Correction: Naomi et al. Elateriospermum tapos Yogurt Supplement in Maternal Obese Dams during Pregnancy Modulates the Body Composition of F1 Generation. Nutrients 2023, 15, 1258

After a careful and comprehensive review of our data and the figures in our manuscript, we have identified an area where we believe a correction is warranted in order to enhance the clarity and precision of our findings [...].

Analyzing Active Compounds in Elateriospermum tapos Yogurt for Maternal Obesity: A Network Pharmacology and Molecular Docking Study

Maternal obesity, characterized by an elevated body mass index (BMI) during pregnancy, is known to have adverse effects on the offspring. However, a recent study suggests that Elateriospermum tapos (E. tapos) yogurt may hold potential in mitigating excessive weight retention post-pregnancy. Thus, this study aims to employ network pharmacology to explore the pharmacological effects of the bioactive compounds present in E. tapos yogurt against maternal obesity. Initially, a screening process is conducted to identify the bioactive compounds in E. tapos yogurt, followed by the prediction of potential gene targets for these compounds using Swiss Target Prediction and the SuperPred databases. Maternal obesity-associated genes are sourced from the OMIM, DisGeNet, and GeneCards databases. The interaction between the identified compounds and maternal obesity genes is established via protein-protein interaction analysis, gene ontology examination, and KEGG pathway analysis. To validate the results, molecular docking studies are conducted using AutoDock Tools software. The findings reveal that out of the 64 compounds analyzed, three meet the screening criteria, resulting in a total of 380 potential gene targets. Among these targets, 240 are shared with maternal obesity-related genes. Further analysis demonstrates the favorable affinity of these active compounds with key targets, linking them to biological processes involving protein phosphorylation, inflammation, as well as the pathways related to lipid metabolism, atherosclerosis, and the other signaling pathways. In conclusion, this study provides valuable insights into the potential pharmacological effects of the bioactive compounds found in E. tapos yogurt against maternal obesity. These findings open avenues for further exploration and potential therapeutic interventions targeting maternal obesity.

Unraveling Obesity: Transgenerational Inheritance, Treatment Side Effects, Flavonoids, Mechanisms, Microbiota, Redox Balance, and Bioavailability-A Narrative Review

Obesity is known as a transgenerational vicious cycle and has become a global burden due to its unavoidable complications. Modern approaches to obesity management often involve the use of pharmaceutical drugs and surgeries that have been associated with negative side effects. In contrast, natural antioxidants, such as flavonoids, have emerged as a promising alternative due to their potential health benefits and minimal side effects. Thus, this narrative review explores the potential protective role of flavonoids as a natural antioxidant in managing obesity. To identify recent in vivo studies on the efficiency of flavonoids in managing obesity, a comprehensive search was conducted on Wiley Online Library, Scopus, Nature, and ScienceDirect. The search was limited to the past 10 years; from the search, we identified 31 articles to be further reviewed. Based on the reviewed articles, we concluded that flavonoids offer novel therapeutic strategies for preventing obesity and its associated co-morbidities. This is because the appropriate dosage of flavonoid compounds is able to reduce adipose tissue mass, the formation of intracellular free radicals, enhance endogenous antioxidant defences, modulate the redox balance, and reduce inflammatory signalling pathways. Thus, this review provides an insight into the domain of a natural product therapeutic approach for managing obesity and recapitulates the transgenerational inheritance of obesity, the current available treatments to manage obesity and its side effects, flavonoids and their sources, the molecular mechanism involved, the modulation of gut microbiota in obesity, redox balance, and the bioavailability of flavonoids. In toto, although flavonoids show promising positive outcome in managing obesity, a more comprehensive understanding of the molecular mechanisms responsible for the advantageous impacts of flavonoids-achieved through translation to clinical trials-would provide a novel approach to inculcating flavonoids in managing obesity in the future as this review is limited to animal studies.

The role of Elateriospermum tapos yoghurt in mitigating high-fat dietary cause of maternal obesity-an experimental study

Maternal obesity is the key predictor for childhood obesity and neurodevelopmental delay in the offspring. Medicinal plants are considered to be the safe and best option, and at the same time, probiotic consumption during pregnancy provides beneficial effects for both the mother and the child. Current research has shown that Elateriospermum tapos (E. tapos) yoghurt is safe to consume and consists of many bioactive compounds that can exert an anti-obesity effect. Thus, this study has been designed to study the role of E. tapos yoghurt in mitigating maternal obesity. In this study, a total of 48 female Sprague Dawley (SD) rats were assigned to six groups, with eight rats per group, and obesity was induced over 16 weeks with a high-fat diet (HFD) pellet. On the 17th week, the rats were allowed to mate and pregnancy was confirmed through vaginal smear. The obese induced group was further divided into negative and positive control groups, followed by E. tapos yoghurt treatment groups with three different concentrations (5, 50, and 500 mg/kg). The changes in body weight, calorie intake, lipid profile, liver profile, renal profile, and histopathological analysis were measured on postnatal day (PND) 21. The results show that the group with the highest concentration of E. tapos yoghurt (HYT500) supplementation shows gradual reduction in body weight and calorie intake on PND 21 and modulates the lipid level, liver, and renal enzymes to a normal level similar to the normal group. In histological analysis, HYT500 reverses the damage caused by HFD in liver and colon, and reverses the adipocytes' hypertrophy in retroperitoneal white adipose tissue and visceral fat. In conclusion, supplementation of E. tapos yoghurt during the gestational period up to weaning is effective in the gradual weight loss of maternal obese dams from the 500-mg/kg-supplemented group in this study.

Elateriospermum tapos Yoghurt as a Therapeutic Intervention for Obesity-Associated Cognitive Impairments and Anxiety-like Behaviour in a High Fat Diet Maternal Obese Rat Model

Maternal obesity can be considered an intergenerational cycle and is also an important indicator of cognitive impairments. It is thought that using natural products is the best and safest way to combat maternal obesity and associated complications. Recent studies have shown that Elateriospermum tapos (E. tapos) contains bioactive compounds with anti-obesity effects, and yoghurt is a convenient medium for supplementing obese maternal rats with E. tapos extract. Thus, the aim of this study is to investigate the impact of E. tapos in yoghurt on maternally obese rats' cognitive function supplemented with a high-fat diet (HFD). In this study, 48 female Sprague-Dawley rats were used. The rats were fed HFD for a period of 16 weeks to induce obesity, after which they were allowed to mate. Upon confirmation of pregnancy, obese rats were given varying doses of E. tapos (5, 50, and 500 mg/kg) in yoghurt until postnatal (PND) day 21. On PND 21, the dams' body mass index (BMI), Lee index, abdominal circumference, oxidative status, and metabolic profile were measured. The behavioral tests (open field, place, and object recognition) were conducted on PND 21 to access memory. The results show that the 50 and 500 mg/kg E. tapos in yoghurt supplemented groups had similar BMI, Lee index, abdominal circumference, lipid profile, FBG, insulin, FRAP, and GSH levels, as well as a similar recognition index, in comparison with the control group supplemented with saline. In conclusion, the results of this study indicate that the newly formulated E. tapos in yogurt can act as an anti-obesity agent in maternal obesity, alleviate anxiety, and enhance hippocampal-dependent memory.

The Role of Oxidative Stress and Inflammation in Obesity and Its Impact on Cognitive Impairments-A Narrative Review

Obesity is a chronic low-grade inflammatory condition that induces the generation of oxidative stress and inflammation. This oxidative stress and inflammation stimulate brain atrophy and some morphological changes in the brain that eventually result in cognitive impairments. However, there is no exact study that has summarized the role of oxidative stress and inflammation in obesity and its impact on cognitive impairments. Thus, the objective of this review is to recapitulate the current role of oxidative stress and inflammation in cognitive decline based on in vivo evidence. A comprehensive search was performed in Nature, Medline and Ovid, ScienceDirect, and PubMed, and the search was limited to the past 10 years of publication. From the search, we identified 27 articles to be further reviewed. The outcome of this study indicates that a greater amount of fat stored in individual adipocytes in obesity induces the formation of reactive oxygen species and inflammation. This will lead to the generation of oxidative stress, which may cause morphological changes in the brain, suppress the endogenous antioxidant system, and promote neuroinflammation and, eventually, neuronal apoptosis. This will impair the normal function of the brain and specific regions that are involved in learning, as well as memory. This shows that obesity has a strong positive correlation with cognitive impairments. Hence, this review summarizes the mechanism of oxidative stress and inflammation that induce memory loss based on animal model evidence. In conclusion, this review may serve as an insight into therapeutic development focusing on oxidative stress and inflammatory pathways to manage an obesity-induced cognitive decline in the future.

Dietary Polyphenols as a Protection against Cognitive Decline: Evidence from Animal Experiments; Mechanisms and Limitations

Emerging evidence suggests that cognitive impairments may result from various factors, such as neuroinflammation, oxidative stress, mitochondrial damage, impaired neurogenesis, synaptic plasticity, blood-brain barrier (BBB) disruption, amyloid β protein (Aβ) deposition, and gut dysbiosis. Meanwhile, dietary polyphenol intake in a recommended dosage has been suggested to reverse cognitive dysfunction via various pathways. However, excessive intake of polyphenols could trigger unwanted adverse effects. Thus, this review aims to outline possible causes of cognitive impairments and how polyphenols alleviate memory loss via various pathways based on in vivo experimental studies. Thus, to identify potentially relevant articles, the keywords (1) nutritional polyphenol intervention NOT medicine AND neuron growth OR (2) dietary polyphenol AND neurogenesis AND memory impairment OR (3) polyphenol AND neuron regeneration AND memory deterioration (Boolean operators) were used in the Nature, PubMed, Scopus, and Wiley online libraries. Based on the inclusion and exclusion criteria, 36 research papers were selected to be further reviewed. The outcome of all the studies included supports the statement of appropriate dosage by taking into consideration gender differences, underlying conditions, lifestyle, and causative factors for cognitive decline, which will significantly boost memory power. Therefore, this review recapitulates the possible causes of cognitive decline, the mechanism of polyphenols involving various signaling pathways in modulating the memory, gut dysbiosis, endogenous antioxidants, bioavailability, dosage, and safety efficacy of polyphenols. Hence, this review is expected to provide a basic understanding of therapeutic development for cognitive impairments in the future.

Remodulation Effect of Elateriospermum tapos Yoghurt on Metabolic Profile of Maternal Obesity Induced Cognitive Dysfunction and Anxiety-like Behavior in Female Offspring-An In Vivo Trial on Sprague Dawley Rats

Pre-pregnancy weight gain induces dysregulation in the metabolic profile of the offspring, thereby serving as a key factor for cognitive decline and anxiety status in the offspring. However, early probiotic supplementation during the gestational period is linked with improved metabolic health. At the same time, a natural plant known as Elateriospermum tapos (E. tapos) is proven to improve cognition and modulate the stress hormone due to its high concentration of flavonoids. However, the effects of medicinal plant integrated probiotics in F1 generations warrants further investigation. Thus, this study aimed to study the effect of E. tapos yoghurt on the maternal obesity induced cognitive dysfunction and anxiety in female offspring. In this study, female Sprague Dawley rats were fed with normal chow (n = 8) or high fat diet (n = 40) across pre-pregnancy, gestation, and weaning. The treatment with different concentrations of E. tapos yoghurt (5, 50, and 500 mg/kg/day) were initiated in the obese dams upon post coitum day 0 up to postnatal day 21 (PND 21). Female offspring were weaned on PND 21 and body mass index, waist circumference, lee index, behavior, metabolic parameter, and antioxidant status were analyzed. The result shows that the female offspring of the 500 mg/kg E. tapos yoghurt supplemented group shows a decreased level of insulin, fasting blood glucose, cholesterol, triglycerides, LDL, low fat tissue mass with a high level of HDL, and an increased level of antioxidant status in the hypothalamus. The behavioral assessment proves that the female offspring of the 500 mg/kg E. tapos yoghurt supplemented group exhibits a high recognition index on novel object/place with low anxiety-like behavior in an open field test. In conclusion, our data signify the beneficial effect of early intervention in obese dams on the transgenerational impact on female offspring's metabolic profile, cognitive performance, and anxiety-like behavior.

Elateriospermum tapos Yogurt Supplement in Maternal Obese Dams during Pregnancy Modulates the Body Composition of F1 Generation

Maternal obesity is a key predictor of childhood obesity and a determining factor for a child's body composition. Thus, any form of maternal nutrition during the gestational period plays a vital role in influencing the growth of the fetus. Elateriospermum tapos (E. tapos) yogurt has been found to comprise many bioactive compounds such as tannins, saponins, α-linolenic acid, and 5'-methoxy-bilobate with apocynoside I that could cross the placenta and exhibit an anti-obesity effect. As such, this study aimed to investigate the role of maternal E. tapos yogurt supplementation on offspring body composition. In this study, 48 female Sprague Dawley (SD) rats were induced with obesity using a high-fat diet (HFD) and were allowed to breed. Upon confirmation of pregnancy, treatment was initiated with E. tapos yogurt on the obese dams up to postnatal day 21. The weaning offspring were then designated into six groups according to their dam's group (n = 8) as follows; normal food and saline (NS), HFD and saline (HS), HFD and yogurt (HY), HFD and 5 mg/kg of E. tapos yogurt (HYT5), HFD and 50 mg/kg of E. tapos yogurt (HYT50), and HFD and 500 mg/kg of E. tapos yogurt (HYT500). The body weight of the offspring was accessed every 3 days up to PND 21. All the offspring were euthanized on PND 21 for tissue harvesting and blood sample collection. The results showed that both male and female offspring of obese dams treated with E. tapos yogurt showed growth patterns similar to NS and reduced levels of triglycerides (TG), cholesterol, LDL, non-HDL, and leptin. Liver enzymes such as ALT, ALP, AST, GGT, and globulin, and renal markers such as sodium, potassium, chloride, urea, and creatinine levels significantly reduced (p < 0.05) in the offspring of E. tapos yogurt-treated obese dams with the normal histological architecture of the liver, kidney, colon, RpWAT, and visceral tissue that is comparable to NS. In toto, E. tapos yogurt supplementation of obese dams exerted an anti-obesity effect by preventing intergenerational obesity by reversing HFD-induced damage in the fat tissue of the offspring.

Bisphenol A (BPA) Leading to Obesity and Cardiovascular Complications: A Compilation of Current In Vivo Study

BPA is one of the most common endocrine disruptors that is widely being manufactured daily nationwide. Although scientific evidence supports claims of negative effects of BPA on humans, there is also evidence suggesting that a low level of BPA is safe. However, numerous in vivo trials contraindicate with this claim and there is a high possibility of BPA exposure could lead to obesity. It has been speculated that this does not stop with the exposed subjects only, but may also cause transgenerational effects. Direct disruption of endocrine regulation, neuroimmune and signaling pathways, as well as gut microbiata, has been identified to be interrupted by BPA exposure, leading to overweight or obesity. In these instances, cardiovascular complications are one of the primary notable clinical signs. In regard to this claim, this review paper discusses the role of BPA on obesity in the perspective of endocrine disruptions and possible cardiovascular complications that may arise due to BPA. Thus, the aim of this review is to outline the changes in gut microbiota and neuroimmune or signaling mechanisms involved in obesity in relation to BPA. To identify potentially relevant articles, a depth search was done on the databases Nature, PubMed, Wiley Online Library, and Medline & Ovid from the past 5 years. According to Boolean operator guideline, selected keywords such as (1) BPA OR environmental chemical AND fat OR LDL OR obese AND transgenerational effects or phenocopy (2) Endocrine disruptors OR chemical AND lipodystrophy AND phenocopy (3) Lipid profile OR weight changes AND cardiovascular effect (4) BPA AND neuroimmune OR gene signaling, were used as search terms. Upon screening, 11 articles were finalized to be further reviewed and data extraction tables containing information on (1) the type of animal model (2) duration and dosage of BPA exposure (3) changes in the lipid profile or weight (4) genes, signaling mechanism, or any neuroimmune signal involved, and (5) transgenerational effects were created. In toto, the study indicates there are high chances of BPA exposure affecting lipid profile and gene associated with lipolysis, leading to obesity. Therefore, this scoping review recapitulates the possible effects of BPA that may lead to obesity with the evidence of current in vivo trials. The biomarkers, safety concerns, recommended dosage, and the impact of COVID-19 on BPA are also briefly described.

1076 Online Availability of Hand Splints for Patients with Common Upper Limb Nerve Entrapment Syndromes During COVID-19 Pandemic

Aim

Splinting is first line treatment in mild to moderate cases of carpal and cubital tunnel syndrome. During COVID-19 lockdown, patients experience prolonged waiting time for their splints from specialist service if not requiring surgery. Many of our patients have not trialled splinting prior to their specialist appointments. We aimed to look at the quality of splints commercially available for the general public to purchase thereby starting treatment earlier.

Method

Hand splints for nerve entrapment are readily available through two of the biggest UK online retailers, Amazon.co.uk and eBay.co.uk. We searched the terms ‘carpal’ and ‘cubital’ tunnel splints on both sites, the top 5 results were assessed for their suitability, accessibility, and affordability.

Results

The average cost of splints for carpal tunnel syndrome on Amazon and eBay are £9 and £8 respectively, and £15 on Amazon and £10 on eBay for cubital tunnel syndrome. We found that all top 5 hand splints found on these websites are suitable for the conditions they advertised. The average time for free delivery of splints is 2 days for Amazon and 3 days for eBay. Splints are easily sized by using the sellers wrist/elbow circumference measurement guide.

Conclusions

This study has given us the confidence to encourage patients to purchase splints, at an affordable price, from online sites whilst either waiting for specialist appointments or as part of their specialist recommended treatment. With early initiation of treatment, patients may have symptomatic relief and, in some cases, avoid the need for further treatment, leading to reduced hospital footfall.

1081 'Making the Leap’ To ST3 Plastic Surgery: An Interactive Online Course, In Response To COVID-19

Aim

The ‘Making the Leap’ interactive online course (MTL) was specifically designed to be delivered during the COVID-19 restrictions. This course aimed to facilitate the difficult transition from CT to ST3 in Plastic Surgery.

Method

The courses consisted of interactive small-group tutorials, each conducted over 2 days, via Zoom, covering 12 plastic surgery core topics in 8 tutorials. The course was attended by 43 delegates from across the UK and abroad. The tutorials were delivered by 27 plastic surgery consultants. Anonymous feedback was collected from both delegates and faculty.

Results

The overall feedback from delegates were unanimously positive; 100% of the delegates stated that ‘they would recommend the course to a colleague’. All faculty and delegates agreed the use of video conferencing and small group tutorial to be either ‘very’ or ‘extremely’ suitable for an interactive virtual course like MTL. 98% of delegates thought the course has made them feel more prepared to be a registrar, and 69% of delegates preferred an online interactive course instead of the traditional face-to-face method, for non-practical based courses.

Conclusions

COVID-19 necessitated delivering ‘Making the Leap” as a Zoom course. However, the feedback clearly demonstrated the need for such a course, and the suitability of the format. We discuss the challenges and learning points from our experience delivering successful interactive courses via Zoom.

Quality of life and associated factors among university students during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

This study aimed to evaluate the quality of life (QoL) and determine its association with various factors and social support among university students during the COVID-19 pandemic after the end of movement lockdown.

DESIGN, SETTING AND PARTICIPANTS

This online cross-sectional study recruited 316 participants. The inclusion criteria were students 18 years and above who were registered with the faculties of medicine at Malaysian public universities located in Klang Valley and in the states of Penang and Kelantan in Peninsular Malaysia. The exclusion criteria were those who presented with psychotic disorders, bipolar mood disorder or a history of illicit drugs.

OUTCOME MEASURES

Participants were administered a self-reported questionnaire to gather data on demographic, personal, clinical and psychological characteristics. The questionnaire comprised of the 21-item Depression, Anxiety and Stress Scale, the Multidimensional Scale of Perceived Social Support, and the WHO Quality of Life- Brief Version (WHOQoL-BREF).

RESULTS

The psychological and social QoL scores were lower than the non-pandemic norms of the general population, while the physical health and environmental QoL scores were comparable. After adjusting for relevant demographic, personal and clinical variables, religious coping, greater number of hours of online classes attended, and greater social support from family, friends and significant others were significantly associated with higher QoL among the participants. Frustration due to study disruption, living in areas with a high prevalence of COVID-19 cases, and a higher severity of depressive and stress symptoms were significantly associated with lower QoL.

CONCLUSION

COVID-19 impaired the QoL of university students even after the movement lockdown was lifted.

An uncommon case of gouty arthritis in a teenage boy

Joint pain is a common complaint in the paediatric age group with overuse and traumatic injury being the common causes. However, joint pain involving multiple sites, persistent or recurrent, and severe may suggest other diagnoses. One of the possible groups of diagnosis is rheumatology in nature, which is often difficult to diagnose, especially in paediatric patients. Gouty arthritis is a rather uncommon rheumatology problem in children and the diagnosis is often missed at the initial presentation. We report a 16-year-old boy who repeatedly presented with debilitating and alternating polyarthritis, diagnosed and treated as juvenile gouty arthritis after thorough clinical assessment and basic laboratory investigations in a resource-limited primary care clinic. Bangladesh Journal of Medical Science Vol.20(1) 2021 p.200-203

Ketogenesis and SIRT1 as a tool in managing obesity

Obesity is a serious chronic disease and a public health concern in both developing and developed countries. Managing obesity has been a great challenge for both health care professionals and patients alike. Among the various diet programs aimed at promoting weight loss, the ketogenic diet, a diet high in fat and low in carbohydrates, has been at the forefront recently and its mechanism in weight loss is much debated. Activation of Sirtuin 1 or SIRT1 is able to circumvent various diseases, including metabolic syndrome and obesity and is thought to be a potentially reliable treatment target for both of them. Augmentation of SIRT1 may be carried out using dietary means such as nicotinamide adenine dinucleotide (NAD) supplementation and/or ketogenic diet. Although ketogenic diet may augment SIRT1 activation in people affected by obesity, recent studies have indicated that the relationship between SIRT1 and ketogenesis is unpredictable. The exact circumstances and mechanisms of SIRT1, NAD and ketogenesis in the clinical setting as an intervention tool in managing obesity remained uncertain. Although several recent literatures have documented significant weight-loss following ketogenic diet interventions, there were limitations with regards to duration of trial, choice and the number of trial subjects. Studies investigating the safety of ketogenic diet in the long term, beyond 46 weeks and related mechanism and pathways are still lacking and the sustainability of this diet remains to be determined. This review explores the recent progress on ketogenic diet and its relationships with SIRT1 as a tool in managing obesity and relevant clinical implications.

Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis

Objective

To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries.

Methods

We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties.

Findings

We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of −0.38 for glycated haemoglobin (95% confidence interval, CI: −0.52 to −0.23; I² = 86.70%), −0.20 for fasting blood sugar (95% CI: −0.32 to −0.08; I² = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I² = 93.75%), 0.55 for diabetes knowledge (95% CI: −0.10 to 1.20; I² = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I² = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of −0.04 for body mass index (95% CI: −0.13 to 0.05; I² = 35.94%), −0.06 for total cholesterol (95% CI: −0.16 to 0.04; I² = 59.93%) and −0.02 for triglycerides (95% CI: −0.12 to 0.09; I² = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications.

Conclusion

Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.

Harnessing Telemedicine for the Provision of Health Care: Bibliometric and Scientometric Analysis

Background

In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning.

Objective

This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required.

Methods

For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field.

Results

We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics.

Conclusions

Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era.

MON-126 Telemedicine Interventions for Treatment of Diabetes Mellitus in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Diabetes mellitus (DM) is associated with significant morbidity, mortality and poor quality of life. It also has substantial social and financial implications because over 75% of patients with DM live in low- and middle-income countries (LMIC). In this context, it is often opined that diabetes care can be improved by employing telemedicine interventions. The present systematic review and meta-analysis aims to estimate the clinical effectiveness of telemedicine in improving biochemical and treatment adherence outcomes related to DM and provide the certainty of evidence for these interventions. Using a pretested search strategy, nine academic databases were searched from their inception to August 2019: Web of Science, PubMed, Medline, Global Health Library, Cochrane Central Register of Controlled Trials (CENTRAL), New York Academy of Medicine (NYAM) and Popline. We only included RCTs and cluster RCTs testing the effectiveness of tele-medicine-based interventions in type 1, 2 and gestational diabetes in LMIC. Risk of bias in the included RCTs was assessed using the Cochrane tool for assessment of risk of bias in randomized controlled trials. A series of meta-analyses for each individual outcome was run using random effects analyses. Certainty of evidence for these interventions was assessed using the GRADE guidelines. A total of 22 studies describing 23 interventions were included. We identified five modes of interventions delivered using telephone calls (n=6), SMS (n=5), telemetry (n=5) web-based systems (n=3) and smartphone apps (n=3). Major strategies included health record keeping, follow ups, reminders, psychoeducation, glucose monitoring, monitoring prompts, alerts and online consultations Overall, a significant treatment effect was seen among outcomes of HbA1c (SMD=-0.30, 95% CI= -0.42 to -0.17, n=6548, I²= 80.21%) and fasting blood sugar levels (SMD=-0.17, 95% CI= -0.32 to -0.01, n=4709, I²=60.49%), self-efficacy (SMD= 1.94, 95% CI= 1.31 to 2.58, n=626, I²= 95.99) and treatment adherence (SMD= 1.16, 95% CI= 0.78 to 1.54, n=437, I²= 84.8%). A marginally significant effect was seen in improvement of knowledge regarding diabetes (SMD= 0.66, 95% CI= -0.006 to 1.33, n=1345, I²= 93.38%). No significant treatment effect was seen in outcomes of serum triglyceride levels (SMD= -0.02, 95% CI= -0.18 to 0.14, n= 1535, I²=2.98%), serum total cholesterol levels (SMD= -0.05, 95% CI= -0.20 to 0.09, n= 4862, I²=66.45%) and BMI (SMD= -0.03, 95% CI= -0.13 to 0.07, n= 5372, I²=41.78 %). Telephone calls and SMS based telemedicine interventions yielded the highest treatment effects when compared with telemetry and smartphone apps-based services. Although telemedicine was found to be effective in improving several DM related outcomes, the certainty of evidence was downgraded to very low due to substantial heterogeneity, publication bias and risk of bias.

A case of Gilbert’s syndrome diagnosis during pregnancy

Gilbert’s syndrome (GS) is a benign condition that presents with recurrent jaundice due to isolated hyperbilirubinemia which predominates by its unconjugated component. It is a diagnosis of exclusion and often missed by attending physician. The uncertainty of diagnosis may cause anxiety among patients especially in pregnant women fearing the condition impacting the outcome of their pregnancies. We present a case of a primigravida woman with recurrent jaundice for the last ten years whohad not been givena definitive diagnosis of her illness despite on regular follow up in tertiary centre. She was anxious about her undiagnosed condition and the possibility of it affecting her pregnancy. Gilbert’s syndrome was diagnosed after evaluating information from the tertiary centre and she was assured regarding the prognosis of her pregnancy. She went into labour at term without complication and her postpartum period was uneventful. Bangladesh Journal of Medical Science Vol.19(2) 2020 p.333-335

pSTAT3 and MYC in Epstein-Barr virus-positive diffuse large B-cell lymphoma

INTRODUCTION

Epstein-Barr Virus (EBV) is associated with several B-cell non-Hodgkin's lymphoma (NHL), but the role of EBV in diffuse large B-cell lymphoma (DLBCL) is poorly defined. Several studies indicated the expression of phosphorylated STAT3 (pSTAT3) is predominant in EBV(+)- DLBCL, of which its activated form can promote the downstream oncogenes expression such as c-MYC. c-MYC gene rearrangements are frequently found in aggressive lymphoma with inferior prognosis. Furthermore, EBV is a co-factor of MYC dysregulation. JAK1/STAT3 could be the downstream pathway of EBV and deregulates MYC. To confirm the involvement of EBV in JAK1/ STAT3 activation and MYC deregulation, association of EBV, pSTAT3 and MYC in EBV(+)- DLBCL cases were studied. The presence of pSTAT3 and its upstream proteins: pJAK1 is identify to delineate the role of EBV in JAK1/STAT3 pathway.

MATERIALS AND METHODS

51 cases of DLBCL paraffin-embedded tissue samples were retrieved from a single private hospital in Kuala Lumpur, Malaysia. EBER-ISH was performed to identify the EBV expression; ten EBV(+)-DLBCL cases subjected to immunohistochemistry for LMP1, pJAK1, pSTAT3 and MYC; FISH assay for c-MYC gene rearrangement.

RESULTS

Among 10 cases of EBV(+)-DLBCL, 90% were non-GCB subtype (p=0.011), 88.9% expressed LMP1. 40% EBV(+)-DLBCL had pJAK1 expression.

CONCLUSION

66.7% EBV(+)-DLBCL showed the positivity of pSTAT3, which implies the involvement of EBV in constitutive JAK/STAT pathway. 44.5% EBV(+)-DLBCL have co-expression of pSTAT3 and MYC, but all EBV(+)-DLBCL was absence with c-MYC gene rearrangement. The finding of clinical samples might shed lights to the lymphomagenesis of EBV associated with non-GCB subtypes, and the potential therapy for pSTAT3-mediated pathway.

Prevalence and associated factors of undiagnosed glycaemic disorders in men with erectile dysfunction attending a primary care clinic

Objectives

Undiagnosed glycaemic disorders remain a major health concern as in such cases the opportunity for early interventions that can potentially prevent complications is missed. Erectile dysfunction (ED) has been suggested as a predictor for glycaemic disorders in men. However, data on men with ED having undiagnosed glycaemic disorders is limited, especially in the Malaysian context. This study aimed to identify prevalence and associated factors of undiagnosed glycaemic disorders in men with ED.

Methods

We applied a cross-sectional purposive sampling technique on a group of 114 men with ED without underlying glycaemic disorders. They underwent a 2-h oral glucose tolerance test and the cases were then classified into two groups: normal and undiagnosed glycaemic disorders groups. The glycaemic disorders group consisted of patients with diabetes mellitus (DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG). The patients were interviewed, and their medical records were reviewed for their sociodemographic and clinical profiles.

Results

Prevalence of undiagnosed glycaemic disorders in men with ED was 41.2%. Higher age (adjusted OR = 1.10, 95% CI: 1.03, 1.17, p = 0.002) and BMI (adjusted OR = 1.16, 95% CI: 1.05, 1.29, p = 0.003) were found to be significantly associated with undiagnosed glycaemic disorders.

Conclusion

This study found that men with ED had a high prevalence of undiagnosed glycaemic disorders. ED was associated with advancing age and higher BMI. Further research to validate the findings of this study is needed to increase the prevalence of DM screening among men with ED.

Autologous bone marrow clot as an alternative to autograft for bone defect healing

Objectives

Long bone defects often require surgical intervention for functional restoration. The ‘gold standard’ treatment is autologous bone graft (ABG), usually from the patient’s iliac crest. However, autograft is plagued by complications including limited supply, donor site morbidity, and the need for an additional surgery. Thus, alternative therapies are being actively investigated. Autologous bone marrow (BM) is considered as a candidate due to the presence of both endogenous reparative cells and growth factors. We aimed to compare the therapeutic potentials of autologous bone marrow aspirate (BMA) and ABG, which has not previously been done.

Methods

We compared the efficacy of coagulated autologous BMA and ABG for the repair of ulnar defects in New Zealand White rabbits. Segmental defects (14 mm) were filled with autologous clotted BM or morcellized autograft, and healing was assessed four and 12 weeks postoperatively. Harvested ulnas were subjected to radiological, micro-CT, histological, and mechanical analyses.

Results

Comparable results were obtained with autologous BMA clot and ABG, except for the quantification of new bone by micro-CT. Significantly more bone was found in the ABG-treated ulnar defects than in those treated with autologous BMA clot. This is possibly due to the remnants of necrotic autograft fragments that persisted within the healing defects at week 12 post-surgery.

Conclusion

As similar treatment outcomes were achieved by the two strategies, the preferred treatment would be one that is associated with a lower risk of complications. Hence, these results demonstrate that coagulated BMA can be considered as an alternative autogenous therapy for long bone healing.

Cite this article: Z. X. H. Lim, B. Rai, T. C. Tan, A. K. Ramruttun, J. H. Hui, V. Nurcombe, S. H. Teoh, S. M. Cool. Autologous bone marrow clot as an alternative to autograft for bone defect healing. Bone Joint Res 2019;8:107–117. DOI: 10.1302/2046-3758.83.BJR-2018-0096.R1.

Patients' blood pressure control and doctors' adherence to hypertension clinical practice guideline in managing patients at health clinics in Kuala Muda district, Kedah

BACKGROUND

blood pressure (bP) control among Malaysian is poor and doctor's adherence to clinical practice guideline (cPG) has been a well-known factor that may improve it. this study was designed to evaluate patients' bP control, doctors' adherence to the latest hypertension cPG and their association. Factors associated with bP control and cPG adherence was also examined.

METHODS

A cross-sectional study was conducted in Kuala Muda district's health clinics. 331 medical records were selected using stratified random sampling and standard proforma was used for data collection. the latest edition of the Malaysian cPG on hypertension was employed to define related variables.

RESULTS

A total of 160 patients (48.3%) had controlled bP and it was significantly associated with patients' age (adjusted Odds ratio, aOr= 1.03, 95% cI: 1.004, 1.05, p= 0.016) and systolic bP at presentation (aOr= 0.95, 95% cI: 0.93, 0.96, p< 0.001). About 60.7% of the medical records showed doctor's good level of cPG adherence. this adherence has significant association with presence of chronic kidney disease (aOr= 0.51, 95% cI: 0.31, 0.85, p= 0.007) and cardiovascular disease (aOr= 2.68, 95% cI: 1.04, 6.95, p= 0.030) in the patients and physicians' treatment intensification (aOr= 2.00, 95% cI: 1.26, 3.19, p= 0.009). However, no association was found between bP control and cPG adherence.

CONCLUSION

Hypertension control in this study was poor and the prevalence of physicians with good level of cPG adherence was slightly above average. these findings are important for relevant stakeholders to strategise an action plan to improve hypertension management outcome.

Angry patient with fibromyalgia: Diagnosis and management in primary care

I report a case of 40-year-old lady who presented with symptoms and signs suggestive of fibromyalgia but was disregarded by attending doctor. She was infuriated and lodged a complaint to Family Medicine Specialist (FMS) whereby further assessment confirmed the diagnosis of fibromyalgia and subsequently treated in primary care setting.

Development of perforated microthin poly(ε-caprolactone) films as matrices for membrane tissue engineering

The design and fabrication of thin films based on bioresorbable polymers such as poly(epsilon-caprolactone) (PCL) has been the focus of a part of current biomedical research, especially as matrices for membrane tissue engineering. We have successfully developed perforated microthin PCL membrane for this purpose. Two critical issues are the control of moisture permeability and understanding the degradation of PCL microthin film. In order to increase the moisture permeability. PCL films were biaxially stretched to a thickness of 10 +/- 3 microm and perforated with uniform array of holes (180-275 microm) using a Sony Robotic system. After perforation, the water vapour transmission rate was increased by 50% to a value of 47.6 +/- 2.7 g/h per m2. Accelerated hydrolytic degradations were performed in 5 M NaOH. The degraded samples were characterised for changes in weight, surface morphology, mechanical properties, crystallinity and molecular weight. Hydrolytic degradation commenced with random chain scission of backbone ester bonds on the film surface and followed by loss of material due to surface erosion. In general, the perforated films degraded faster than the unperforated microthin films. Scanning electron microscopic images showed that surface erosion led to extensive formation of micropores, microcracks and increased in surface roughness.

A multiscale model for bioimpedance dispersion of liver tissue

Radio-frequency ablation (RFA) has been used in liver surgery to minimize blood loss during tissue division. However, the current RFA tissue division method lacks an effective way of determining the stoppage of blood flow. There is limitation on the current state-of-the-art laser Doppler flow sensor due to its small sensing area. A new technique was proposed to use bioimpedance for blood flow sensing. This paper discusses a new geometrical multiscale model of the liver bioimpedance incorporating blood flow impedance. This model establishes correlation between the physical tissue structure and bioimpedance measurement. The basic Debye structure within a multilevel framework is used in the model to account for bioimpedance dispersion. This dispersion is often explained by the Cole-Cole model that includes a constant phase element without physical explanation. Our model is able to account for reduced blood flow in its output with changes in permittivity in gamma dispersion that is mainly due to the polarization of water molecules. This study demonstrates the potential of a multiscale model in determining the stoppage of blood flow during surgery.

Development of dual-compartment perfusion bioreactor for serial coculture of hepatocytes and stellate cells in poly(lactic-co-glycolic acid)-collagen scaffolds

An important challenge in liver tissue engineering is to overcome the rapid loss of hepatocyte functions. In vivo, hepatocytes are compact polyhedral cells with round nuclei; however, they readily loss many of their differentiated functions in vitro. To overcome this challenge, we have established a new perfusion bioreactor that consists of two compartments which enabled the serial coculture of hepatocytes and hepatic stellate cells-T6 without direct contact between each other. Three dimensional scaffolds were utilized in the bioreactor as physical anchors for cells. The scaffolds consist of collagen grafted poly(lactic-co-glycolic acid) microfibers and cross-linked collagen sponges between microfibers for additional cellular support and adhesion. The advantages of this new bioreactor are enabling cell culture in three dimensional organization and controlling the culture parameters of the supporting cells independently from the hepatocytes. The results showed that the hepatocytes exhibited much higher levels of the differentiated functions such as albumin secretion, urea synthesis, and cytochrome P450 enzymatic activity when compared with the monoculture system where hepatocytes alone were cultured. This perfusion bioreactor system has potential applications in the development of bioartificial liver devices or cell-based tissue constructs transplantation therapies.

The degradation profile of novel, bioresorbable PCL-TCP scaffolds: an in vitro and in vivo study

Degradation studies of scaffolds are important in bone tissue engineering. Previously, novel poly(epsilon-caprolactone)-20% tricalcium phosphate (PCL-TCP) based scaffolds were developed and proven useful for bone regeneration. In this study in vitro degradation analyses were carried out with the PCL-TCP scaffolds immersed in standard culture medium for 24 weeks. In vivo degradation was performed with the scaffolds implanted in the abdomen of rats for the same period of time. Results demonstrated greater degradation of PCL-TCP scaffolds in vivo than in vitro. At 24 weeks, the increase of average porosity of the scaffolds in vivo was 29.2% compared to 2.65% in vitro. Gel permeation chromatography (GPC) analysis revealed a decrease of 29% and 20% respectively in the Mn and Mw values after 24 weeks in vitro. However, a significant decrease in Mn and Mw values (79.6% and 88.7% respectively) were recorded in vivo. The mechanical properties however, were relatively similar and closely match those of cancellous bone even at 24 weeks. The results showed that the scaffold can be used for dentoalveolar reconstruction and PCL-TCP scaffolds have shown to possess the potential to degrade within the desired time period of 5-6 months and favorable mechanical properties.

Heterogeneous meshing and biomechanical modeling of human spine

We aim to develop a patient-specific biomechanical model of human spine for the purpose of surgical training and planning. In this paper, we describe the development of a finite-element model of the spine from the VHD Male Data. The finite-element spine model comprises volumetric elements suitable for deformation and other finite-element analysis using ABAQUS. The mesh generation solution accepts segmented radiological slices as input, and outputs three-dimensional (3D) volumetric finite element meshes that are ABAQUS compliant. The proposed mesh generation method first uses a grid plane to divide the contours of the anatomical boundaries and its inclusions into discrete meshes. A grid frame is then built to connect the grid planes between any two adjacent planes using a novel scheme. The meshes produced consist of brick elements in the interior of the contours and with tetrahedral and wedge elements at the boundaries. The nodal points are classified according to their materials and hence, elements can be assigned different properties. The resultant spine model comprises a detailed model of the 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, and S1. Each of the vertebrae and intervertebral disc has between 1200 and 6000 elements, and approximately 1200 elements, respectively. The accuracy of the resultant VHD finite element spine model was good based on visual comparison of volume-rendered images of the original CT data, and has been used in a computational analysis involving needle insertion and static deformation. We also compared the mesh generated using our method against two automatically generated models; one consists of purely tetrahedral elements and the other hexahedral elements.

Radio-Translucent 3-Axis Mechanical Testing Rig for the Spine in Micro-CT

To date, no apparatus has yet been devised which would allow the study of bone microstructure of the whole vertebrae under mechanical loading. This paper outlines the design and development of a 3-axis radio-translucent mechanical testing rig for spinal research and testing. This rig is to be used in conjunction with a Shimadzu micro-CT scanner. Several tests were conducted to verify the feasibility of the rig design. First, the maximum range of deformation in compression, flexion\extension, and lateral bending that could be exerted on a goat lumbar functional spinal unit was evaluated using the noncontact digital markers method. Stepwise compression loading was also conducted on a single porcine vertebra and the loading data was compared to results obtained from an industrial grade compression testing machine. Finally, micro-CT scans of a porcine vertebra prior to and at a compression failure strain were obtained. The rig was confirmed to be able to exert pure moment loading in the above mentioned modes of deformation and the extent of deformation was comparable to previous documented results. The stepwise compression loading conducted in the rig was also found to effectively approximate a continuous loading of the same specimen in an industrial grade compression testing machine. Finally, resultant micro-CT images of isotropic resolution 32.80μm of a porcine vertebra loaded in the rig were obtained. For the first time, trabecular microarchitecture detail of a whole vertebra buckling under 12.1% failure compression strain loading was studied using voxel-data visualization software. These initial series of tests verify the feasibility of the rig as an apparatus incorporating spinal testing and imaging.

An in vitro evaluation of PCL-TCP composites as delivery systems for platelet-rich plasma

In this study, we first investigated the in vitro degradation properties of biodegradable, bioresorbable polycaprolactone-20% tricalcium phosphate (PCL-TCP) composites immersed in simulated body fluid (SBF) and phosphate buffered saline (PBS). Then, the release profiles of the growth factors present in platelet-rich plasma (PRP) loaded onto the composites incubated in SBF and PBS were compared. Composites immersed in both buffers showed water uptake of 13.7%+/-0.75 at day 1, followed by a constant uptake of 12.1%+/-0.3 until day 12. Henceforth the water uptake declined for SBF- and increased for PBS-soaked composites. The weight loss data did not reveal any trend. SBF- and PBS-soaked samples displayed 1-2% weight loss for 2 and 5 of the ten time points measured respectively. The original protein retention (PR) of the composites was 49.1%+/-1.50. After immersion in SBF and PBS for 4 weeks, the PR was augmented to 88.5%+/-1.40 and 69.1%+/-1.40 correspondingly. PRP after activation contained 164.7+/-24.8, 194+/-43 and 18.3+/-4.75 ng/ml of TGF-beta1, PDGF-BB and IGF-1. Microscopic analysis verified the attachment of PRP to the rods and pores of the composites. Interestingly, the buffers played an important role in determining the release profiles of TGF and PDGF. Firstly, PBS-soaked composites manifested a tri-phasic burst-like profile that was absent in SBF. Secondly, SBF-soaked composites experienced delayed release of the growth factors and total release was not achieved (64.4% for TGF and 60.5% for PDGF), whereas total release was realized for PBS-soaked composites. Lastly, release profiles from SBF-soaked composites were growth factor mediated in terms of their amounts and sizes. This was not observed for PBS-soaked composites. IGF-1, on the other hand, exhibited a progressive reduction in levels over the entire experimental period for both buffers. The mechanisms of release were theorized to be a combination of diffusion, degradation and bioactivity. Since SBF is analogous to our body fluids in terms of its ionic constituents, we expect the elution profiles derived from SBF-soaked samples to more accurately emulate the in vivo situation. In conclusion, this study has deemed PCL-TCP composites as suitable delivery systems for platelet-rich plasma.

Computational biomechanical modelling of the lumbar spine using marching-cubes surface smoothened finite element voxel meshing

There is a need for the development of finite element (FE) models based on medical datasets, such as magnetic resonance imaging and computerized tomography in computation biomechanics. Direct conversion of graphic voxels to FE elements is a commonly used method for the generation of FE models. However, conventional voxel-based methods tend to produce models with jagged surfaces. This is a consequence of the inherent characteristics of voxel elements; such a model is unable to capture the geometries of anatomical structures satisfactorily. We have developed a robust technique for the automatic generation of voxel-based patient-specific FE models. Our approach features a novel tetrahedronization scheme that incorporates marching-cubes surface smoothing together with a smooth-distortion factor (SDF). The models conform to the actual geometries of anatomical structures of a lumbar spine segment (L3). The resultant finite element analysis (FEA) at the surfaces is more accurate compared to the use of conventional voxel-based generated FE models. In general, models produced by our method were superior compared to that obtained using the commercial software ScanFE.

Flow modelling within a scaffold under the influence of uni-axial and bi-axial bioreactor rotation

The problem of donor scarcity has led to the recent development of tissue engineering technologies, which aim to create implantable tissue equivalents for clinical transplantation. These replacement tissues are being realised through the use of biodegradable polymer scaffolds; temporary/permanent substrates, which facilitate cell attachment, proliferation, retention and differentiated tissue function. To optimise gas transfer and nutrient delivery, as well as to mimic the fluid dynamic environment present within the body, a dynamic system might be chosen. Experiments have shown that dynamic systems enhance tissue growth, with the aid of scaffolds, as compared to static culture systems. Very often, tissue growth within scaffolds is only seen to occur at the periphery. The present study utilises the Computational Fluid Dynamics package FLUENT, to provide a better understanding of the flow phenomena in scaffolds, within our novel bioreactor system. The uni-axial and bi-axial rotational schemes are studied and compared, based on a vessel rotating speed of 35 rpm. The wall shear stresses within and without the constructs are also studied. Findings show that bi-axial rotation of the vessel results in manifold increases of fluid velocity within the constructs, relative to uni-axial rotation about the X- and Z-axes, respectively.

Novel PCL-based honeycomb scaffolds as drug delivery systems for rhBMP-2

This study investigated a novel drug delivery system (DDS), consisting of polycaprolactone (PCL) or polycaprolactone 20% tricalcium phosphate (PCL-TCP) biodegradable scaffolds, fibrin Tisseel sealant and recombinant bone morphogenetic protein-2 (rhBMP-2) for bone regeneration. PCL and PCL-TCP-fibrin composites displayed a loading efficiency of 70% and 43%, respectively. Fluorescence and scanning electron microscopy revealed sparse clumps of rhBMP-2 particles, non-uniformly distributed on the rods' surface of PCL-fibrin composites. In contrast, individual rhBMP-2 particles were evident and uniformly distributed on the rods' surface of the PCL-TCP-fibrin composites. PCL-fibrin composites loaded with 10 and 20 microg/ml rhBMP-2 demonstrated a triphasic release profile as quantified by an enzyme-linked immunosorbent assay (ELISA). This consisted of burst releases at 2 h, and days 7 and 16. A biphasic release profile was observed for PCL-TCP-fibrin composites loaded with 10 microg/ml rhBMP-2, consisting of burst releases at 2 h and day 14. PCL-TCP-fibrin composites loaded with 20 microg/ml rhBMP-2 showed a tri-phasic release profile, consisting of burst releases at 2 h, and days 10 and 21. We conclude that the addition of TCP caused a delay in rhBMP-2 release. Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and alkaline phosphatase assay verified the stability and bioactivity of eluted rhBMP-2 at all time points.

Laser surface modification of poly(epsilon-caprolactone) (PCL) membrane for tissue engineering applications

Ultra-thin polycaprolactone (PCL) produced by bi-axial stretching was previously shown to have significant advantage for membrane tissue engineering. However, the permeability of the membrane needs to be enhanced. In this study, ablation experiments using femtosecond laser and excimer laser were carried out to modify the PCL surface. The use of the femtosecond laser produces neat drilled-through holes while the excimer laser is employed to produce blind-holes on the membrane. The modified surface of the membrane was studied and analyzed for different laser parameters (such as pulse energy and pulse repetition rate and characterized using several techniques that include optical microscopy, scanning electron microscopy and water contact angle measurements). Results showed that the morphological surface changes with different laser parameters, and the water contact angle decreases as the surface of the membrane is modified. The decrease in water contact angle suggests that surface of the membrane had become more hydrophilic than the non-laser treated membrane. The present study demonstrated that laser surface modification on the PCL can be achieved with high degree of success and precision. This paved the way for further enhancement in membrane tissue engineering.

The effect of rhBMP-2 on canine osteoblasts seeded onto 3D bioactive polycaprolactone scaffolds

Our strategy entails investigating the influence of varied concentrations (0, 10, 100 and 1000ng/ml) of human recombinant bone morphogenetic protein-2 (rhBMP-2) on the osteogenic expression of canine osteoblasts, seeded onto poly-caprolactone 20% tricalcium phosphate (PCL-TCP) scaffolds in vitro. Biochemical assay revealed that groups with rhBMP-2 displayed an initial burst in cell growth that was not dose-dependent. However, after 13 days, cell growth declined to a value similar to control. Significantly less cell growth was observed for construct with 1000ng/ml of rhBMP-2 from 20 days onwards. Confocal microscopy confirmed viability of osteoblasts and at day 20, groups seeded with rhBMP-2 displayed heightened cell death as compared to control. Phase contrast and scanning electron microscopy revealed that osteoblasts heavily colonized surfaces, rods and pores of the PCL-TCP scaffolds. This was consistent for all groups. Finally, Von Kossa and osteocalcin assays demonstrated that cells from all groups maintained their osteogenic phenotype throughout the experiment. Calcification was observed as early as four days after stimulation for groups seeded with rhBMP-2. In conclusion, rhBMP-2 seems to enhance the differentiated function of canine osteoblasts in a non-dose dependent manner. This resulted in accelerated mineralization, followed by death of osteoblasts as they underwent terminal differentiation. Notably, PCL-TCP scaffolds seeded only with canine osteoblasts could sustain excellent osteogenic expression in vitro. Hence, the synergy of PCL with bioactive TCP and rhBMP-2 in a novel composite scaffold, could offer an exciting approach for bone regeneration.

Conservative management of recurrent bilateral ovarian cysts in pregnancy: a case report

This is a case report of recurrent bilateral ovarian cysts in pregnancy. From the clinical picture these are likely to be theca lutein cysts. A lookout for complications involving these cysts is important. Patients can be managed conservatively in the absence of complications. Likely mechanisms for the causation of this phenomenon are discussed.

Comparison of flexural properties of composite restoratives using the ISO and mini-flexural tests

The purpose of this study was to investigate the flexural properties (flexural strength and flexural modulus) of four commercial composite restoratives (Silux Plus, Z100, Ariston and Surefil) using the ISO 4049 flexural test (IFT) and a mini-flexural test (MFT). Both tests involved the use of three-point loading and the same fixture. The difference between the tests was in the length of the composites specimens and the distance between the supports [20 mm (IFT) and 10 mm (MFT)]. Six specimens were made for each material and flexural test. Test specimens [25 x 2 x 2 mm (IFT) and 12 x 2 x 2 mm (MFT)] were fabricated according to manufacturers' recommendations. After light-polymerization, the specimens were stored in distilled water at 37 degrees C for 24 h. The specimens were subsequently blotted dry, measured and subjected to flexural testing using an Instron Universal Testing Machine with a crosshead speed of 0.75 mm min(-1). Data was analysed using anova/Scheffe's, paired samples test (P < 0.05) and Pearson's correlation (P < 0.01). For both IFT and MFT, results of statistical analysis of flexural strength were identical. Silux had significantly lower flexural strength compared with the other composites and the flexural strength of Ariston was significantly lower than Z100 and Surefil. For IFT, the flexural modulus of Z100 was significantly higher than Silux, Ariston and Surefil while for MFT, Silux had significantly lower modulus compared with Z100, Ariston and Surefil. A significant, strong and positive correlation (r = 0.95) was observed for flexural strength between IFT and MFT. Correlation for flexural modulus was also significant and positive but was weaker (r = 0.53). As MFT has the advantage of ease of specimen fabrication and is more clinically realistic, it is suggested for the testing of composite restoratives.

CLINICAL RELEVANCE

The mini-flexural test may be better than the ISO flexural test for screening of composite restoratives for clinical applications.

Compression-induced changes on physical structures and calcification of the aromatic polyether polyurethane composite

It is generally accepted that stress causes calcification in both bio-prosthetic and polyurethane heart valves. However, simple uni-axially- and bi-axially-stretched samples did not yield a feasible model for the elaboration of the stress-induced calcification. In this study, heat compaction combined with the incorporation of polyethylene has been explored. Specimens of polyurethane were solution cast onto a porous bi-axially-drawn ultra-high-molecular-weight polyethylene film and then heat compacted under a pressure of 18 MPa at a chosen temperature for 1.5 h. The heat-compaction-induced calcification and physical changes of the polyurethane composite were evaluated using a 28-day in vitro calcification model and Attenuated Total Reflection-Fourier Transform-Infrared (ATR-FT-IR) spectroscopy. The calcification results indicated that heat-compaction-induced calcification was double that achieved without heat compaction. Heat-compacted polyurethane composite showed higher affinity to calcium ions than the non-heat compacted sample. The ATR-FT-IR results showed that the heat-compaction-induced physical changes include distortions of polymeric molecules and permanent changes of microstructures. The distortions of polymeric molecules could be deteriorated in contact with different media. The relaxation of the stressed structures of the polyether moiety might serve as a calcium trap and a heterogeneous nucleation site for calcification. The permanent changes of microstructures resulted from high distortions also served as affinity sites attracting calcification.

Multi-axial spine biomechanical testing system with speckle displacement instrumentation

This paper reports on the design and development of a multi-axis (up to 6 axes) mechanical tester for spinal research and testing. The developed spine tester allowed true motion to be simulated on a specimen in pure or combined modes. To demonstrate the capability of the new tester flexural stiffness properties of sheep lumbar motion segments were evaluated together wiith a non-contact speckle displacement measurement system. The flexural stiffness of the specimens was measured and compared under constrained and non-constrained testing conditions; with relieving of shear forces (non-constrained), it was found that the specimen behaved in a 'stiffer' manner.

An elasto-plastic finite element model for polyethylene wear in total hip arthroplasty

A new finite element model (FEM) based on an elasto-plastic behavior of ultra high molecular weight polyethylene (UHMWPE) was used to study the wear behavior of UHMWPE acetabular cup, which has a 32 mm diameter femoral head. The model imposed a plastic yield stress of 8 MPa on the UHMWPE so that any stresses beyond this would automatically be redistributed to its neighbor. The FEM model adopted a unique mesh design based on an open cube concept which eliminated the problems of singularities. Wear prediction combined the influences of contact stress, sliding distance and a surface wear coefficient. The new model predicted significantly higher volumetric wear rate (57 mm(3)/yr) well within the average reported clinical values. The model was also used to study the effect of friction and clearance between the acetabular cup and the femoral head. Increase in friction increased the volumetric wear rate but did not appear to affect the linear wear rate, which remained at 0.12 +/- 0.02 mm/yr. The predicted wear was sensitive to clearance. It was found that when the clearance was close to 0 and >0.5mm, severe wear occurred. The best clearance range was between 0.1 and 0.15 mm where the average linear wear rate was 0.1mm/yr and the volumetric wear was 55 mm(3)/yr. The present work indicates the importance of avoiding too tight or too loose a diametrical clearance.

Effects of cyclic loading on occlusal contact area wear of composite restoratives

OBJECTIVES

To investigate the effects of cyclic loading on occlusal contact area (OCA) wear and the possible presence of fatigue wear mechanisms in four composite resins (Silux, Z100, Ariston and Surefil) using a reciprocal compression-sliding test apparatus.

METHODS

Six specimens were made for each composite material and the amalgam alloy (Dispersalloy) control. The wear specimens were subjected to wear testing at 20 MPa with artificial saliva as lubricant. Wear depth (microm) was measured using profilometry every 20,000 cycles up to 120,000 cycles. The worn specimens were subjected to SEM to determine the presence of fatigue wear mechanisms. Results were analyzed using ANOVA/Scheffe's test (P<0.05) and Pearson's Correlation (P<0.01).

RESULTS

Dispersalloy had the lowest wear at all cyclic intervals. For all materials, OCA wear increased with increased number of cycles. Although Dispersalloy, Ariston and Surefil experienced no significant increase in wear between each 20,000 cycles increment, a significant increase was observed with Silux. For Z100, a significant difference was observed only from 40,000 cycles onwards. Both Z100 and Dispersalloy exhibited fatigue wear after wear testing for 120,000 cycles. Cyclic loading resulted in deep and wide microcracks in Silux. Fatigue wear was not observed with Silux, Ariston and Surefil.

SIGNIFICANCE

The effects of cyclic loading on wear is material dependent. While some restorative materials exhibit fatigue wear, others exhibit deep microcrack formation with extended cyclic loading. The latter may precipitate catastrophic failure despite the low wear observed. Care should, therefore, be exercised when selecting materials for posterior stress-bearing areas.

Environmental damage and occlusal contact area wear of composite restoratives

The chemical environment is one aspect of the oral environment, which could have an appreciable influence on the in-vivo degradation of composite resins. The resin matrix can be softened and fillers constituents can be leached out when composites are exposed to certain chemicals/food-simulating liquids (FSLs). A reciprocal compression sliding wear device was used to study the effects of the chemical environment on occlusal contact area (OCA) wear of four composite restoratives (Silux Plus, Z100, Ariston pHc and Surefil). The effects of FSL on hardness was also investigated and correlated to wear. Thirty-six hardness/wear specimens of each material were made and stored in artificial saliva at 37 degrees C for 24 h. The specimens were then divided into six groups of six specimens and stored in the following FSL for 1 week at 37 degrees C: distilled water (W), 0.02 N citric acid (C), 0.02 N lactic acid (L), heptane (H) and 75-25% ethanol-water solution (E). Conditioning in artificial saliva (S) was used as control. After conditioning, the specimens were wear tested at 20 MPa contact stress against SS304 counter-bodies in the respective FSL/artificial saliva up to 20 000 cycles. Wear depth (lm, n=6) was measured using profilometry. Change in hardness (DeltaKHN, Knoop hardness number) was determined by microhardness testing pre- and post-conditioning. Results of statistical analyses (ANOVA/Scheffe's at significance level 0.05) of wear data were as follows: Silux - S, W > L, H, E and C, L > H; Z100 - S, W > all other mediums and E > H; Ariston - all other mediums > H; Surefil - W, C > S, L, H, E (> indicates significantly more wear). With the exception of Surefil, the greatest wear was observed with conditioning and wear testing in water. This ranged from 93.18 +/- 21.96 lm for Z100 to 31.43 +/- 2.80 lm for Surefil. For all materials, conditioning in heptane resulted in the least wear. This ranged from 8.9 +/- 2.2 microm for Ariston to 16.5 +/- 5.9 lm for Silux. The effects of the different FSL on OCA wear were material dependent. No correlation was observed between DeltaKHN and wear.

Effects of cyclic temperature changes on hardness of composite restoratives

The clinical durability of some composite restorative materials may be significantly affected by cyclic temperature changes. This study investigated the effects of cyclic temperature changes on surface hardness of four commercial composite resins (Silux, Z100, Ariston and Surefil). Eighteen specimens of each material were divided into three treatment groups comprising a control and two different thermal cycling regimes. Control specimens were stored in distilled water at 35 degrees C for 178 hours. Thermal cycled specimens were stored in distilled water at 35 degrees C for 173 hours and subjected to five hours (300 cycles) of a thermal cycling regime consisting of the cycle ABAC, where A and B represent the fixed temperatures of 35 degrees C (28 seconds) and 15 degrees C (two seconds) and C, depending on the treatment group, either 45 degrees C or 60 degrees C (two seconds). All specimens were subsequently subjected to hardness testing (KHN) using a digital microhardness tester (load = 500 gf; dwell time = 15 seconds). Results were analyzed using ANOVA/Scheffe's test (p<0.05). The effect of thermal cycling on hardness was material-dependent. While thermal cycling significantly increased the surface hardness of Z100 and Surefil, it significantly decreased the hardness of Ariston. The hardness of Silux was not significantly affected by cyclic temperature changes. For all treatment groups, Z100 was significantly harder than the other composite resins evaluated and Surefil was significantly harder than Silux and Ariston. For both thermal cycled groups, Silux was significantly harder than Ariston.

Evaluation of ultra-thin poly(epsilon-caprolactone) films for tissue-engineered skin

Various natural and synthetic polymeric materials have been used as scaffold matrices for tissue-engineered skin. However, the commercially available skin replacement products pose problems of poor mechanical properties and immunological rejection. We have thus developed a film of 5 microm thickness, via biaxial stretching of poly(epsilon-caprolactone) (PCL), as a potential matrix for living skin replacements. The aim of this study was to evaluate the feasibility of using biaxially stretched PCL films as matrices for culturing human dermal fibroblasts. For this purpose, we cultured human dermal fibroblasts for 7 days on the films. Glass cover slips and polyurethane (PU) sheets were used as controls. The data from phase contrast light, confocal laser, and scanning electron microscopy suggested that biaxially stretched PCL films support the attachment and proliferation of human dermal fibroblasts. Thymidine-labeling results showed quantitatively that cell proliferation on the PCL films was superior to that on the PU samples. These results indicated that biaxially stretched PCL films supported the growth of human dermal fibroblasts and might have potential to be applied in tissue engineering a dermal equivalent or skin graft.

Comparative wear resistance of reinforced glass ionomer restorative materials

This study investigated the wear resistance of three restorative reinforced glass ionomer cements (Fuji IX GP FAST [FJ], Miracle Mix [MM] and Ketac Silver [KS]). Microfilled (Silux [SX]) and mini-filled (Z100 [ZO]) composites were used for comparison. Six specimens were made for each material. The specimens were conditioned for one week in distilled water at 37 degrees C and subjected to wear testing at 20 MPa contact stress against SS304 counterbodies using a reciprocal compression-sliding wear instrumentation. Distilled water was used as lubricant. Wear depth (microm) was measured using profilometry every 2,000 cycles up to 10,000 cycles. Results were analyzed using ANOVA/Scheffe's test (p<0.05). After 10,000 cycles of wear testing, ranking was as follows: KS>ZO>MM>FJ>SX. Wear ranged from 26.1 microm for SX to 71.5 microm for KS. The wear resistance of KS was significantly lower than FJ, MM and SX at all wear intervals. Although KS had significantly more wear than ZO at 2,000 to 6,000 cycles, no significant difference in wear was observed between these two materials at 8,000 and 10,000 cycles. Sintering of silver particles to glass ionomer cement (KS) did not appear to improve wear resistance. The simple addition of amalgam alloy to glass ionomer may improve wear resistance but results in poor aesthetics (silver-black color). FJ, which relies on improved chemistry instead of metal fillers, showed comparable wear resistance to the composites evaluated and is tooth-colored. It may serve as a potential substitute for composites in low-stress situations where fluoride release is desirable and aesthetic requirements are not high.

Influence of thermal cycling on OCA wear of composite restoratives

This study investigated the effects of thermal cycling on wear of four commercial composite resins (Silux, Z100, Ariston and Surefil). Specimens of each material were divided into three treatment groups comprising a control and two different thermal cycling regimes. Control specimens were stored in distilled water at 35 degrees C for 178 hours. Thermal cycled specimens were stored in distilled water at 35 degrees C for 173 hours and subjected to five hours (300 cycles) of a thermal cycling regime consisting of the cycle ABAC, where A and B represent the fixed temperatures of 35 degrees C (28 seconds) and 15 degrees C (two seconds) and C, depending on the treatment group, was either 45 degrees C or 60 degrees C (two seconds). All specimens were subsequently subjected to wear testing at 20 MPa contact stress against SS304 counterbodies with distilled water as the lubricant. Wear depth (microm; n=6) was measured using profilometry every 2,000 cycles up to 10,000 cycles. Results were analyzed using ANOVA/Scheffe's test (p<0.05). The effect of thermal cycling on wear was material-dependent. The wear of Silux and Z100 were not significantly affected by thermal cycling. Thermal cycling of Ariston at an upper temperature of 60 degrees C significantly decreased wear resistance. Thermal cycling affected only the early wear resistance of Surefil.

Mechanical properties and cell cultural response of polycaprolactone scaffolds designed and fabricated via fused deposition modeling

A number of different processing techniques have been developed to design and fabricate three-dimensional (3D) scaffolds for tissue-engineering applications. The imperfection of the current techniques has encouraged the use of a rapid prototyping technology known as fused deposition modeling (FDM). Our results show that FDM allows the design and fabrication of highly reproducible bioresorbable 3D scaffolds with a fully interconnected pore network. The mechanical properties and in vitro biocompatibility of polycaprolactone scaffolds with a porosity of 61 +/- 1% and two matrix architectures were studied. The honeycomb-like pores had a size falling within the range of 360 x 430 x 620 microm. The scaffolds with a 0/60/120 degrees lay-down pattern had a compressive stiffness and a 1% offset yield strength in air of 41.9 +/- 3.5 and 3.1 +/- 0.1 MPa, respectively, and a compressive stiffness and a 1% offset yield strength in simulated physiological conditions (a saline solution at 37 degrees C) of 29.4 +/- 4.0 and 2.3 +/- 0.2 MPa, respectively. In comparison, the scaffolds with a 0/72/144/36/108 degrees lay-down pattern had a compressive stiffness and a 1% offset yield strength in air of 20.2 +/- 1.7 and 2.4 +/- 0.1 MPa, respectively, and a compressive stiffness and a 1% offset yield strength in simulated physiological conditions (a saline solution at 37 degrees C) of 21.5 +/- 2.9 and 2.0 +/- 0.2 MPa, respectively. Statistical analysis confirmed that the five-angle scaffolds had significantly lower stiffness and 1% offset yield strengths under compression loading than those with a three-angle pattern under both testing conditions (p < or = 0.05). The obtained stress-strain curves for both scaffold architectures demonstrate the typical behavior of a honeycomb structure undergoing deformation. In vitro studies were conducted with primary human fibroblasts and periosteal cells. Light, environmental scanning electron, and confocal laser microscopy as well as immunohistochemistry showed cell proliferation and extracellular matrix production on the polycaprolactone surface in the 1st culturing week. Over a period of 3-4 weeks in a culture, the fully interconnected scaffold architecture was completely 3D-filled by cellular tissue. Our cell culture study shows that fibroblasts and osteoblast-like cells can proliferate, differentiate, and produce a cellular tissue in an entirely interconnected 3D polycaprolactone matrix.