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  1. Fulltext Early outcome of bariatric surgery for the treatment of type 2 diabetes mellitus in super-obese Malaysian population
    Rajan R, Sam-Aan M, Kosai NR, Shuhaili MA, Chee TS, Venkateswaran A, et al.
    J Minim Access Surg, 2019 1 9;16(1):47-53.
    PMID: 30618425 DOI: 10.4103/jmas.JMAS_219_18
    Introduction: Despite many challenges, the benefit of bariatric surgery in super-obese population remains irrefutable with significant improvement in metabolic syndrome and quality of life. There are currently no published data from Malaysia on this topic.

    Objective and Methodology: A single-centre retrospective study aimed at analysing the outcome of laparoscopic bariatric surgery on super-obese Malaysians with type 2 diabetes mellitus (T2DM) at 12 months following surgery. Demographic details, glycaemic control and weight-loss parameters were analysed.P < 0.01 was considered statistically significant.

    Results: Of the 33 patients, 55% were women and 45% were men with a mean age of 40 ± 11 years and body mass index (BMI) of 59.3 ± 9.0 kg/m2. Majority of patients were of Malay ethnicity (82%). Malaysian-Indians and Malaysian-Chinese each accounted for 9% of total case volume. The three types of laparoscopic bariatric surgery recorded in this study were sleeve gastrectomy (82%), Roux-en-Y gastric bypass (9%) and mini-gastric bypass (9%) with operative time of 103.5 ± 31.1, 135.8 ± 32.6 and 116.2 ± 32.3 min, respectively. Percentage total body weight loss was 33.11% ± 9.44% at 12 months following surgery (P < 0.01). BMI change and percentage excess BMI loss showed similar improvement. Glycosylated haemoglobin and fasting blood sugar decreased from pre-operative values of 7.0% ± 1.0% and 7.0 ± 0.9 mmol/L to 5.6% ± 0.4% and 5.0 ± 0.6 mmol/L at 12 months (P < 0.01). Remission of T2DM was noted in 93% of patients. There was no correlation between weight loss and improvement in glycaemic status.

    Conclusion: There are significant weight loss and improvement of glycaemic control at 12 months post-laparoscopic bariatric surgery among super-obese Malaysians.

  2. Fulltext Overview of Urethral Reconstruction by Tissue Engineering: Current Strategies, Clinical Status and Future Direction
    Rashidbenam Z, Jasman MH, Hafez P, Tan GH, Goh EH, Fam XI, et al.
    Tissue Eng Regen Med, 2019 08;16(4):365-384.
    PMID: 31413941 DOI: 10.1007/s13770-019-00193-z
    BACKGROUND: Urinary tract is subjected to a variety of disorders such as urethral stricture, which often develops as a result of scarring process. Urethral stricture can be treated by urethral dilation and urethrotomy; but in cases of long urethral strictures, substitution urethroplasty with genital skin and buccal mucosa grafts is the only option. However a number of complications such as infection as a result of hair growth in neo-urethra, and stone formation restrict the application of those grafts. Therefore, tissue engineering techniques recently emerged as an alternative approach, aiming to overcome those restrictions. The aim of this review is to provide a comprehensive coverage on the strategies employed and the translational status of urethral tissue engineering over the past years and to propose a combinatory strategy for the future of urethral tissue engineering.

    METHODs: Data collection was based on the key articles published in English language in years between 2006 and 2018 using the searching terms of urethral stricture and tissue engineering on PubMed database.

    RESULTS: Differentiation of mesenchymal stem cells into urothelial and smooth muscle cells to be used for urologic application does not offer any advantage over autologous urothelial and smooth muscle cells. Among studied scaffolds, synthetic scaffolds with proper porosity and mechanical strength is the best option to be used for urethral tissue engineering.

    CONCLUSION: Hypoxia-preconditioned mesenchymal stem cells in combination with autologous cells seeded on a pre-vascularized synthetic and biodegradable scaffold can be said to be the best combinatory strategy in engineering of human urethra.

  3. Fulltext Fabrication of Adipose-Derived Stem Cell-Based Self-Assembled Scaffold under Hypoxia and Mechanical Stimulation for Urethral Tissue Engineering
    Rashidbenam Z, Jasman MH, Tan GH, Goh EH, Fam XI, Ho CCK, et al.
    Int J Mol Sci, 2021 Mar 25;22(7).
    PMID: 33805910 DOI: 10.3390/ijms22073350
    Long urethral strictures are often treated with autologous genital skin and buccal mucosa grafts; however, risk of hair ingrowth and donor site morbidity, restrict their application. To overcome this, we introduced a tissue-engineered human urethra comprising adipose-derived stem cell (ASC)-based self-assembled scaffold, human urothelial cells (UCs) and smooth muscle cells (SMCs). ASCs were cultured with ascorbic acid to stimulate extracellular matrix (ECM) production. The scaffold (ECM) was stained with collagen type-I antibody and the thickness was measured under a confocal microscope. Results showed that the thickest scaffold (28.06 ± 0.59 μm) was achieved with 3 × 104 cells/cm2 seeding density, 100 μg/mL ascorbic acid concentration under hypoxic and dynamic culture condition. The biocompatibility assessment showed that UCs and SMCs seeded on the scaffold could proliferate and maintain the expression of their markers (CK7, CK20, UPIa, and UPII) and (α-SMA, MHC and Smootheline), respectively, after 14 days of in vitro culture. ECM gene expression analysis showed that the ASC and dermal fibroblast-based scaffolds (control) were comparable. The ASC-based scaffold can be handled and removed from the plate. This suggests that multiple layers of scaffold can be stacked to form the urothelium (seeded with UCs), submucosal layer (ASCs only), and smooth muscle layer (seeded with SMCs) and has the potential to be developed into a fully functional human urethra for urethral reconstructive surgeries.
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