Body Fluids ; physiology ; Dehydration ; metabolism ; prevention & control ; Fluid Therapy ; methods ; standards ; Humans ; Practice Guidelines as Topic

Several modifiable risk factors for sudden infant death syndrome (SIDS) have been identified such as sleeping prone or on the side, sleeping on a soft surface, bed-sharing, no prenatal care and maternal ante-natal smoking. A crosssectional survey of infant sleep and care practices was conducted among parents of babies aged below 8 months to determine the prevalence and predictors of non-supine sleep position and the prevalence of other high-risk infant care practices for SIDS. Of 263 infants, 24.7% were placed to sleep in the non-supine position and age of infants was a factor positively associated with this (adjusted odds ratio 1.275, 95% CI=1.085, 1.499). The most common modifiable risk factor was the presence of soft toys or bedding in the infants’ bed or cot (89.4%). Results from this study indicate that although the predominant sleep position of Malaysian infants in this population is supine, the majority of infants were exposed to other care practices which have been shown to be associated with SIDS.

INTRODUCTIONThe revised Human Organ Transplant Act (HOTA) was implemented in Singapore in July 2004. We aim to evaluate expanding the potential donor pool for liver transplant in Singapore with the inclusion of marginal donors.

MATERIALS AND METHODSAll donor referrals between July 2004 and June 2007 were studied. All potential deceased liver donors were heart-beating. After being reviewed by the transplant coordinator, potential donors were assessed by a transplant hepatologist and a transplant surgeon for suitability of organ donation strictly based on the programme's donor assessment protocol. Reasons for rejection as potential donors were documented. The clinical characteristics of all donor referrals were retrospectively reviewed, and an independent decision was made as to whether liver retrieval in each rejected case might have been possible.

RESULTSAmong the 128 potential donor referrals, 20 donors (15.6%) underwent liver retrieval. Of the 20 livers retrieved, 16 were implanted and 4 were not implanted (3 unfit recipients, and 1 donor liver with 40% steatosis). Another 10 donor livers were assessed intraoperatively and were rejected because of varying levels of steatosis. Of these livers assessed, 5 donor livers had steatosis <40% and 5 had steatosis >40%. Of the remaining potential donors, 45 were deemed not possible because of prolonged hypotension (9), on-going or unresolved sepsis (13), high-risk behaviour (4), non-actualisation (8), or pre-existing medical conditions (11). Another 53 donors may potentially have been suitable donors but were rejected because of possible sepsis (13), no suitable recipients (12), transient hypotension (10), transient abnormal liver function test (6), history of alcohol ingestion (5), non-actualisation because of consent (4) and other reasons (3). Overall, it was deemed that 61 donors (47.7%) might potentially have been suitable liver donors.

CONCLUSIONSDespite new legislation (HOTA) in Singapore, the utilisation of cadaveric donor livers showed no increase in the last 3 years. By expanding our donor criteria to include marginal donors, we could potentially increase the availability of deceased donor livers to meet our waiting list demands.

Adult ; Female ; Humans ; Liver Transplantation ; Living Donors ; legislation & jurisprudence ; supply & distribution ; Male ; Middle Aged ; Referral and Consultation ; organization & administration ; Retrospective Studies ; Singapore ; Tissue and Organ Procurement ; legislation & jurisprudence ; Waiting Lists

Background: Neuropathic symptoms and signs are common in the elderly and are often considered normal fi ndings. However, symptomatic polyneuropathy may contribute to disability and falls in the elderly. The prevalence of peripheral neuropathy in the elderly in Malaysia has not been previously reported. The objective of this pilot study is to determine the frequency of symptomatic sensory polyneuropathy in a group of elderly subjects in the community and their possible associated factors. Methods: Cross sectional survey of subjects aged 65 years and above, carried out in an urban neighbourhood in Petaling Jaya. Using a standardised questionnaire, subjects were asked about sensory neuropathic symptoms, associated medical conditions and social habits. They were examined for the ankle refl ex, vibration, joint position, and pinprick sensations. Possible symptomatic sensory polyneuropathy was defi ned as bilateral distal neuropathic symptoms, loss of pinprick sensation and proprioception sense. Results: Of the 100 subjects, 63% had neuropathic symptoms and signs and 20% had possible symptomatic sensory polyneuropathy. Subjects with polyneuropathy complained of more postural instability and giddiness and distal weakness. Diabetes mellitus was associated with the presence of neuropathic symptoms and signs but not with polyneuropathy. Age was signifi cantly associated with polyneuropathy. Conclusion: The frequency of symptomatic sensory polyneuropathy in a group of elderly subj

To identify the 'physiatry' in a single word is difficult. This may be due that physiatry originated from two different fields, physical medicine and rehabilitation and focuses on assisting the general improvement of functional recovery in disabled patients. In addition, physiatry has new markets to develop; health and welfare. Therefore, the identity of physiatry will change depending on how physiatrists act in these fields. We attempt to define the physiatry from several aspects.
Humans ; Physical and Rehabilitation Medicine

Anticoagulants ; therapeutic use ; Atrial Fibrillation ; etiology ; genetics ; therapy ; Catheter Ablation ; Humans ; Thromboembolism ; prevention & control ; United States

OBJECTIVE: The object of this study was to assess the accuracy of dipyridamole stress intravenous (IV) myocardial contrast echocardiography (MCE) using pulse inversion harmonic imaging and PESDA in the detection of perfusion defect in the patients with coronary artery disease in comparison with dipyridamole stress Tc-99m sestamibi SPECT. METHODS: Total 46 patients (29 males, mean age 64 years old) were consecutively enrolled. Patients with prior myocardial infarction were excluded. MCE and Tc-99m sestamibi SPECT were performed at the same day during rest and after 0.56 or 0.84mg/Kg dipyridamole infusion. Continuous IV infusion of PESDA (2-5 mL/min) was administered while obtaining triggered (1:1) end-systolic apical 2, 4 chamber and long axis views. Tc-99m sestamibi was injected 3 minutes after dipyridamole. Tc-99m sestamibi SPECT images were obtained one hour later. Coronary angiography was followed within two days in all patients. Tc-99m sestamibi SPECT images were matched to the sixteen segments of left ventricle according to American Society of Echocardiography for segmental comparison. Both images were analyzed visually. Results Using coronary angiography as the standard, MCE showed overall sensitivity of 70.7%, specificity of 95.8%, positive predictive value (PPV) of 87.8% and negative predictive value (NPV) of 88.5% in the detection of coronary atherosclerosis (70% stenosis). Tc-99m sestamibi SPECT showed sensitivity of 75.6%, specificity of 98.9%, PPV of 96.8% and NPV of 90.6%. The overall concordance rate between MCE and Tc-99m sestamibi SPECT for the detection of perfusion defects was 86.9% (Cohen's kappa value 0.63) according to the coronary territory and 86.8% (Cohen's kappa value 0.55) according to segmental analysis. CONCLUSION: Dipyridamole stress IV MCE using pulse inversion harmonic imaging and PESDA is feasible and comparable to Tc-99m sestamibi SPECT in identifying significant coronary stenosis and inducible myocardial perfusion defects in the patients with coronary artery disease. MCE using pulse inversion harmonic imaging seems to be a promising modality for assessing myocardial perfusion in the patients with suspected coronary artery disease.
Axis, Cervical Vertebra ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Dipyridamole ; Echocardiography* ; Heart Ventricles ; Humans* ; Male ; Myocardial Infarction ; Perfusion* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: The diagnosis of influenza based on clinical grounds alone may be inaccurate, because the presenting symptoms of influenza are similar to those caused by other infectious agents. We evaluate two influenza rapid tests, SD BIOLINE Influenza Ag (Standard Diagnostic inc., Yongin, Korea) and QuickVueTM Influenza Test (Quidel corporation, San Diego, USA) with influenza virus culture and RT-PCR. METHODS: The two commercially available rapid test kits, SD BIOLINE Influenza Ag and QuickVueTM Influenza Test, for influenza virus detection were evaluated with 189 respiratory specimens collected during Dec. 2004 to Nov. 2005 in Vietnam and compared with viral culture and RT-PCR. RESULTS: Overall, the SD BIOLINE Influenza Ag and QuickVueTM Influenza Test showed high sensitivities (88.4% and 82.6%, respectively) and high specificities (99.0% and 99.0%, respectively), high positive predictive value (PPV) (98.7% and 98.6%, respectively) and high negative predictive value (NPV) (91.1% and 87.2%, respectively). CONCLUSION: Both SD BIOLINE Influenza Ag and QuickVueTM Influenza Test were easy to perform and showed high sensitivity and can be used as an additional tool for rapid diagnosis of influenza virus.
Diagnosis ; Gyeonggi-do ; Immunoassay* ; Influenza, Human* ; Membranes* ; Orthomyxoviridae* ; Sensitivity and Specificity ; Vietnam

OBJECTIVE: To identify the precise locations of the motor branches and motor points of hamstring and triceps surae muscles to the bony landmarks. METHOD: Twenty-eight limbs of 14 adult cadavers were anatomically dissected. The adult cadavers were selected randomly without regard to gender and age. The cadravers which were unable to obtain a neutral position or which received a trauma to the posterior thighs or the lower legs were excluded from the study. The number and location of the motor branches and motor points from sciatic nerve to each hamstirng muscles and from tibial nerve to each triceps surae muscles were identified related to the bony landmarks. Bony landmarks were ischial tuberosity, medial and lateral epicondyles of femur, and medial and lateral malleolli of tibia. The length of femur was defined as the distance from the ischial tuberosity to the intercondylar line of femur and the length of lower leg was defined as the distance from the intercondylar line of femur to the intermalleolar line of tibia. The locations of the muscular branches and the motor points were expressed as the percentage of the length of femur and lower leg. RESULTS: One muscular branch from the sciatic nerve to the semimembranosus muscle and from the posterior tibial nerve to the soleus muscle, and one or two muscular branches to the biceps femoris, semitendinosus, and semimembranosus, medial gastrocnemius, lateral gastrocnemius and soleus muscle were located at 23.0+/-5.7%, 21.0+/-10.5%, 25.0+/-10.3% of the femur from the ischial tuberosity and 2.0+/-6.2%, 4.0+/-3.3% and 10.0+/-3.3% of the lower leg from the intercondylar line of femur. There were one to four motor points in the hamstring and triceps surae muscles. The motor points of biceps femoris, semitendinosus and semimembranosus were located at 33.0+/-7.8%, 28.0+/-14.5% and 48.0+/-19.0% of the femur. The motor points of the medial gastrocnemius, lateral gastrocnemius and soleus were located in 5.0+/-0.6%, 10.0+/-3.0% and 18.0+/-4.3% of the lower leg below the intercondylar line of femur. CONCLUSION: The identification of the locations of muscular branches and motor points related to the bony landmarks from this study would increase the accuracy of the motor branch blocks or motor point blocks to the hamstrings and triceps surae muscles.
Adult ; Cadaver ; Extremities ; Femur ; Humans ; Leg ; Muscle, Skeletal ; Muscles* ; Sciatic Nerve ; Thigh ; Tibia ; Tibial Nerve

Extracellular vesicles (EVs) function as potent mediators of intercellular communication for many in vivo processes, contributing to both health and disease related conditions. Given their biological origins and diverse functionality from correspondingly unique “cargo” compositions, both endogenous and modified EVs are garnering attention as promising therapeutic modalities and vehicles for targeted therapeutic delivery applications. Their diversity in composition, however, has revealed a significant need for more comprehensive analytical-based characterization methods, and manufacturing processes that are consistent and scalable. In this review, we explore the dynamic landscape of EV research and development efforts, ranging from novel isolation approaches, to their analytical assessment through novel characterization techniques, and to their production by industrial-scale manufacturing process considerations. Expanding the horizon of these topics to EVs for in-human applications, we underscore the need for stringent development and adherence to Good Manufacturing Practice (GMP) guidelines. Wherein, the intricate interplay of raw materials, production in bioreactors, and isolation practices, along with analytical assessments compliant with the Minimal Information for Studies of Extracellular Vesicles (MISEV) guidelines, in conjunction with reference standard materials, collectively pave the way for standardized and consistent GMP production processes.