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Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

Volumen 7 (2013): Heft 6 (December 2013)

Zeitschriftendaten
Format
Zeitschrift
eISSN
1875-855X
Erstveröffentlichung
01 Jun 2007
Erscheinungsweise
6 Hefte pro Jahr
Sprachen
Englisch

Suche

21 Artikel

Editorial

Uneingeschränkter Zugang

Breaking the species barrier

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 731 - 733

Zusammenfassung

Review Article

Uneingeschränkter Zugang

Physicians’ perceptions of patient safety factors: a systematic review and narrative synthesis

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 735 - 742

Zusammenfassung

Abstract

Background: Patient safety (PS) is a global issue that affects both developed and developing countries. Physicians play a key role in overcoming this common healthcare issue.

Objective: To understand the physicians’ perceptions of factors contributing to PS incidents in secondary care.

Methods: Covering a period from 1999 to 2011, three electronic databases were used to identify potential studies for inclusion. Individual searching of selected journals and reference scanning of identified studies were also conducted. To summarize and synthesize the findings, we adopted a narrative synthesis approach, and used a content analysis method directed by Vincent’s framework.

Results: Of 1,405 potentially relevant citations identified, 14 studies ultimately met the inclusion criteria, and were divided into trainee and non-trainee physician studies. Quality scores of included studies ranged from 6 to 12.5 (possible range 1-16). In total, 158 patient safety factors (PSFs) were identified and categorized into seven safety levels and 22 corresponding themes. In all the studies, the rank order of safety levels by frequency of PSFs was: individual = team > work environment > organizational and management > task and technology > contextual > patient. There was an almost similar result in the trainee studies, whereas in the non-trainee studies, the result was almost the reverse.

Conclusion: Overall, the results show a clear tendency for physicians to focus on the proximal causes of PS incidents. This suggests the need for safety skills training. The next research generation would provide a holistic view of physicians’ perceptions of PSFs by moving toward more sophisticated designs, such as mixed-methods.

Schlüsselwörter

  • Medical errors
  • patient safety
  • physicians
  • secondary care

Original article

Uneingeschränkter Zugang

Osteogenic differentiation of human umbilical cord-derived mesenchymal stem cells promoted by overexpression of osterix

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 743 - 752

Zusammenfassung

Abstract

Background: Umbilical cord-derived mesenchymal stem cells (UC-MSCs) are considered to be multipotent mesenchymal stem cells that are easily induced to differentiate into functional osteoblasts both in vitro and in vivo. Osterix (Osx), a novel zinc-⃞nger-containing transcription factor of the Sp family, is required for osteoblast differentiation and bone formation.

Objective: We investigated the effect of Osx on the proliferation and osteogenic differentiation of the UC-MSCs.

Method: The primary UC-MSCs were isolated and cultured. An Osx-expressing plasmid (pEGFP-Osx) was constructed and transfected into UC-MSCs. Then expression of bone morphogenesis-related genes, proliferation rate, alkaline phosphatase activity, and mineralization were examined to evaluate the osteogenic potential of the Osx gene-modified UC-MSCs.

Result: UC-MSCs transfected with pEGFP-Osx exhibited apparent osteogenic differentiation as determined by increased activity of alkaline phosphatase, the formation of mineralized nodules and the expression of related osteoblastic genes.

Conclusion: These results confirmed the ability of Osx to enhance osteoblast differentiation of UC-MSCs in vitro, and the Osx gene-modified UC-MSCs are potential as novel cell resources of bone tissue engineering.

Schlüsselwörter

  • Osteogenic differentiation
  • osterix
  • umbilical cord-derived mesenchymal stem cells
Uneingeschränkter Zugang

Evaluation of cancellous bone density in the alveolar bone by cone-beam computed tomography in Taiwanese adults

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 753 - 760

Zusammenfassung

Abstract

Background: The preoperative evaluation of bone quality and stability at the site of a dental implant is important for the long-term prognosis of the implant.

Objective: We evaluated the density and its distribution of cancellous bone in the alveolar bone between a Taiwanese cohort and a U.S. cohort.

Methods: A retrospective analysis using cone-beam computed tomography (CBCT) images was conducted on 1211 Taiwanese and 154 U.S. adults who were evaluated for dental implants. Reconstructed representations of the anterior, premolar, and molar maxillary regions, and of the anterior, premolar, and molar mandibular regions were evaluated in consideration of age, gender and ethnicity.

Results: The mean cancellous bone density was significantly higher at mandibular as compared to maxillary sites (all p ≤ 0.001). In Taiwanese more than 55 years old, men had higher cancellous bone densities than that in women at all sites (except mandible anterior site) (all p < 0.001). Taiwanese women more than 55 years old had significantly lower bone densities than women less than 55 years old at maxilla anterior and premolar sites and mandible premolar and molar sites (all p < 0.05). This did not occur in Taiwanese men or the U.S. cohort. Taiwanese had higher cancellous bone densities at mandibular sites than the U.S. cohort. Mandibular sites had significantly higher densities than maxillary sites. Taiwanese had higher cancellous bone densities at mandible sites than the U.S. cohort. Male Taiwanese had higher cancellous bone densities than females. For female, but not male, Taiwanese, the cancellous bone density decreased when the age increased.

Conclusion: CBCT can be used to evaluate alveolar cancellous bone density to predict primary stability prior to implantation.

Schlüsselwörter

  • Alveolar
  • bone
  • CBCT
  • density
Uneingeschränkter Zugang

The clinical relevance of urinary soluble fas (sFas) for diagnosis of bilharzial bladder cancer

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 761 - 767

Zusammenfassung

Abstract

Background: Fas/CD95, a membrane-bound type I protein, plays a key role in induction of apoptosis and in tumorigenesis.

Objective: We adapted and evaluated measurement of urinary sFas using enzyme-linked immunosorbent assay and compared the results with voided urine cytology.

Materials and Methods: Voided urine samples were provided from 203 individuals (120 bladder cancer [112 bilharzial]; 43 benign urologic disorders [20 bilharzial dysplastic lesions]; and 40 healthy volunteers). Urine sediment was used for cytology and the supernatant for estimation of sFas by ELISA.

Results: A receiver operating characteristic curve (ROC) was used to determine the best cutoff value for urinary sFas. Positivity rates and mean rank levels for sFas showed significant difference among the three investigated groups (p < 0.0001), and was related to bilharzial infection, pathological type, clinical stages, and histological grades (p < 0. 01). The sensitivity of sFas for early detection of bladder cancer, especially those with superficial and low grades tumors, was superior to urine cytology; moreover, results from sensitivity of urine cytology were improved when combined with sFas.

Conclusion: Urinary sFas may be used as a novel noninvasive diagnostic marker for bilharzial bladder cancer patients. Further multicentric studies are warranted to corroborate these findings and to establish an optimal sFas cut-point.

Uneingeschränkter Zugang

A case control study using radial artery pulse signals to evaluate the low pulsatility index in Koreans

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 769 - 776

Zusammenfassung

Abstract

Background: Noninvasive radial artery pulse signal analysis has been widely used to assess vascular diseases, but there is no evidence of a relationship between the radial artery pulse signal and pulsatility index.

Objective: To determine whether radial artery pulse signal changes in patients with a low pulsatility index would provide diagnostic information for evaluating vascular disease.

Methods: In this case control study, 36 Korean subjects were distributed into two groups, a normal pulsatility index group and a low pulsatility index group, based on their Doppler test results. Multivariate logistic regression analysis of these two groups was conducted to identify significant radial artery pulse signals for evaluating the low pulsatility index. A receiver operating characteristic (ROC) curve analysis was used to evaluate the logistic model.

Results: The low pulsatility index group displayed significantly different radial artery pulse signals compared with the normal pulsatility index group (A1; primary amplitude of right Cun, σ1; shape of the primary wave of right Chi, τ2: secondary phase of left Cun, σ2/L: ratio of the shape of the secondary wave to the length of a single-period waveform). A predictive value for the low pulsatility index was obtained using binary logistic regression, which included A1, σ1, τ2 and σ2/L. A ROC curve analysis assessed the accuracy of the test for low pulsatility index evaluation (AUC=0.931).

Conclusion: A1 (primary amplitude), σ1 (shape of the primary wave), τ2 (secondary phase), and σ2/L (ratio of the shape of the secondary wave to the length of a single-period waveform) derived from radial artery pulse signals may be used to assess a low pulsatility index in Koreans.

Schlüsselwörter

  • Aortic obstruction
  • pulsatility index
  • pulse signal
  • radial artery
  • vascular disease
Uneingeschränkter Zugang

Isolation and cellular properties of mesenchymal stem cells from human periosteum

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 777 - 785

Zusammenfassung

Abstract

Background: Cell-based therapy has achieved good functional recovery for tissue repair. Mesenchymal stem cells (MSCs) exhibit multilineage potential, long-term viability, and capacity for self-renewal. Periosteum-derived mesenchymal stem cells (PD cells) may be an attractive cell source for tissue engineering because of their easy accessibility and reduced ethical concerns.

Objectives: To isolate and investigate the phenotypic and functional characteristics of mesenchymal stem cells derived from human periosteum. We also examined the differentiation of PD cells with a trilineage differentiation assay to determine whether they were MSCs.

Materials and Methods: Periosteum-derived cells were cultured in osteogenic, chondrogenic or adipogenic media to evaluate their multilineage differentiation potential. Adherent fibroblast-like cells were analyzed by flow cytometry for MSC cell surface markers. Differentiation of PD cells into osteogenic, chondrogenic, and adipogenic lineages was also evaluated by von Kossa, Alizarin red, Alcian blue, and oil red O stains, respectively. Expression of mesenchymal stem cell markers were assessed using reverse transcriptase-polymerase chain reaction (RT-PCR) analysis.

Results: We successfully isolated and expanded MSCs from human periosteum. Flow cytometry revealed that PD cells were positive for mesenchymal adhesion cell markers (CD29, CD44, CD90, and CD105) and negative for hematopoietic markers (CD34 and CD45). In osteogenic differentiation, calcium accumulation (positive von Kossa and Alizarin red) and RUNX2, alkaline phosphatase, collagen type I, osteopontin genes were detected. In adipogenic differentiation, the cells displayed oil red O positive and expressed lipoprotein lipase and peroxisome proliferator-activated receptor-gamma (PPAR-γ) associated with adipogenesis. The cells grown in chondrogenic conditions were positively stained for Alcian blue and expressed SOX-9.

Conclusion: PD cells presented osteogenic, chondrogenic, and adipogenic differentiation abilities in vitro and could provide an alternative cellular source for tissue repair in clinical applications.

Schlüsselwörter

  • Adipogenic
  • chondrogenic
  • differentiation
  • mesenchymal stem cells
  • osteogenic
  • periosteum
Uneingeschränkter Zugang

Growth pattern and pubertal development in patients with classic 21-hydroxylase deficiency

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 787 - 794

Zusammenfassung

Abstract

Background: The goal of treatment in children with congenital adrenal hyperplasia (CAH) is to normalize growth and pubertal development. There are limited studies reporting on growth and pubertal outcome in CAH patients from low-resource settings as in Thailand, where CAH newborn screening is lacking, and standard medications are not widely available.

Objective: We analyzed the longitudinal growth data, and pubertal characteristics in children and adolescents with CAH, compared with population-based references.

Methods: Fifty-eight patients with classic 21-hydroxylase deficiency (21OHD) [49 had salt-wasting (SW)-CAH and 9 patients had simple virilizing (SV)-CAH] were retrospectively assessed for growth and pubertal development until they reached their final height (FH). Details of treatment, and hormonal profiles were recorded.

Results: Mean FH SD scores (SDS) of patients were in the lower range of normal population (SW boys -1.88±0.6, SW girls -1.88±1.1 and SV boys -1.06, SV girls -1.56±1.4). Nine of the 19 male, and 6 of the 39 female patients had BMI SDS >2.0. Mean ages of pubertal onset in SW, and SV boys were 8.2±2.4 years, and 7.1±1.9 years, respectively, while in SW girls were 9.7±2.2 years, and SV 7.0±1.7 years. Twelve of the 38 patients had central precocious puberty and required GnRH analog treatment. Total pubertal growth was significantly decreased in the SW group, but not in the SV group; SW boys 15.5±10.6 cm (reference 22.1±3.6 cm), and SW-females 10.6±5.5 cm (reference 18.3±4.0 cm). Glucocorticoid dose was not associated with FH-SDS (n = 19, r = -0.132, p = 0.589). Markedly elevated 17-hydroxyprogesterone and testosterone levels were observed during the pubertal period.

Conclusion: Our results demonstrate poor final height outcome in Thai children with classic 21OHD. Obesity, secondary central precocious puberty, and poor hormonal control are common. These findings necessitate early diagnosis and treatment by establishing newborn screening system in Thailand as well as new treatment regimen and monitoring methods.

Schlüsselwörter

  • Congenital adrenal hyperplasia
  • growth
  • puberty
  • 21-Hydroxylase deficiency
Uneingeschränkter Zugang

Irrigation with water during transurethral resection of the prostate (TURP) induces intravascular hemolysis

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 795 - 802

Zusammenfassung

Abstract

Background: The transurethral resection syndrome TUR syndrome is the most serious complication following transurethral resection of prostate (TURP).

Objective: We compared 5% dextrose in water with sterile water as an irrigating solution and evaluated postoperative intravascular hemolysis.

Methods: A prospective, randomized, controlled trial of 41 benign prostatic hypertrophy (BPH) patients who underwent TURP. The differences between preoperative and postoperative free plasma hemoglobin were measured by using a spectrophotometric method to determine the degree of intravascular hemolysis. Serum glucose and electrolytes were measured preoperatively and postoperatively. Signs and symptoms of TUR syndrome were recorded. Prostatic tissues were weighed. Volumes of irrigating fluid were recorded.

Results: Free plasma hemoglobin was significantly increased in the sterile water group (n = 21) and higher than in the 5% dextrose in water group (n = 20) (p < 0.001). The postoperative plasma glucose was higher in the 5% dextrose in water group (p = 0.007). None of patients developed a TUR syndrome. There was no difference in other serum electrolytes between both groups.

Conclusion: Intravascular hemolysis can be prevented by using 5% dextrose in water instead of sterile water. No correlation between hemolysis and TUR syndrome was found in TURP patients with postoperative stable serum sodium.

Schlüsselwörter

  • Benign prostatic hypertrophy
  • intravascular hemolysis
  • transurethral resection of prostate
  • transurethral resection syndrome
Uneingeschränkter Zugang

CT evaluation of anatomical variations of the internal jugular veins in Thai adults

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 803 - 811

Zusammenfassung

Abstract

Background: The internal jugular vein (IJV) is used to obtain central venous access for various reasons. Awareness of the expected location and anatomic variations of the IJV is very important to avoid inadvertent arterial puncture.

Objective: We evaluated anatomical variations of the IJVs, including diameter, depth from skin surface, relative distance from common carotid artery (CCA) and position in relation to CCA in Thai adults by using CT scan of the neck.

Material and Methods: A total of 77 patients who underwent CT scan of the neck (nasopharynx, larynx) at the Department of Radiology, King Chulalongkorn Memorial Hospital (KCMH) from May 1, 2009 to April 30, 2012 were retrospectively reviewed. The diameter of the IJVs, depth from skin surface and relative distance between the IJVs and CCAs were taken bilaterally. Bilateral CCAs were taken as reference points for measuring the location of the IJVs, recorded as lateral, anterior, medial or posterior position. These parameters were evaluated using the same axial slice at a level of cricoid cartilage, which was compatible with the recommended point for central venous catheter insertion via the IJV. Intra- and interobserver reliability between researcher and another radiologist was assessed by intraclass correlation coefficient (ICC).

Results: The right IJVs were usually larger than the left IJVs (57/77 or 74.0%) with significant difference in diameter (14.9 ± 4.0 mm vs. 11.6 ± 3.8 mm, p <0.0001). The right IJVs were significantly located more superficial than the left IJVs (16.3 ± 4.2 mm vs. 17.0 ± 4.4 mm, p = 0.049). The right IJVs tended to have distance far from the CCAs more than the left IJVs (1.3 ± 0.6 mm vs. 1.2 ± 0.9 mm, p = 0.372). Most of the IJVs located laterally to the CCAs (145/154 or 94.2%). A total of 4/154 IJVs (2.6%) were located anteriorly and 5/154 IJVs (3.2%) were located posteriorly. There were two cases that the posterior position of the IJVs was seen bilaterally. No medially located IJV was found.

Conclusion: There were anatomical variations of the IJVs, including diameter, depth from skin surface, relative distance from the CCAs and position in relation to CCAs, which remained potential risk when jugular venous access was attempted. Awareness of these variations is very important.

Schlüsselwörter

  • Central venous access
  • CT
  • internal jugular vein (IJV)
  • Thai
  • variation

Brief communication (Original)

Uneingeschränkter Zugang

Genetic characterization of Nipah virus from Thai fruit bats (Pteropus lylei)

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 813 - 819

Zusammenfassung

Abstract

Background: Nipah virus (NiV) is an emerging zoonosis of paramyxovirus that causes febrile encephalitis with high death rates in humans. It has been successfully isolated and genetically characterized in three species of fruit bats including Pteropus hypomelanus, P. vampyrus in Malaysia, and P. lylei (Lyle’s fruit bat) in Cambodia. Little is still known about NiV genetic information in Lyle’s fruit bats in Thailand.

Objective: Partial NiV sequences obtained from 61 isolates from nine bat roosting sites, in Central Thailand during 2002-2008 were genetically characterized to determine the diversity of NiV found in Thai bats.

Methods: All samples were collected from Lyle’s fruit bats, except for two from insectivorous bats. NiV RNA was extracted directly from the bat urine, saliva or serum specimens, and a fragment of the nucleoprotein (N) gene was amplified by hemi-nested RT-PCR and 357 base pairs were sequenced for phylogenetic analysis.

Results: The NiV isolates from bats found in Thailand form a monophyletic group with those from Malaysia, Bangladesh and Cambodia. It is divided into two closely related lineages: Clade A and B. Clade A represents the majority of those found in Thailand (52/61).

Conclusion: The genetic divergence of NiV isolates obtained from Lyle’s fruit bats in a small geographic region might indicate that the ancestor of this group of virus has circulated in Pteropus fruit bats for a long time. More viral surveillance studies in Pteropus bat populations in this region might help to clarify the genetic distribution of bat-NiV in Pteropus and allow risk assessment in NiV outbreaks from fruit bats.

Schlüsselwörter

  • Bats
  • Nipah virus
  • nucleoprotein gene
  • phylogenetic
Uneingeschränkter Zugang

Treatment of chronic neck pain by two combined physiotherapy programs: comparison of phonophoresis and ultrasound

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 821 - 827

Zusammenfassung

Abstract

Background: Chronic neck pain is common. The value of various physiotherapy, phonophoresis, and ultrasound is not known.

Objective: We determined the short-term effect of combined physiotherapy methods on pain intensity, disability, and quality of life in patients with chronic neck pain (CNP). We also compared the short-term effectiveness of phonophoresis (PP) and therapeutic ultrasound (US).

Methods: Fifty-five patients (48 women, 7 men) aged 25 to 65 years who had neck pain at least twelve weeks participated in this study. The patients were randomly divided into two groups: US (n = 29) and PP (n = 26). The patients in both groups received the same combined physiotherapy treatment programme including thermotherapy, TENS, therapeutic massage, therapeutic exercises, and recommendations for daily living activities. Additionally, the patients in the PP group received phonophoresis (5% lidocaine), and the US group received ultrasound therapy. All patients received 14 sessions of treatment throughout three weeks. Pain intensity, disability, and quality of life were measured at baseline and after the treatment programme. Pain intensity was assessed by using a visual analog scale, the Neck Pain Disability Index was used to assess disability and the SF-36 Health Survey was used to assess quality of life. A Wilcoxon signed rank test, Mann-Whitney U test, and effect size were used for statistically analysis.

Results: In both groups, pain intensity, disability and quality of life scores were found to have improved after the treatment programme (p < 0.05). However, the efficiency of both treatment programmes was similar (p > 0.05) and the effect sizes for pain intensity, disability, and quality of life were large in both groups.

Conclusion: The results suggest that phonophoresis and ultrasound combined with physiotherapy methods can have positive effects in the management of patients with chronic neck pain. However, no superiority of phonophoresis or ultrasound was determined.

Schlüsselwörter

  • Disability
  • neck pain
  • phonophoresis
  • physiotherapy
  • quality of life
  • ultrasound
Uneingeschränkter Zugang

The prevalence of fungal infections in a level I Iranian burn hospital

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 829 - 833

Zusammenfassung

Abstract

Background: With significant increase in incidence of fungal infections in burn victims, determination of pattern of fungal infections and colonization is required to allow medical staff to begin proper empirical antibiotic therapy in early stages of septic episodes.

Objective: To determine the current infection profile (especially fungal profile) of burn wounds in a level I burn care center in Tehran.

Methods: A cross-sectional survey was conducted from January 2008 to September 2009 on burn wound patients admitted in Shahid Motahari Burn Hospital, Tehran, Iran. Wound swab cultures and tissue specimens from 869 patients (634 male and 235 female) out 4083 were taken and cultured in Sabouraud dextrose agar. The fungal organisms were then identified with macroscopic and microscopic structures.

Results: The incidence of fungal infection (not colonization) among the patients of this study was 13%. Candida albicans was identified as the dominant fungal agent (45%) followed by Aspergillus fumigatus (35%), Penicillium (8%), Aspergillus niger (5%), and other fungal organisms (7%).

Conclusion: With such high mortality rate and an increasing incidence of fungal wound infections, fungal infections should be a top infectious complication of burn patients and should be managed immediately and aggressively.

Schlüsselwörter

  • Burn wound
  • Candida albicans
  • colonization
  • fungal infection
  • incidence
Uneingeschränkter Zugang

Computational fluid dynamics study of the effect of posture on airflow characteristics inside the nasal cavity

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 835 - 840

Zusammenfassung

Abstract

Background: Postural changes in nasal airway resistances are of clinical importance when assessing patients with nasal obstruction. Computed tomography (CT) that is used in computational fluid dynamics (CFD) studies is obtained in a supine position, and it is therefore important to identify whether different positions such as supine, prone, and standing/sitting have any influence on flow behavior inside the nasal cavity.

Objectives: To study the effect of posture on modeling nasal airflow and evaluate its influence in determining wall shear stress and other parameters.

Method: A three-dimensional nasal cavity model was constructed based on CT images of a healthy Malaysian adult nose. Navier-Stokes and continuity equations for steady airflow were solved to examine inspiratory nasal flow.

Results: Around a 0.3% change in the average static pressure is observed while changing from a sitting to supine position. A significant drop in velocity was seen while shifting from sitting to supine position.

Conclusion: The gravity effect resulting from postural change influences flow parameters suggesting that future CFD studies should consider posture when conducting analyses. The implication of this study on posture holds importance in future studies of drug delivery though the nasal cavity.

Schlüsselwörter

  • CFD
  • posture
  • resistance
  • velocity
  • wall shear stress
Uneingeschränkter Zugang

A nonlinear model for diagnosing malignancy in patients with exudative plural effusion using routine plural fluid findings

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 841 - 846

Zusammenfassung

Abstract

Background: There is a challenge in diagnosing cancer in patients with exudative plural effusion using a noninvasive and accurate method.

Objective: We developed artificial neural network (ANN), as a nonlinear model, to discriminate malignant exudative plural effusion from nonmalignant based on routine pleural fluid findings.

Methods: The plural fluid parameters including total and differential cell counts, total proteins, lactate dehydrogenase (LDH), glucose, adenosine deaminase (ADA), as well as age and sex of 114 patients with exudative plural effusion were applied by models as input. The output was supposed to be the presence or absence of the cancer.

Results: The accuracy, sensitivity and specificity of ANN for predicting malignancy were 89.7%, 86.7%, and 91.7%, respectively. In addition, the neural network significantly outperformed the logistic regression model, as a linear model, (AUC: 0.892 vs. 0.633, respectively, p < 0.001).

Conclusion: The ANN is a novel accurate and noninvasive method that can be used clinically to diagnose malignancy in patients with exudative plural effusion.

Schlüsselwörter

  • Artificial neural network
  • exudative plural effusion
  • malignancy
Uneingeschränkter Zugang

Correlation between maternal and neonatal urine iodine with thyroid-stimulating hormone (TSH) levels in Srinagarind Hospital, Khon Kaen, Thailand

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 847 - 853

Zusammenfassung

Abstract

Background: Thailand is an endemic area for iodine deficiency disorders (IDD) in Southeast Asia. More than 50% of pregnant women in northeast Thailand have low urine iodine levels. While rising thyroid- stimulating hormone (TSH) levels in neonates are particularly sensitive to IDD.

Objective: To establish the iodine status of postpartum mothers and neonates and its relationship with TSH in Khon Kaen Province.

Materials and Methods: A prospective study was conducted between June and October 2011. Three hundred postpartum mothers and their neonates were enrolled. Urine iodine was collected and measured using a simple microplate method. TSH assay was performed using an immunoradiometric assay. The optimum level of maternal urine iodine including children <2 years was >100 μg/L and neonatal whole blood TSH <5 mU/L (equivalent to serum TSH <11.2 mU/L).

Results: The median postpartum maternal urine iodine was 208.4 μg/L, 29.3% had values <100 μg/L and 42.3% <150 μg/L. The median neonatal urine iodine was 151.0 μg/L with 26.0% having urine iodine levels <100 μg/L and 49.7 % <150 μg/L. The median neonatal whole blood TSH was 4.3 mU/L, 3.0% had TSH >5 mU/L. There was no significant correlation between postpartum maternal urine iodine and neonatal TSH (p = 0.340, r = 0.055), but there was a significant positive correlation between maternal and neonatal urine iodine levels (p = 0.013, r = 0.143), neonatal urine iodine and TSH levels (p = <0.01, r = 0.203).

Conclusion: After a national campaign of iodized salt coverage and oral iodine supplement for all pregnant women, there was increasing median maternal and neonatal urine iodine and a weakly positive correlation between maternal and neonatal urine iodine levels, neonatal urine iodine and TSH levels, but no correlation between maternal urine iodine and TSH levels. The prevalence of IDD in pregnant women in northeast Thailand seems to have decreased, but intervention programs needs to be extended to reach populations that still have inadequate iodine intake.

Schlüsselwörter

  • Khon Kaen
  • maternal urine iodine excretion
  • neonatal TSH screening
  • neonatal urine iodine
  • urine iodine
Uneingeschränkter Zugang

Intestinal parasitic infections: high prevalence of Giardia intestinalis in children living in an orphanage compared with hill-tribe children as detected by microscopy and ELISA

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 855 - 863

Zusammenfassung

Abstract

Background: Data regarding intestinal parasitic infections in preschool-aged children (less than 6 years old) living in an orphanage and remote mountainous areas are very limited.

Objectives: We surveyed infections in orphans and hill-tribe children.

Materials and Methods: They were studied in 2008 by stool examination (simple smear and concentration), Scotch-tape and culture (Boeck and Drbohlav’s Lock-Egg-Serum medium) techniques. The Giardia coproantigen ELISA was also performed. The risk correlation between unusual stool types and giardiasis by univariate analysis was tested.

Results: The overall infection rates in 137 orphans and in 145 hill-tribe children were 58.4% and 77.9%, respectively. Giardia intestinalis had the highest prevalence in orphans (with microscopy 28.5%, with copro-antigen ELISA 31.4%). Other pathogens included Blastocystis hominis (23.4%), Enterobius vermicularis (9.5%), and hookworm (0.7%), whereas the nonpathogens were Trichomonas hominis (19.0%), Entamoeba coli (11.7%), and Endolimax nana (2.2%). Ascaris lumbricoides had the highest prevalence (62.1%) in hill-tribe children, while Giardia intestinalis showed 7.6% with microscopy and 9.0% by ELISA. The other pathogens were E. vermicularis (25.5%), Trichuris trichiura (10.3%), B. hominis (2.8%), hookworm (1.4%), Sarcocystis hominis (1.4%) and E. histolytica (0.7%), whereas the nonpathogenic organisms were E. coli (19.3%), and E. nana (0.7%). Giardiasis stools from orphans had significantly greater cyst density than those from the hill-tribe children. The coproantigen ELISA for giardiasis demonstrated 91.4% specificity, 72.0% sensitivity, 64.3% positive predictive value, and 93.8% negative predictive value, respectively. By univariate analysis, a loose (mushy) stool type was 2.43 times likely to have Giardia cysts.

Conclusion: In large-scale epidemiological studies, a Giardia ELISA might be a useful aid for diagnosis, because conventional microscopy is time-consuming and relies on the expertise of the microscopist.

Schlüsselwörter

  • ELISA
  • Giardia intestinalis
  • hill-tribe children
  • intestinal parasite
  • microscopy
  • orphanage children
  • preschool-aged children
Uneingeschränkter Zugang

Normative anatomy of the anal sphincter detected with 3D-endoanal ultrasonography

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 865 - 871

Zusammenfassung

Abstract

Background: Understanding anal sphincter anatomy is crucial in management of anorectal disorders, including anorectal sepsis and fecal incontinence. Three-dimensional endoanal ultrasound (EAUS) provides better resolution of the tissue layers. Previous normative studies were obtained in Western populations.

Objective: We demonstrated the anal sphincter anatomy in normal East Asian subjects.

Methods: Forty-six healthy subjects without anorectal symptoms (M:F = 15:31, mean age ± SD = 47 ± 13 years) were enrolled. High-frequency (16 MHz) EAUS was performed with a mechanically rotated probe. Thickness and length of anal sphincter components were measured. Differences between sexes were assessed using a Student t test.

Results: We demonstrated 4 differentiable components: the anal sphincter; internal anal sphincter (IAS), subcutaneous external anal sphincter (Sc EAS), superficial external anal sphincter (Sp EAS), and puborectalis muscle (PRm). The mean length of anal sphincter components were obtained in mm (men vs. women), IAS (28.5 vs. 25.3, p = 0.03), Sc EAS (13.2 vs. 11.2, p = 0.005), Sp EAS (24.1 vs. 19.6, p = 0.0001), and PRm (12.4 vs. 12.2, p = 0.84). The anal canal was significantly longer in men (38.6 vs. 34.0, p = 0.007). The mean thickness for IAS (1.7 vs. 1.8, p = 0.095), Sc EAS (7.5 vs. 7.6, p = 0.587), Sp EAS (8.1 vs. 6.9, p = 0.001), and PRm (8.7 vs. 9.0, p = 0.605) were measured. The PRm was the thickest and the Sp EAS was the longest voluntary sphincter.

Conclusion: Normative details of anal sphincter components in an East Asian population are described. This data can be used for future consideration of diseased states.

Schlüsselwörter

  • Anal sphincter anatomy
  • anal ultrasound
  • endoanal ultrasonography
  • normal anal sphincter anatomy
  • normative data
  • transanal ultrasound
Uneingeschränkter Zugang

Intravenous iloprost may be an effective first-line treatment for persistent pulmonary hypertension of the newborn in limited-resource situations

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 873 - 880

Zusammenfassung

Abstract

Background: Persistent pulmonary hypertension of the newborn (PPHN) is one of the most serious conditions in neonates, and has high mortality and morbidity rates. New alternative therapies have been sought for improving survival and reducing morbidity for PPHN.

Objective: To report an initial experience of using intravenous iloprost to treat infants with PPHN, and assess its effect on oxygenation and hemodynamic stability over a 96-hour study.

Methods: The clinical data of infants who received intravenous iloprost as first line adjunctive therapy for PPHN at our institution between March 2009 and June 2010 were retrospectively reviewed.

Results: During the study period, 10 PPHN infants received intravenous iloprost as the first line of adjunctive therapy. The median gestational age was 40 weeks (range: 38-42), and birth weight was 3,250 grams (range: 2,310-3,900 g). Intravenous iloprost was initiated at an average age of 38 ± 26 hours (median: 32 h, range: 6-79 h), with an average baseline oxygen index (OI) of 25 ± 18 (median: 18, range: 8-65). Two infants who died while receiving the intravenous iloprost were excluded from our analysis because of incomplete data. Of the 8 who survived, the baseline OI was 24 ± 20 (median: 17, range: 8-65), and the mean OIs at 24 and 72 hours following treatment were significantly improved (16 ± 18 (median: 6, range: 4-50) (p = 0.02), and 9 ± 5 (median: 8, range: 3-18) (p = 0.02), respectively). No clinically significant changes in heart rate or blood pressure were noted during the iloprost therapy. At discharge, 6 of the infants were clinically normal, and 2 were complicated with cholestatic jaundice. No neurodevelopmental or cardiopulmonary disorders were observed in the 8 surviving infants at hospital discharge or later follow-up visits.

Conclusion: Intravenous iloprost may be a useful adjunctive therapy in PPHN, and should be investigated in a larger controlled study.

Schlüsselwörter

  • Iloprost
  • newborn infant
  • neonatal mortality
  • persistent pulmonary hypertension of the newborn
Uneingeschränkter Zugang

Stress analysis of a polyethylene acetabular component in the extreme flexion position—a finite element analysis

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 881 - 884

Zusammenfassung

Abstract

Background: Many factors cause impingement of the femoral neck and polyethylene liners. Impingements definitely increase the rate of polyethylene wear. This effect has been a major cause of revision hip surgery. Squatting and sitting cross-legged are specific sitting positions typically used by Asian people, including Thai. These types of positions may cause impingements and abnormal stress distributions, resulting in massive destruction of polyethylene liners.

Objective: To analyze the effects of squatting and sitting in a cross-legged position in total hip replacement patients using finite element analysis.

Methods: A three-dimensional finite element model was developed to study the effects of squatting and sitting in a cross-legged position. The study was divided into two parts. First, mean hip ranges of motion of sitting positions were analyzed. Second, hip ranges of motion at one standard deviation were also analyzed. Locations of the impingement area and stress distribution were demonstrated using finite element software.

Results: Squatting and sitting cross-legged at one standard deviation obviously cause significant impingement at the superior part of the polyethylene liner. Maximum principal stresses are 103 MPa and 24.5 MPa in squatting and sitting cross-legged, respectively. There is no impingement when the mean hip ranges of motion are used. The distance between the neck and cup are 4.05 mm and 4.15 mm in squatting and sitting cross-legged, respectively.

Conclusion: Squatting and sitting cross-legged can cause significant impingement in commonly used total hip replacements. Massive destruction of the prostheses can develop by the process of the impingement.

Schlüsselwörter

  • Finite element analysis
  • impingement
  • polyethylene
  • stress
  • total hip replacement

Clinical report

Uneingeschränkter Zugang

Ilizarov apparatus in Cambodia: a review of its history and versatility in a resources poor region. With case illustrations

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 885 - 892

Zusammenfassung

Abstract

Background: The Ilizarov apparatus is a versatile external fixation system that can be used for a variety of indications in orthopaedic and reconstructive surgery to provide stability, bone transport, and correct angular deformities. The Children’s Surgical Centre is a non-governmental hospital in Phnom Penh, Cambodia providing free elective surgery to Cambodian nationals. The Ilizarov apparatus has been used in our centre since 2005.

Objective: We described the frame’s use in our centre and discuss its impact on our patient population.

Methods: This is an analysis of care series with six illustrated examples.

Results: The apparatus is well tolerated by patients. Its use results in higher rate of unions.

Conclusion: Ilizarov apparatus is associated with higher rates of unions. This external fixation is suitable for areas where access to healthcare is impeded by distance.

Schlüsselwörter

  • Developing world surgery
  • external fixator
  • Ilizarov
  • orthopaedics
  • reconstructive surgery
  • ring fixator
21 Artikel

Editorial

Uneingeschränkter Zugang

Breaking the species barrier

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 731 - 733

Zusammenfassung

Review Article

Uneingeschränkter Zugang

Physicians’ perceptions of patient safety factors: a systematic review and narrative synthesis

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 735 - 742

Zusammenfassung

Abstract

Background: Patient safety (PS) is a global issue that affects both developed and developing countries. Physicians play a key role in overcoming this common healthcare issue.

Objective: To understand the physicians’ perceptions of factors contributing to PS incidents in secondary care.

Methods: Covering a period from 1999 to 2011, three electronic databases were used to identify potential studies for inclusion. Individual searching of selected journals and reference scanning of identified studies were also conducted. To summarize and synthesize the findings, we adopted a narrative synthesis approach, and used a content analysis method directed by Vincent’s framework.

Results: Of 1,405 potentially relevant citations identified, 14 studies ultimately met the inclusion criteria, and were divided into trainee and non-trainee physician studies. Quality scores of included studies ranged from 6 to 12.5 (possible range 1-16). In total, 158 patient safety factors (PSFs) were identified and categorized into seven safety levels and 22 corresponding themes. In all the studies, the rank order of safety levels by frequency of PSFs was: individual = team > work environment > organizational and management > task and technology > contextual > patient. There was an almost similar result in the trainee studies, whereas in the non-trainee studies, the result was almost the reverse.

Conclusion: Overall, the results show a clear tendency for physicians to focus on the proximal causes of PS incidents. This suggests the need for safety skills training. The next research generation would provide a holistic view of physicians’ perceptions of PSFs by moving toward more sophisticated designs, such as mixed-methods.

Schlüsselwörter

  • Medical errors
  • patient safety
  • physicians
  • secondary care

Original article

Uneingeschränkter Zugang

Osteogenic differentiation of human umbilical cord-derived mesenchymal stem cells promoted by overexpression of osterix

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 743 - 752

Zusammenfassung

Abstract

Background: Umbilical cord-derived mesenchymal stem cells (UC-MSCs) are considered to be multipotent mesenchymal stem cells that are easily induced to differentiate into functional osteoblasts both in vitro and in vivo. Osterix (Osx), a novel zinc-⃞nger-containing transcription factor of the Sp family, is required for osteoblast differentiation and bone formation.

Objective: We investigated the effect of Osx on the proliferation and osteogenic differentiation of the UC-MSCs.

Method: The primary UC-MSCs were isolated and cultured. An Osx-expressing plasmid (pEGFP-Osx) was constructed and transfected into UC-MSCs. Then expression of bone morphogenesis-related genes, proliferation rate, alkaline phosphatase activity, and mineralization were examined to evaluate the osteogenic potential of the Osx gene-modified UC-MSCs.

Result: UC-MSCs transfected with pEGFP-Osx exhibited apparent osteogenic differentiation as determined by increased activity of alkaline phosphatase, the formation of mineralized nodules and the expression of related osteoblastic genes.

Conclusion: These results confirmed the ability of Osx to enhance osteoblast differentiation of UC-MSCs in vitro, and the Osx gene-modified UC-MSCs are potential as novel cell resources of bone tissue engineering.

Schlüsselwörter

  • Osteogenic differentiation
  • osterix
  • umbilical cord-derived mesenchymal stem cells
Uneingeschränkter Zugang

Evaluation of cancellous bone density in the alveolar bone by cone-beam computed tomography in Taiwanese adults

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 753 - 760

Zusammenfassung

Abstract

Background: The preoperative evaluation of bone quality and stability at the site of a dental implant is important for the long-term prognosis of the implant.

Objective: We evaluated the density and its distribution of cancellous bone in the alveolar bone between a Taiwanese cohort and a U.S. cohort.

Methods: A retrospective analysis using cone-beam computed tomography (CBCT) images was conducted on 1211 Taiwanese and 154 U.S. adults who were evaluated for dental implants. Reconstructed representations of the anterior, premolar, and molar maxillary regions, and of the anterior, premolar, and molar mandibular regions were evaluated in consideration of age, gender and ethnicity.

Results: The mean cancellous bone density was significantly higher at mandibular as compared to maxillary sites (all p ≤ 0.001). In Taiwanese more than 55 years old, men had higher cancellous bone densities than that in women at all sites (except mandible anterior site) (all p < 0.001). Taiwanese women more than 55 years old had significantly lower bone densities than women less than 55 years old at maxilla anterior and premolar sites and mandible premolar and molar sites (all p < 0.05). This did not occur in Taiwanese men or the U.S. cohort. Taiwanese had higher cancellous bone densities at mandibular sites than the U.S. cohort. Mandibular sites had significantly higher densities than maxillary sites. Taiwanese had higher cancellous bone densities at mandible sites than the U.S. cohort. Male Taiwanese had higher cancellous bone densities than females. For female, but not male, Taiwanese, the cancellous bone density decreased when the age increased.

Conclusion: CBCT can be used to evaluate alveolar cancellous bone density to predict primary stability prior to implantation.

Schlüsselwörter

  • Alveolar
  • bone
  • CBCT
  • density
Uneingeschränkter Zugang

The clinical relevance of urinary soluble fas (sFas) for diagnosis of bilharzial bladder cancer

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 761 - 767

Zusammenfassung

Abstract

Background: Fas/CD95, a membrane-bound type I protein, plays a key role in induction of apoptosis and in tumorigenesis.

Objective: We adapted and evaluated measurement of urinary sFas using enzyme-linked immunosorbent assay and compared the results with voided urine cytology.

Materials and Methods: Voided urine samples were provided from 203 individuals (120 bladder cancer [112 bilharzial]; 43 benign urologic disorders [20 bilharzial dysplastic lesions]; and 40 healthy volunteers). Urine sediment was used for cytology and the supernatant for estimation of sFas by ELISA.

Results: A receiver operating characteristic curve (ROC) was used to determine the best cutoff value for urinary sFas. Positivity rates and mean rank levels for sFas showed significant difference among the three investigated groups (p < 0.0001), and was related to bilharzial infection, pathological type, clinical stages, and histological grades (p < 0. 01). The sensitivity of sFas for early detection of bladder cancer, especially those with superficial and low grades tumors, was superior to urine cytology; moreover, results from sensitivity of urine cytology were improved when combined with sFas.

Conclusion: Urinary sFas may be used as a novel noninvasive diagnostic marker for bilharzial bladder cancer patients. Further multicentric studies are warranted to corroborate these findings and to establish an optimal sFas cut-point.

Uneingeschränkter Zugang

A case control study using radial artery pulse signals to evaluate the low pulsatility index in Koreans

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 769 - 776

Zusammenfassung

Abstract

Background: Noninvasive radial artery pulse signal analysis has been widely used to assess vascular diseases, but there is no evidence of a relationship between the radial artery pulse signal and pulsatility index.

Objective: To determine whether radial artery pulse signal changes in patients with a low pulsatility index would provide diagnostic information for evaluating vascular disease.

Methods: In this case control study, 36 Korean subjects were distributed into two groups, a normal pulsatility index group and a low pulsatility index group, based on their Doppler test results. Multivariate logistic regression analysis of these two groups was conducted to identify significant radial artery pulse signals for evaluating the low pulsatility index. A receiver operating characteristic (ROC) curve analysis was used to evaluate the logistic model.

Results: The low pulsatility index group displayed significantly different radial artery pulse signals compared with the normal pulsatility index group (A1; primary amplitude of right Cun, σ1; shape of the primary wave of right Chi, τ2: secondary phase of left Cun, σ2/L: ratio of the shape of the secondary wave to the length of a single-period waveform). A predictive value for the low pulsatility index was obtained using binary logistic regression, which included A1, σ1, τ2 and σ2/L. A ROC curve analysis assessed the accuracy of the test for low pulsatility index evaluation (AUC=0.931).

Conclusion: A1 (primary amplitude), σ1 (shape of the primary wave), τ2 (secondary phase), and σ2/L (ratio of the shape of the secondary wave to the length of a single-period waveform) derived from radial artery pulse signals may be used to assess a low pulsatility index in Koreans.

Schlüsselwörter

  • Aortic obstruction
  • pulsatility index
  • pulse signal
  • radial artery
  • vascular disease
Uneingeschränkter Zugang

Isolation and cellular properties of mesenchymal stem cells from human periosteum

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 777 - 785

Zusammenfassung

Abstract

Background: Cell-based therapy has achieved good functional recovery for tissue repair. Mesenchymal stem cells (MSCs) exhibit multilineage potential, long-term viability, and capacity for self-renewal. Periosteum-derived mesenchymal stem cells (PD cells) may be an attractive cell source for tissue engineering because of their easy accessibility and reduced ethical concerns.

Objectives: To isolate and investigate the phenotypic and functional characteristics of mesenchymal stem cells derived from human periosteum. We also examined the differentiation of PD cells with a trilineage differentiation assay to determine whether they were MSCs.

Materials and Methods: Periosteum-derived cells were cultured in osteogenic, chondrogenic or adipogenic media to evaluate their multilineage differentiation potential. Adherent fibroblast-like cells were analyzed by flow cytometry for MSC cell surface markers. Differentiation of PD cells into osteogenic, chondrogenic, and adipogenic lineages was also evaluated by von Kossa, Alizarin red, Alcian blue, and oil red O stains, respectively. Expression of mesenchymal stem cell markers were assessed using reverse transcriptase-polymerase chain reaction (RT-PCR) analysis.

Results: We successfully isolated and expanded MSCs from human periosteum. Flow cytometry revealed that PD cells were positive for mesenchymal adhesion cell markers (CD29, CD44, CD90, and CD105) and negative for hematopoietic markers (CD34 and CD45). In osteogenic differentiation, calcium accumulation (positive von Kossa and Alizarin red) and RUNX2, alkaline phosphatase, collagen type I, osteopontin genes were detected. In adipogenic differentiation, the cells displayed oil red O positive and expressed lipoprotein lipase and peroxisome proliferator-activated receptor-gamma (PPAR-γ) associated with adipogenesis. The cells grown in chondrogenic conditions were positively stained for Alcian blue and expressed SOX-9.

Conclusion: PD cells presented osteogenic, chondrogenic, and adipogenic differentiation abilities in vitro and could provide an alternative cellular source for tissue repair in clinical applications.

Schlüsselwörter

  • Adipogenic
  • chondrogenic
  • differentiation
  • mesenchymal stem cells
  • osteogenic
  • periosteum
Uneingeschränkter Zugang

Growth pattern and pubertal development in patients with classic 21-hydroxylase deficiency

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 787 - 794

Zusammenfassung

Abstract

Background: The goal of treatment in children with congenital adrenal hyperplasia (CAH) is to normalize growth and pubertal development. There are limited studies reporting on growth and pubertal outcome in CAH patients from low-resource settings as in Thailand, where CAH newborn screening is lacking, and standard medications are not widely available.

Objective: We analyzed the longitudinal growth data, and pubertal characteristics in children and adolescents with CAH, compared with population-based references.

Methods: Fifty-eight patients with classic 21-hydroxylase deficiency (21OHD) [49 had salt-wasting (SW)-CAH and 9 patients had simple virilizing (SV)-CAH] were retrospectively assessed for growth and pubertal development until they reached their final height (FH). Details of treatment, and hormonal profiles were recorded.

Results: Mean FH SD scores (SDS) of patients were in the lower range of normal population (SW boys -1.88±0.6, SW girls -1.88±1.1 and SV boys -1.06, SV girls -1.56±1.4). Nine of the 19 male, and 6 of the 39 female patients had BMI SDS >2.0. Mean ages of pubertal onset in SW, and SV boys were 8.2±2.4 years, and 7.1±1.9 years, respectively, while in SW girls were 9.7±2.2 years, and SV 7.0±1.7 years. Twelve of the 38 patients had central precocious puberty and required GnRH analog treatment. Total pubertal growth was significantly decreased in the SW group, but not in the SV group; SW boys 15.5±10.6 cm (reference 22.1±3.6 cm), and SW-females 10.6±5.5 cm (reference 18.3±4.0 cm). Glucocorticoid dose was not associated with FH-SDS (n = 19, r = -0.132, p = 0.589). Markedly elevated 17-hydroxyprogesterone and testosterone levels were observed during the pubertal period.

Conclusion: Our results demonstrate poor final height outcome in Thai children with classic 21OHD. Obesity, secondary central precocious puberty, and poor hormonal control are common. These findings necessitate early diagnosis and treatment by establishing newborn screening system in Thailand as well as new treatment regimen and monitoring methods.

Schlüsselwörter

  • Congenital adrenal hyperplasia
  • growth
  • puberty
  • 21-Hydroxylase deficiency
Uneingeschränkter Zugang

Irrigation with water during transurethral resection of the prostate (TURP) induces intravascular hemolysis

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 795 - 802

Zusammenfassung

Abstract

Background: The transurethral resection syndrome TUR syndrome is the most serious complication following transurethral resection of prostate (TURP).

Objective: We compared 5% dextrose in water with sterile water as an irrigating solution and evaluated postoperative intravascular hemolysis.

Methods: A prospective, randomized, controlled trial of 41 benign prostatic hypertrophy (BPH) patients who underwent TURP. The differences between preoperative and postoperative free plasma hemoglobin were measured by using a spectrophotometric method to determine the degree of intravascular hemolysis. Serum glucose and electrolytes were measured preoperatively and postoperatively. Signs and symptoms of TUR syndrome were recorded. Prostatic tissues were weighed. Volumes of irrigating fluid were recorded.

Results: Free plasma hemoglobin was significantly increased in the sterile water group (n = 21) and higher than in the 5% dextrose in water group (n = 20) (p < 0.001). The postoperative plasma glucose was higher in the 5% dextrose in water group (p = 0.007). None of patients developed a TUR syndrome. There was no difference in other serum electrolytes between both groups.

Conclusion: Intravascular hemolysis can be prevented by using 5% dextrose in water instead of sterile water. No correlation between hemolysis and TUR syndrome was found in TURP patients with postoperative stable serum sodium.

Schlüsselwörter

  • Benign prostatic hypertrophy
  • intravascular hemolysis
  • transurethral resection of prostate
  • transurethral resection syndrome
Uneingeschränkter Zugang

CT evaluation of anatomical variations of the internal jugular veins in Thai adults

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 803 - 811

Zusammenfassung

Abstract

Background: The internal jugular vein (IJV) is used to obtain central venous access for various reasons. Awareness of the expected location and anatomic variations of the IJV is very important to avoid inadvertent arterial puncture.

Objective: We evaluated anatomical variations of the IJVs, including diameter, depth from skin surface, relative distance from common carotid artery (CCA) and position in relation to CCA in Thai adults by using CT scan of the neck.

Material and Methods: A total of 77 patients who underwent CT scan of the neck (nasopharynx, larynx) at the Department of Radiology, King Chulalongkorn Memorial Hospital (KCMH) from May 1, 2009 to April 30, 2012 were retrospectively reviewed. The diameter of the IJVs, depth from skin surface and relative distance between the IJVs and CCAs were taken bilaterally. Bilateral CCAs were taken as reference points for measuring the location of the IJVs, recorded as lateral, anterior, medial or posterior position. These parameters were evaluated using the same axial slice at a level of cricoid cartilage, which was compatible with the recommended point for central venous catheter insertion via the IJV. Intra- and interobserver reliability between researcher and another radiologist was assessed by intraclass correlation coefficient (ICC).

Results: The right IJVs were usually larger than the left IJVs (57/77 or 74.0%) with significant difference in diameter (14.9 ± 4.0 mm vs. 11.6 ± 3.8 mm, p <0.0001). The right IJVs were significantly located more superficial than the left IJVs (16.3 ± 4.2 mm vs. 17.0 ± 4.4 mm, p = 0.049). The right IJVs tended to have distance far from the CCAs more than the left IJVs (1.3 ± 0.6 mm vs. 1.2 ± 0.9 mm, p = 0.372). Most of the IJVs located laterally to the CCAs (145/154 or 94.2%). A total of 4/154 IJVs (2.6%) were located anteriorly and 5/154 IJVs (3.2%) were located posteriorly. There were two cases that the posterior position of the IJVs was seen bilaterally. No medially located IJV was found.

Conclusion: There were anatomical variations of the IJVs, including diameter, depth from skin surface, relative distance from the CCAs and position in relation to CCAs, which remained potential risk when jugular venous access was attempted. Awareness of these variations is very important.

Schlüsselwörter

  • Central venous access
  • CT
  • internal jugular vein (IJV)
  • Thai
  • variation

Brief communication (Original)

Uneingeschränkter Zugang

Genetic characterization of Nipah virus from Thai fruit bats (Pteropus lylei)

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 813 - 819

Zusammenfassung

Abstract

Background: Nipah virus (NiV) is an emerging zoonosis of paramyxovirus that causes febrile encephalitis with high death rates in humans. It has been successfully isolated and genetically characterized in three species of fruit bats including Pteropus hypomelanus, P. vampyrus in Malaysia, and P. lylei (Lyle’s fruit bat) in Cambodia. Little is still known about NiV genetic information in Lyle’s fruit bats in Thailand.

Objective: Partial NiV sequences obtained from 61 isolates from nine bat roosting sites, in Central Thailand during 2002-2008 were genetically characterized to determine the diversity of NiV found in Thai bats.

Methods: All samples were collected from Lyle’s fruit bats, except for two from insectivorous bats. NiV RNA was extracted directly from the bat urine, saliva or serum specimens, and a fragment of the nucleoprotein (N) gene was amplified by hemi-nested RT-PCR and 357 base pairs were sequenced for phylogenetic analysis.

Results: The NiV isolates from bats found in Thailand form a monophyletic group with those from Malaysia, Bangladesh and Cambodia. It is divided into two closely related lineages: Clade A and B. Clade A represents the majority of those found in Thailand (52/61).

Conclusion: The genetic divergence of NiV isolates obtained from Lyle’s fruit bats in a small geographic region might indicate that the ancestor of this group of virus has circulated in Pteropus fruit bats for a long time. More viral surveillance studies in Pteropus bat populations in this region might help to clarify the genetic distribution of bat-NiV in Pteropus and allow risk assessment in NiV outbreaks from fruit bats.

Schlüsselwörter

  • Bats
  • Nipah virus
  • nucleoprotein gene
  • phylogenetic
Uneingeschränkter Zugang

Treatment of chronic neck pain by two combined physiotherapy programs: comparison of phonophoresis and ultrasound

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 821 - 827

Zusammenfassung

Abstract

Background: Chronic neck pain is common. The value of various physiotherapy, phonophoresis, and ultrasound is not known.

Objective: We determined the short-term effect of combined physiotherapy methods on pain intensity, disability, and quality of life in patients with chronic neck pain (CNP). We also compared the short-term effectiveness of phonophoresis (PP) and therapeutic ultrasound (US).

Methods: Fifty-five patients (48 women, 7 men) aged 25 to 65 years who had neck pain at least twelve weeks participated in this study. The patients were randomly divided into two groups: US (n = 29) and PP (n = 26). The patients in both groups received the same combined physiotherapy treatment programme including thermotherapy, TENS, therapeutic massage, therapeutic exercises, and recommendations for daily living activities. Additionally, the patients in the PP group received phonophoresis (5% lidocaine), and the US group received ultrasound therapy. All patients received 14 sessions of treatment throughout three weeks. Pain intensity, disability, and quality of life were measured at baseline and after the treatment programme. Pain intensity was assessed by using a visual analog scale, the Neck Pain Disability Index was used to assess disability and the SF-36 Health Survey was used to assess quality of life. A Wilcoxon signed rank test, Mann-Whitney U test, and effect size were used for statistically analysis.

Results: In both groups, pain intensity, disability and quality of life scores were found to have improved after the treatment programme (p < 0.05). However, the efficiency of both treatment programmes was similar (p > 0.05) and the effect sizes for pain intensity, disability, and quality of life were large in both groups.

Conclusion: The results suggest that phonophoresis and ultrasound combined with physiotherapy methods can have positive effects in the management of patients with chronic neck pain. However, no superiority of phonophoresis or ultrasound was determined.

Schlüsselwörter

  • Disability
  • neck pain
  • phonophoresis
  • physiotherapy
  • quality of life
  • ultrasound
Uneingeschränkter Zugang

The prevalence of fungal infections in a level I Iranian burn hospital

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 829 - 833

Zusammenfassung

Abstract

Background: With significant increase in incidence of fungal infections in burn victims, determination of pattern of fungal infections and colonization is required to allow medical staff to begin proper empirical antibiotic therapy in early stages of septic episodes.

Objective: To determine the current infection profile (especially fungal profile) of burn wounds in a level I burn care center in Tehran.

Methods: A cross-sectional survey was conducted from January 2008 to September 2009 on burn wound patients admitted in Shahid Motahari Burn Hospital, Tehran, Iran. Wound swab cultures and tissue specimens from 869 patients (634 male and 235 female) out 4083 were taken and cultured in Sabouraud dextrose agar. The fungal organisms were then identified with macroscopic and microscopic structures.

Results: The incidence of fungal infection (not colonization) among the patients of this study was 13%. Candida albicans was identified as the dominant fungal agent (45%) followed by Aspergillus fumigatus (35%), Penicillium (8%), Aspergillus niger (5%), and other fungal organisms (7%).

Conclusion: With such high mortality rate and an increasing incidence of fungal wound infections, fungal infections should be a top infectious complication of burn patients and should be managed immediately and aggressively.

Schlüsselwörter

  • Burn wound
  • Candida albicans
  • colonization
  • fungal infection
  • incidence
Uneingeschränkter Zugang

Computational fluid dynamics study of the effect of posture on airflow characteristics inside the nasal cavity

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 835 - 840

Zusammenfassung

Abstract

Background: Postural changes in nasal airway resistances are of clinical importance when assessing patients with nasal obstruction. Computed tomography (CT) that is used in computational fluid dynamics (CFD) studies is obtained in a supine position, and it is therefore important to identify whether different positions such as supine, prone, and standing/sitting have any influence on flow behavior inside the nasal cavity.

Objectives: To study the effect of posture on modeling nasal airflow and evaluate its influence in determining wall shear stress and other parameters.

Method: A three-dimensional nasal cavity model was constructed based on CT images of a healthy Malaysian adult nose. Navier-Stokes and continuity equations for steady airflow were solved to examine inspiratory nasal flow.

Results: Around a 0.3% change in the average static pressure is observed while changing from a sitting to supine position. A significant drop in velocity was seen while shifting from sitting to supine position.

Conclusion: The gravity effect resulting from postural change influences flow parameters suggesting that future CFD studies should consider posture when conducting analyses. The implication of this study on posture holds importance in future studies of drug delivery though the nasal cavity.

Schlüsselwörter

  • CFD
  • posture
  • resistance
  • velocity
  • wall shear stress
Uneingeschränkter Zugang

A nonlinear model for diagnosing malignancy in patients with exudative plural effusion using routine plural fluid findings

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 841 - 846

Zusammenfassung

Abstract

Background: There is a challenge in diagnosing cancer in patients with exudative plural effusion using a noninvasive and accurate method.

Objective: We developed artificial neural network (ANN), as a nonlinear model, to discriminate malignant exudative plural effusion from nonmalignant based on routine pleural fluid findings.

Methods: The plural fluid parameters including total and differential cell counts, total proteins, lactate dehydrogenase (LDH), glucose, adenosine deaminase (ADA), as well as age and sex of 114 patients with exudative plural effusion were applied by models as input. The output was supposed to be the presence or absence of the cancer.

Results: The accuracy, sensitivity and specificity of ANN for predicting malignancy were 89.7%, 86.7%, and 91.7%, respectively. In addition, the neural network significantly outperformed the logistic regression model, as a linear model, (AUC: 0.892 vs. 0.633, respectively, p < 0.001).

Conclusion: The ANN is a novel accurate and noninvasive method that can be used clinically to diagnose malignancy in patients with exudative plural effusion.

Schlüsselwörter

  • Artificial neural network
  • exudative plural effusion
  • malignancy
Uneingeschränkter Zugang

Correlation between maternal and neonatal urine iodine with thyroid-stimulating hormone (TSH) levels in Srinagarind Hospital, Khon Kaen, Thailand

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 847 - 853

Zusammenfassung

Abstract

Background: Thailand is an endemic area for iodine deficiency disorders (IDD) in Southeast Asia. More than 50% of pregnant women in northeast Thailand have low urine iodine levels. While rising thyroid- stimulating hormone (TSH) levels in neonates are particularly sensitive to IDD.

Objective: To establish the iodine status of postpartum mothers and neonates and its relationship with TSH in Khon Kaen Province.

Materials and Methods: A prospective study was conducted between June and October 2011. Three hundred postpartum mothers and their neonates were enrolled. Urine iodine was collected and measured using a simple microplate method. TSH assay was performed using an immunoradiometric assay. The optimum level of maternal urine iodine including children <2 years was >100 μg/L and neonatal whole blood TSH <5 mU/L (equivalent to serum TSH <11.2 mU/L).

Results: The median postpartum maternal urine iodine was 208.4 μg/L, 29.3% had values <100 μg/L and 42.3% <150 μg/L. The median neonatal urine iodine was 151.0 μg/L with 26.0% having urine iodine levels <100 μg/L and 49.7 % <150 μg/L. The median neonatal whole blood TSH was 4.3 mU/L, 3.0% had TSH >5 mU/L. There was no significant correlation between postpartum maternal urine iodine and neonatal TSH (p = 0.340, r = 0.055), but there was a significant positive correlation between maternal and neonatal urine iodine levels (p = 0.013, r = 0.143), neonatal urine iodine and TSH levels (p = <0.01, r = 0.203).

Conclusion: After a national campaign of iodized salt coverage and oral iodine supplement for all pregnant women, there was increasing median maternal and neonatal urine iodine and a weakly positive correlation between maternal and neonatal urine iodine levels, neonatal urine iodine and TSH levels, but no correlation between maternal urine iodine and TSH levels. The prevalence of IDD in pregnant women in northeast Thailand seems to have decreased, but intervention programs needs to be extended to reach populations that still have inadequate iodine intake.

Schlüsselwörter

  • Khon Kaen
  • maternal urine iodine excretion
  • neonatal TSH screening
  • neonatal urine iodine
  • urine iodine
Uneingeschränkter Zugang

Intestinal parasitic infections: high prevalence of Giardia intestinalis in children living in an orphanage compared with hill-tribe children as detected by microscopy and ELISA

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 855 - 863

Zusammenfassung

Abstract

Background: Data regarding intestinal parasitic infections in preschool-aged children (less than 6 years old) living in an orphanage and remote mountainous areas are very limited.

Objectives: We surveyed infections in orphans and hill-tribe children.

Materials and Methods: They were studied in 2008 by stool examination (simple smear and concentration), Scotch-tape and culture (Boeck and Drbohlav’s Lock-Egg-Serum medium) techniques. The Giardia coproantigen ELISA was also performed. The risk correlation between unusual stool types and giardiasis by univariate analysis was tested.

Results: The overall infection rates in 137 orphans and in 145 hill-tribe children were 58.4% and 77.9%, respectively. Giardia intestinalis had the highest prevalence in orphans (with microscopy 28.5%, with copro-antigen ELISA 31.4%). Other pathogens included Blastocystis hominis (23.4%), Enterobius vermicularis (9.5%), and hookworm (0.7%), whereas the nonpathogens were Trichomonas hominis (19.0%), Entamoeba coli (11.7%), and Endolimax nana (2.2%). Ascaris lumbricoides had the highest prevalence (62.1%) in hill-tribe children, while Giardia intestinalis showed 7.6% with microscopy and 9.0% by ELISA. The other pathogens were E. vermicularis (25.5%), Trichuris trichiura (10.3%), B. hominis (2.8%), hookworm (1.4%), Sarcocystis hominis (1.4%) and E. histolytica (0.7%), whereas the nonpathogenic organisms were E. coli (19.3%), and E. nana (0.7%). Giardiasis stools from orphans had significantly greater cyst density than those from the hill-tribe children. The coproantigen ELISA for giardiasis demonstrated 91.4% specificity, 72.0% sensitivity, 64.3% positive predictive value, and 93.8% negative predictive value, respectively. By univariate analysis, a loose (mushy) stool type was 2.43 times likely to have Giardia cysts.

Conclusion: In large-scale epidemiological studies, a Giardia ELISA might be a useful aid for diagnosis, because conventional microscopy is time-consuming and relies on the expertise of the microscopist.

Schlüsselwörter

  • ELISA
  • Giardia intestinalis
  • hill-tribe children
  • intestinal parasite
  • microscopy
  • orphanage children
  • preschool-aged children
Uneingeschränkter Zugang

Normative anatomy of the anal sphincter detected with 3D-endoanal ultrasonography

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 865 - 871

Zusammenfassung

Abstract

Background: Understanding anal sphincter anatomy is crucial in management of anorectal disorders, including anorectal sepsis and fecal incontinence. Three-dimensional endoanal ultrasound (EAUS) provides better resolution of the tissue layers. Previous normative studies were obtained in Western populations.

Objective: We demonstrated the anal sphincter anatomy in normal East Asian subjects.

Methods: Forty-six healthy subjects without anorectal symptoms (M:F = 15:31, mean age ± SD = 47 ± 13 years) were enrolled. High-frequency (16 MHz) EAUS was performed with a mechanically rotated probe. Thickness and length of anal sphincter components were measured. Differences between sexes were assessed using a Student t test.

Results: We demonstrated 4 differentiable components: the anal sphincter; internal anal sphincter (IAS), subcutaneous external anal sphincter (Sc EAS), superficial external anal sphincter (Sp EAS), and puborectalis muscle (PRm). The mean length of anal sphincter components were obtained in mm (men vs. women), IAS (28.5 vs. 25.3, p = 0.03), Sc EAS (13.2 vs. 11.2, p = 0.005), Sp EAS (24.1 vs. 19.6, p = 0.0001), and PRm (12.4 vs. 12.2, p = 0.84). The anal canal was significantly longer in men (38.6 vs. 34.0, p = 0.007). The mean thickness for IAS (1.7 vs. 1.8, p = 0.095), Sc EAS (7.5 vs. 7.6, p = 0.587), Sp EAS (8.1 vs. 6.9, p = 0.001), and PRm (8.7 vs. 9.0, p = 0.605) were measured. The PRm was the thickest and the Sp EAS was the longest voluntary sphincter.

Conclusion: Normative details of anal sphincter components in an East Asian population are described. This data can be used for future consideration of diseased states.

Schlüsselwörter

  • Anal sphincter anatomy
  • anal ultrasound
  • endoanal ultrasonography
  • normal anal sphincter anatomy
  • normative data
  • transanal ultrasound
Uneingeschränkter Zugang

Intravenous iloprost may be an effective first-line treatment for persistent pulmonary hypertension of the newborn in limited-resource situations

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 873 - 880

Zusammenfassung

Abstract

Background: Persistent pulmonary hypertension of the newborn (PPHN) is one of the most serious conditions in neonates, and has high mortality and morbidity rates. New alternative therapies have been sought for improving survival and reducing morbidity for PPHN.

Objective: To report an initial experience of using intravenous iloprost to treat infants with PPHN, and assess its effect on oxygenation and hemodynamic stability over a 96-hour study.

Methods: The clinical data of infants who received intravenous iloprost as first line adjunctive therapy for PPHN at our institution between March 2009 and June 2010 were retrospectively reviewed.

Results: During the study period, 10 PPHN infants received intravenous iloprost as the first line of adjunctive therapy. The median gestational age was 40 weeks (range: 38-42), and birth weight was 3,250 grams (range: 2,310-3,900 g). Intravenous iloprost was initiated at an average age of 38 ± 26 hours (median: 32 h, range: 6-79 h), with an average baseline oxygen index (OI) of 25 ± 18 (median: 18, range: 8-65). Two infants who died while receiving the intravenous iloprost were excluded from our analysis because of incomplete data. Of the 8 who survived, the baseline OI was 24 ± 20 (median: 17, range: 8-65), and the mean OIs at 24 and 72 hours following treatment were significantly improved (16 ± 18 (median: 6, range: 4-50) (p = 0.02), and 9 ± 5 (median: 8, range: 3-18) (p = 0.02), respectively). No clinically significant changes in heart rate or blood pressure were noted during the iloprost therapy. At discharge, 6 of the infants were clinically normal, and 2 were complicated with cholestatic jaundice. No neurodevelopmental or cardiopulmonary disorders were observed in the 8 surviving infants at hospital discharge or later follow-up visits.

Conclusion: Intravenous iloprost may be a useful adjunctive therapy in PPHN, and should be investigated in a larger controlled study.

Schlüsselwörter

  • Iloprost
  • newborn infant
  • neonatal mortality
  • persistent pulmonary hypertension of the newborn
Uneingeschränkter Zugang

Stress analysis of a polyethylene acetabular component in the extreme flexion position—a finite element analysis

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 881 - 884

Zusammenfassung

Abstract

Background: Many factors cause impingement of the femoral neck and polyethylene liners. Impingements definitely increase the rate of polyethylene wear. This effect has been a major cause of revision hip surgery. Squatting and sitting cross-legged are specific sitting positions typically used by Asian people, including Thai. These types of positions may cause impingements and abnormal stress distributions, resulting in massive destruction of polyethylene liners.

Objective: To analyze the effects of squatting and sitting in a cross-legged position in total hip replacement patients using finite element analysis.

Methods: A three-dimensional finite element model was developed to study the effects of squatting and sitting in a cross-legged position. The study was divided into two parts. First, mean hip ranges of motion of sitting positions were analyzed. Second, hip ranges of motion at one standard deviation were also analyzed. Locations of the impingement area and stress distribution were demonstrated using finite element software.

Results: Squatting and sitting cross-legged at one standard deviation obviously cause significant impingement at the superior part of the polyethylene liner. Maximum principal stresses are 103 MPa and 24.5 MPa in squatting and sitting cross-legged, respectively. There is no impingement when the mean hip ranges of motion are used. The distance between the neck and cup are 4.05 mm and 4.15 mm in squatting and sitting cross-legged, respectively.

Conclusion: Squatting and sitting cross-legged can cause significant impingement in commonly used total hip replacements. Massive destruction of the prostheses can develop by the process of the impingement.

Schlüsselwörter

  • Finite element analysis
  • impingement
  • polyethylene
  • stress
  • total hip replacement

Clinical report

Uneingeschränkter Zugang

Ilizarov apparatus in Cambodia: a review of its history and versatility in a resources poor region. With case illustrations

Online veröffentlicht: 04 Feb 2017
Seitenbereich: 885 - 892

Zusammenfassung

Abstract

Background: The Ilizarov apparatus is a versatile external fixation system that can be used for a variety of indications in orthopaedic and reconstructive surgery to provide stability, bone transport, and correct angular deformities. The Children’s Surgical Centre is a non-governmental hospital in Phnom Penh, Cambodia providing free elective surgery to Cambodian nationals. The Ilizarov apparatus has been used in our centre since 2005.

Objective: We described the frame’s use in our centre and discuss its impact on our patient population.

Methods: This is an analysis of care series with six illustrated examples.

Results: The apparatus is well tolerated by patients. Its use results in higher rate of unions.

Conclusion: Ilizarov apparatus is associated with higher rates of unions. This external fixation is suitable for areas where access to healthcare is impeded by distance.

Schlüsselwörter

  • Developing world surgery
  • external fixator
  • Ilizarov
  • orthopaedics
  • reconstructive surgery
  • ring fixator

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