During the 2nd ILSI SEA Region Expert Consultation and Planning Meeting in 2011, the following information gaps were identified: (i) Some Southeast Asian countries did not have data on infant and young child feeding (IYCF) indicators; (ii) There is a need to know the reasons for the disparities in duration of breastfeeding, age of giving complementary foods, and other breastfeeding and complementary feeding practices in Southeast Asian populations; (iii) Optimal complementary feeding practices that are most suitable in the context of Southeast Asia need to be identified. This report presents highlights from a literature review regarding the above topics. Findings from nationwide surveys and small scale studies were compiled to provide a snapshot of the state of infant and young child feeding practices in the region. Results for Cambodia, Indonesia, Philippines, and Vietnam are presented here.

Introduction: The Infant and Early Childhood Nutrition Task Force, International Life Sciences Institute Southeast Asia (ILSI SEA) Region, organised the 1st and 2nd Expert Consultation and Planning Meeting on Infant and Early Childhood Nutrition in 2009 and 2011, respectively. The goal of the consultations was “to generate and promote relevant science-based information that will help improve nutritional status, growth and development of infants and young children in Southeast Asia.” Methods: An Expert Panel Core Group was created whose role is to provide advice and recommendations through a review of current scientific knowledge regarding issues related to early childhood growth and nutrition. The Panel is composed of experts representing 7 countries (China, Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam). In July 2012, the Panel convened the 3rd Expert Consultation and Planning Meeting on Infant and Young Child Nutrition in Singapore. This report presents the highlights of the meeting and recommendations made by the Panel on ways to improve infant and young child nutrition in Southeast Asia. Results and Conclusion: The effective use of WHO indicators for assessing infant and young child feeding practices, mitigating the effects of maternal employment on breastfeeding, using behaviour change communication, updating the education of health personnel, and improving maternal health were considered important actions to be taken. Since current feeding practices in Southeast Asia fall short of WHO recommendations, studies are needed to develop strategies which take into consideration the diverse cultural settings that characterise the region.

A review conducted on the regulatory status of bioactive non-nutritional food components in foods and beverages in eight Southeast Asian countries indicates these components have been recognised for their health benefits. Indonesia and Malaysia have promulgated specific regulations allowing the addition of these bioactive components in foods and beverages, provided a list of the permitted components that may be used, and clear process for the industry to apply for new components. Both countries also have separate regulations that govern the making of function claims which refer to the beneficial physiological or health effects brought about by such bioactive components. The other six countries do not have a specific regulation governing the use of these bioactive components. However, these countries also permit the making of similar function claims, provided they are scientifically substantiated, preferably human clinical trials. Each country has slightly different requirements and process in place for reviewing applications for claims. All countries, except Myanmar, also allow the sale and marketing of foods containing probiotics, another functional food component. Indonesia, Malaysia, Philippines and Thailand have promulgated specific probiotic regulations and, except for Indonesia, have published permitted list of probiotics. All seven countries have provisions for the industry to apply for the use of new probiotics. Malaysia, Philippines, Singapore and Thailand permit the use of a pre-approved generic function claims related to probiotics. The sharing of experiences in regulatory approaches would be beneficial to the advancement of scientific and regulatory development of bioactive non-nutritional food components in the region and would benefit all stakeholders.

Calcifying tendinopathy is a tendon disorder with calcium deposits in the mid-substance presented with chronic activity-related pain, tenderness, local edema and various degrees of incapacitation. Most of current treatments are neither effective nor evidence-based because its underlying pathogenesis is poorly understood and treatment is usually symptomatic. Understanding the pathogenesis of calcifying tendinopathy is essential for its effective evidence-based management. One of the key histopathological features of calcifying tendinopathy is the presence of chondrocyte phenotype which surrounds the calcific deposits, suggesting that the formation of calcific deposits was cell-mediated. Although the origin of cells participating in the formation of chondrocyte phenotype and ossification is still unknown, many evidences have suggested that erroneous tendon cell differentiation is involved in the process. Recent studies have shown the presence of stem cells with self-renewal and multi-differentiation potential in human, horse, mouse and rat tendon tissues. We hypothesized that the erroneous differentiation of tendon-derived stem cells (TDSCs) to chondrocytes or osteoblasts leads to chondrometaplasia and ossification and hence weaker tendon, failed healing and pain, in calcifying tendinopathy. We present a hypothetical model on the pathogenesis and evidences to support this hypothesis. Understanding the key role of TDSCs in the pathogenesis of calcifying tendinopathy and the mechanisms contributing to their erroneous differentiation would provide new opportunities for the management of calcifying tendinopathy. The re-direction of the differentiation of resident TDSCs to tenogenic or supplementation of MSCs programmed for tenogenic differentiation may be enticing targets for the management of calcifying tendinopathy in the future.
Animals ; Cell Differentiation ; physiology ; Humans ; Mice ; Rats ; Stem Cells ; pathology ; Tendinopathy ; etiology ; pathology ; Tendons ; pathology

BACKGROUNDSynovium-derived stem cells (SDSCs) with higher chondrogenic potential are attracting considerable attention as a cell source for cartilage regeneration. We investigated the effect of bone morphogenetic protein 2 (BMP-2) on transforming growth factor beta3 (TGF-β3)-induced chondrogenesis of SDSCs isolated from human osteoarthritic synovium in a pellet culture system.

METHODSThe clonogenicity, stem cell marker expression and multi-differentiation potential of isolated SDSCs were determined by colony forming unit assay, flow cytometry and specific staining including alizarin red S, Oil red O and alcian blue staining, respectively. SDSCs pellet was cultured in chondrogenic medium with or without TGF-β3 or/and BMP-2. At day 21, the diameter and the weight of the pellets were measured. Chondrogenic differentiation of SDSCs was evaluated by Safranin O staining, immunohistochemical staining of collagen type II, sulfated glycosaminoglycan (sGAG) synthesis and mRNA expression of collagen type II, aggrecan, SOX9, link-protein, collagen type X and BMP receptor II.

RESULTSCells isolated under the optimized culturing density (10(4)/60 cm(2)) showed clonogenicity and multi-differentiation potential. These cells were positive (> 99%) for CD44, CD90, CD105 and negative (< 10%) for CD34 and CD71. SDSCs differentiated to a chondrocytic phenotype in chondrogenic medium containing TGF-β3 with or without BMP-2. Safranin O staining of the extracellular matrix was positive and the expression of collagen type II was detected. Cell pellets treated with TGF-β3 and BMP-2 were larger in diameter and weight, produced more sGAGs, and expressed higher levels of collagen type II and other chondrogenic markers, except COL10A1, than medium with TGF-β3 alone.

CONCLUSIONSSDSCs could be isolated from human osteoarthritic synovium. Supplementation with BMP-2 significantly promoted the in vitro TGF-β3-induced chondrogenic differentiation of SDSCs.

Aged ; Bone Morphogenetic Protein 2 ; pharmacology ; Cell Differentiation ; drug effects ; Cells, Cultured ; Chondrogenesis ; drug effects ; Female ; Humans ; Immunohistochemistry ; Male ; Mesenchymal Stromal Cells ; cytology ; drug effects ; Middle Aged ; Synovial Membrane ; cytology ; Transforming Growth Factor beta3 ; pharmacology

INTRODUCTIONThis is the fi rst prospective study done locally to determine the effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers.

MATERIALS AND METHODSAn electronic vacuum pump was used to apply controlled negative pressure evenly across the wound surface. Changes in wound dimension, presence of wound granulation and infection status of diabetic foot ulcers in 11 consecutive patients with diabetes were followed over the course of VAC therapy.

RESULTSHealing was achieved in all wounds. Nine wounds were closed by split-skin grafting and 2 by secondary closure. The average length of treatment with VAC therapy was 23.3 days. Ten wounds showed reduction in wound size. All wounds were satisfactorily granulated and cleared of bacterial infection at the end of VAC therapy.

CONCLUSIONSVAC therapy was useful in the treatment of diabetic foot infection and ulcers, which after debridement, may present with exposed tendon, fascia and/or bone. These included ray amputation wounds, wounds post-debridement for necrotising fasciitis, wounds post-drainage for abscess, a heel ulcer and a sole ulcer. It was able to prepare ulcers well for closure via split-skin grafting or secondary closure in good time. This reduced cost of VAC therapy, as therapy was not prolonged to attain greater reduction in wound area. VAC therapy also provides a sterile, more controlled resting environment to large, exudating wound surfaces. Large diabetic foot ulcers were thus made more manageable.

Adult ; Debridement ; Diabetic Foot ; classification ; surgery ; therapy ; Female ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Prospective Studies ; Wound Healing

Background: The use of the International Classification of Functioning, Disability, and Health (ICF) framework is advocated in Speech-Language Pathology (SLP) clinical practice. As using the ICF leads to improved quality of life in relation to communication and swallowing compared to the medical model, SLP practitioners are encouraged to adopt the ICF framework in their practice. However, there is a lack of ICF-related literature in the Philippines that can serve as a guide for SLP practitioners. Objectives: The study aimed to identify and describe available international literature and extract key ideas that can serve as a guide for SLP practitioners as they adopt ICF into their practice. Methodology: The York Framework for scoping reviews was utilized. The review consisted of five stages: (1) identifying research questions, (2) identifying relevant literature, (3) identifying eligible literature, (4) data charting, and (5) summarizing and extracting themes. Results: The majority of the articles collated were research studies from developed countries. The ICF was applied equally across all age groups and focused on activities and participation rather than health conditions. Thematic analysis showed that ICF was applied in assessment, intervention, and health care service delivery. Conclusion Gaps exist in using ICF-based tools in the SLP clinical practice and in the social understanding of the ICF. SLP practitioners are encouraged to learn and adapt the identified ICF-related themes in their practice as it facilitates a holistic understanding of their patient's functioning, disability, and evidence-based clinical decisions, thus, contributing to effective diagnostic and therapeutic processes.
Speech-Language Pathology ; Health

Objectives: The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP). Methods: A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation. Results: This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients’ fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate. Conclusions The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.

Adolescent ; Adult ; Cross-Sectional Studies ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Intensive Care Units ; statistics & numerical data ; Male ; Middle Aged ; Organ Transplantation ; psychology ; statistics & numerical data ; Surveys and Questionnaires ; Tissue and Organ Procurement ; statistics & numerical data ; Young Adult