Search results for: coronary artery obstruction

Authors: Nicholas Marinus Batt, Angus Radford, Khaled Saraya

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Pulmonary Embolus Severity Index (PESI) score is a well-validated decision-making score grading mortality rates (MR) in patients with a suspected or confirmed diagnosis of pulmonary embolism (PE) into 5 classes. Thirty and 90 days MR in class I and II are lower allowing the treatment of these patients as outpatients. In a London District General Hospital (DGH) with mixed ethnicity and high disease burden, we looked at MR at 1, 3, and 7 days of all PESI score classes. Our pilot study of 112 patients showed MR of 0% in class I, II, and III. The current study includes positive Computed Tomographic Scans (CT scans) for PE over the following three years (total of 555). MR was calculated for all PESI score classes at 1, 3 & 7 days. Thirty days MR was additionally calculated to validate the study. Our initial results so far are in line with our pilot studies. Further subgroup analysis accounting for the local co-morbidities and disease burden and its impact on the MR will be undertaken.

Keywords: Pulmonary Embolism (PE), Pulmonary Embolism Severity Index (PESI) score, mortality rate (MR), CT pulmonary artery

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Authors: Nursel Koyuncu, Nihal Ata Tutkun

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Frailty model is a survival model that takes into account the unobserved heterogeneity for exploring the relationship between the survival of an individual and several covariates. In the recent years, proposed survival models become more complex and this feature causes convergence problems especially in large data sets. Therefore selection of sample from these big data sets is very important for estimation of parameters. In sampling literature, some authors have defined new sampling schemes to predict the parameters correctly. For this aim, we try to see the effect of sampling design in semi-parametric frailty model. We conducted a simulation study in R programme to estimate the parameters of semi-parametric frailty model for different sample sizes, censoring rates under classical simple random sampling and ranked set sampling schemes. In the simulation study, we used data set recording 17260 male Civil Servants aged 40–64 years with complete 10-year follow-up as population. Time to death from coronary heart disease is treated as a survival-time and age, systolic blood pressure are used as covariates. We select the 1000 samples from population using different sampling schemes and estimate the parameters. From the simulation study, we concluded that ranked set sampling design performs better than simple random sampling for each scenario.

Keywords: frailty model, ranked set sampling, efficiency, simple random sampling

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Authors: T. Warinpramote, J. Sanguanjeen, P. Pholphakwaen, S. Kittisorayut, J. Kerdtubtim, S. Palachote, M. Taweechotipatr

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Cholesterol is a type of lipid molecule which is the significant risk factor for coronary heart disease. Currently, there are many cholesterol-lowering alternative treatments especially bile salt hydrolase positive lactobacilli. BSH can cleave the peptide linkage of bile salt, which results in removal of the amino acid group from the steroid core and increases production of the new bile acid by using more cholesterol. The purpose of this study was to isolate, and screen probiotic characteristics of lactobacilli from fermented Thai foods and further investigated for their comparative BSH activity. The result showed that 2 of 81 Lactobacillus strains, JPK2-2 and JPK3-2, isolated from Brassica juncea (L.) had significantly exhibited high BSH activity. In addition, these Lactobacillus strains showed their results that the ability to tolerate acid and bile salt. Furthermore, the using of 16S rDNA sequencing for definitive microbial identifications showed that these 2 strains belong to Lactobacillus plantarum. In the future, the L. plantarum with BSH activity strains JPK2-2 and JPK3-2 may be the candidate probiotics for application in functional foods and dairy products to improve in the patient with cardiovascular diseases.

Keywords: Lactobacillus plantarum, probiotics, bile salt hydrolase, cholesterol-lowering, fermented Thai food

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Authors: Bing-Fang Lee, Srinivasan Periasamy, Ming-Yie Liu

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Shift work sleep disorder is a common problem in industrialized world. It is a type of circadian rhythmic sleep disorders characterized by insomnia and sleep deprivation. Lack of sleep in workers may lead to poor health conditions such as hepatic dysfunction. Melatonin is a hormone secreted by the pineal gland to alleviate insomnia. Moreover, it is a powerful antioxidant and may prevent acute liver injury. Therefore, workers take in melatonin to deal with sleep-related health is an important issue. The aim of this study was to investigate the effect of melatonin on an acute hepatic injury model sinusoidal obstruction syndrome (SOS) in mice. Male C57BL/6 mice were injected with a single dose (500 mg/kg) of monocrotaline (MCT) to induce SOS. Melatonin (1, 3, 10 and 30 mg/kg) was injected 1 h before MCT treatment. After 24 h of MCT treatment, mice were sacrificed. The blood and liver were collected. Organ damage was evaluated by serum biochemistry, hematology analyzer, and histological examination. Low doses of melatonin (1 and 3 mg/kg) had no protective effect on SOS. However, high doses (10 and 30 mg/kg) exacerbated SOS. In addition, it not only increased serum glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT) and extended liver damage indicated by histological examination but also decreased platelet levels, lymphocyte ratio, and glutathione level; it had no effect on malondialdehyde and nitric oxide level in SOS mice. To conclude, melatonin may exacerbate MCT-induced SOS in mice. Furthermore, melatonin might have a synergistic action with SOS. Usage of melatonin for insomnia by people working in long shift must be cautioned; it might cause acute hepatic injury.

Keywords: acute liver injury, melatonin, shift work, sleep deprivation

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Authors: Fatma Abdel Moneim Al Tawil

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Low back pain (LBP) among nurses has been the subject of research studies worldwide. However, evidence of the influence of patients lifting behaviors and LBP among nurses in Saudi Arabia remains scarce. The purpose of this study was to investigate the relationship between LBP and nurses lifting behaviors. LBP questionnaire was distributed to 100 nurses working in Alsadairy Hospital distributed as Emergency unit(9),Coronary Care unit (9), Intensive Care Unit (7), Dialysis unit (30), Burn unit (5), surgical unit (11), Medical (14) and, X-ray unit (15). The questionnaire included demographic data, attitude scale, Team work scale, Back pain history and Knowledge scale. Regarding to emergency unit, there is appositive significant relation between teamwork scale and Knowledge as r = (0.807) and P =0.05. Regarding to ICU unit, there is a positive significant relation between teamwork scale and attitude scale as r= (0.781) and P =0.05. Regarding to Dialysis unit, there is a positive significant relation between attitude scale and teamwork scale as r=(0.443) and P =0.05. The findings suggest enhanced awareness of occupational safety with safe patient handling practices among nursing students must be emphasized and integrated into their educational curriculum. Moreover, back pain prevention program should incorporate the promotion of an active lifestyle and fitness training the implementation of institutional patient handling policies.

Keywords: low back pain, lifting behaviors, nurses, team work

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Authors: Ying Zhu, Ning Wu, Hai-Dong Huang, Yu-Chao Dong, Qin-Ying Sun, Wei Zhang, Qin Wang, Qiang Li

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Background and study aims: Tracheobronchopathia osteochondroplastica (TO) is an uncommon disease of the tracheobronchial system that leads to narrowing of the airway lumen from cartilaginous and/or osseous submucosal nodules. The aim of this study is to perform a detailed review of this rare disease in a large cohort of patients with TO proven by fiberoptic bronchoscopy from China. Patients and Methods: Retrospective chart review was performed on 41,600 patients who underwent bronchoscopy in the Department of Respiratory Medicine of Changhai Hospital between January 2005 and December 2012. Cases of TO were identified based on characteristic features during bronchoscopic examination. Results: 22 cases of bronchoscopic TO were identified. Among whom one-half were male and the mean age was 47.45 ±10.91 years old. The most frequent symptoms at presentation were chronic cough (n=14) and increased sputum production (n=10). Radiographic abnormalities were observed in 3/18 patients and findings on computed tomography consistent with TO such as beaded intraluminal calcifications and/or increased luminal thickenings were observed in 18/22 patients. Patients were classified into the following categories based on the severity of bronchoscopic findings: Stage I (n=2), Stage II (n=6) and Stage III(n=14). The result that bronchoscopic improvement was observed in 2 patients administered with inhaled corticosteroids suggested that resolution of this disease is possible. Conclusions: TO is a benign disease with slow progression, which could be roughly divided into 3 stages on the basis of the characteristic endoscopic features and histopathologic findings. Chronic inflammation was thought to be more important than the other existing plausible hypotheses in the course of TO. Inhaled corticosteroids might have some impact on patients at Stage I/II.

Keywords: airway obstruction, bronchoscopy, etiology, Tracheobronchopathia osteochondroplastica (TO), treatment

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Authors: K. Masingboon, S. Duangpaeng, N. Chaiwong

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Acute myocardial infarction (AMI) is the most common cause of death among Thai with coronary heart disease (CHD). Thai AMI survivors are most likely to have impaired health-related quality of life (HRQoL) due to their lifestyle, functional, and psychological problems. Guided by the Individual and Family Self-Management Theory, this study aimed to explore HRQoL and identify its predictors among Thai AMI survivors. 155 Thai AMI survivors were recruited by stratified random sampling from three hospitals located in eastern region of Thailand. HRQol was measured using the Short Form -12 Health Survey (SF-12). The Center for Epidemiologic studies Depression Scale (CES-D) was utilized to assess the presence of depression, and the Family Support questionnaire was administered to examine family support. Results revealed that 92 percent of Thai AMI survivors reported a generally high level of HRQoL and 80 percent of them reported higher level of HRQoL in physical health and mental health dimension. Depression and family support were significantly predicted HRQoL among Thai AMI survivors and accounted for 28.5 percent of variance (p < .001). Interestingly, depression was the most significant predictors of HRQoL (β = -.65, p < .001) In conclusion, depression is a significant predictor of HRQoL in Thai AMI survivors. Increasing awareness of depression among these survivors is important. Depressive symptoms in should be routinely assessed. In addition, intervention to improve HRQoL among Thai AMI survivors should be addressed through depressive symptom management and family collaboration.

Keywords: health-related quality of life, AMI survivors, predictors, collaboration

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Authors: R. M. Kashim

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The study investigated primary school teachers’ conceptual and procedural knowledge of rational numbers and its effects on pupil’s achievement in rational numbers. Specifically, primary school teachers’ level of conceptual knowledge about rational numbers, primary school teachers’ level of procedural knowledge about rational numbers, and the effects of teachers conceptual and procedural knowledge on their pupils understanding of rational numbers in primary schools is investigated. The study was carried out in Bauchi metropolis in the Bauchi state of Nigeria. The design of the study was a multi-stage design. The first stage was a descriptive design. The second stage involves a pre-test, post-test only quasi-experimental design. Two instruments were used for the data collection in the study. These were Conceptual and Procedural knowledge test (CPKT) and Rational number achievement test (RAT), the population of the study comprises of three (3) mathematics teachers’ holders of Nigerian Certificate in Education (NCE) teaching primary six and 210 pupils in their intact classes were used for the study. The data collected were analyzed using mean, standard deviation, analysis of variance, analysis of covariance and t- test. The findings indicated that the pupils taught rational number by a teacher that has high conceptual and procedural knowledge understand and perform better than the pupil taught by a teacher who has low conceptual and procedural knowledge of rational number. It is, therefore, recommended that teachers in primary schools should be encouraged to enrich their conceptual knowledge of rational numbers. Also, the superiority performance of teachers in procedural knowledge in rational number should not become an obstruction of understanding. Teachers Conceptual and procedural knowledge of rational numbers should be balanced so that primary school pupils will have a view of better teaching and learning of rational number in our contemporary schools.

Keywords: conceptual, procedural knowledge, rational number, pupils

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Authors: Walid Moudani

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The healthcare environment is generally perceived as being information rich yet knowledge poor. However, there is a lack of effective analysis tools to discover hidden relationships and trends in data. In fact, valuable knowledge can be discovered from application of data mining techniques in healthcare system. In this study, a proficient methodology for the extraction of significant patterns from the coronary heart disease warehouses for heart attack prediction, which unfortunately continues to be a leading cause of mortality in the whole world, has been presented. For this purpose, we propose to enumerate dynamically the optimal subsets of the reduced features of high interest by using rough sets technique associated to dynamic programming. Therefore, we propose to validate the classification using Random Forest (RF) decision tree to identify the risky heart disease cases. This work is based on a large amount of data collected from several clinical institutions based on the medical profile of patient. Moreover, the experts’ knowledge in this field has been taken into consideration in order to define the disease, its risk factors, and to establish significant knowledge relationships among the medical factors. A computer-aided system is developed for this purpose based on a population of 525 adults. The performance of the proposed model is analyzed and evaluated based on set of benchmark techniques applied in this classification problem.

Keywords: multi-classifier decisions tree, features reduction, dynamic programming, rough sets

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Authors: Pramote Thangkratok

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The aims of this experimental study were to investigate the effect of Reverse Trendelenburg Position on the Back Pain after Cardiovascular Angiography and Interventions. In addition, to compare bleeding and hematoma occurrences at the Access site between experimental and control groups. The randomized controlled trial (RCT) was conducted in 70 patients who underwent Cardiovascular Angiography and Interventions via the femoral artery and received post procedural care at the intermediate cardiac care unit, Bangkok Heart Hospital. From December 2015 to February 2016. The control group (35 patients) was to get standard care after the intervention, whereas the experimental group (35 patients) was Reverse Trendelenburg Position 30-45 degrees. The groups were not significantly different in terms of demographic characteristics, Age, Gender, BMI, blood pressure, heart rate. While not significantly different from each other, the intensity of back pain control group had a significantly higher pain score than experimental group. Vascular complications in terms of bleeding and hematoma were not significantly different between the control and experimental groups. The findings show that Reverse Trendelenburg Position after Cardiovascular Angiography and Interventions would reduce or prevent the back pain without increasing the chance of bleeding and hematoma.

Keywords: reverse trendelenburg position, back pain, cardiovascular angiography, cardiovascular interventions

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Authors: Armaghan Moravej Aleali, Seyed Mahmoud Latifi, Homeira Rashidi

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Objective: High blood pressure in a risk factor for some disease like stroke, coronary heart disease, and renal failure. High blood pressure in children is an increasing health problem. The aim of this present was to determine prevalence of hypertension and pre-hypertension age between 10 to 17 years old. Material & Methods: This descriptive-analytic study was conducted using multiphase sampling method in Ahvaz (Southwest of Iran). A questionnaire include: height, weight, and body mass index, systolic and diastolic blood pressures filled for each participant. Blood pressure was measured twice for each person. For the diagnosis of hypertension, the fourth report of the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents of the National Health Institute of United States was used. Results: The subject participants of the study were 1707children and adolescents including 922 boys (54%) and 785 girls 46%). The prevalence of high blood pressure was 1.7% (boys 2.5% girls 0.8%). The prevalence of pre-hypertension was 9 % (7.6% in boys, 10.6% in girls). The mean systolic and diastolic blood pressures increased with increasing body mass index. Conclusion: In this study, the prevalence of high blood pressure was found to be lower than other studies in our country. The prevalence of the high blood pressure in boys was significantly higher than girls. This study, like other studies, showed a high correlation between being overweight and an increase in systolic and diastolic blood pressure.

Keywords: hypertension, pre-hypertension, childhood, adolescence

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Authors: Lakmali Anthony, Madeline Gillies

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Background: Incisional and ventral hernias are highly prevalent, with primary ventral hernias occurring in approximately 20% of adults and incisional hernias developing in up to 30% of midline abdominal incisions. Recent data from the United States have shown an increasing incidence of elective incisional and ventral hernia repair (IVHR) and emergency repair of complicated hernias. This study examines Australian population trends in IVHR over a two-decade study period. Methods: This retrospective study was performed using procedure data from the Australian Institute of Health and Welfare, and population data from the Australian Bureau of Statistics captured between 2000 and 2021 to calculate incidence rates per 100,000 population by age and sex for selected subcategories of IVHR operations. Trends over time were evaluated using simple linear regression. Results: There were 809,308 IVHR operations performed in Australia during the study period. The cumulative incidence adjusted for the population was 182 per 100,000; this increased by 9.578 per year during the study period (95% CI = 8.431- 10.726, p<.001). IVHR for primary umbilical hernias experienced the most significant increase in population-adjusted incidence, 1.177 per year. (95% CI = 0.654- 1.701, p<.001). Emergency IVHR for incarcerated, obstructed, and strangulated hernias increased by 0.576 per year (95% CI = 0.510 -0.642, p<.001). Only 20.2% of IVHR procedures were performed as day surgery. Conclusions: Australia has seen a significant increase in IVHR operations performed in the last 20 years, particularly those for primary ventral hernias. IVHR for hernias complicated by incarceration, obstruction, and strangulation also increased significantly. The proportion of IVHR operations performed as day surgery is well below the target set by the Royal Australasian College of Surgeons. With the increasing incidence of IVHR operations and an increasing proportion of these being emergent, elective IVHR should be performed as day surgery when it is safe.

Keywords: ventral, incisional, hernia, trends

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Authors: Guoqiang Yu, Mehrana Mohtasebi, Jinghong Sun, Thomas Pittman

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Malignant glioma (MG) is the most common type of primary malignant brain tumor. Surgical resection of MG remains the cornerstone of therapy, and the extent of resection correlates with patient survival. A limiting factor for resection, however, is the difficulty in differentiating the tumor from normal tissue during surgery. Fluorescence imaging is an emerging technique for real-time intraoperative visualization of MGs and their boundaries. However, most clinical-grade neurosurgical operative microscopes with fluorescence imaging ability are hampered by low adoption rates due to high cost, limited portability, limited operation flexibility, and lack of skilled professionals with technical knowledge. To overcome the limitations, we innovatively integrated miniaturized light sources, flippable filters, and a recording camera to the surgical eye loupes to generate a wearable fluorescence eye loupe (FLoupe) device for intraoperative imaging of fluorescent MGs. Two FLoupe prototypes were constructed for imaging of Fluorescein and 5-aminolevulinic acid (5-ALA), respectively. The wearable FLoupe devices were tested on tumor-simulating phantoms and patients with MGs. Comparable results were observed against the standard neurosurgical operative microscope (PENTERO® 900) with fluorescence kits. The affordable and wearable FLoupe devices enable visualization of both color and fluorescence images with the same quality as the large and expensive stationary operative microscopes. The wearable FLoupe device allows for a greater range of movement, less obstruction, and faster/easier operation. Thus, it reduces surgery time and is more easily adapted to the surgical environment than unwieldy neurosurgical operative microscopes.

Keywords: fluorescence guided surgery, malignant glioma, neurosurgical operative microscope, wearable fluorescence imaging device

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Authors: Si-yang Zhang, Chi Zhao

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Comprehensive transportation hubs are important nodes of the transportation network, and their internal signage the functions as guidance and distribution assistance, which directly affects the operational efficiency of traffic in and around the hubs. Reasonably installed signage effectively attracts the visual focus of travelers and improves wayfinding efficiency. Among the elements of signage, the visual guidance effect is the key factor affecting the information conveyance, whom should be evaluated during design and optimization process. However, existing evaluation methods mostly focus on the layout, and are not able to fully understand if signage caters travelers’ need. This study conducted field investigations and developed panoramic videos for multiple transportation hubs in China, and designed survey accordingly. Human subjects are recruited to watch panoramic videos via virtual reality (VR) and respond to the surveys. In this paper, Pudong Airport and Xi'an North Railway Station were studied and compared as examples due to their high traveler volume and relatively well-developed traveler service systems. Visual attention was captured by eye tracker and subjective satisfaction ratings were collected through surveys. Entropy Weight Method (EWM) was utilized to evaluate the effectiveness of signage elements and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was used to further rank the importance of the elements. The results show that the degree of visual attention of travelers significantly affects the evaluation results of guidance signage. Key factors affecting visual attention include accurate legibility, obstruction and defacement rates, informativeness, and whether signage is set up in a hierarchical manner.

Keywords: traveler guidance signage, panoramic video, visual attention, entropy weight method, TOPSIS

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Authors: Leili Iranirad, Mohammad Saleh Sadeghi, Seyed Fakhreddin Hejazi, Negar Vakili Razlighi

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Objective: Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI) is an unknown acute kidney injury (AKI) occurring after exposure to contrast media (CM). Contrast agents are most often used for diagnostic procedures or therapeutic angiographic interventions. Recently, Na/K citrate as a urine alkalinization has been evaluated for the prevention of CIN. We conducted this experiment to evaluate the efficiency of Na/K citrate on CIN in high-risk patients treated with cardiac catheterization. Methods: A prospective randomized clinical trial was conducted on 400 patients having moderate to high-risk factors for CIN treated with elective percutaneous coronary intervention (PCI) and were assigned randomly to the control group or the Na/K citrate group. The Na/K citrate group (n=200) received 5 g Na/K citrate solution, which was diluted in 200 mL water two h before and four hours after the first administration and intravenous hydration for two h prior to and six h after the procedure, while the control group (n=200) only received intravenous hydration. Serum creatinine (SCr) was calculated prior to the contrast exposure and after 48 h. CIN was described as a 25% increase in creatinine of serum (SCr) or >0.5 mg/dl 48 h after contrast administration. Results: CIN was observed in 33 patients (16.5%) in the control group and in 6 patients (3%) in the Na/K citrate group. A significant variation was recorded in the CIN incidence between the two groups 48 h after the radiocontrast agent administration (p < 0.001). Conclusion: Our results show that Na/K citrate is useful and substantially reduces the incidence of CIN.

Keywords: contrast media, citrate, PCI

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Authors: Kristel Dame Bañez Sumagaysay, Marie Victoria Cruz-javier

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The current subject is a case of a 21 year-old woman at 29 1/7 weeks of gestation with Pre-B cell Acute Lymphoblastic Leukemia who was admitted to the coronary care unit (CCU) of the St. Luke’s Medical Center-Global City for Severe Acute Respiratory Distress Syndrome (ARDS) secondary to hospital-acquired pneumonia secondary to pneumocystis jiroveci; central line-associated bloodstream infection (E. aerogenes). She presented with chronic hypoxemia caused by Pulmonary edema, probably secondary to heart failure secondary to cardiomyopathy chemotherapy-induced. Due to worsening feto-maternal status, extracorporeal membrane oxygenation (ECMO) for respiratory support was instituted, and an elective cesarean section was done due to multiple maternal factors and deteriorating health status under total intravenous anesthesia assisted by veno-venous extracorporeal membrane oxygenation. She delivered a live preterm newborn male, APGAR Score: 1, 0, 0, birth weight 985 grams, birth length: 40.5cm, small for gestational age.

Keywords: extracorporeal membrane oxygenation, pre-b cell acute lymphoblastic leukemia, severe acute respiratory distress syndrome, ethical dilemmas

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Authors: Alok Nahata

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Introduction: Nowadays, androgen-mediated diseases such as prostate cancer, hirsutism, acne, androgenic alopecia and benign prostatic hyperplasia (BPH) have become serious problems. The aim of the present study was to find out whether Ganoderma lucidum (GL) can be used as a clinically effective medicine for the management of prostatic hyperplasia. Methodology: In vitro studies were conducted to assess the 5α-reductase inhibitory potential of GL. Testosterone (3 mg/kg s.c.) was administered to the rats along with the test extracts (10, 20 and 50 mg/kg p.o for a period of 28 days. Finasteride was used as a positive control (1 mg/kg p.o.). Major Findings: GL extracts attenuated the increase in the prostate/body weight ratio (P/BW) induced by testosterone. Most of the values were significant when compared to testosterone-treated group and finasteride treated groups. Petroleum ether extract (50 mg/kg p.o.) exhibited the best activity (P < 0.01). Ethanolic extract (20 and 50 mg/kg p.o.) also exhibited significant activity (P < 0.01). The urine output also improved significantly (P < 0.01 in all groups as compared to standard finasteride), which emphasize the clinical implications of the study. Testosterone levels measured weekly and prostate-specific antigen (PSA) levels measured at the end of the study also support the findings. Histological studies suggested improvement in prostatic histoarchitecture in extract-treated groups as compared to the testosterone-treated group. Conclusion: Study clearly reflects the utility of extracts in BPH. Because of conversion of testosterone to dihydrotestosterone, the prostate size is increased, thereby causing obstruction in urinary output. The observed effect that extracts do not allow the increase as reflected by urinary output, P/BW ratios and histoarchitecture showed that activity of administered testosterone was blocked by the extract and resulted in recovery.

Keywords: benign prostatic hyperplasia, Ganoderma lucidum, prostate-specific antigen, 5α-reductase, testosterone

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Authors: Dušica L. Marić, Mirela Erić, Dušan M. Maić, Nebojša T. Milošević, Dragana Radošević, Nikola Vučinić

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The anatomical existence of transforaminal ligaments has been studied widely. The crucial anatomic study of these structures describes the transforaminal ligaments as an anomalous structure. The ligaments associated with the intervertebral foramen were classified in the external, intraforaminal and internal foraminal ligaments. The external ligaments are the most frequently reported type of transforaminal ligaments in adult spine. The purpose of this study was to examine the appearance of the ligaments within the external space of the intervertebral foramen in adult cadavers. External transforaminal ligaments branch out forward from the root of the transverse process toward the vertebral body with superior, transverse and inferior directions. The ligament detected in the study was different from the other reported descriptions of L1 foraminal ligaments. This ligament extends from the root of the pedicle to the inferior border of the vertebral body below the level of the disc and forms the compartment through which pass the ventral root of the spinal nerve and a small branch of the spinal artery. The results of this study show that the external ligaments can be clearly macroscopic visualized, and it is very important to have prior knowledge of the cadaveric specimens, to identify these structures. The presence of these ligaments is clinically important. These ligaments could be the cause of nerve root compression and the low back syndrome.

Keywords: anatomy, ligaments, lumbar spine, spinal nerve roots

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Authors: Gopal Lamichhane, Biswash Sapkota, Grinsun Sharma, Mahendra Adhikari

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Urolithiasis is a condition in which insoluble or less soluble salts like oxalate, phosphate etc. precipitate in urinary tract and causes obstruction in ureter resulting renal colic or sometimes haematuria. It is the third most common disorder of urinary tract affecting nearly 2% of world’s population. Poor urinary drainage, microbial infection, oxalate and calcium containing diet, calciferol, hyperparathyroidism, cysteine in urine, gout, dysfunction of intestine, drought environment, lifestyle, exercise, stress etc. are risk factors for urolithiasis. Wide ranges of treatments are available in allopathic system of medicine but reoccurrence is unpreventable even with the surgical removal of stone or lithotripsy. So, people prefer alternative medicinal systems such as Unani, homeopathic, ayurvedic etc. systems of medicine due to their fewer side effects over allopathic counterpart. Different plants based ethnomedicines are being well established by their continuous effective use in human since long time in treatment of urinary problem. Many studies have scientifically proved those ethnomedicines for antiurolithiatic effect in animal and in vitro model. Plant-based remedies were found to be therapeutically effective for both prevention as well as cure of calcium oxalate urolithiasis. Plants were known to show these effects through a combination of many effects such as antioxidant, diuretic, hypocalciuric, urine alkalinizing effect in them. Berberine, triterpenoids, lupeol are the phytochemicals established for antiurolithiatic effect. Hence, plant-based medicine can be the effective herbal alternative as well as means of discovery of novel drug molecule for curing urolithiatic disorder and should be focused on further research to discover their value in coming future.

Keywords: urolithiasis, herbal medicine, ethnomedicine, kidney stone, calcium oxalate

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Authors: Sajjad Shojaeidoust, Mohsen Ghanbarzadeh, Abdolhamid Habibi

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Exercise-induced bronchospasm (EIB) is a transitory condition of airflow obstruction that is associated with physical activities. It is noted that high ventilation can lead to an increase in the heat and reduce in the moisture in airways resistance of trachea. Also causes of pathophysiological mechanism are EIB. Accordingly, studying some parameters of pulmonary function (FVC, FEV1) among active people seems quintessential. The aim of this study was to analyze bronchospasm following the implementation of a program of maximum aerobic exercise in active men at Chamran University of Ahwaz. Method: In this quasi-experimental study, the population consisted of all students at Chamran University. Among from 55 participants, of which, 15 were randomly selected as the experimental group. In this study, the size of the maximum oxygen consumption was initially measured, and then, based on the maximum oxygen consumed, the active individuals were identified. After five minutes’ warm-up, Strand treadmill exercise test was taken (one session) and pulmonary parameters were measured at both pre- and post-tests (spirometer). After data normalization using KS and non-normality of the data, the Wilcoxon test was used to analyze the data. The significance level for all statistical surveys was considered p≤0/05. Results: The results showed that the ventilation factors and bronchospasm (FVC, FEV1) in the pre-test and post-test resulted in no significant difference among the active people (p≥0/05). Discussion and conclusion: Based on the results observed in this study, it appears that pulmonary indices in active individuals increased after aerobic test. The increase in this indicator in active people is due to increased volume and elasticity of the lungs as well. In other words, pulmonary index is affected by rib muscles. It is considered that progress over respiratory muscle strength and endurance has raised FEV1 in the active cases.

Keywords: aerobic active maximum, bronchospasm, pulmonary function, spirometer

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Authors: Namugenyi Ephrance Eunice, Julianne Sansa Otim, Marco Zennaro, Stephen D. Wolthusen

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The Internet of Things (IoT) is a network of connected data processing devices, mechanical and digital machinery, items, animals, or people that may send data across a network without requiring human-to-human or human-to-computer interaction. Each component has sensors that can pick up on specific phenomena, as well as processing software and other technologies that can link to and communicate with other systems and/or devices over the Internet or other communication networks and exchange data with them. IoT is increasingly being used in fields other than consumer electronics, such as public safety, emergency response, industrial automation, autonomous vehicles, the Internet of Medical Things (IoMT), and general environmental monitoring. Consumer-based IoT applications, like smart home gadgets and wearables, are also becoming more prevalent. This paper presents the main IoT deployment areas for environmental monitoring in developing regions and the backhaul options suitable for them. A detailed review of each of the list of papers selected for the study is included in section III of this document. The study includes an overview of existing IoT deployments, the underlying communication architectures, protocols, and technologies that support them. This overview shows that Low Power Wireless Area Networks (LPWANs), as summarized in Table 1, are very well suited for monitoring environment architectures designed for remote locations. LoRa technology, particularly the LoRaWAN protocol, has an advantage over other technologies due to its low power consumption, adaptability, and suitable communication range. The prevailing challenges of the different architectures are discussed and summarized in Table 3 of the IV section, where the main problem is the obstruction of communication paths by buildings, trees, hills, etc.

Keywords: communication technologies, environmental monitoring, Internet of Things, IoT deployment challenges

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Authors: Wedad Azhar

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Vitamin D is an essential fat-soluble vitamin that is required for the maintenance of good health. It is obtained either through exposure to sunlight (ultraviolet B radiation) or through dietary sources. The role of vitamin D is beyond bone health. Indeed, it plays a critical role in the immune system and a broad range of organ functions such as the cardiovascular system. Moreover, vitamin D plays a critical role in the endothelial function, which is one of the main indicators of atherosclerosis. This study is investigating the correlation between vitamin D status and endothelial function in preventing and treating atherosclerosis especially in country that has ample of sunshine but yet, Saudis from suffering from this issue vitamin D deficiency and insufficiency. Ninety participants from both genders and aged 40 to 60will be involved. The participants will be categorised into three groups: the control group will be healthy persons, patients at risk of developing atherosclerosis, patients formally diagnosed atherosclerosis. Half of the participants in each group should already have been taking vitamin D supplementations. Fasting blood samples will be taken from the participants for biochemical assays. Endothelial function will be assist by flow-mediated dilation of the brachial artery. Participants will be asked to complete a questionnaire on their social and economic status, education level, daily exposure to sunlight, smoking status, consumption of supplements and medication, and a food frequency of vitamin D intake. The data will be analysed using SPSS.

Keywords: atherosclerosis, endothelial function, nutrition, vitamin D

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Authors: Lokesh Bhatt, Jayesh Rathod

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Hypertension is one of the most prevalent cardiovascular disorder. It is responsible for several other cardiovascular disorders. Although many drugs are available for the treatment of hypertension, still a large population has uncontrolled blood pressure. Thus there is an unmet need for new therapeutic approaches for the same. Fruit juice of Citrus paradise contains several flavonoids with vasodilatory activity. We hypothesized that alcoholic extract of Citrus paradise, which contains flavonoids, might attenuate hypertension. The objective of the present study was to evaluate the antihypertensive activity of alcoholic extract of Citrus paradise fruit juice in rats. Hypertension was induced using one clip one kidney model in rats. The renal artery was occluded for 4 h after removal of one kidney. Once stabilized, the ganglionic blockade was performed followed by removal of the arterial clip from the kidney. Removal of clip resulted in an increase in blood pressure which is due to release of renin from the kidney. Alcoholic extract of Citrus paradise fruit juice was then administered at 50 mg/kg and 100 mg/kg dose by intravenous injection. Blood pressure was monitored continuously. Alcoholic extract of Citrus paradise fruit juice reduced hypertension in dose-dependent manner. Antihypertensive activity was found to be associated with vasodilation. The results of the present study showed antihypertensive potential of alcoholic extract of Citrus paradise fruit juice.

Keywords: citrus paradise, alcoholic extract, one clip one kidney model, vasodilation

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Authors: Sara Javanmardi, Sepehr Aziziz, Baharak Divband, Masoumeh Firouzamandi

Abstract:

Post-operative adhesions are the most common cause of intestinal obstruction, female infertility and chronic abdominal pain. We developed a novel approach for preventing post-operative peritoneal adhesions using a biodegradable and thermosensitive curcumin hydrogel in rats. Thirteen male Sprague-Dawley rats were assigned randomly into five groups of six animals each: In SHAM group, the cecum was exteriorized, gently manipulated and sent back into the abdomen. In CONTROL group, the surgical abrasion was performed with no further treatment. In Hydrogel group, surgical abrasion was performed with local application of blank hydrogel (1 mL). In Curcumin group, surgical abrasion was performed with local application of curcumin (1 mL). In CUR/HGEL group, surgical abrasion was performed with local application of curcumin hydrogel (1 mL). On day 10, adhesions were assessed using a standardized scale (Evans model), and samples were collected for the Real-time PCR. Real-time PCR was performed to determine mRNA levels of VCAM-1, ICAM-1 and GAPDH. The macroscopic adhesion intensity showed statistically significant differences between the CUR/HGEL and other groups (P=0.0005). The findings of the present study revealed there were statistically significant differences between the groups regarding adhesion band length and numbers (P<0.0001). The protein and mRNA expression of VCAM-1 and ICAM-1 in secal tissues were significantly down regulated due to curcumin-hydrogel application in CUR/HGEL compared to other groups (p<0.05). The thermosensitive hydrogel could reduce the severity and even prevent formation of intra-abdominal adhesion. Curcumin hydrogel could serve as a potential barrier agent to prevent post-operative peritoneal adhesion in rats.

Keywords: peritoneal adhesion, hydrogel, curcumijn, ICAM-1, VCAM-1

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Authors: Olga Blagova, Yuliya Osipova, Evgeniya Kogan, Alexander Nedostup

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Purpose: to quantify the value of various clinical, laboratory and instrumental signs in the diagnosis of myocarditis in comparison with morphological studies of the myocardium. Methods: in 100 patients (65 men, 44.7±12.5 years) with «idiopathic» arrhythmias (n = 20) and dilated cardiomyopathy (DCM, n = 80) were performed 71 endomyocardial biopsy (EMB), 13 intraoperative biopsy, 5 study of explanted hearts, 11 autopsy with virus investigation (real-time PCR) of the blood and myocardium. Anti-heart antibodies (AHA) were also measured as well as cardiac CT (n = 45), MRI (n = 25), coronary angiography (n = 47). The comparison group included of 50 patients (25 men, 53.7±11.7 years) with non-inflammatory heart diseases who underwent open heart surgery. Results. Active/borderline myocarditis was diagnosed in 76.0% of the study group and in 21.6% of patients of the comparison group (p < 0.001). The myocardial viral genome was observed more frequently in patients of comparison group than in study group (group (65.0% and 40.2%; p < 0.01. Evaluated the diagnostic value of noninvasive markers of myocarditis. The panel of anti-heart antibodies had the greatest importance to identify myocarditis: sensitivity was 81.5%, positive and negative predictive value was 75.0 and 60.5%. It is defined diagnostic value of non-invasive markers of myocarditis and diagnostic algorithm providing an individual assessment of the likelihood of myocarditis is developed. Conclusion. The greatest significance in the diagnosis of latent myocarditis in patients with 'idiopathic' arrhythmias and DCM have AHA. The use of complex of noninvasive criteria allows estimate the probability of myocarditis and determine the indications for EMB.

Keywords: myocarditis, "idiopathic" arrhythmias, dilated cardiomyopathy, endomyocardial biopsy, viral genome, anti-heart antibodies

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Authors: Treder Natalia, Siemiński Mariusz

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Takotsubo cardiomyopathy (TC) is a recently defined clinical entity. First described by Japanese researchers, today is diagnosed worldwide in 1-2% of patients admitted with the preliminary diagnosis of Acute Coronary Syndrome. The etiology of takotsubo cardiomyopathy remains still largely unknown. Currently, the most likely cause of takotsubo is direct cytotoxicity caused by catecholamine surge triggered by emotional stress. There is a strong relation between recent severe emotional stress and TC. The aim of this study was to analysis the role of stress and personality as a risk factor of TT. The presented research involves 35 people who are diagnosed TC. All patients were women, mean age 60 years. The methods used in the research are popular psychological tests: Perceived Stress Scale, DS14 scale to measure type D personality, The Neo-Five Factor Inventory of Personality and psychological interview. The obtained results prove that stress events may directly precede or even release TC. The stressful events occurred directly before the symptoms in 75% examined. 65% assessed their family life as very stressful. Examiners have also a high level of experienced stress. Only 25% of the TC were classified as having type D personality but they have a high level of negative affectivity. The subjects had a high level of extraversion, openness to experiences and an average level of neuroticism. The results suggested that such a type of personality profile may predispose to the development of takotsubo cardiomyopathy. Patients with TT are the individuals who reveal joint tendency to the experience of negative emotions and very stressful family life.

Keywords: stress, personality trails, familiar problems, Takotsubo cardiomyopathy

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Authors: Min Jee Lee, Young Sun Park, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Yoon Seon Lee, Kyung Soo Lim, Won Young Kim

Abstract:

Background: Acute myocardial infarction (AMI) concomitant with acute aortic syndrome (AAS) is rare but prompt recognition of concomitant AAS is crucial, especially in patients with ST-segment elevation myocardial infarction (STEMI) because misdiagnosis with early thrombolytic or anticoagulant treatment may result in catastrophic consequences. Objectives: This study investigated the clinical features of patients of STEMI concomitant with AAS that may lead to the diagnostic clue. Method: Between 1 January 2010 and 31 December 2014, 22 patients who were the initial diagnosis of acute coronary syndrome (AMI and unstable angina) and AAS (aortic dissection, intramural hematoma and ruptured thoracic aneurysm) in our emergency department were reviewed. Among these, we excluded 10 patients who were transferred from other hospital and 4 patients with non-STEMI, leaving a total of 8 patients of STEMI concomitant with AAS for analysis. Result: The mean age of study patients was 57.5±16.31 years and five patients were Standford type A and three patients were type B aortic dissection. Six patients had ST-segment elevation in anterior leads and two patients had in inferior leads. Most of the patients had acute onset, severe chest pain but no patients had dissecting nature chest pain. Serum troponin I was elevated in three patients but all patients had D-dimer elevation. Aortic regurgitation or regional wall motion abnormality was founded in four patients. However, widened mediastinum was seen in all study patients. Conclusion: When patients with STEMI have elevated D-dimer and widened mediastinum, concomitant AAS may have to be suspected.

Keywords: aortic dissection, myocardial infarction, ST-segment, d-dimer

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Authors: Panadda Rojpibulstit, Suthathip Kittisenachai, Songchan Puthong, Sirikul Manochantr, Pornpen Gamnarai, Sasichai Kangsadalampai, Sittiruk Roytrakul

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Hepatocellular carcinoma (HCC) is the most primary hepatic cancer worldwide. Nowadays a targeted therapy via monoclonal antibodies (mAbs) specific to tumor-associated antigen is continually developed in HCC treatment. In this regard, after establishing and consequently exploring Hep88 mAb’s tumoricidal effect on hepatocellular carcinoma cell line (HepG2 cell line), the Hep88 mAb’s specific Ag from both membrane and cytoplasmic fractions of HepG2 cell line was identified by 2-D gel electrophoresis and western blot analysis. After in-gel digestion and subsequent analysis by liquid chromatography-mass spectrometry (LC-MS), mortalin (HSPA9) and alpha-enolase were identified. The recombinant proteins specific to Hep88 mAb were cloned and expressed in E.coli BL21 (DE3). Moreover, alteration of HepG2 and Chang liver cell line after being induced by Hep88 mAb for 1-3 days was investigated using a transmission electron microscope. The result demonstrated that Hep88 mAb can bind to the recombinant mortalin (HSPA9) andalpha-enolase. In addition, gradual appearance of mitochondria vacuolization and endoplasmic reticulum dilatation were observed. Taken together, paraptosis-like programmed cell death (PCD) of HepG2 is induced by binding of mortalin (HSPA9) and alpha-enolase to Hep88 mAb. Mortalin depletion by formation of Hep88 mAb-mortalin (HSPA9) complex might initiate transcription-independent of p53-mediated apoptosis. Additionally, Hep88 mAb-alpha-enolase complex might initiate HepG2 cells energy exhaustion by glycolysis pathway obstruction. These results imply that Hep88 mAb might be a promising tool for development of an effective treatment of HCC in the next decade.

Keywords: Hepatocellular carcinoma, Monoclonal antibody, Paraptosis-like program cell death, Transmission electron microscopy, mortalin (HSPA9), alpha-enolase

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Authors: Sundip Charmode, Simmi Mehra, Sudhir Kushwaha, Shalom Philip, Pratik Amrutiya, Ranjna Jangal

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Introduction: Quadrangular space syndrome involves compression of the axillary nerve and posterior circumflex humeral artery and its management in few cases, requires surgical decompression. The current study reviews the surgical approaches used in the decompression of neurovascular structures and presents our reflections and recommendations. Methods: Four human cadavers, in the Department of Anatomy were used for dissection of the Axillae and the Scapular region by the senior residents of the Department of Anatomy and Department of Orthopedics, who dissected quadrangular space in the eight upper limbs, using anterior and posterior surgical approaches. Observations: Posterior approach to identify the quadrangular space and secure its contents was recognized as the easier and much quicker method by both the Anatomy and Orthopedic residents, but it may result in increased postoperative morbidity. Whereas the anterior (Delto-pectoral) approach involves more skill but reduces postoperative morbidity. Conclusions: Anterior (Delto-pectoral) approach with suggested modifications can prove as an effective method in surgical decompression of quadrangular space syndrome. The authors suggest more cadaveric studies to facilitate anatomists and surgeons with the opportunities to practice and evaluate older and newer surgical approaches.

Keywords: surgical approach, anatomical approach, decompression, axillary nerve, quadrangular space

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Authors: Talal Asif, Maya Kosinska, Lucas Georger, Krish Sardesai, Muhammad Shah Miran

Abstract:

This article presents a case review and literature review focused on the challenges of managing subaortic membranes (SAM) in young adult patients with mild aortic regurgitation (AR) or aortic stenosis (AS). The study aims to discuss the diagnosis of SAM, imaging studies used for assessment, management strategies in young patients, the risk of valvular damage, and the controversy surrounding prophylactic resection in mild AR. The management of SAM in adults poses challenges due to limited treatment options and potential complications, necessitating further investigation into the progression of AS and AR in asymptomatic SAM patients. The case presentation describes a 40-year-old male with muscular dystrophy who presented with symptoms and was diagnosed with SAM. Various imaging techniques, including CT chest, transthoracic echocardiogram (TTE), and transesophageal echocardiogram (TEE), were used to confirm the presence and severity of SAM. Based on the patient's clinical profile and the absence of surgical indications, medical therapy was initiated, and regular outpatient follow-up was recommended to monitor disease progression. The discussion highlights the challenges in diagnosing SAM, the importance of imaging studies, and the potential complications associated with SAM in young patients. The article also explores the management options for SAM, emphasizing surgical resection as the definitive treatment while acknowledging the limited success rates of alternative approaches. Close monitoring and prompt intervention for complications are crucial in the management of SAM. The concluding statement emphasizes the need for further research to explore alternative treatments for SAM in young patients.

Keywords: subaortic membrane, management, case report, literature review, aortic regurgitation, aortic stenosis, left ventricular outflow obstruction, guidelines, heart failure

Procedia PDF Downloads 90