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  1. Wee SY, Aris AZ
    Ecotoxicol Environ Saf, 2023 Nov 15;267:115663.
    PMID: 37976959 DOI: 10.1016/j.ecoenv.2023.115663
    Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals that have been widely utilized in various industries since the 1940s, and have now emerged as environmental contaminants. In recent years, perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) have been restricted and replaced with several alternatives. The high persistence, bioaccumulation, and toxicity of these substances have contributed to their emergence as environmental contaminants, and several aspects of their behavior remain largely unknown and require further investigation. The trace level of PFAS makes the development of a monitoring database challenging. Additionally, the potential health issues associated with PFAS are not yet fully understood due to ongoing research and inadequate evidence (experimental and epidemiological studies), especially with regard to the combined effects of exposure to PFAS mixtures and human health risks from drinking water consumption. This in-depth review offers unprecedented insights into the exposure pathways and toxicological impacts of PFAS, addressing critical knowledge gaps in their behaviors and health implications. It presents a comprehensive NABC-Needs, Approach, Benefits, and Challenges-analysis to guide future strategies for the sustainable monitoring and management of these pervasive environmental contaminants.
  2. Al-Kandari AM, Alenezi A
    Urol Ann, 2020;12(4):314-318.
    PMID: 33776325 DOI: 10.4103/UA.UA_48_20
    PURPOSE: Male infertility represents 50% of all infertility problems. The management of male infertility is expensive, causing a huge burden on the patients. In this study, we aimed to calculate the cost burden of male infertility investigations and treatments.

    METHODS: A total of 600 infertile male patients from a single center in Kuwait city were asked to fulfill an internet-based survey. The survey encompassed data about the cost of different investigations and treatments of male infertility. Patients were also asked about the preference of covering their condition either through government or by private insurance.

    RESULTS: A total of 145 patients responded to the survey. Most of the patients earned 3295 United States Dollar (USD) to 6590 USD per month. The cost of the outpatient visit ranged from 131.7 to 263.4 USD. The cost of each hormonal test was 164.5 USD while the average cost of each imaging study was 131.8-164.7 USD. Most of the patients (62.8%) received medical therapy with an expense of >988.74 USD. Varicocelectomy cost ranged from 3295 to 6590 USD while the cost of testicular sperm extraction ranged from 1644 to 3294 USD. Most patients (96.3%) did not have health insurance coverage of infertility. On average, patients spent around 18% of their annual income on infertility care, excluding major surgeries.

    CONCLUSION: Male infertility is a worrisome medical condition that causes a huge burden on the Kuwait community. Effective management necessitates insurance coverage and public health support owing to the huge financial burden on the patients and their partners. Thus, policymakers should re-evaluate their protocols of spending on male infertility care.

  3. Pahrudin Arrozi A, Shukri SNS, Mohd Murshid N, Ahmad Shahzalli AB, Wan Ngah WZ, Ahmad Damanhuri H, et al.
    Front Cell Neurosci, 2022;16:846459.
    PMID: 35614968 DOI: 10.3389/fncel.2022.846459
    The amyloid precursor protein (APP) processing pathway was altered in Alzheimer's disease (AD) and contributed to abnormal amyloid-beta (Aβ) production, which forms insoluble interneuron protein aggregates known as amyloid plaques in the brain. Targeting the APP processing pathway is still fundamental for AD modifying therapy. Extensive research has evaluated the protective effects of vitamin E as an antioxidant and as a signaling molecule. The present study aimed to investigate the modulatory effects of different tocopherol isomers on the expression of genes involved in regulating the APP processing pathway in vitro. The screening for the effective tocopherol isomers in reducing APP expression and Aβ-42 was carried out in SH-SY5Y stably overexpressed APP Swedish. Subsequently, quantitative one-step real-time PCR was performed to determine the modulatory effects of selected tocopherol isomers on the expression of genes in SH-SY5Y stably overexpressed three different types of APP (wild-type, APP Swedish, and APP Swedish/Indiana). Our results showed that all tocopherol isomers, especially at higher concentrations (80-100 μM), significantly increased (p < 0.05) the cell viability in all cells group, but only α-tocopherol (ATF) and γ-tocopherol (GTF) significantly decreased (p < 0.05) the APP mRNA level without statistically significant APP protein level, accompanied with a reduced significance (p < 0.05) on the level of Aβ-42 in SH-SY5Y APP Swedish. On the other hand, β- and δ-tocopherol (BTF and DTF) showed no effects on the level of APP expression and Aβ-42. Subsequent results demonstrated that ATF and GTF significantly decreased (p < 0.05) the expression of gene beta-site APP cleaving enzyme (BACE1), APH1B, and Nicastrin (NCSTN), but significantly increased (p < 0.05) the expression of Sirtuin 1 (SIRT1) in SH-SY5Y stably expressed the mutant APP form. These findings suggested that ATF and GTF could modulate altered pathways and may help ameliorate the burden of amyloid load in AD.
  4. Kanwal N, Isha ASN
    Front Public Health, 2022;10:805733.
    PMID: 35372179 DOI: 10.3389/fpubh.2022.805733
    BACKGROUND: Social media activities affect every aspect of human life, be it personal, social or professional. Previous studies have confirmed the role of social media in affecting health in terms of releasing stress and providing social support. Increased occupational health disorders and increased time spent on social media activities motivate us to investigate this phenomenon in the context of occupational health. Therefore, the objective of this study is to measure the effects of social media activities related to personal and social life as well as work-life on health and wellbeing of office employees, on their job efforts and job rewards, and in moderating the effect of effort-reward imbalance on health and wellbeing.

    METHODS: Initially, to develop constructs related to social media activities, web-based structured interviews were conducted with five office employees working in the oil and gas industry for the last 5 years. Then, using an online questionnaire survey, data was collected from 424 office employees working in the oil and gas industry in Malaysia. Using statistical software for social science (SPSS) and Smart PLS, exploratory factor analysis and confirmatory factor analysis were conducted to identify reliability and validity (discriminant validity, convergent validity and composite validity) of the constructs. Following this, path analysis was conducted and the moderating effects were identified.

    RESULTS: Social media activities related to work-life decrease health and wellbeing by 11% and weaken the negative effect of effort-reward-imbalance on health and wellbeing by 17.6% at a 1% level of significance. The results of social media activities related to personal and social life strengthen the negative effect of effort-reward imbalance on health and wellbeing by 12% and negatively affects health and wellbeing and job rewards by 13, 55%, respectively. The direct effect of effort-reward imbalance and job efforts is significantly negative on health and wellbeing by 59 and 10%, respectively.

    CONCLUSION: It is concluded that social media activities of the office employees significantly moderate the effect of effort-reward imbalance on health and wellbeing and intervene in job rewards in the organizations. Hence, the effect of social media activities reduces the health and wellbeing of office employees.

  5. Arumugam A, Abdull Razis AF
    Asian Pac J Cancer Prev, 2018 Jun 25;19(6):1439-1448.
    PMID: 29936713
    Cruciferous vegetables are a rich source of glucosinolates that have established anti-carcinogenic activity. Naturally-occurring glucosinolates and their derivative isothiocyanates (ITCs), generated as a result of their enzymatic degradation catalysed by myrosinase, have been linked to low cancer incidence in epidemiological studies, and in animal models isothiocyanates suppressed chemically-induced tumorigenesis. The prospective effect of isothiocyanates as anti-carcinogenic agent has been much explored as cytotoxic against wide array of cancer cell lines and being explored for the development of new anticancer drugs. However, the mechanisms of isothiocyanates in inducing apoptosis against tumor cell lines are still largely disregarded. A number of mechanisms are believed to be involved in the glucosinolate-induced suppression of carcinogenesis, including the induction of apoptosis, biotransformation of xenobiotic metabolism, oxidative stress, alteration of caspase activity, angiogenesis, histone deacytylation and cell cycle arrest. The molecular mechanisms through which isothiocyanates stimulate apoptosis in cancer cell lines have not so far been clearly defined. This review summarizes the underlying mechanisms through which isothiocyanates modify the apoptotic pathway leading to cell death.
  6. Supee AH, Zaini MAA
    Environ Monit Assess, 2023 Sep 17;195(10):1218.
    PMID: 37718332 DOI: 10.1007/s10661-023-11866-7
    This study presents the kinetics and thermodynamics of biomass pyrolysis. The kinetics of the pyrolysis process was estimated using ten kinetic models from three different mechanisms, namely chemical reaction, diffusion, and nucleation and growth. Results showed that each pyrolysis subdivision was described by a different reaction model, signifying the complex nature of the pyrolysis process. The average values of activation energy determined from the kinetic models for empty fruit bunch, coconut shell, bamboo, and cardboard are 10.2-64.6 kJ/mol, 18.7-186.2 kJ/mol, 8.0-70.8 kJ/mol, and 13.1-277.3 kJ/mol, respectively. The biomass pyrolysis is endothermic and non-spontaneous and would require external energy to initiate the degradation process. The findings are helpful in characterizing the thermal degradation of biomass in exploring its potential as a source of alternative solid fuel.
  7. Wee SY, Aris AZ
    Environ Int, 2017 09;106:207-233.
    PMID: 28552550 DOI: 10.1016/j.envint.2017.05.004
    To date, experimental and epidemiological evidence of endocrine disrupting compounds (EDCs) adversely affecting human and animal populations has been widely debated. Notably, human health risk assessment is required for risk mitigation. The lack of human health risk assessment and management may thus unreliably regulate the quality of water resources and efficiency of treatment processes. Therefore, drinking water supply systems (DWSSs) may be still unwarranted in assuring safe access to potable drinking water. Drinking water supply, such as tap water, is an additional and crucial route of human exposure to the health risks associated with EDCs. A holistic system, incorporating continuous research in DWSS monitoring and management using multi-barrier approach, is proposed as a preventive measure to reduce human exposure to the risks associated with EDCs through drinking water consumption. The occurrence of EDCs in DWSSs and corresponding human health risk implications are analyzed using the Needs, Approaches, Benefits, and Challenges (NABC) method. Therefore, this review may act as a supportive tool in protecting human health and environmental quality from EDCs, which is essential for decision-making regarding environmental monitoring and management purposes. Subsequently, the public could have sustainable access to safer and more reliable drinking water.
  8. Chen AH, Abidin AH
    Malays J Med Sci, 2002 Jan;9(1):9-15.
    PMID: 22969312
    Sixty primary school children, were measured for for accommodation and, vergence facility, accommodation accuracy, relative accommodation, fusional vergence / reserve and heterophoria.Analysis of Variance revealed that no - single factor was significant by involved among the six age groups for all the above (p>0.05). However, a significant age difference (p<0.05) was found in the fusional reserve. The mean and standard deviation was 20.08 (±6.43) cpm for the monocular accommodation facility, 19.77 (±6.26) cpm for the binocular accommodation facility, 20.18 (±5.00) cpm for the vergence facility, 0.44 (±0.27) D for the accommodation accuracy, -0.28 (±0.82) PD for the heterophoria at distance, -1.84 (±3.9) PD for the near heterophoria, 3.25 (±0.79) D for the negative relative accommodation, and -3.90 (±1.32) D for the positive relative accommodation.There was no age difference in the accommodation and the vergence status between years the ages of 7 and 12 years old but the fusional reserve component of the vergence system varied with age. The vergence and the accommodation findings in our subjects were discussed and compared with previous studies to serve as a guideline in clinical data interpretation and diagnosis for binocular vision problems in Malay children.
  9. Hisamuddin Nar N, Suhailan M A
    Int J Emerg Med, 2011;4:67.
    PMID: 22032555 DOI: 10.1186/1865-1380-4-67
    INTRODUCTION: Cardiac biomarkers may be invaluable in establishing the diagnosis of acute myocardial infarction (AMI) in the ED setting.
    OBJECTIVE: To assess the diagnostic indices of the Cardio Detect assay and the quantitative cardiac troponin T test, in diagnosing AMI in the ED, according to the time of onset of chest pain.
    METHODOLOGY: A total of 80 eligible patients presenting with ischemic type chest pain with duration of symptoms within the last 36 h were enrolled. All patients were tested for H-FABP and troponin T at presentation to the ED. A repeated Cardio Detect test was performed 1 h after the initial negative result, and a repeated troponin T test was also performed 8-12 h after an initial negative result. The diagnostic indices [sensitivity, specificity, positive predictive value, negative predictive value, receiver operating curve (ROC)] were analyzed for Cardio Detect and Troponin T (individually and in combination) and also for the repeat Cardio Detect test. Data entry and analysis were performed using SPSS version 12.0 and Analyze-it software.
    RESULTS: The Cardio Detect test was more sensitive and had a higher NPV than the troponin T (TnT) test during the first 12 h of onset of chest pain. The repeat Cardio Detect had better sensitivity and NPV than the initial Cardio Detect. The sensitivity and NPV of the combination test (Cardio Detect and troponin T) were also superior to each test performed individually.
    CONCLUSION: The Cardio Detect test is more sensitive and has a better NPV than the troponin T test during the first 12 h of AMI. It may be used to rule out myocardial infarction during the early phase of ischemic chest pain.
  10. Wan Ahmad WS, Zaki WM, Ahmad Fauzi MF
    Biomed Eng Online, 2015;14:20.
    PMID: 25889188 DOI: 10.1186/s12938-015-0014-8
    Unsupervised lung segmentation method is one of the mandatory processes in order to develop a Content Based Medical Image Retrieval System (CBMIRS) of CXR. The purpose of the study is to present a robust solution for lung segmentation of standard and mobile chest radiographs using fully automated unsupervised method.
  11. Abd Aziz CB, Ahmad Suhaimi SQ, Hasim H, Ahmad AH, Long I, Zakaria R
    J Integr Med, 2019 Jan;17(1):66-70.
    PMID: 30591413 DOI: 10.1016/j.joim.2018.12.002
    OBJECTIVE: This study was done to determine whether Tualang honey could prevent the altered nociceptive behaviour, with its associated changes of oxidative stress markers and morphology of the spinal cord, among the offspring of prenatally stressed rats.

    METHODS: Pregnant rats were divided into three groups: control, stress, and stress treated with Tualang honey. The stress and stress treated with Tualang honey groups were subjected to restraint stress from day 11 of pregnancy until delivery. Ten week old male offspring (n = 9 from each group) were given formalin injection and their nociceptive behaviours were recorded. After 2 h, the rats were sacrificed, and their spinal cords were removed to assess oxidative stress activity and morphology. Nociceptive behaviour was analysed using repeated measures analysis of variance (ANOVA), while the levels of oxidative stress parameters and number of Nissl-stained neurons were analysed using a one-way ANOVA.

    RESULTS: This study demonstrated that prenatal stress was associated with increased nociceptive behaviour, changes in the oxidative stress parameters and morphology of the spinal cord of offspring exposed to prenatal stress; administration of Tualang honey reduced the alteration of these parameters.

    CONCLUSION: This study provides a preliminary understanding of the beneficial effects of Tualang honey against the changes in oxidative stress and neuronal damage in the spinal cord of the offspring of prenatally stressed rats.

  12. Ahmad NN, Ahmad Kamarudin NH, Leow ATC, Rahman RNZRA
    Molecules, 2020 Aug 25;25(17).
    PMID: 32854267 DOI: 10.3390/molecules25173858
    Surface charge residues have been recognized as one of the stability determinants in protein. In this study, we sought to compare and analyse the stability and conformational dynamics of staphylococcal lipase mutants with surface lysine mutation using computational and experimental methods. Three highly mutable and exposed lysine residues (Lys91, Lys177, Lys325) were targeted to generate six mutant lipases in silico. The model structures were simulated in water environment at 25 °C. Our simulations showed that the stability was compromised when Lys177 was substituted while mutation at position 91 and 325 improved the stability. To illustrate the putative alterations of enzyme stability in the stabilising mutants, we characterized single mutant K325G and double mutant K91A/K325G. Both mutants showed a 5 °C change in optimal temperature compared to their wild type. Single mutant K325G rendered a longer half-life at 25 °C (T1/2 = 21 h) while double mutant K91A/K325G retained only 40% of relative activity after 12 h incubation. The optimal pH for mutant K325G was shifted from 8 to 9 and similar substrate preference was observed for the wild type and two mutants. Our findings indicate that surface lysine mutation alters the enzymatic behaviour and, thus, rationalizes the functional effects of surface exposed lysine in conformational stability and activity of this lipase.
  13. Zaini MS, Liew JYC, Alang Ahmad SA, Mohmad AR, Ahmad Kamarudin M
    ACS Omega, 2020 Dec 08;5(48):30956-30962.
    PMID: 33324803 DOI: 10.1021/acsomega.0c03768
    The existence of surface organic capping ligands on quantum dots (QDs) has limited the potential in QDs emission properties and energy band gap structure alteration as well as the carrier localization. This drawback can be addressed via depositing a thin layer of a semiconductor material on the surface of QDs. Herein, we report on the comparative study for photoluminescent (PL) properties of PbS and PbS/MnS QDs. The carrier localization effect due to the alteration of energy band gap structure and carrier recombination mechanism in the QDs were investigated via PL measurements in a temperature range of 10-300 K with the variation of the excitation power from 10 to 200 mW. For PbS QDs, the gradient of integrated PL intensity (IPL) as a function of excitation power density graph was less than unity. When the MnS shell layer was deposited onto the PbS core, the PL emission exhibited a blue shift, showing dominant carrier recombination. It was also found that the full width half-maximum showed a gradual broadening with the increasing temperature, affirming the electron-phonon interaction.
  14. Rani E, Mohshim SA, Ahmad MZ, Goodacre R, Alang Ahmad SA, Wong LS
    Polymers (Basel), 2019 Mar 25;11(3).
    PMID: 30960545 DOI: 10.3390/polym11030561
    There is an increasing demand for lithography methods to enable the fabrication of diagnostic devices for the biomedical and agri-food sectors. In this regard, scanning probe lithography methods have emerged as a possible approach for this purpose, as they are not only convenient, robust and accessible, but also enable the deposition of "soft" materials such as complex organic molecules and biomolecules. In this report, the use of polymer pen lithography for the fabrication of DNA oligonucleotide arrays is described, together with the application of the arrays for the sensitive and selective detection of Ganoderma boninense, a fungal pathogen of the oil palm. When used in a sandwich assay format with DNA-conjugated gold nanoparticles, this system is able to generate a visually observable result in the presence of the target DNA. This assay is able to detect as little as 30 ng of Ganoderma-derived DNA without any pre-amplification and without the need for specialist laboratory equipment or training.
  15. Hassan N, Ahmad T, Ashaari A, Awang SR, Mamat SS, Wan Mohamad WM, et al.
    Results Phys, 2021 Jun;25:104267.
    PMID: 33968605 DOI: 10.1016/j.rinp.2021.104267
    Complex systems require rigorous analysis using effective method, in order to handle and interpret their information. Spectrum produced from Fourier transform infrared (FTIR) instrument is an example of a complex system, due to their overlapped bands and interactions within the spectrum. Thus, chemometrics techniques are required to further analyze the data, in particular, chemometrics fuzzy autocatalytic set (c-FACS). The c-FACS is initially used to analyze the FTIR spectra of gelatins. However, in this study, the c-FACS is generalized and implemented for analysis of Coronavirus disease 2019 (Covid-19), particularly, the pandemic outbreak in Malaysia. The daily Covid-19 cases in states in Malaysia are modeled and analyzed using c-FACS, to observe the trend and severity of the disease in Malaysia. As a result, the classification of severity of zones in Malaysia are identified. The obtained results offer descriptive insight for strategizing purposes in combating the Covid-19 outbreak in Malaysia.
  16. Maher T, Ahmad Raus R, Daddiouaissa D, Ahmad F, Adzhar NS, Latif ES, et al.
    Molecules, 2021 May 07;26(9).
    PMID: 34066963 DOI: 10.3390/molecules26092741
    Leukemia is a leukocyte cancer that is characterized by anarchic growth of immature immune cells in the bone marrow, blood and spleen. There are many forms of leukemia, and the best course of therapy and the chance of a patient's survival depend on the type of leukemic disease. Different forms of drugs have been used to treat leukemia. Due to the adverse effects associated with such therapies and drug resistance, the search for safer and more effective drugs remains one of the most challenging areas of research. Thus, new therapeutic approaches are important to improving outcomes. Almost half of the drugs utilized nowadays in treating cancer are from natural products and their derivatives. Medicinal plants have proven to be an effective natural source of anti-leukemic drugs. The cytotoxicity and the mechanisms underlying the toxicity of these plants to leukemic cells and their isolated compounds were investigated. Effort has been made throughout this comprehensive review to highlight the recent developments and milestones achieved in leukemia therapies using plant-derived compounds and the crude extracts from various medicinal plants. Furthermore, the mechanisms of action of these plants are discussed.
  17. Najwa-Sawawi S, Azman NM, Rusli MU, Ahmad A, Fahmi-Ahmad M, Fadzly N
    Saudi J Biol Sci, 2021 Sep;28(9):5053-5060.
    PMID: 34466082 DOI: 10.1016/j.sjbs.2021.05.021
    Sea turtle eggs incubation involves natural and artificial incubation of eggs, and indeed the depth will be varied and presumably affect the development of hatchlings. For nest relocation, the researcher needs to decide on the depth to incubate the eggs. Sea turtle eggs clutches may vary between 40 and 120 eggs for the green turtle, thus using a single value as the standard procedure might affect the quality of hatchlings. Here we quantify the dimension of the natural (in-situ) nest constructed by the nester and the artificial (ex-situ) built by our ranger during nest relocation. We suggest a linear regression calculation of Y = 0.2366X + 59.3267, better predict a more accurate nest depth based on the number of eggs to imitate the natural nest.
  18. Syamila N, Syahir A, Ikeno S, Tan WS, Ahmad H, Ahmad Tajudin A
    Colloids Surf B Biointerfaces, 2020 Jan 01;185:110623.
    PMID: 31735420 DOI: 10.1016/j.colsurfb.2019.110623
    Bio-nanogate involves synthesized or natural molecules as a 'gate' towards bioreceptors and responds upon the presence of targeted analytes in nanoscale dimension. Development of bio-nanogate improves analyte selectivity and signal response across various types of biosensors. The versatility of PAMAM dendrimers to form conjugates with guest molecules, such as proteins can be utilized in forming a bio-nanogate. PAMAM interaction with peptide bioreceptor for antibody detection is of interest in this study. This study investigated the interaction of synthesized immunogenic 'a' determinant (aD) region of hepatitis B virus surface antigen (HBsAg) with PAMAM G4 and anti-HBsAg antibody, as a potential bio-nanogate for anti-HBsAg detection. The aD peptide fused with maltose binding protein (MBP), was confirmed with Western blotting. Nano-Differential Scanning Fluorimetry (nano-DSF) study revealed that the interaction of MBP-aD with anti-HBsAg indicated a higher thermal stability as compared to its interaction with PAMAM G4. Electrochemical impedance spectroscopy showed that a higher binding constant of MBP-aD interaction with anti-HBsAg (0.92 μM-1) was observed at maximum saturation, as compared with PAMAM G4 (0.07 μM-1). Thermodynamic parameters demonstrated that MBP-aD interacted with anti-HBsAg and PAMAM G4, through van der Waals and hydrogen bonding. These analyses suggest that the weak interaction of MBP-aD and PAMAM G4 may form a potential bio-nanogate. It is hypothesized that the presence of anti-HBsAg has a higher affinity towards MBP-aD which may displace PAMAM G4 in the anti-HBsAg detection system. This interaction study is crucial as an initial platform of using peptide-PAMAM as a bio-nanogate in an antibody detection system.
  19. Kow RY, Che-Ahmad A, Ayeop MAS, Ahmad MW, Yusof S
    J Orthop Surg (Hong Kong), 2021 11 11;29(3):23094990211043987.
    PMID: 34753329 DOI: 10.1177/23094990211043987
    BACKGROUND: Strayer's gastrocnemius recession is a common technique in treating ankle equinus of gastrocnemius origin. Nevertheless, this technique is associated with a few flaws. We aim to introduce a novel technique of isolated gastrocnemius recession and perform a cadaveric study to evaluate its safety and at the same time compare this novel technique with the existing Strayer procedure biomechanically.

    METHODS: Eight fresh cadaveric models of gastrocnemius tightness were established by isolated traction of the gastrocnemius muscles. Gastrocnemius recession was performed on all eight models with Strayer method and the novel method randomized equally. The safety of both the techniques was evaluated by identifying any iatrogenic injury to the surrounding structures. The lengthening and improvement of the ankle dorsiflexion was measured and compared between the two techniques.

    RESULTS: There was no iatrogenic sural nerve or saphenous vein injury in all eight models. There was no significant difference between the two techniques in terms of lengthening (24.25 mm vs 21.00 mm; p = 0.838) and improvement of ankle dorsiflexion (26.5° vs 26°; p = .829).

    CONCLUSIONS: Both Strayer technique and the novel technique of gastrocnemius recession lengthened the gastrocnemius and improved the ankle dorsiflexion in this cadaver trial. Both procedures were safe with proper techniques, and there was no significant difference in efficacy between them.

    LEVEL OF EVIDENCE: Level II, randomized controlled trial.

  20. Ahmad Kendong SM, Raja Ali RA, Nawawi KNM, Ahmad HF, Mokhtar NM
    PMID: 34966694 DOI: 10.3389/fcimb.2021.744606
    Colorectal cancer (CRC) is a heterogeneous disease that commonly affects individuals aged more than 50 years old globally. Regular colorectal screening, which is recommended for individuals aged 50 and above, has decreased the number of cancer death toll over the years. However, CRC incidence has increased among younger population (below 50 years old). Environmental factors, such as smoking, dietary factor, urbanization, sedentary lifestyle, and obesity, may contribute to the rising trend of early-onset colorectal cancer (EOCRC) because of the lack of genetic susceptibility. Research has focused on the role of gut microbiota and its interaction with epithelial barrier genes in sporadic CRC. Population with increased consumption of grain and vegetables showed high abundance of Prevotella, which reduces the risk of CRC. Microbes, such as Fusobacterium nucleatum, Bacteroides fragilis and Escherichia coli deteriorate in the intestinal barrier, which leads to the infiltration of inflammatory mediators and chemokines. Gut dysbiosis may also occur following inflammation as clearly observed in animal model. Both gut dysbiosis pre- or post-inflammatory process may cause major alteration in the morphology and functional properties of the gut tissue and explain the pathological outcome of EOCRC. The precise mechanism of disease progression from an early stage until cancer establishment is not fully understood. We hypothesized that gut dysbiosis, which may be influenced by environmental factors, may induce changes in the genome, metabolome, and immunome that could destruct the intestinal barrier function. Also, the possible underlying inflammation may give impact microbial community leading to disruption of physical and functional role of intestinal barrier. This review explains the potential role of the interaction among host factors, gut microenvironment, and gut microbiota, which may provide an answer to EOCRC.
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