Fraud and deceit in published medical research.

Medical research casts a great impact on health of the entire human population so it must be conducted and publicized without dishonesty or bias. Any misrepresentation can have extremely serious consequences for patients and clinical practice. Unfortunately, fraud and deceit have increasingly been detected and have become a problem in today's research. They are falsification, fabrication, plagiarism, and deliberate use of inappropriate statistical analysis. It is sometimes difficult to differentiate fraud from incompetence, errors, bias, and misunderstanding. Many fraudulent articles are still undercover. The question is how to detect and prevent the fraud and deceit in medical research. In addition, the system of handling research misconduct is still lacking. Critical audit and inspection are required to diagnose it. There is no standard guideline to treat fraud. Prevention is the best way of treatment. This relies on research institutions, editors of journals, citing authors, and, most of all the researchers who must adhere strictly to medical professionalism, which is solely based on honesty and ethics to self-regulate and conduct only ethical and genuine research.

Manometric tests of anorectal function in healthy adult Thai subjects.

BACKGROUND AND OBJECTIVES: Diseases of the distal gastrointestinal tract are becoming more common among Thai people especially in the elderly. Manometry is a new and useful technique in the diagnosis and management of anorectal disorders. This cross-sectional study aimed to measure anorectal manometric parameters in normal Thai subjects. MATERIAL AND METHOD: Thirty healthy Thai subjects (17 males and 13 females) were studied. They completed a questionnaire assessing their bowel function. A water-perfused manometric system with non-pull-through technique was used to monitor pressure in the rectum and anus. All subjects were asked to squeeze the anal sphincters, bear down, then blow up a party balloon. Rectal sensation and recto-anal inhibitory reflex were also assessed by intermittent phasic balloon distention. Simulated defecation or balloon expulsion test was also performed. RESULT: The study revealed the following anorectal manometric parameters. The mean with standard deviation of the resting, squeezed, and sustained squeezed pressures were 55.4 +/- 15.3, 170.3 +/- 81.7 and 109.3 +/- 54.4 mm Hg respectively. Men had a longer anal sphincter (p = 0.01) and higher squeezed, and sustained squeezed pressures (p < 0. 001) compared to women, while their resting sphincter pressures were similar. Threshold volumes for rectal sensation and desire to defecate were not different among male and female subjects, but the threshold for urgency to defecate was higher in men. The study yielded normal anorectal manometric parameters in Thai subjects. Some parameters vary with gender. It is difficult to compare these normal ranges in Thai subjects to those in Caucasians, as the number of subjects is rather small and the details of instruments and techniques always vary from lab to lab. The manometric findings in these Thai subjects create more understanding in anorectal physiology and can be used as a guideline for the investigation of anorectal function in a symptomatic Thai population in a motility clinic.

Uroflowmetry in normal Thai subjects.

BACKGROUND AND OBJECTIVES: Uroflowmetric parameters of urination may be influenced by many factors including age, sex, voiding position, technique used and also anatomical and physiological variations. A cross-sectional study was carried out to measure uroflowmetric parameters in normal Thai subjects and to compare these parameters among different ages and genders. Correlations between peak flow rate and other parameters were also studied. METHOD: One hundred and forty healthy Thai subjects were studied. They were classified into two groups. Group I comprised of 50 male and 50 female young adults aged 18-30 years. Group II comprised of 20 male and 20 female pre-elderly aged 50-60 years. A Dantec Urodyn 1,000 uroflowmeter was used. The residual urine measurement was performed using an ultrasonograph. RESULT: The techniques revealed the following uroflowmetric parameters. In the young adults, the mean with standard deviation of the peak flow rate was 31.2 +/- 9.0 ml/sec, mean flow rate 22.6 +/- 7.4 ml/sec, voiding time 24.7 +/- 10.6 sec, and voided volume 376.9 +/- 147.5 ml. In the pre-elderly group, the peak flow rate was 27.5 +/- 9.2 ml/sec, mean flow rate 19.1 +/- 6.2 ml/sec, voiding time 24.4 +/- 8.5 sec, and voided volume 310.3 +/- 107.8 ml. The peak flow and mean flow rates were significantly higher in the young adults (p < 0.05). The voided volume in the young was higher with similar voiding time. The peak flow and mean flow rates in females were significantly higher than the males (32.5 +/- 10.0 vs 27.8 +/- 8.0 ml/sec, p < 0.05 and 23.5 +/- 8.1 vs 19.8 +/- 5.8 ml/sec, p < 0.05 respectively). Voided volume and voiding time did not differ among both genders. The correlation between peak flow rate and voided volume was significant (r = 0.382, p < 0.01) indicating that the higher the voided volume the higher the peak flow rate. Residual urine was less than 50 ml in all subjects indicating that these subjects could void completely well. This study yielded normal uroflowmetric parameters in Thai young adult and pre-elderly subjects without urological symptoms. These parameters vary with age and gender, and are useful for the investigations of bladder function in a urological clinic.

Renal functional reserve in lacto-vegetarian adolescents.

A high-protein meal causes an increase in the glomerular filtration rate (GFR) and is a tool to assess renal functional reserve. This study aimed to assess the GFR and renal functional reserve in lacto-vegetarians who had abstained from protein from animal sources for years. Twenty healthy lacto-vegetarian adolescents (LVA) aged 12-15 years including ten males and ten females were recruited. They had consumed no meat, poultry, fish or eggs for 1.0 - 4.8 years (average 2.13 + 1.03 years). An age-and-sex matched control group composed of adolescents who regularly consumed a mixed diet from both animal and vegetable sources (MDA). The baseline GFR was assessed in each subject using the 24-hour creatinine clearance method. Then each subject consumed a meal containing 1.2 grams of protein per kg body weight in the form of steamed chicken breast. After this meal, urine and blood specimens were collected for GFR assessment every 30 minutes for three-and-a-half hours. The result showed that the LVA had a lower baseline GFR compared to the MDA ( 72.6 ฑ 7.7 Vs 89.3 ฑ 14.9 ml/min/1.73 m2). A high-protein meal caused an increase in GFR of 60.3 per cent in the LVA and 76.3 per cent in the MDA. The LVA group whose protein intake was rather low and who had abstained from animal protein for several years showed a smaller and slower response to the renal-hyperfiltration effect of a high animal-protein diet. This might be due to changes in gastro-intestinal digestion and absorption of protein, or changes in renal hemodynamics, other renal functions or structures. In addition, the study revealed that the LVA group has lower body weight, height, body surface area, hemoglobin, serum cholesterol and uric acid concentrations. The female LVA reached menarche at a later age compared to the MDA group. In conclusion, lacto-vegetarian adolescents showed a lower baseline GFR and less renal functional reserve compared to those regularly consuming protein from animal sources.

Effect of high-protein diet on the glomerular filtration rate in the adult and the elderly.

A high-protein meal causes an increase in the glomerular filtration rate (GFR) and can be used to assess renal functional reserve. Renal function can be affected by aging. This study was aimed at assessing GFR and renal functional reserve in healthy elderly Thais in comparison with young adults. Twenty elderly subjects aged 60-80 years, and 20 young subjects aged 20-30 years, were recruited ; each group included 10 males and 10 females. A 24 hour urine specimen was collected from each subject. Venous blood was drawn to measure serum creatinine concentration. Creatinine clearance, which represented GFR, was calculated. Each subject consumed a meal containing 1.5 grams of protein per kg BW. Urine and blood specimens were collected at 30, 60, 90, 120, 180 and 240 minutes after the meal for GFR assessment. The results showed that the elderly had a lower GFR compared with the young (70.8+ 14.5 vs 85.6+ 16.2 ml/min/1.73 m2). A high-protein meal caused an increase in GFR of 155+ 63 per cent in the young and 88+ 49 per cent in the aged. In conclusion, healthy elderly subjects showed a lower GFR and less renal functional reserve compared with young adults.

The antihypertensive effect of celery in renovascular occlusive dogs.

The antihypertensive effect of Chinese celery decoction was studied using a renal-occlusive animal model. Sixteen male dogs were anaesthesized and operated. The left renal artery was then occluded. Three hours after the renovascular occlusion, eleven dogs were fed with distilled water in the same pattern. The intracarotid arterial pressure, electrocardiogram and urine output were continually recorded. Blood samples for plasma rennin activity (PRA) radio-immunoassay were collected before renovascular occlusion, just before feeding, and then two hours after feeding. In the experimental group, the systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP) and the PRA stepped up within three hours after renovascular occlusion. The celery feeding then brought the SP, DP, or MAP though the PRA came down slightly. In both groups, the urine volume decreased after renovascular occlusion then increased after feeding, but no statistically significant difference was found between the two groups. The study confirmed the antihypertensive effect of Chiness celery even in the renovascular hypertensive model. The celery decoction brought down the blood pressure without causing pronounced diuresis or any decrease in rennin activity.