Volume 6 (2012): Issue 2 (April 2012)

Background: Angiostrongyliasis is caused by Angiostrongylus cantonensis or rat lungworm. Definitive diagnosis via recovery of the worm is uncommon. The diagnosis is done by a combination of methods.

Objective: Review of available methods used in the diagnosis of angiostrongyliasis.

Methods: We carried out a systematic review to document the available methods used in the diagnosis of angiostrongyliasis using MEDLINE as the main database supplemented by other resources.

Results: At present, only a few cases of this disease are diagnosed by parasitological methods. Thus, more commonly, a diagnosis of A. cantonensis infection is made by the combination of clinical manifestations and a history of ingestion of intermediate or paratenic hosts. In addition, serodiagnosis, including an enzyme linked immunosorbent assay (ELISA), and immunoblot test are useful in assisting diagnosis of this disease.

Conclusion: Further development of diagnostics for human angiostrongyliasis is needed for definite diagnosis of angiostrongyliasis

Background: Being overweight is a major risk factor for chronic diseases. In 2008, the health screening for chronic diseases in 273,171 Thai workers in Bangkok reported that 85% of them were at risk.

Objective: We evaluated the health behavioral modification programs conducted by the participating hospitals in Bangkok. We also compared behavior change and biomedical indicators between before and after program completion.

Methods: The behavioral modification program was conducted by 17 public hospitals in Bangkok between May and December 2009. Two thousand nine hundred seventy outpatients at-risk for metabolic diseases were recruited. The intervention program included the various activity lessons focusing on client-centered techniques based on the behavioral and managerial model (PROMISE model). Data was collected using interviewing forms based on Context, Input, Process, Product Evaluation model (CIPP model). Information was obtained from three groups of people including program leaders, commanders of program leaders, some clients, questionnaires for assessing 3-self behavior including self-efficacy, self-regulation, and self-care were prepared for behavioral assessment changes.

Results: At the beginning of program implementation, it was found that results from supervision and evaluation of the feasibility for program success revealed that opinions on the context, input, process, and product were at the very good level among the three groups. After the program application, the 3-self health behavior of clients improved significantly (p <0.05). Therefore, after program participation for a certain period, clients had an improvement in biomedical indicators as follows, FBS, BP, waist, weight, and BMI (p <0.05). In addition, after participation, clients with lower BMI tended to have better self-regulation and self-care than those with higher BMI group (p <0.05).

Conclusion: The health behavioral modification program based on PROMISE model conducted by the participating hospitals were considered successful and effective in producing improved 3-self behavior and decreased in biomedical indicators.

Background: Hyperlipidemia (HLP) is one of the cardinal manifestations of primary nephrotic syndrome (PNS). More importantly, HLP appears to act as a close link between cardiovascular risk and renal progression in nephrotic children. However, until recently, little information based on clinical and biochemical evidence was available to support this hypothesis.

Objective: We investigated the linkage between cardiovascular risk and renal progression of nephritic syndrome in children.

Methods: Three hundred seventy eight PNS children and 200 healthy volunteers were recruited into this study. Fasting serum levels of lipoprotein (a) [Lp(a)], cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), blood urea nitrogen (BUN), and creatinine (Cr) were measured. Serum LDL and estimate glomerular filtration rate (eGFR) were calculated by the Friedewald formula and the Schwartz formula respectively.

Results: Serum concentrations of Lp(a), TC, TG, HDL, LDL, and apoB were higher in the PNS than in the control group (p <0.05). Two hundred seventy three and 63 patients suffered from dyslipidemia and renal dysfunction to some extent, and the prevalence rates were 72.2% and 16.7%. More specifically, the most prevalent type of HLP was [TC‘!] with a constituent ratio of 49.1%, and the most prevalent type of renal dysfunction was [eGFR“!] with a constituent ratio of 76.2%. PNS children undergoing renal dysfunction exhibited significantly higher Lp(a) and TG concentrations than those with normal renal function (p <0.05). PNS children suffering from HLP had significantly higher BUN and lower eGFR levels than those with normal serum lipids (p <0.05). Serum Lp(a) was negatively correlated with eGFR (r = -0.36, p <0.05) in nephrotic children. In addition, Serum TG was also negatively correlated with eGFR (r = -0.45, p <0.05), While positively correlated with BUN (r = 0.43, p <0.05) in nephrotic children.

Conclusions: Lipid abnormalities may parallel with the reduction in renal function. On the other hand, the upregulations of serum lipid profiles, especially to Lp(a) and TG levels, can indeed accelerate cardiovascular risk in PNS children.

Background: Coronary Artery Disease (CAD) is the most frequent form of heart diseases. IL-10 is an antiinflammatory cytokine and down regulates the Th1 response by suppression of pro-inflammatory cytokine. There are interindividual variations in IL-10 production, which are genetically contributed by polymorphisms within IL- 10 promoter region.

Objectives: We investigated the association of IL-10 gene promoter -1082 G/A, -819 C/T, and -592 C/A polymorphism with CAD susceptibility in Pakistani individuals.

Methods: Ninety-three CAD patients and ninety-nine controls were enrolled in the study. IL-10 (-1,082 G/A, -819 C/T, -592 C/A) genotyping was performed by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR).

Results: There is an indication that IL-10 -1082 GG (p = 0.033, OR = 0.26, 95%, CI = 0.07-0.97) has positive association while -1082 GA (p = 0.031, OR = 2.7, 95%, CI = 1.07-6.90) has negative association with CAD. IL-10 -819 TT (-592 AA) were significantly higher in control than in patients (p = 0.008, OR= 3.1, 95%, CI = 1.09-9.02). We have not found any significant association between IL-10 alleles and haplotypes and CAD. GTA/ATA was the diplotype, which showed the protective effect (p = 0.006, OR = 3.6, 95%, CI = 1.16-10.57) in CAD susceptibility.

Conclusion:We found a significant distributional variation in IL-10 promoter SNPs in healthy individuals and the disease group. This difference may be manifested in IL-10 production and disturb the pro- and anti- inflammatory cytokine balance hence influencing the susceptibility of CAD.

Background: Previous study suggests that high mobility group box 1 (HMGB1) can be a potential late inflammatory mediator. However, whether heat shock factor 1 (HSF1) regulate HMGB1 expression via binding to heat shock element (HSE) is not known.

Objective:We investigated the role of HSF1 in the transcriptional regulation of HMGB1 protein.

Methods: A probe that included HMGB1 promoter region containing HSE was synthesized for electrophoretic mobility shift assay (EMSA) to determine the binding of HSF1 and HSE in the promoter region of HMGB1 gene. Mutant mouse HMGB1 promoter was prepared by PCR amplification on a template of wild-type plasmid DNA with site-directed mutant primers. The mutant DNA fragments were also inserted into a corresponding plasmid. In addition, luciferase reporter plasmids of HMGB1 promoter were constructed to transfect RAW264.7 cells. After that, luciferase activity was measured to assay the effects of the HSF1 transfection on the promoter activity.

Results: EMSA result showed a retardation strap after the coculture of biotin labeled HSF1 binding fragment and nuclear protein extracts. The retardation phenomenon could be competed by unlabeled probe and not by unlabeled mutant probe. A super retardation strap was present after adding HSF1 monoclonal antibody. After the HSE core sites was mutated, the relative luciferase activity of the mutant plasmid decreased by 4.26 folds compared with that in the wild-type (23.54±1.68 vs.100.25±3.26, p <0.01). EMSA assay also confirmed that there were HSF1 binding sites HSE (-668bp~-651bp) in the promoter region of HMGB1. The mutation of the core base of HSF1 binding sites decreased the transcriptional activity of HMGB1.

Conclusion: HSF1 can bind to the promoter region HSE (-668bp~-651bp) of HMGB1, which down-regulates the expression of HMGB1.

Background: Progressive nephropathy represents a substantial source of morbidity and mortality in type 2 diabetes. Increasing albuminuria is a strong predictor of progressive renal dysfunction and heightened cardiovascular risk. Endothelial damage is associated with albuminuria. VonWillebrand factor (vWf) and Thrombomodulin (TM) are possible markers of endothelial dysfunction and damage.

Objectives: We studied the relationship between plasma vWf, TM, and urinary albumin excretion.

Methods: We conducted on 90 diabetic patients fulfilled the WHO criteria for type 2 diabetes. Diabetic patients were placed into three groups according to urinary albumin concentration (UAC) in a 24-hour urine collection. Group I: included 30 patients with normal urinary albumin concentration (without nephropathy); microalbumin/24 hour urine less than 30 mg. Group II: included 30 patients with microalbuminuria (incipient diabetic nephropathy), microalbumin/24 hour urine from 30 to 299 mg. Group III: included 30 patients with macroalbuminuria (overt diabetic nephropathy); microalbumin/24 hour urine greater than 300 mg. We measured plasma levels of vonWillebrand factor (vWf) and Thrombomodulin (TM) as markers of endothelial dysfunction, to evaluate their relationship to urinary albumin excretion in patients with type 2 diabetes mellitus.

Results: There were significant increase in the levels of cholesterol and triglyceride, and significant decrease in HDL in group III compared to the control group, while it was highly significant with group II and III. TM levels showed no significant difference between control group and group I while it was highly significant with group II and III (p <0.01), also there was highly significant difference between group I and III (p <0.01). TM index showed no significant difference between control group and group I and II, while there was highly significant difference between control group and group III (p <0.01) and highly significant difference between group II and III (p <0.01). Albumin concentration in 24 hours urine showed no significant difference between control group and group I, while there were highly significant difference between control group and group II and III (p <0.01), also there was significant difference between group II and III (p <0.01). There were highly significant positive correlation between vWF, TM levels and all studied variables. Multivariate analysis which showed that total cholesterol, urinary albumin and age retained significant influence on the plasma vWF and TM.

Conclusions: These results suggested that generalized vascular endothelial damage occurs in diabetic nephropathy including the microalbuminuric stage. Hence, plasma vWF and TM represents valuable markers of endothelial dysfunction that could be used for early detection of diabetic microvascular complications.

Background: How to deliver sufficient therapeutic genes into cancer cells while causing fewer side effects are major challenges in cancer gene therapies. Receptor mediated gene delivery enables specific delivering therapeutic genes into target cancer cells and increases the efficacy.

Objectives: We developed a novel receptor mediated short interference RNA (siRNA) expression plasmid delivery system against ovarian carcinoma cells with improved biocompatibility in vitro.

Methods: Follice stimulating hormone (FSH) peptide (β: 33-55) was grafted to polyethylenimine (PEI) via a bifunctional polyethylene glycol (PEG) and complexed with anti chemokine c-x-c motif ligand 1 (CXCL1) plasmid DNA (pDNA) to form FSH-PEG-PEI/pDNA polyplexes at various N/P ratios. The cytotocity, transfection efficiency, and CXCL1 silencing effect were evaluated respectively.

Results: The FSH-PEG-PEI/pDNA polyplexes showed low cytotoxicity, high transfection efficiency, and specific CXCL1 gene silencing effect. The 2% FSH-PEG-PEI conjugate complexed with pDNA at N/P ratio of 25 has better physicochemical properties. The therapeutic siRNA expression plasmid uptake by follice stimulating hormone receptor (FSHR) expression ovarian carcinoma cells was through a receptor-mediated manner.

Conclusion: The FSH-PEG-PEI conjugate can be used as a novel receptor mediated gene delivery system against ovarian carcinomas. This strategy could be extended to a wide range of targeted gene therapeutics against different cancers.

Background: Grape seed proanthocyanidin extracts (GSPE) prevent and treat a variety of disorders caused by oxidative stress. However, it is unclear whether GSPE has protective effect on rats with diabetic nephropathy.

Objectives: We investigated the effects of GSPE on kidney of diabetic nephropathy rats.

Materials and methods: Thirty male Sprague-Dawley rats were divided into three groups; control, diabetic nephropathy, and diabetic nephropathy, that received GSPE 500 mg/kg for six week. The first, 24 hours urinary albumin excretion (UAE) was studied two weeks after induction of diabetes. Then the UAE was studied each week until the end of the experimental period in all of groups. At the end, the experimental animals were sacrificed and both kidneys were collected and prepared for light microscopy and electron microscopy evaluation and measurement of lipid peroxidation content.

Results: The results showed that the UAE and kidney weight in diabetic nephropathy rats were significantly higher than in controls. Increases of the mesangial matrix, glomerular basement membrane thickness, broadening of foot process, and lipid peroxidation content in diabetic nephropathy group rats were observed. In addition, apoptosis cells were present in this group when compared to controls. These features were reversed when the GSPE was administered to the experimental rats.

Conclusion: GSPE prevented the progression of diabetic nephropathy in rats by its antioxidant properties

Backgrounds: Plasminogen activator inhibitor-1 (PAI-1) gene was reported to associate with ischemic stroke, particularly the insertion/deletion 4G/5G promoter polymorphism. However, because of the complexity and multifactorial nature of stroke, many previous studies showed inconsistent results.

Objectives: We investigated whether PAI-1 gene polymorphism is associated with ischemic stroke by genetic association and meta-analysis in Thais.

Methods: A case-control genetic association study on PAI-1 polymorphism was conducted. It contains 179 patients with ischemic stroke and 229 healthy controls. We also conducted a meta-analysis by combining the results from our work with other published association studies obtained between 1994 and 2010.

Results: The genetic association studies on PAI-1 polymorphism on the Thai samples indicate marginal odds ratio between the PAI-1 polymorphisms and the risk of ischemic stroke. Combining our samples with all previously reported PAI-1 association studies, we did not find any genetic model significant by the lambda method. However, the allele-based method showed the recessive genetic model to be significant for the Asian-derived population when analyzed separately from Caucasians.

Conclusions: From the meta-analysis on our Thai data combined with other publications, it can be concluded that the homozygous-4G polymorphism is a risk factor for ischemic stroke in Asian, but not Caucasian populations. However, according to marginal odds ratio results, the cryptic genetic contribution, or other missing heritability should be considered for the study of ischemic stroke for Thais.

Background: The anatomy of superior mesenteric artery (SMA) is complicated and has numerous variations. Awareness of aberrant branches of SMA can result in accurate interpretation of disease and vascular involvement, optimal selection of treatment options or operative planning, and help avoid iatrogenic injury from surgical and interventional radiological procedures.

Objective: We determined different aberrant arterial branches of SMA and their order of frequencies by using MDCT angiography of the abdominal aorta in order to achieve accurate diagnostic interpretation and for safety of surgical, laparoscopic, and interventional procedures.

Material and Methods: One hundred ninety nine MDCT angiography of abdominal aorta or whole aorta studies, done between January 1, 2007 and December 31, 2009, were retrospectively reviewed by consensus of two radiologists. Interobserver reliability is obtained using ⃞-statistics. Assessment for the presence of aberrant arterial branches of SMA was performed. The number and specific name of each aberrant arteries of mesenteric circulation were recorded.

Results: One hundred sixty three patients (81.8%) have classic normal branches of SMA. Thirty-six patients (18.1%) have single arterial variant identified, and none has multiple arterial variant from SMA. Identified aberrant branches of SMA are replaced right hepatic artery (8.5%), celiacomesenteric trunk (3.5%), inferior pancreatic artery (2.5%), common hepatic artery (2%), right gastroepiploic artery (0.5%), splenic artery (0.5%), and cystic artery (0.5%). Associations of single arterial variant of SMA with other variation of mesenteric circulation are found in seven patients.

Conclusion: Aberrant branches of SMA in Thai people present in 18.1% of cases. The highest incidence is replaced right hepatic artery arising from SMA (8.5%). Incidence and order of frequency are conformed to previous reports in other nationalities. There is also associated variation of other mesenteric circulation in 3.5% of cases presented with aberrant arterial branch from SMA, while none has shown multiple aberrant branches from SMA.

Background: Living donor liver transplantation has been used for the treatment of end-stage liver disease due to the decline in organ donations. Living donor graft volume (GV) to recipient standard liver volume (SLV) ratio should be estimated before surgery to assess the degree of graft size disparity. In order to avoid post-operative liver failure, it is important to calculate SLV as a reference point for the minimal volume necessary for the recipient.

Objective: We determined which formula is the most appropriate and accurate for calculating SLV in the Thai population.

Materials and methods: One hundred twenty patients with multi-detector computed tomography (MDCT) of the upper or whole abdomen for conditions unrelated to hepatobiliary system with normal liver images between August 1, 2009 and March 31, 2010 were enrolled into the study. TLV measurements obtained from MDCT were compared to the SLV calculation based on the previously reported formulae.

Results: The formula derived from the Thai population by Hatthapornsawan S et al. was based on the body weight and its SLV estimation was the closest to TLV (ICC = 0.703). However, this formula underestimated SLV on average by 69.8 cc. The formula derived from the Japanese population by Urata et al. underestimated SLV by 97.7 cc with an ICC of 0.44. The body weight was found to correlate most closely with TLV (R² = 0.972, P<0.001). The new linear regression formula used to estimate SLV was modifies to SLV = 20.67 × body weight.

Conclusion: From the six previously reported formulae for the calculation of SLV, values obtained from the formula by Hatthapornsawan S et al. was the closest in estimating the liver volume in the Thai population but also slightly underestimated SLV. We have modified the formula. We recommend that Thai physicians use this new formula to calculate SLV because it is more accurate than the previously reported formula.

Background: Ostomy surgery profoundly affects life of the patient, both physically and psychologically. Health- Related Quality of Life (HRQOL) is an important evaluation of health outcome that has not been studied in Thai patients with ostomy.

Objectives: We determined HRQOL of patients living with ostomy, correlated factors, and average cost of ostomy supplies per month.

Methods: Cross-sectional study with questionnaires was carried out given to 107 patients with ostomy at King Chulalongkorn Memorial Hospital. Self-administered individual factors questionnaire, WHOQOL-BREFTHAI questionnaire, and ostomy appliances satisfaction questionnaire surveys were employed.

Results: Response rate was 75.9%. Cronbach’s alpha of the WHOQOL-BREF-THAI questionnaire was 0.883. The mean of overall HRQOL scores was 82.5 (SD = 11.0) out of 130. It reveals that most participants had moderate HRQOL levels and were satisfied with ostomy appliances. Social relationships domain of WHOQOL-BREF-THAI had the highest number of participants who had poor HRQOL level. Significant factors related to HRQOL were gender, age groups, obesity, marital status, payment scheme, financial status, skin disorders, and underlying diseases. The mean cost of ostomy supplies per month per stoma was 1,770 Thai Baht (SD = 858.9). One-piece ostomy appliance system had lower cost with better HRQOL scores and better ostomy appliances satisfaction scores. However, the sample size was limited for the one-piece system.

Conclusion: Most Thai patients living with ostomy have moderate quality of life, and they adjust well. The social relationships compromises are major issues that healthcare professionals should address with this group of patients. Ostomy supplies can be an important expense for patients.

Background: Human bone marrow stem cell (hBMSC) is a promising candidate in regenerative medicine due to its plasticity and homing ability. However, in vitro survival and therapeutic efficacy of hBMSCs decline with donor age as a result of physiological cellular aging.

Objectives: We transfected human telomerase reverse transcriptase (hTERT) into hBMSCs from patients more than 60 years old in the hope of extending cellular life span.

Methods: In our study on 11 donors (aged 16-74 years), no telomerase activity was detected in hBMSCs from donors ≥60 years old. We then performed transient transfection on hBMSC from these elderly donors (n = 4) with hTERT gene using non-viral methods.

Results: Transfection efficiency of 38.5% and 55.6% was achieved by lipofection and electroporation with viability at 83% and 44%, respectively. Telomerase was detected on day 5 for all post-transfected samples. Maximum passage number achieved after transfection was ≥13 (≈45 doublings) compared with 6 (≈15 doublings) before transfection.

Conclusion: We conclude that transient expression of hTERT increased cellular life span of hBMSCs from elderly patients, while maintaining a normal cell morphology and growth rate.

Background: Essential hypertension is a complex polygenic disorder arising from the interaction of several genes with environmental factors. Of the various physiological pathways affecting the homeostasis of blood pressure, the renin-angiotensin system (RAS) is considered important with angiotensin converting enzyme (ACE) playing a key role in causing susceptibility to hypertension.

Objective: Explore the single locus, haplotype and epistasis patterns of two polymorphisms of ACE gene (I/D and g.2350G>A) and their contribution in causing risk for essential hypertension.

Methods: Two hundred seventy nine hypertensive cases and 200 healthy controls were recruited. Genotype of the ACE I/D polymorphism was determined by PCR and g.2350G>A polymorphism was assessed using a polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) based method.

Results: The distribution of genotypes showed a significant association of ACE I/D polymorphism (χ² = 7.148, p = 0.028), while ACE g.2350G>A polymorphism did not show any such association (χ² = 0.85, p = 0.65). For ACE I/D and g.2350G>A polymorphisms, genotypic proportions were statistically significant especially in males (p <0.05). The frequency of H1 haplotype with ACE I and G2350 alleles was higher among hypertensives than in normotensives. The analysis for epistatic interaction showed a strong synergistic effect between I/D and g.2350G>A polymorphisms.

Conclusion: Our study suggests significant association of allele I of I/D polymorphism and essential hypertension with strong synergism when segregating with allele G of g.2350G>A polymorphism at ACE locus.

Background: Coronary artery bypass grafting (CABG) is an effective method to afford sufficient blood flow for that ischemic myocardium. Off-pump coronary bypass surgery (OPCAB) has been rediscovered and refined to avoid cardiopulmonary bypass. However, it’s a high technique demanding skill. And evaluation of the blood flow should be reliable. Transit time flow measurement (TTFM) is introduced to evaluate graft flow and anastomosis patency intraoperatively. The accuracy of graft flow depends on how to explain the parameters of TTFM. Here, we introduce our experiences on the explanation of TTFM parameters.

Objective: We compared the graft patency of off-pump coronary artery bypass grafting with those of on-pump coronary artery bypass grafting by intraoperative transit time flow measurement (TTFM).

Methods: Three hundred patients were divided into off-pump group and on-pump group. TTFM was routinely performed for assessment of graft patency during operation. Revision of the grafts depends on the TTFM findings.

Results: One patient in OPCAB group was converted to conventional CABG group due to ventricular fibrillation. One patient died of multiple organ failure 21 days post-operation. Seven grafts were revised based on unsatisfactory TTFM findings. There was no statistical difference in the variables between the two groups except for anastmosis to right coronary artery.

Conclusions: Off-pump surgery can provide the same flow of grafts as that of on-pump surgery. TTFM is an effective tool to decide if a well-function graft is or not, and it allows for revision of failure graft during operation.

Background: Silver sulfadiazine (SSD) is the most used topical agent for the treatment of burn wounds. However, it has some side effects such as delayed and incomplete epithelialization, generation of black scars, and limited penetration to the depth of a wound.

Objective: The present study investigated the efficacy of herbal combination cream containing Aloe vera gel and essential oils of Lavandula stoechas and Pelargonium roseum in the alleviation of symptoms in patients with superficial second-degree burns and comparison of its effects with those of SSD 1% cream.

Methods: One hundred eleven patients with second-degree burns (occurring in the preceding 48 hours and affecting <50% body area) were randomized to receive either herbal cream (n = 56) or SSD 1% cream (n = 55) applied once daily for 14 days. Prevalence of skin dryness and pain severity (assessed using a visual analogue scale) and evidence of infection was determined for patients at baseline as well days 2, 7, and 14.

Results: Both groups experienced a significant reduction in the pain severity at day 14 compared to baseline (p <0.001). As for the magnitude of change in pain score, there was a significantly greater reduction from baseline to the seven (p = 0.014) and 14 (p = 0.05) day in the herbal cream compared to control group. The frequency of skin dryness was not significantly different between the groups at any of the assessed time points (p >0.05). There was a single case of infection in the herbal cream group, which cleared with continuation of treatment.

Conclusion: Our findings suggested that the herbal cream used here is superior to SSD 1% cream in the alleviation of pain and may serve as a natural alternative for treatment of second-degree burns.

Background: Ischemia/reperfusion (I/R) injury is a potentially devastating condition, associated with a systemic inflammatory response. It occurs during shock, transplant procedures, or vascular surgery.

Objective: We evaluated the protective effects of Fenofibrate (FEN) over intestinal I/R injury.

Materials and methods: Intestinal I/R was induced in male Wistar rats by clamping the superior mesenteric artery for 60 minutes, followed by 60 minutes of reperfusion. Rats either received saline or FEN (100 mg/k, via gavage) daily, for three days before inducing I/R. Sham operated rats were used as normal controls. At the end of the procedure, tissue and blood samples were obtained. Serum concentrations of AST, ALT, LDH, tumor necrosis factor-alpha (TNF-alpha), malonaldehyde (MDA), and total antioxidant capacity (TAC) were determined. A histopathological analysis was also performed.

Results: After I/R, there was evident tissue injury, as well as serum elevations of AST, ALT, and LDH concentrations. These alterations were reduced by FEN treatment. TNF-alpha concentrations were increased in saline treated animals when compared with FEN treated group (2.26±1 ng/ml vs. 0.23±0.41 ng/ml, respectively, p <0.05). A similar pattern was observed in MDA levels (7.42±1.72 μM/ml vs. 1.72±0.61 μM/ml, respectively, p <0.05). TAC was reduced in saline treated animals (2.05±0.36 Trolox-Equivalents), but preserved in the FEN treated group (3.08±0.36 Trolox-Equivalents, p <0.05).

Conclusion: FEN reduced intestinal I/R injury, probably due to anti-inflammatory and antioxidant properties. Its usefulness as a treatment for I/R should be studied.

Background: The aging process, bone remodeling, and risks of fracture were associated with alteration of blood perfusion in the bone. However, capillary changes during aging in the bone have not been examined due to methodological difficulties.

Objective: Investigate changes of capillary density and length during aging in rat femur using intravital confocal laser microscopy.

Methods: Two-month male Wistar rats were divided into three groups: young (aged 4 to 6 months), adult (aged 12 to 14 months), and aged group (aged 20 to 22 months). The microvasculature of femur periosteum of each rat was visualized with FITC-labeled dextran, and observed via the window chamber under a confocal laser microscopic system. Capillary diameters, lengths, and densities were measured based on the obtained images. Capillary changes (density and length) during aging were analyzed.

Results: The mean capillary density increases up to 130% from young to adult, but decreases up to 15% from adult to aged. Capillary densities against diameter were in a near-normal distribution with a maximum of 130, 250, and 15/mm² at 3 to 5, 3 to 5, and 5 to 7 μm diameter in the young, adult and aged group, respectively. The capillary length in the adult group was much shorter than those in the young and aged groups

Conclusion: The capillary density in the rat femur changes from youth to aging. This can alter blood perfusion and result in bone changes.

Background: Intraocular pressure (IOP) is the most important risk factor in glaucoma. Before each measurement, anesthetic eye drop must be applied. The effect of these eye drops may affect the central corneal thickness (CCT) and the IOP.

Objective: We investigated the effect of 0.5% tetracaine hydrochloride on central CCT and IOP in glaucoma patients.

Methods: Glaucoma subjects aged ≥18 years, with spherical refractive error <±6 diopters(D) and astigmatism ≤3D were included. All underwent CCT and IOP measurement using Orbscan II and air-puff tonometer at baseline, and 1, 3, 5, 7, 9, 11, 13, and 15 minutes after application of 0.5% tetracaine hydrochloride.

Results: There were 19 and 24 eyes eligible for CCT and IOP measurements. The mean±SD ages were 62.7±8.2 and 62.9±8.3 years. The mean±SD CCT at baseline was 527.8±32.2 μm. The mean±SD IOP at baseline was 13.2±5.6 mmHg. Although CCT did not change from baseline (p = 0.071), IOP significantly decreased from baseline at three, seven, and 11 minutes (p = 0.003, <0.001, and 0.002).

Conclusions: CCT and IOP change trends were different. Although IOP decreased from baseline, CCT was unchanged.

Background: Unnecessary use of antibiotics can be a problem in the treatment of hordeolum since the providers prescriptions, pathogens and their susceptibilies are peculiar to local situations.

Objectives: We identified current pathogenic organisms in hordeolum and its susceptibilities to antimicrobial agents in topical eye medications in Thai patients.

Methods: Seventy-nine patients from the King Chulalongkorn Memorial Hospital who never received any treatment for hordeolum participated in the study. Pus specimens were collected from incision and curettage. The bacteria was stained by Gram stain and grown on aerobic and anaerobic culture agars. If there was bacterial growth, drug susceptibility test was conducted utilizing Ciprofloxacin, Fusidic acid, Oxytetracycline, Polymyxin, Neomycin, and Chloramphenicol.

Results: Bacterial growth was detected in 54 isolates from 50 patients (63.3%). These isolates were identified to be Staphylococcus epidermidis (19 isolates, 35.2%), Proprionibacterium acnes (13 isolates, 24.1%), Staphylococcus aureus (10 isolates, 18.5%), Corynebacterium spp. (10 isolates, 18.5%), Aerococcus viridans (1.85%), and Prevotella intermedia (1.85%). Susceptabilty test of P. acne to Tobramycin and Polymyxin showed MIC₉₀ (Minimal Inhibitory Concentration) was more than 10 times lower compared to other antibiotics tested.

Conclusion: Most of the pathogens were from the normal skin flora. The most common organism continues to be the Staphylococcus species. All eye medications tested had antibiotic concentrations more than 10 times higher than the values of MIC₉₀ except for Tobramycin and Polymyxin which indicated that there was an emergence of drug resistant P. acne.

Background: Pupil dilatation is essential for complete fundoscopic examinations and some eye surgeries. Whether temporary punctual occlusion will enhance the magnitude of pupillary dilation is not known.

Objectives: We measured the pupil diameter after one drop of 1% tropicamide instillation with and without temporary punctal occlusion at 0 and 30 min in the same patient.

Methods: Ninety-eight eyes from 49 patients at the Department of Ophthalmology, King Chulalongkorn Memorial Hospital were randomized into temporary punctal occlusion group (group 1) and simple closure group (group 2) after instillation one drop of 1% tropicamide in both eyes. Pupil diameters were photographed and measured before starting the drop and again 30 minutes later for each patient.

Results: At 30 minutes the mean pupil sizes of group 1 and group 2 were 3.92±1.53 mm and 3.83±1.43 mm, respectively. The mean difference of pupillary dilatation in group 1 was 2.75±1.94 mm whereas group 2 was 3.19±1.77 mm. The difference between the two group was statistically significant but not clinically important (p = 0.001) (95%CI (-0.69)-(-0.18)).

Conclusions: Temporary punctal occlusion could enhance pupil dilation after one drop of 1% tropicamide instillation within 30 minutes. The degree of dilatation was not clinically important. Additional doses of 1% tropicamide or combination preparation will be required for clinically adequate mydriasis.

Background: Significantly lower LINE-1 methylation levels have been observed in several cancers compared to their normal cell counterparts. It is of interest to note that this epigenetic phenomenon is rather common to cancers with multistage oncogenesis.

Objective: We compared LINE-1 methylation levels of cancer cells between the primary and matched metastatic sites.

Methods: COBRA method was used to determine LINE-1 methylation levels of tumor cells at the primary and matched metastatic sites in five malignancies (10 cases each of head and neck squamous carcinoma, papillary thyroid carcinoma, non-small cell lung cancer, invasive mammary ductal carcinoma, and colorectal adenocarcinoma). LINE-1 methylation levels between the primary and matched metastatic site were compared.

Results: Significantly lower LINE-1 methylation levels were observed at metastatic sites (as compared to primary sites) in head and neck squamous cell carcinoma (p = 0.002) and non-small cell lung cancer (p = 0.012).

Conclusion: In head, neck, and pulmonary cancers, significantly lower LINE-1 methylation levels were found at metastatic sites, as compared to the matched primary tumor. Further studies are warranted to determine whether this altered methylation is the result or the cause of cancer metastasis.

Background: Body mass index (BMI) and percentage of body fat may be linked to physical performance. However, the nature and extent of such association is not known. In addition, it is unknown whether BMI is a good reflection of body fat.

Objectives: We measured the impact of obesity on physical performance and to determine the association between BMI, body fat, and various parameters of physical performance. Therefore, we tested whether BMI could be used as a good reflection of body fat.

Methods: Three hundred people (126 men and 174 women) attending Chula Medical Exposition 2008 were included in this study. All participants underwent various measurements including percentage of body fat by Lange skinfold caliper, submaximal cycle ergometer test, handgrip strength, leg and back dynamometer, and flexibility determination. They were classified by BMI Asian criteria into normal (BMI <23 kg/m²), overweight (BMI 23-24.9 kg/m²), and obesity (BMI >25 kg/m²). The body fat categorized was into satisfied (body fat <16.9%) and unsatisfied (body fat ≥16.9%). Differences in physical performance between groups were calculated by unpaired t-test and analysis of covariance using SPSS for windows version 16.0.

Results: Subjects with normal BMI had significantly higher handgrip strength than overweight and obese group (p = 0.007 and p <0.001 respectively). Regarding percentage of body fat, subjects in unsatisfied group were found having significantly less aerobic power and muscular strength when compared with satisfied group (p <0.001 in all aspects). The present study showed significant correlation between BMI and body fat (r = 0.33, p <0.001), body fat and aerobic power (r = -0.18, p = 0.002), body fat and handgrip strength (r = -0.65, p <0.001), and body fat and leg muscular strength (r = -0.52, p <0.001).

Conclusions: Increased BMI and body fat tended to inversely affect physical performance in both cardiorespiratory fitness and muscular strength. Body fat seemed to have a stronger correlation with impaired physical performance. It could not be fully replaced by BMI in determination of aerobic power and muscular strength.