BACKGROUND: HbA1c measurement is currently routinely used to predict long term outcome of diabetes, thus playing a fundamental role in the management of diabetes. The relationship between HbA1c value and long term diabetic complications has been established by a randomised control Diabetes Control and Complications Trial (DCCT) which used high performance liquid chromatography (HPLC) as a reference method for HbA1c assay. To ensure that HbA1c results from a variety HbA1c assay methods are similar to the DCCT values, the American Diabetes Association (ADA) recommended that all laboratories should use methods certified by the National Glycohemoglobin Standardization Programme (NGSP) with interassay coefficient variation (CV) of < 5% (ideally < 3%). The International Federation of Clinical Chemistry (IFCC) working group on HbA1c standardisation has set a CV < 2.5% as a criteria for its reference laboratories. OBJECTIVES: To evaluate the performance of Arkray Adams HA-8160 HbA1c analyser which uses a cation exchange HPLC method and its correlation to HbA1c assay on Cobas Integra 800 which is an immunoturbidimetric method. METHODS: For the imprecision study, patient samples and control material of two levels were analysed on HA-8160 analyser 20 times in a single run (within-run imprecision) and twice a day on five consecutive days (between-run imprecision). For the recovery study, two samples each with high and low values were selected and mixed in ratios of 1:3, 1:1 and 3:1, and were analysed by HA-8160. Sixty samples were analysed by both Cobas Integra 800 and HA-8160 for method comparison study. Ten uraemic samples and ten thalassaemic samples were assayed on Cobas Integra 800 and HA 8160 for interference study. RESULTS: Within-run CVs were 0.6% and 0.7% for medium and high value samples respectively, 0.6% and 0.7% for low and high level controls respectively. Between-run CVs were 0.5% and 0.4% for medium and high value samples respectively, 0.5% and 0.6% for low and high level controls respectively. The mean recovery was 100.1%. A good correlation between the 2 methods (Adams = 1.00 Cobas - 0.11, r = 0.98) was observed. CONCLUSIONS: The Akray Adams HA-8160 HbA1c analyser performed within the target CV of < 2.5% and showed a good correlation with the Cobas Integra 800.
Glycosylated hemoglobin A ; Sjogren's syndrome B antibody ; Adams ; Performance ; cyclophosphamide/etoposide

Adult ; Amputation ; methods ; Female ; Humans ; Knee Joint ; Leg Injuries ; surgery ; Male ; Surgical Flaps

Animals ; Behavior, Animal ; Blindness ; rehabilitation ; Bonding, Human-Pet ; Culture ; Dogs ; Humans ; Locomotion ; Singapore

INTRODUCTIONIntra-articular fractures of the distal radius represent high energy, complex, unstable injuries and the optimal method of treatment remains controversial.

MATERIALS AND METHODSThe aim of the paper is to compare the outcomes of external fixation (EF) with open reduction internal fixation (ORIF) with plates and screw fixation in the treatment of intra-articular fractures of the distal radius. Thirty-five patients were enlisted from December 2003 to September 2005 after a failure of initial conservative treatment. The patients were randomised into EF or ORIF groups. The patients were followed-up at 1 week, 3, 6, 12 and 24 months. Clinical and radiological outcomes were measured. They were scored using the Green and O'Brien or the Gartland and Wertley score.

RESULTSOf the 35 patients, 5 defaulted the 6-month follow-up and were excluded. We found that the clinical and radiological outcomes for the 2 groups were not significantly different. Complication rates were also similar.

CONCLUSIONThere is no significant difference in the outcome of intra-articular distal radius fractures treated with either EF or ORIF.

Adult ; Bone Plates ; Bone Screws ; External Fixators ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Radiography ; Radius Fractures ; diagnostic imaging ; surgery ; Range of Motion, Articular ; Recovery of Function ; Wrist Injuries ; diagnostic imaging ; surgery ; Young Adult

BACKGROUND: Complex elbow injuries with associated nerve, muscle, or joint injury commonly develop post-inury stiffness. In order to preserve function, joint congruency, elbow stability and durable wound coverage must be achieved in a timely manner. METHODS: A retrospective review of patients who underwent orthopaedic fixation followed by free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients were identified and included in this study. RESULTS: We present a series of 5 cases managed with this principle. Soft tissue defects ranged in size from 4x9 cm (36 cm2) to 15x30 cm (450 cm2) and were located either posteriorly (n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nerve transection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11 to 42 day). There were no flap failures and no major complications. The mean postoperative active elbow motion was 102degrees (range, 45degrees to 140degrees). CONCLUSIONS: In our small series we have highlighted the safety and utility of using the free ALT flap in complex elbow injuries. The ALT flap has many advantages which include abundant skin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our series to obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and, access to fascia lata grafts for reconstruction of the triceps tendon.
Elbow ; Elbow Joint ; Fascia Lata ; Fractures, Open ; Free Tissue Flaps ; Humans ; Joints ; Muscles ; Quadriceps Muscle ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skin ; Tendons ; Thigh ; Transplants

A hemodynamic model of capillary and tissue, in which tissue pressure changed with swing manipulation of Traditional Chinese Medical Massage (TCMM), is presented in this paper to explain the hemodynamic mechanism of swing manipulation. Blood flowed in capillary with low Reynolds number. Plasma exuded through capillary according to the Starling's Law. Tissue pressure changed linearly with the massage force measured. Blood apparent viscosity, plasma protein concentration and red cell's hematocrit were taken into account. Capillary flow rate, blood apparent viscosity, filtration rate and filtration fraction with dynamical change of tissue pressure were calculated numerically, and were compared with those in static tissue pressure condition. Results showed that, dynamical change of tissue pressure led to the increase of capillary flow rate and the decrease of blood apparent viscosity, which qualitatively explained the hemodynamic mechanism of "promoting blood circulation and removing blood stasis" in swing manipulation of TCMM.
Biomechanical Phenomena ; Blood Flow Velocity ; Blood Viscosity ; Capillaries ; physiology ; Hematocrit ; Hemodynamics ; Humans ; Massage ; Models, Cardiovascular ; Pressure ; Regional Blood Flow

INTRODUCTIONThe clinical management of Smooth Muscle Tumours of Uncertain Malignant Potential (STUMPs) remains controversial because little is known about the natural history of these tumours and pathological classifications do not correlate well with clinical outcomes and therefore cannot direct management. The objective of this study was to review a single institution's experience with STUMP and recommend a rational clinical approach to the management of patients with this histological diagnosis.

MATERIALS AND METHODSA systematic review of all diagnoses of STUMP and leiomyosarcoma from the gynaecologic oncology and pathology databases between January 1970 and February 2006.

RESULTSA total of 18 diagnoses of STUMP and 72 diagnoses of Ieiomyosarcoma were made during the study period. None of these 72 cases of leiomyosarcoma had a prior diagnosis of STUMP. There were no recurrences in the 18 cases of STUMP with all 18 cases being registered as disease-free after 5 years.

CONCLUSIONSWe recommend that patients with a diagnosis of STUMP be expectantly managed given the low likelihood of leiomyosarcomatous transformation, the lack of any evidence that adjuvant treatments result in better long-term outcomes and that recurrences are amenable to surgical resection with good outcomes.

Adult ; Female ; Humans ; Leiomyoma ; diagnosis ; pathology ; surgery ; Retrospective Studies ; Smooth Muscle Tumor ; diagnosis ; pathology ; surgery ; Uterine Neoplasms ; diagnosis ; pathology ; surgery ; Uterus ; pathology ; surgery

Background/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines. Methods: We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis. Results: Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis. Conclusions The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool.

Background/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines. Methods: We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis. Results: Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis. Conclusions The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool.

INTRODUCTIONThis study reviewed the epidemiological trends of poliomyelitis from 1946 to 2010, and the impact of the national immunisation programme in raising the population herd immunity against poliovirus. We also traced the efforts Singapore has made to achieve certification of poliomyelitis eradication by the World Health Organisation.

MATERIALS AND METHODSEpidemiological data on all reported cases of poliomyelitis were obtained from the Communicable Diseases Division of the Ministry of Health as well as historical records. Coverage of the childhood immunisation programme against poliomyelitis was based on the immunisation data maintained by the National Immunisation Registry, Health Promotion Board. To assess the herd immunity of the population against poliovirus, 6 serological surveys were conducted in 1962, 1978, 1982 to 1984, 1989, 1993 and from 2008 to 2010.

RESULTSSingapore was among the fi rst countries in the world to introduce live oral poliovirus vaccine (OPV) on a mass scale in 1958. With the comprehensive coverage of the national childhood immunisation programme, the incidence of paralytic poliomyelitis declined from 74 cases in 1963 to 5 cases from 1971 to 1973. The immunisation coverage for infants, preschool and primary school children has been maintained at 92% to 97% over the past decade. No indigenous poliomyelitis case had been reported since 1978 and all cases reported subsequently were imported.

CONCLUSIONSingapore was certified poliomyelitis free along with the rest of the Western Pacific Region in 2000 after fulfilling all criteria for poliomyelitis eradication, including the establishment of a robust acute flaccid paralysis surveillance system. However, post-certification challenges remain, with the risk of wild poliovirus importation. Furthermore, it is timely to consider the replacement of OPV with the inactivated poliovirus vaccine in Singapore's national immunisation programme given the risk of vaccine-associated paralytic poliomyelitis and circulating vaccine-derived polioviruses.

Adolescent ; Certification ; Child ; Child, Preschool ; Disease Eradication ; organization & administration ; Female ; Humans ; Infant ; Male ; Poliomyelitis ; epidemiology ; prevention & control ; virology ; Poliovirus ; immunology ; Singapore ; epidemiology