatalytic reduction of Cr(VI) on grassy anatase TiO2 NTs.
  14. Muniandy K, Gothai S, Tan WS, Kumar SS, Esa NM, Chandramohan G, et al.
    PMID: 32617103 DOI: 10.1155/2020/2705479
    [This corrects the article DOI: 10.1155/2018/3142073.].
  15. Sai A, Furusawa T, Othman MY, Tomojiri D, Wan Zaini WFZ, Tan CSY, et al.
    Heliyon, 2020 Jul;6(7):e04414.
    PMID: 32743089 DOI: 10.1016/j.heliyon.2020.e04414
    Compared with females, little research on muscularity and the sociocultural influences on this domain has been conducted with males in non-Western societies. The current study explored these sociocultural predictors of drive for muscularity among Malaysian male college students, specifically in terms of ethnicity and exposure to media (i.e., Internet and social media). In total, 166 male college students from two universities in Kuala Lumpur were asked to rate the questionnaires as to muscularity-oriented attitudes and behaviours. Multivariable general linear model analyses revealed that being Chinese was a strong predictor of muscularity-oriented attitudes and behaviours. In addition, modern media, particularly, Internet use and the number of followers on Instagram, was found to significantly predict males' drive for muscularity. Overall findings suggest that males of particular ethnic groups may be at higher risk for negative body image compared to the other ethnic populations and modern media use may accelerate drive for muscularity, which may also in turn place males at higher risk for excess muscularity-oriented thoughts and behaviours.
  16. Fatahi S, Nazary-Vannani A, Sohouli MH, Mokhtari Z, Kord-Varkaneh H, Moodi V, et al.
    Crit Rev Food Sci Nutr, 2021;61(20):3383-3394.
    PMID: 32744094 DOI: 10.1080/10408398.2020.1798350
    Inconsistencies exist with regard to influence of fasting and energy-restricting diets on markers of glucose and insulin controls. To address these controversial, this study was conducted to determine the impact of fasting diets on fasting blood sugars (FBSs), insulin, homeostatic model assessment insulin resistance (HOMA-IR) and hemoglobin A1c (HbA1c) levels. A comprehensive systematic search was carried out in electronic databases, i.e., Scopus, PubMed, and Web of Science through June 2019 for RCTs that investigated the impact of fasting and energy-restricting diets on circulating FBS, insulin, HOMA-IR and HbA1c levels from. Weighted mean difference (WMD) with the 95% CI were used for estimating combined effect size. The subgroup analysis was applied to specify the source of heterogeneity among articles. Pooled results from 30 eligible articles with 35 arms demonstrated a significant decrease in FBS (WMD): -3.376 mg/dl, 95% CI: -5.159, -1.594, p 8 weeks had a greater reduction in FBS, insulin and HOMA-IR level compared with other subgroups. The evidence from available studies suggests that the fasting or energy-restricting diets leads to significant reductions in FBS, insulin and HOMA-IR level and has modest, but, non-significant effects on HbA1c levels.
  17. Tan SZK, Temel Y, Chan AY, Mok ATC, Perucho JAU, Blokland A, et al.
    Brain Struct Funct, 2020 Sep;225(7):1957-1966.
    PMID: 32594260 DOI: 10.1007/s00429-020-02102-w
    Electrical stimulation of the dorsolateral periaqueductal gray (dlPAG) in rats has been shown to elicit panic-like behaviour and can be a useful as an unconditioned stimulus for modelling anticipatory fear and agoraphobia in a contextual fear conditioning paradigm. In this study, we further analysed our previous data on the effects of escitalopram (a selective serotonin reuptake inhibitor, SSRI) and buspirone (a 5-HT1A receptor partial agonist) on dlPAG-induced anticipatory fear behaviour in a rat model using freezing as a measure. We then attempted to unravel some of the interactions with dopamine signalling using tyrosine hydroxylase (TH) immunohistochemistry to probe the effects on dopaminergic neurons. We showed that acute treatment of escitalopram, but not buspirone, was effective in reducing anticipatory freezing behaviour, while chronic administrations of both drugs were effective. We found that the dlPAG stimulation induced increase number of dopaminergic neurons in the ventral tegmental area (VTA) which was reversed in both chronic buspirone and escitalopram groups. We further found a strong positive correlation between the number of dopaminergic neurons and freezing in the VTA and showed positive correlations between dopaminergic neurons in the VTA and substantia nigra pars compacta (SNpc) in escitalopram and buspirone groups, respectively. Overall, we showed that chronic treatment with an SSRI and a 5-HT1A agonist reduced anticipatory freezing behaviour which seems to be associated, through correlative studies, with a reversal of dlPAG stimulation induced increase in number of dopaminergic neurons in the VTA and/or SNpc.
  18. Faghfouri AH, Zarezadeh M, Tavakoli-Rouzbehani OM, Radkhah N, Faghfuri E, Kord-Varkaneh H, et al.
    Eur J Pharmacol, 2020 Oct 05;884:173368.
    PMID: 32726657 DOI: 10.1016/j.ejphar.2020.173368
    Prolonged inflammation could be considered as the leading cause of chronic diseases such as cardiovascular disorders, type two diabetes, and obesity. N-acetylcysteine (NAC) is considered an antioxidant. The present meta-analysis aims to determine the efficacy of NAC in alleviating inflammation and oxidative stress. PubMed-Medline, SCOPUS, Web of Science and Embase databases and Google Scholar were searched up to Nov 2019. Random effect analysis was used to perform meta-analysis. Subgroup analyses were carried out to find heterogeneity sources. Meta-regression analysis was used to explore linear relationship between effect size and variables. Trim and fill analysis were performed in case of the presence of publication bias. Quality assessment was performed using Cochrane Collaboration's tool. A total of 28 studies were included in meta-analysis. NAC significantly decreased malondialdehyde (MDA) (SMD = -1.44 μmol/L; 95% CI: -2.05, -0.84; P 
  19. Walters R, Collier JM, Braighi Carvalho L, Langhorne P, Katijjahbe MA, Tan D, et al.
    BMJ Open, 2020 06 11;10(6):e035850.
    PMID: 32532772 DOI: 10.1136/bmjopen-2019-035850
    OBJECTIVES: Information about younger people of working age (≤65 years), their post stroke outcomes and rehabilitation pathways can highlight areas for further research and service change. This paper describes: (1) baseline demographics; (2) post acute rehabilitation pathways; and (3) 12-month outcomes; disability, mobility, depression, quality of life, informal care and return to work of working age people across three geographic regions (Australasia (AUS), South East (SE) Asia and UK).

    DESIGN: This post hoc descriptive exploration of data from the large international very early rehabilitation trial (A Very Early Rehabilitation Trial (AVERT)) examined the four common post acute rehabilitation pathways (inpatient rehabilitation, home with community rehabilitation, inpatient rehabilitation then community rehabilitation and home with no rehabilitation) experienced by participants in the 3 months post stroke and describes their 12-month outcomes.

    SETTING: Hospital stroke units in AUS, UK and SE Asia.

    PARTICIPANTS: Patients who had an acute stroke recruited within 24 hours who were ≤65 years.

    RESULTS: 668 participants were ≤65 years; 99% lived independently, and 88% no disability (modified Rankin Score (mRS)=0) prior to stroke. We had complete data for 12-month outcomes for n=631 (94%). The proportion receiving inpatient rehabilitation was higher in AUS than other regions (AUS 52%; UK 25%; SE Asia 23%), whereas the UK had higher community rehabilitation (UK 65%; AUS 61%; SE Asia 39%). At 12 months, 70% had no or little disability (mRS 0-2), 44% were depressed, 28% rated quality of life as poor or worse than death. For those working prior to stroke (n=228), only 57% had returned to work. A noteworthy number of working age survivors received no rehabilitation services within 3 months post stroke.

    CONCLUSIONS: There was considerable variation in rehabilitation pathways and post acute service use across the three regions. At 12 months, there were high rates of depression, poor quality of life and low rates of return to work.

    TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12606000185561).

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