A 65-year-old lady with End-Stage Renal Failure (ESRF) receiving Continuous Ambulatory Peritoneal Dialysis (CAPD) was admitted acutely for altered mental status and neurological symptoms. She presented to the Emergency Department with bilateral upper limb weakness and clumsiness, bilateral lower limb weakness for 1 day’s duration. In addition, her family members reported altered behaviour for the previous 1 day. On examination, the patient had slurred speech, weakness in all limbs and brisk reflexes throughout. Significantly, she had been diagnosed with herpes zoster 2 days earlier by a family physician, for which she was started on oral acyclovir. Our patient was diagnosed as having acyclovir toxicity and commenced on urgent haemodialysis. Her symptoms resolved completely after 2 days. Our case details the uncommon but potentially fatal complication of acyclovir toxicity in patients with renal impairment, reinforces the importance of dose reduction in these patients and demonstrates haemodialysis as a good form of treatment for acyclovir toxicity. Family physicians should be familiar with dose adjustments for common medications prescribed to ESRF patients in the outpatient setting as the burden of chronic kidney disease increases in Singapore.

Objective To evaluate the influence of pregnancy outcomes with different dosage of estradiol valerate in addition to progesterone for luteal supplementation in IVF-ET cycles. Methods From February 2011 to October 2012, 362 patients undergoing IVF-ET in the second affiliated hospital of Kunming Medical University were selected. The patients were randomly assigned into three groups. Since oocyte retrieval, all of them were injected luteal supplementation with progesterone in oil 60 mg/d, im. Group A as control group (112 cases) did not add with pentanoic acid estradiol;Group B for the experimental group (122 cases), added pentanoic acid estradiol 4 mg/d after embryo transfer;Group C for the experimental group (128 cases) added pentanoic acid estradiol 6 mg/d after embryo transfer. Finally the pregnancy outcome and implantation rate were compared for each group. Results There were no significant differences between group A and group B, group B and group C in the rate of embryos grow and pregnancy rate ( >0.05) . The embryo planting rate and pregnancy rate have significant difference between Group A and group C ( < 0.05) . Conclusion 6 mg/d fill estradiol valerate for luteal supplementation may improve implantation rate and pregnancy rate after IVF.

Background: Hemispheric asymmetry studies of working memory are mainly carried out in western countries. Data on Chinese is limited in this area of research. On the other hand, working memory assessment can be limited by the temporal resolution of the imaging modality as well as the design of the cognitive paradigm. These methodological limitations infl uence result interpretation hence hinder cross study comparison. Hemispheric study of memory using a pure working memory paradigm on native Chinese speakers, using a hemodynamic technique with high temporal resolution is thus mandatory. Objective: We aimed to investigate the feasibility of the functional transcranial Doppler sonography (fTCD) and 2-back task with alphabets in assessing the hemispheric lateralization of memory in healthy right-handed Chinese. Methods: Thirteen healthy right-handed Chinese subjects (7 males and 6 females, 19-22 years old) were included. Bilateral monitoring of the cerebral blood fl ow velocity (CFBV) changes in their left and right middle cerebral arteries (MCAs) was performed using fTCD during their performance of a 2-back working memory task with alphabets. Differences of CBFV change between left and right MCAs were analyzed, and the laterality index (LI) was determined. Results: Left lateralization was found in all subjects, with females performed better than males (p < 0.05). No difference in age, response time and LI between the male and female subjects could be observed (p > 0.05). A weak correlation was found between performance accuracy/response time and LI (r2 = 0.12). Conclusion: To the best of our knowledge, this is the fi rst report on the use of fTCD in memory function assessment in Chinese. The consistency of our results with previous studies demonstrates the feasibility as well as the potential application of the 2-back task with alphabets and f

Objective To investigate the relationship between cysteine-rich protein 61 ( Cyr61 ) and phosphatidylinositol 3-kinase ( PI3K ) signal pathway on cell proliferation and apoptotic in human ovarian carcinoma cells.Methods Recombinant human Cyr61 (rhCyr61) was pretreated with ovarian carcinoma cells.The expression of Cyr61 protein was detected by confocal spectral microscopy.Then treated the ovarian carcinoma cells with PI3K transduction inhibitors (LY294002) for 24 hours.Cell apoptosis was detected by flow cytometry (FCM).Cell viability was determined by methyl thiazolyl tetrazolium (MTT) method.The mRNA expressions of Cyr61,the protein levels of protein kinase B ( PKB),phospho-PKB and Cyr61 were assaved by real time-PCR and western blot analysis,respectively.Results The Cyr61 and phospho-PKB protein expression in two ovarian carcinoma cells (OV2008 and OVCAR-3 ) were increased in rhCyr61pretreated group.The decreasing of cell apoptosis [ ( 1.4 ±0.9)％,(2.1 ± 1.0)％ ] and increasing of cell proliferation [ ( 124.0 ± 1.8)％,( 133.0 ±2.2)％ ] was detected in the same time,compared with negative control group,there were significant difference ( P ＜ 0.05 ).After exposed to LY294002 for 24 hours,the apoptosis rate of OV2008 and OVCAR-3 in pretreated with rhCyr61 group exposed to LY294002 were (21.1 ± 1.6)％ and (26.4 ± 1.5 )％,respectively.Cells viability [ (59.0 ± 2.3 )％,(51.0 ± 2.0)％ ]was also significantly decreased in OV2008 and OVCAR-3 pretreated with rhCyr61 cells.Meanwhile,the mRNA expressions of Cyr61 (3.2 ± 0.8,6.2 ± 1.1 ) and the protein levels of phospho-PKB and Cyr61 were greatly decreased.Compared with negative control group,there were significant difference in OV2008 and OVCAR-3 cells (all P ＜ 0.0l ).Conclusions The activation of PI3K intracellular signaling pathways may lead to up-regulation of Cyr61 expression.Block PI3K signal pathway could significantly inhibit the expression of Cyr61,and may promote the apoptotic effects and inhibit the cell growth of ovarian carcinoma cells.

Objective Studies show that the ERCC1 gene may be involved in secondary cisplatin resistance.This article aims to investigate the effects of shRNA targeting silencing excision repair cross-complementation group 1 (ERCC1-shRNA) on the proliferation and apoptosis of lung cancer A549/DDP cells treated with different concentrations of cisplatin.Methods Lung cancer A549/DDP cells were divided into a negative control, a blank control, an ERCC1-shRNA1, and an ERCC1-shRNA2 group.Human interfering RNA (RNAi) targeting the human ERCC1 gene was constructed and transfected into the A549/DDP cells using Lipofectamine 2000.The mRNA and protein expressions of ERCC1 in the A549/DDP cells were detected by real-time PCR and Western blot respectively, the proliferation-inhibition rate was assessed by MTT, and their cell cycle and apoptosis were determined by flow cytometry.Results ERCC1-shRNA was successfully constructed and transfected into the A549/DDP cells.Both the mRNA and protein expressions of ERCC1 were significantly lower in the ERCC1-shRNA1 (0.20±0.04 and 0.24±0.10) and ERCC1-shRNA2 (0.47±0.28 and 0.37±0.11) than in the negative control (0.96±0.12 and 1.32±0.13) and blank control groups (0.84±0.07 and 1.45±0.23) (P<0.01).Compared with the negative and blank control groups, the ERCC1-shRNA1 group showed a significantly decreased IC50 value (16.71±2.33 and 16.69±1.69 vs 7.78±0.54, P<0.01) and an increased proportion of G0/G1 phase cells ([72.87±3.23] and [71.75±4.56] vs [82.99±4.23]%, P<0.05), with the cell cycle arrested in the G0/G1 phase.The apoptosis rate of the cells in the ERCC1-shRNA1 group was remarkably lower after treated with cisplatin at the concentrations of 6.25 and 12.5 μg/mL than at 0 μg/mL ([8.17±0.65] and [11.91±1.41] vs [29.97±3.14]%, P<0.05).Conclusion ERCC1-shRNA can inhibit the proliferation and enhance the apoptosis of A549/DDP cells by silencing the expression of the ERCC1 gene.

Iodine deficiency disorders (IDD) during pregnancy may impair the neurological development of the fetus. The aim of this study is to determine the iodine status among pregnant women (PW) in Sarawak after introduction of mandatory universal salt iodisation (USI) for seven years.

Iodine deficiency disorders (IDD), is one of the most important micronutrient deficiencies which has multiple adverse effects on growth and development. The aim of this study was to determine the prevalence of IDD among school children and to elucidate the distribution of iodized salt at household level in Sarawak, East Malaysia. This cross-sectional study was conducted among school children aged 8 to 10 years in 2008. A multi-stage probability proportionate to population size (PPS) cluster sampling method was used to obtain a representative state sample of 1200 school children. Spot urine samples were collected for the determination of urinary iodine concentration while the iodine content in salt was determined using field rapid test kits. The thyroid status was determined by palpation. Response rate was 92.0% (n=1104/1200). The prevalence of goitre among school children in Sarawak was 2.9% (5.2% in urban, 0.7% in rural). The median urinary iodine concentration (UIC) among the school children was 102.1 µg/L (IQR, 62.3-146.5 µg/L). Urban children had significantly higher median UIC of 109.3 µg/L (IQR, 72.4-159.0 µg/L) than their rural counterparts [91.9 µg/L (IQR, 55.7-140.2 µg/L)]. The salt samples tested by rapid test kit (RTK) showed only 46.0% of household salt contained iodine. The present study revealed that the population in Sarawak were of borderline iodine sufficient with mild IDD seen in rural areas. Hence, the state IDD control programmes need to encourage and advocate the consumption of iodized salt in order to eliminate IDD-related health problems in Sarawak.
Congenital Hypothyroidism ; Goiter ; Schools ; Child ; Malaysia

Following the reveal of borderline iodine sufficiency among the Sarawakians from the 2008 National Iodine Deficiency Disorders (IDDs) survey, a mandatory universal salt iodization (USI) was implemented in Sarawak thereafter. This study aimed to determine the current status of USI in Sarawak after a 3-year implementation of USI from 2008 to 2011. The IDD survey was conducted between Jun 2011 to July 2011 involving six districts in Sarawak (Sarikei, Mukah, Kapit, Sibu, Bintulu and Miri). The schools were selected via multistage proportionate-to-population size sampling technique and the children were randomly selected via systematic sampling. A total of 19 schools and 661 children were recruited into the survey. Thyroid size was determined by palpation and was and graded according to the classification of the World Health Organization (grade 0-2). The iodine excretion level in spot morning urine was measured using in-house microplate method. The urinary iodine concentration (UIC) values were compared by Kruskal-Wallis test and Chi-square tests were used to compare categorical variables. A total of 610 school children were participated in the study (92.3%). The TGR of grade 1 and 2 was found to be 0.3% (n = 2). Overall the median UIC level was 154.2 (IQR, 92.7 - 229.8) µg/L, with the highest median UIC been observed in Sarikei [178.0 (IQR, 117.6 - 308.9) µg/L], followed by Mukah [174.8 (IQR, 99.0 - 224.3) µg/L)], Miri [158.6 (IQR, 92.3 - 235.4) µg/L], Sibu [147.0 (IQR, 89.8 - 221.4) µg/L], Bintulu [142.3 (IQR, 52.8 - 245.1) µg/L] and Kapit [131.0 (IQR, 88.6 - 201.9) µg/L]. One in every ten child was of iodine deficient (UIC < 50µg/L) while a third of the child (32%) were of adequate level of UIC. The present findings indicate that the mandatory USI successfully improves the iodine level of children in Sarawak. However, regular and proper monitoring of the UIC level in the communities is needed to prevent excessive iodine intake.​

OBJECTIVE: Lister's tubercle is used as a standard anatomical landmark in hand surgery and arthroscopy procedures. In this study, we aimed to evaluate and propose a classification for anatomical variants of Lister's tubercle. MATERIALS AND METHODS: Between September 2011 and July 2014, 360 MRI examinations for wrists performed using 1.5T scanners in a single institution were retrospectively evaluated. The prevalence of anatomical variants of Lister's tubercle based on the heights and morphology of its radial and ulnar peaks was assessed. These were classified into three distinct types: radial peak larger than ulnar peak (Type 1), similar radial and ulnar peaks (Type 2) and ulnar peak larger than radial peak (Type 3). Each type was further divided into 2 subtypes (A and B) based on the morphology of the peaks. RESULTS: The proportions of Type 1, Type 2, and Type 3 variants in the study population were 69.2, 21.4, and 9.5%, respectively. For the subtypes, the Type 1A variant was the most common (41.4%) and conformed to the classical appearance of Lister's tubercle; whereas, Type 3A and 3B variants were rare configurations (6.4% and 3.1%, respectively) wherein the extensor pollicis longus tendon coursed along the radial aspect of Lister's tubercle. CONCLUSION: Anatomical variations of Lister's tubercle have potential clinical implications for certain pathological conditions and pre-procedural planning. The proposed classification system facilitates a better understanding of these anatomical variations and easier identification of at-risk and rare variants.
Arthroscopy ; Classification* ; Hand ; Magnetic Resonance Imaging* ; Prevalence ; Retrospective Studies ; Tendons ; Wrist

Objective To explore the mechanisms by which hydrogen sulfide (H2S) regulates collagen metabolism during hypoxic pulmonary vascular structural remodeling. Methods Wistar rats were randomly divided into control group (n=6), hypoxia group (n = 6) and hypoxia+NaHS group(n= 6) H2S content in plasma was measured with spectrophotometry. The expression of collagen I was detected by immunohistochemistry. The expression of tissue inhibitor of metalloproteinase-1(TIMP-1) mRNA was detected with situ hybridization Results Compared with hypoxia group, H2S content in plasma increased significantly and the expressions of collagen I and TIMP-1 mRNA in pulmonary arteries were down- regulated in hypoxia + NaHS group. The H2S content in plasma negatively correlated with TIMP-I mRNA expression. Conclusions H2S increases the degradation of collagen in small and media pulmonary arteries of rats under hypoxia by decreasing the synthesis of TIMP-1, and therefore, attenuats the collagen remodeling in pulmonary arteries of hypoxic rats.