Cardiology ; trends ; Pediatrics ; trends ; Singapore

Enormous progresses have been made in recent years for the involvement of nervous system in particular the vagus nerve in inflammatory responses. The parasympathetic nerve can be activated by “inflammatory reflex” to inhibit macrophages, via their specific nicotinic receptor ?-7 subunit, and hence to reduce the production of tumor necrosis factor (TNF) that plays a pivotal role in many inflammatory reactions and is a key mediator for septic shock. This cholinergic anti-inflammatory pathway has been utilized, with positive outcomes, by means of either pharmacological or electrical stimulation in animal models against inflammatory responses and septic shock. Monoclonal antibodies against TNF and other pro-inflammatory cytokines have also been developed and used against inflammation experimentally and clinically. Although clinical use of these new treatments have yielded primitive and only limited results, these new research findings and concepts are important for the advance of modern medicine, as well as for better comprehension of some theories and practices in traditional medicine. Future directions are discussed herewith. [

Acute Coronary Syndrome ; Brain Ischemia ; complications ; pathology ; Carotid Arteries ; pathology ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; pathology ; Dyspnea ; Female ; Fibrinolytic Agents ; administration & dosage ; therapeutic use ; Humans ; Middle Aged ; Myocardial Infarction ; etiology ; pathology ; Risk Factors ; Stroke ; complications ; pathology ; Time Factors ; Tissue Plasminogen Activator ; administration & dosage ; therapeutic use

Four hundred and nineteen articles related to breast cancer were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000-2013. One hundred and fifty four articles were selected and reviewed on the basis of clinical relevance and future research implications. Overall, Malaysian women have poor survival from breast cancer and it is estimated that half of the deaths due to breast cancer could be prevented. Five-year survival in Malaysia was low and varies among different institutions even within the same disease stage, suggesting an inequity of access to optimal treatment or a lack of compliance to optimal treatment. Malaysian women have poor knowledge of the risk factors, symptoms and methods for early detection of breast cancer, leading to late presentation. Moreover, Malaysian women experience cancer fatalism, belief in alternative medicine, and lack of autonomy in decision making resulting in delays in seeking or avoidance of evidence-based medicine. There are ethnic differences in estrogen receptor status, HER2 overexpression and incidence of triple negative breast cancer which warrant further investigation. Malay women present with larger tumours and at later stages, and even after adjustment for these and other prognostic factors (stage, pathology and treatment), Malay women have a poorer survival. Although the factors responsible for these ethnic differences have not been elucidated, it is thought that pharmacogenomics, lifestyle factors (such as weight-gain, diet and exercise), and psychosocial factors (such as acceptance of 2nd or 3rd line chemotherapy) may be responsible for the difference in survival. Notably, survivorship studies show self-management programmes and exercise improve quality of life, highlighting the need to evaluate the psychosocial impact of breast cancer on Malaysian women, and to design culturally-, religiously- and linguistically-appropriate psycho-education programmes to help women cope with the disease and improve their quality of life. Research done in the Caucasian populations may not necessarily apply to local settings and it is important to embark on local studies particularly prevention, screening, diagnostic, prognostic, therapeutic and psychosocial research. KEY WORDS: breast cancer; Malaysia; review; genetics; screening; diagnosis; prognosis; treatment; outcome

In-utero intestinal volvulus is a rare but potential life threatening foetal complications. It is a surgical emergency and delay in diagnosis or treatment can increase the morbidity and mortality to the foetus. We report a case of mild foetal bowel dilatation diagnosed at 21 weeks of gestation. She was closely follow up and at 31 weeks of gestation, in-utero intestinal volvulus was diagnosed with the characteristic ‘whirlpool’ sign on ultrasound examination. This case emphasises the importance of early recognition and quick decision to delivery when intestinal volvulus is diagnosed. This enabled early surgical intervention to prevent further foetal morbidity.
Intestinal Volvulus

History, 19th Century ; History, 20th Century ; Humans ; Neurology ; history ; Nobel Prize ; Philately ; Portugal ; Psychosurgery ; history ; methods

Su rgical treatment of glaucoma has been classified as cyclodestructive(reducing inflow)or filtering(increasing outflow).Cyclodestructive procedures have traditionally been reserved for eyes with poor visual prognoses and refractory glaucomas including post-trauma,aphakia,congenital and developmental glaucoma.Since Uram described the first use of endoscopic cyclophotocoa gulation(ECP)in 1992,short and long-term outcomes for ECP have been promising.In the present article,we conduct a Pubmed search and review of published English Iiterature on endoscopic cyclophotocoagulation and comparison with limited results in a single Singapore ophthalmic tertiary hospital.Safety and efficacy of ECP and combined phacoemulsification-ECP procedures in treatment of pediatric and adult glaucomas of various etiologies and severities is reported.Local short-term unpublished results from a single Singapore tertiary ophthalmic service is reported and concurs with previously published results.Published reports and current experience with ECP has demonstrated that ECP with direct visualization of the target tissues avoids the complications associated with blind'trans-scleral cyclophotocoagulation by applying optimum energy to target tissue ciliary epithelium with endoscopic visualization and infrared laser wavelength application.Significant financial barriers exist to introducing this service.It is safe and effective in controlling IOP and reducing reliance on anti-glaucoma medications.Wide spread acceptance and use of this technique awaits large scale randomized controlled studies.

Background: Immortalized human endothelial cells are widely used as in vitro models for debilitating conditions such as cancer, cardiovascular and ocular diseases. Human microvascular endothelial cell (HMEC-1) is immortalized via stable transfection with a gene encoding SV40 large antigen whilst telomerase-immortalized human microvascular endothelial (TIME) cells is immortalized by engineering the human telomerase catalytic protein (hTERT) into primary microvascular endothelial cells. Here, we established a three-dimensional (3D) spheroid invasion assay with HMEC-1 and TIME and compared the difference in their ability to invade through the collagen matrix in response to exogenous growth factors, namely vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). Methods: TIME and HMEC-1 spheroids were embedded in a collagen matrix. The spheroids were stimulated with exogenous growth factors, namely VEGF (50ng/mL) and bFGF (200ng/mL). Twelve points of invasion length from a spheroid was measured using image analysis software, Image J. Three independent experiments were conducted and data was analysis by GraphPad Instat software, version 3.05. Results: TIME spheroid invasion was 16.5 fold higher with exogenous VEGF (50ng/mL) and bFGF (200ng/mL) treatment as compared to those cultured in complete growth medium only. In contrast, no significant difference was observed between HMEC-1 spheroids stimulated with and without exogenous growth factors, VEGF and bFGF. Conclusions: This is the first report on the establishment of a 3D-spheroid invasion assay with TIME cells. The requirement of VEGF and bFGF for TIME spheroids invasion is a novel finding. In addition, this assay offers an advantage over HMEC-1 for testing novel angiogenic agents since it is not affected by endogenously secreted growth factors.

This study validates The Malay Version of The Inventory of Socially Supportive Behaviour. Methods: The psychometric properties of the ISSBMalay Version were examined on sixty-eight women who were Malay native speakers and diagnosed with breast cancer. Respondents answered the questionnaire at three weeks and ten weeks following surgery for breast cancer. Results: The Malay Version of ISSB showed excellent internal consistency (Cronbach’s alpha=0.96). Test-retest Intraclass Correlation Coefficient (ICC) was 0.03. Small mean differences were observed at test-retest measurement with Effect Size Index 0.18. Conclusion: The Malay Version of the ISSB could be an appropriate tool to measure the supportive behavior of the Malaysian population.
Social Support ; Psychometrics

The aim of this study is to assess tissue and serum prostate-specific antigen (PSA) in breast lesions; to compare tissue PSA with serum PSA; to compare tissue PSA in benign and malignant lesions and to compare PSA with known prognostic factors in breast carcinoma. Tissue PSA immunoreactivity in twenty women with breast carcinoma was compared with PSA in twenty-three women with benign breast lesions. Tissue PSA was also compared with known prognostic indicators such as tumour size, axillary nodal status, histological type, histological grade, oestrogen receptor status, progesterone receptor status and c-erbB-2 oncoprotein over-expression. Serum free PSAlevels from these women were measured pre- and post-operatively and an attempt was made to correlate serum PSA with tissue PSA expression. 40% and 43% of malignant and benign breast lesions respectively showed tissue PSA immunoreactivity. No significant difference was observed in the tissue PSA expression between these two groups as also between tissue PSA and known prognostic indicators. As serum PSA levels were below the detection limit (< 0.004 ng/ml) in all except two benign cases, no statistical evaluation was done for the latter. Tissue PSA expression did not correlate with other prognostic markers and detectable serum PSA levels were present in too few cases for statistical analysis. Although no definitive conclusion is possible in this preliminary study regarding the role of PSA in breast disease, it stimulates interest in further research in this direction.
public service announcement ; Tissues ; Serum ; Breast ; seconds