A study to determine average knee laxity in the Malaysian population and how it affects daily living was conducted at the University Malaya Medical Centre between January and April 2004. Fifty two male and 76 female subjects were recruited for this study, all of whom were healthy volunteers with no ambulatory problems. Side to side knee laxity testing was performed using a KT 1000 arthrometer. Significant differences in knee laxity were noted among different races and between sexes. For instance, overall,

Atrial fibrillation (AF) is a major public health problem and poses a substantial economic burden on healthcare systems worldwide.[1-4] The emergency department (ED) serves as the first point of contact with the healthcare system and plays a key role in the management of patients with AF, which accounts for 3%-10% of all hospital admissions.[5]Treatment plans are often discussed and initiated at the ED.

Objective　To explore the characteristics of oncoprotein expression of c-fos and c-jun in hypertrophic scars and chronic dermal ulcers and their regulation of basic fibroblast growth factor (bFGF). Methods　Tissues of hypertrophic scars (n=8), chronic dermal ulcers (n=8) and normal skin (n=5) were taken from 21 patients with burns and chronic dermal ulcers in operation. The ABC immunohistochemical method was used to characterize the gene product expression of c-fos, c-jun and bFGF in the above tissues. Results　In normal skin, both c-fos and c-jun protein expression and bFGF protein expression were observed. The signals of both oncoproteins were localized mainly in subcutaneous fibroblasts, but, positive expression of the bFGF protein was mainly in keratinocytes. In hypertrophic scars, positive expression of both oncoproteins could be found mainly in fibroblasts, but bFGF was mainly in fibroblasts and endothelial cells. In chronic dermal ulcers, endothelial cells, some of inflammatory cells and fibroblasts were positive for both of oncoproteins, but the expression of bFGF was only seen in fibroblasts and endothelial cells. Conclusions　The results indicate that the interaction between both oncoproteins and bFGF exists, and the regulating action between protooncogenes and bFGF is a major course in wound healing. The different expressions of c-fos and c-jun gene products play an important role in regulate bFGF action, thus affecting wound healing.

Purpose: Treatment-resistant cluster headache can be successfully alleviated with deep brain stimulation (DBS) of the posterior hypothalamus [1]. Magnetoencephalography (MEG) is a non-invasive functional imaging technique with both high temporal and high spatial resolution. However, it is not known whether the inherent electromagnetic (EM) noise produced by high frequency DBS is compatible with MEG. Materials and methods: We used MEG to record brain activity in an asymptomatic cluster headache patient with a DBS implanted in the right posterior hypothalamus while he made small movements during periods of no stimulation, 7 Hz stimulation and 180 Hz stimulation. Results: We were able to measure brain activity successfully both during low and high frequency stimulation. Analysis of the MEG recordings showed similar activation in motor areas in during the patient’s movements as expected. We also observed similar activations in cortical and subcortical areas that have previously been reported to be associated with pain when the patient’s stimulator was turned on or off [2,3]. Conclusion: These results show that MEG can be used to measure brain activity regardless of the presence of high frequency deep brain stimulation.

The management of pink pulseless limbs in supracondylar fractures has remained controversial, especially with regards to the indication for exploration in a clinically well-perfused hand. We reviewed a series of seven patients who underwent surgical exploration of the brachial artery following supracondylar fracture. All patients had a non-palpable radial artery, which was confirmed by Doppler ultrasound. CT angiography revealed complete blockage of the artery with good collateral and distal run-off. Two patients were more complicated with peripheral nerve injuries, one median nerve and one ulnar nerve. Only one patient had persistent arterial constriction which required reverse saphenous graft. The brachial arteries were found to be compressed by fracture fragments, but were in continuity. The vessels were patent after the release of obstruction and the stabilization of the fracture. There was no transection of major nerves. The radial pulse was persistently present after 12 weeks, and the nerve activity returned to full function.
Humerus ; Fractures, Bone

BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia (PSA) to treat emergency department (ED) patients who need to undergo painful procedures. However, 25% of the EDs in the Netherlands are not staffed by emergency physicians. The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians. METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands. Data were gathered using a standardized questionnaire. RESULTS: The response rate was 34.3% (148/432). Of the respondents, 84/148 (56.8%) provided adult PSA and 30/148 (20.3%) provided paediatric PSA. Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure. The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients. CONCLUSION The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.

Aims: Tryptamine is an amine compound derived from tryptophan by decarboxylation process. This compound can be found in fermented food and beverages, and in human gut and skin as well. This study aims to investigate the effect of tryptamine, on Gram-negative bacteria, namely Escherichia coli, Serratia marcescens and Pseudomonas aeruginosa. Methodology and results: In this study, we used E. coli, S. marcescens and P. aeruginosa due to their relatively observable quorum sensing-regulated phenotype, such as motility, prodigiosin and pyocyanin sequentially. Our results showed that tryptamine started to inhibit the growth and prodigiosin production of S. marcescens at concentration 250 μg/mL, while it inhibits the growth and pyocyanin production of P. aeruginosa at concentration 250 μg/mL and 500 μg/mL, respectively. Tryptamine inhibits both the growth and motility of E. coli at concentration 100 μg/mL. Conclusion, significance and impact of study These results suggest that tryptamine is able to inhibit the growth of E. coli, S. marcescens and P. aeruginosa at relatively high concentration, thus decreases the quorum sensing-regulated phenotypes. It implies that the growth and quorum sensing of Gram-negative bacteria most likely will not be affected by the low concentration of tryptamine that present in the gut.
Tryptamines ; Gram-Negative Bacteria ; Serratia marcescens ; Pseudomonas aeruginosa ; Escherichia coli