Influence of oxyhydrogen gas retrofit into two-stroke engine on emissions and exhaust gas temperature variations.

The generation of power and fuel sustainability that contributes to a cleaner output of exhaust gases is one of the most important objectives the world seeks. In this paper, oxyhydrogen gas is used to retrofit into a two-stroke engine. The water was electrolysed and generated a mixture of oxygen (O2) and hydrogen (H2) or known as oxyhydrogen (HHO) gas via an electrolytic dry cell generator. The HHO was retrofitted experimentally to investigate the engine emissions and exhaust gas temperature from a 1.5 kW gasoline engine. The engine was tested with different power ratings (84-720 W) to investigate the performance and emissions of the engine using gasoline followed by the addition of HHO. The emissions of CO and NOx were measured with different amounts of HHO added. The exhaust temperature was calculated as one of the variables to be considered in relation to pollution. The air-fuel ratios are varied from 12 to 20% in the experiment. The most appropriate air-fuel ratio needed to start the generator with the most environmentally friendly gas emission was analysed. The results showed that the addition of HHO to the engine is successful in reducing fuel consumption up to 8.9%. A higher percentage of HHO added also has improved the emissions and reduced exhaust gas temperature. In this study, the highest quantity of HHO added at 0.15% of the volume fraction reduced CO gas emission by up to 9.41%, NOx gas up to 4.31%, and exhaust gas temperature by up to 2.02%. Generally, adding oxyhydrogen gas has significantly reduced the emissions, and exhaust temperature and provided an eco-friendly environment.

Psychological impact amongst patients with COVID-19 in Perak state.

INTRODUCTION: Psychological distress had been documented since the beginning of the COVID-19 outbreak in 2019. The aim of the study is to describe the psychological impact among those who were hospitalized for COVID-19 infection within 6 months after being discharged from the hospital. The psychological impact in this study is defined as depression, anxiety, and stress. MATERIALS AND METHODS: This was a cross-sectional study conducted from July 2020 till August 2021 in a regional state hospital, north of Malaysia. All patients requiring hospitalization for COVID-19 were approached within the first 2 weeks after admission to administer the Depression, Anxiety and Stress Scale - 21 Items (DASS-21) scale. Follow-up phone calls were made within 3 months of discharged to enquire about the DASS-21 items as well as the Impact of Event Scale-Revised (IES-R) scale items. Participants above the age of 18 and technology savvy to answer an online questionnaire were recruited for the study. We excluded participants with a known history of psychotic disorder from the study. We utilised the DASS-21 to screen for depression, anxiety, and stress, as well as the IES-R to identify symptoms of post-traumatic stress disorder. Participants could answer the questionnaires in either English or Bahasa Malaysia. For comparison of two categorical data, a chi-square was applied. A univariate analysis was first conducted and all variables with a p ≤0.3 was then entered into the multivariate analysis for the final output. Other than the univariate analysis, all other p values <0.05 were considered to be statistically significant. All data collected were tabulated and analysed in the SPSS v21.0 system. RESULTS: A total of 306 out of 696 COVID-19 patients responded. The mean age for the participants was 31.69 (SD:11.19) years old. From the total, 54.2% were ladies, 78.8% were Malay, 50.7% were unmarried, 55.2% had higher education, and 67.6% were employed at the time of the survey. We found 20.5% of the participants were depressed, 38.9% had moderate anxiety, and 17.3% were stressed. From the total, 31.7% of the participants were deemed to have had some symptoms of post-traumatic stress disorder (PTSD) ranging from mild to severe. From the final multivariate analysis, it was found that depression (p=0.02) had a 2.78 times likeliness of having PTSD, anxiety (p<0.001) had a 3.35 times likeliness of having PTSD and stressed patients (p=0.02) 2.86 times likeliness of having PTSD when compared to those without PTSD. CONCLUSION: Patients reported to suffer from symptoms of PTSD and might benefit from psychological interventions to mitigate the impact in the long run.

Whole-grain intake and its inverse relationships with fatty acids intake among multiethnic Malaysian schoolchildren.

INTRODUCTION: Little is known about the relationship of whole-grain intake with dietary fatty acids intake. The present study aimed to assess the whole-grain intake and its relationships with dietary fatty acids intake among multiethnic schoolchildren in Kuala Lumpur, Malaysia. METHODS: This cross-sectional study was conducted among 392 schoolchildren aged 9-11 years, cluster sampled from five randomly selected schools in Kuala Lumpur. Whole-grain and fatty acids intakes were assessed by 3-day, 24-h diet recalls. All whole-grain foods were considered irrespective of the amount of whole grain they contained. RESULTS: In total, 55.6% (n = 218) were whole-grain consumers. Mean (SD) daily intake of whole grain in the total sample was 5.13 (9.75) g day-1 . In the whole-grain consumer's only sample, mean (SD) intakes reached 9.23 (11.55) g day-1 . Significant inverse associations were found between whole-grain intake and saturated fatty acid (SAFA) intake (r = -0.357; P < 0.001), monosaturated fatty acid (MUFA) (r = -0.373; P < 0.001) and polyunsaturated fatty acid (PUFA) (r = -0.307; P < 0.001) intake. Furthermore, whole-grain intake was a significant predictor of SAFA (ß = -0.077; P = 0.004), MUFA (ß = -0.112; P = <0.001) and PUFA (ß = -0.202; P = <0.001) intakes, after controlling for sex, age and ethnicity. CONCLUSIONS: Whole-grain intake in Malaysia was well below recommendations. Schoolchildren who consumed higher whole grain tend to reduce fat intake; however, it would also reduce the SAFA, MUFA and PUFA intakes. Future collaboration may be conducted between industry, government and universities to promote unsaturated fatty acids-rich foods and whole-grain food, although not to promote processed whole-grain foods with a high sugar and salt content.

Effects of preslaughter shackling on postmortem glycolysis, meat quality, changes of water distribution, and protein structures of broiler breast meat.

The objective of this study was to investigate the effects of preslaughter shackling on stress, postmortem glycolysis, meat quality, water distribution, and protein structures of pectoralis majors. Before slaughter, Arbor Acres broilers (n = 105, 42 days old, 2.0 to 2.5 kg) were randomly categorized into 3 treatment groups: (I) control group without shackling (NS); (II) 2.5 min shackling (SS); (III) 4.5 min shackling (LS). Each treatment group consisted of 5 replicates with 7 broilers each. Results indicated that preslaughter shackling increased (P < 0.05) plasma corticosterone and adrenocorticotropic hormone concentrations in comparison with the control group. Antemortem shackling increased (P < 0.05) activity of glycogen phosphorylase and phosphofructokinase-1 (PFK-1) accompanying with rapid glycolysis and pH decline at early postmortem. LS treatment led to myosin denaturation, decreased (P < 0.05) α-helix content, and increased (P < 0.05) ß-sheet structures proportion in the myofibrillar proteins. Furthermore, meat from LS treatment had higher (P < 0.05) lightness, redness, and poorer water-holding capacity. These results indicated that the longer shackling duration (4.5 min) increased stress and the rate of glycolysis, causing myosin denaturation and changes of the secondary structure in the myofibrillar proteins, which aggravated the deterioration of meat quality.

UK guidelines on oesophageal dilatation in clinical practice

These are updated guidelines which supersede the original version published in 2004. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone extensive revision by the 16 members of the Guideline Development Group with representation from individuals across all relevant disciplines, including the Heartburn Cancer UK charity, a nursing representative and a patient representative. The methodological rigour and transparency of the guideline development processes were appraised using the revised Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.Dilatation of the oesophagus is a relatively high-risk intervention, and is required by an increasing range of disease states. Moreover, there is scarcity of evidence in the literature to guide clinicians on how to safely perform this procedure. These guidelines deal specifically with the dilatation procedure using balloon or bougie devices as a primary treatment strategy for non-malignant narrowing of the oesophagus. The use of stents is outside the remit of this paper; however, for cases of dilatation failure, alternative techniques-including stents-will be listed. The guideline is divided into the following subheadings: (1) patient preparation; (2) the dilatation procedure; (3) aftercare and (4) disease-specific considerations. A systematic literature search was performed. The Grading of Recommendations Assessment, Develop-ment and Evaluation (GRADE) tool was used to evaluate the quality of evidence and decide on the strength of recommendations made.

Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry.

BACKGROUND: Barrett's oesophagus (BE) is a pre-malignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BE-related neoplasia. METHODS: We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3-monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008-2010 and 2011-2013). Durability of successful treatment and progression to OAC were also evaluated. RESULTS: 508 patients have completed treatment. CR-D and CR-IM improved significantly between the former and later time periods, from 77% and 56% to 92% and 83%, respectively (p<0.0001). EMR for visible lesions prior to RFA increased from 48% to 60% (p=0.013). Rescue EMR after RFA decreased from 13% to 2% (p<0.0001). Progression to OAC at 12 months is not significantly different (3.6% vs 2.1%, p=0.51). CONCLUSIONS: Clinical outcomes for BE neoplasia have improved significantly over the past 6 years with improved lesion recognition and aggressive resection of visible lesions before RFA. Despite advances in technique, the rate of cancer progression remains 2-4% at 1 year in these high-risk patients. TRIAL REGISTRATION NUMBER: ISRCTN93069556.

Toehold-mediated internal control to probe the near-field interaction between the metallic nanoparticle and the fluorophore.

Metallic nanoparticles (MNPs) are known to alter the emission of vicinal fluorophores through the near-field interaction, leading to either fluorescence quenching or enhancement. Much ambiguity remains in the experimental outcome of such a near-field interaction, particularly for bulk colloidal solution. It is hypothesized that the strong far-field interference from the inner filter effect of the MNPs could mask the true near-field MNP-fluorophore interaction significantly. Thus, in this work, a reliable internal control capable of decoupling the near-field interaction from far-field interference is established by the use of the DNA toehold concept to mediate the in situ assembly and disassembly of the MNP-fluorophore conjugate. A model gold nanoparticle (AuNP)-Cy3 system is used to investigate our proposed toehold-mediated internal control system. The maximum fluorescence enhancement is obtained for large-sized AuNP (58 nm) separated from Cy3 at an intermediate distance of 6.8 nm, while fluorescence quenching is observed for smaller-sized AuNP (11 nm and 23 nm), which is in agreement with the theoretical values reported in the literature. This work shows that the toehold-mediated internal control design can serve as a central system for evaluating the near-field interaction of other MNP-fluorophore combinations and facilitate the rational design of specific MNP-fluorophore systems for various applications.

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.

The impact of neuropsychiatric symptoms on caregiver distress and quality of life in persons with dementia in an Asian tertiary hospital memory clinic.

BACKGROUND: This study aims to determine the prevalence, profile, and severity of neuropsychiatric symptoms (NPS) across the dementia continuum and their relative impact on caregiver distress and quality of life (QoL) in persons with dementia (PWD). METHOD: Six hundred and sixty-seven PWD and their family caregivers presented to a memory clinic in a tertiary hospital across a 60-month period. Clinicians determined the dementia diagnosis and severity using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and the Clinical Dementia Rating scale, respectively. The Neuropsychiatric Inventory Questionnaire was administered to assess NPS in PWD and the corresponding distress experienced by the caregiver. QoL for PWD (PWD-QoL) was assessed by the Quality of Life-Alzheimer's Disease scale. RESULTS: Ninety-six percent of PWD presented with at least one NPS, 18% experiencing mild, 31% moderate, and 47% severe symptoms, respectively. While agitation (63.1%), apathy (61.8%), depression (55.5%), and irritability (55.5%) were the most common NPS; disinhibition (35.2%), hallucination (25.5%), and elation (14.2%) were the least common. NPS increased generally but differentially as dementia progressed and significantly predicted caregiver distress (ηp 2 = 0.732, p < 0.0001) and PWD-QoL (ηp 2 = 0.066, p < 0.0001). Factor analysis revealed two NPS clusters, disruptive and affective; the former exerting greater impact on caregiver distress and the latter on PWD-QoL. CONCLUSION: The results show a high prevalence of NPS which increase caregiver distress and negatively impact PWD-QoL. The differential profile of NPS across the dementia stages warrants stage-specific interventions and due consideration in resource planning and service design for PWD and their caregivers.

Reliability of acute illness dihydrorhodamine-123 testing for chronic granulomatous disease.

BACKGROUND: Dihydrorhodamine (DHR) flow cytometric analysis is used to evaluate granulocyte oxidative bursts and is the test of choice for the diagnosis of chronic granulomatous disease (CGD). We present the clinical and DHR test profiles of five subjects assessed during and after acute illness. METHODS: This was a retrospective report of the findings of five out of a total of one hundred and seventeen patients, whose blood was sent to the laboratory for dihydrorhodamine-123 flow cytometry testing between January 2005 and December 2010. Using whole blood technique and stimulation using phorbol myristate acetate, the results of DHR were expressed as stimulation index and coefficient of variation of histograms of stimulated cells and compared with healthy controls. DHR tests were repeated when the patients had recovered and were clinically well. RESULTS: These five patients showed abnormal DHR test results during their acute illness, with a stimulation index (SI) lower (p = 0.009) and coefficient of variation (CV) higher (p = 0.009) than controls. The DHR profiles repeated when patients had recovered showed normalization of tests with no significant difference for SI (p = 0.602) and CV (p = 0.917) compared to controls. Wilcoxon Signed Rank tests showed a significant improvement in SI (p = 0.043) and CV (p = 0.043) upon recovery. On follow up, all five patients were well, with no further severe or atypical infections. CONCLUSIONS: DHR may be transiently abnormal during acute illness, and may therefore not be reliable when assessed during an acute illness. If these subjects had CGD, it would be of a hypomorphic variant that has not previously been described.

A workplace email-linked website intervention for modifying cancer-related dietary and lifestyle risk factors: rationale, design and baseline findings.

INTRODUCTION: The use of email and website as channels for workplace health information delivery is not fully explored. This study aims to describe the rationale, design, and baseline findings of an email-linked website intervention to improve modifiable cancer risk factors. METHODS: Employees of a Malaysian public university were recruited by systematic random sampling and randomised into an intervention (n = 174) or control group (n = 165). A website was developed for the intervention and educational modules were uploaded onto the website. The intervention group received ten consecutive weekly emails with hypertext links to the website for downloading the modules and two individual phone calls as motivational support whilst the control group received none. Diet, lifestyle, anthropometric measurements, psychosocial factors and stages of change related to dietary fat, fruit and vegetable intake, and physical activity were assessed. RESULTS: Participants were predominantly female and in non-academic positions. Obesity was prevalent in 15% and 37% were at risk of co-morbidities. Mean intake of fats was 31%, fruit was -1 serving/day and vegetable was < 1 serving/day. Less than 20% smoked and drank alcohol and about 40% were physically inactive. The majority of the participants fell into the Preparation stage for decreasing fat intake, eating more fruit and vegetables, and increasing physical activity. Self-efficacy and perceived benefits were lowest among participants in the Precontemplation/Contemplation stage compared to the Preparation and Action/Maintenance stages. CONCLUSION: Baseline data show that dietary and lifestyle practices among the employees did not meet the international guidelines for cancer prevention. Hence the findings warrant the intervention planned.

The FOXM1-PLK1 axis is commonly upregulated in oesophageal adenocarcinoma.

BACKGROUND: The transcription factor FOXM1 is an important regulator of the cell cycle through controlling periodic gene expression during the G2 and M phases. One key target for FOXM1 is the gene encoding the protein kinase PLK1 and PLK1 itself acts in a positive feedback loop to phosphorylate and activate FOXM1. Both FOXM1 and PLK1 have been shown to be overexpressed in a variety of different tumour types. METHODS: We have used a combination of RT-PCR, western blotting, tissue microarrays and metadata analysis of microarray data to study whether the FOXM1-PLK1 regulatory axis is upregulated and operational in oesophageal adenocarcinoma. RESULTS: FOXM1 and PLK1 are expressed in oesophageal adenocarcinoma-derived cell lines and demonstrate cross-regulatory interactions. Importantly, we also demonstrate the concomitant overexpression of FOXM1 and PLK1 in a large proportion of oesophageal adenocarcinoma samples. This co-association was extended to the additional FOXM1 target genes CCNB1, AURKB and CKS1. In a cohort of patients who subsequently underwent surgery, the expression of several FOXM1 target genes was prognostic for overall survival. CONCLUSIONS: FOXM1 and its target gene PLK1 are commonly overexpressed in oesophageal adenocarcinomas and this association can be extended to other FOXM1 target genes, providing potentially important biomarkers for predicting post-surgery disease survival.

Tissue factor expression in the metaplasia-adenoma-carcinoma sequence of gastric cancer in a European population.

BACKGROUND: Tissue factor (TF), which has a role in normal tissue haemostasis, was reported to be aberrantly expressed, associated with higher microvascular density and a poor prognosis in intestinal-type gastric adenocarcinoma in the Japanese population. This is the first study to look at the relationship of TF and the metaplasia-adenoma-carcinoma sequence (MACS) of gastric cancer in a European population. METHODS: The expression of TF was examined immunohistochemically in 191 gastric tissue samples: (13: normal; 18: intestinal metaplasia; 160: gastric adenocarcinoma) from the European population. RESULTS: TF was not expressed in normal gastric mucosal cells. A strong intensity of staining was found in intestinal metaplasia cells but in 2 of 18 samples. TF expression increased with advancing stage of gastric cancer (P<0.0001, Jonckheere's test for ordered medians). Stage 3-4 gastric cancers preferentially expressed TF (34%, P=0.04). In comparison with the Japanese study, TF was not expressed at a higher level in intestinal vs diffuse-type gastric cancers and expression had 'no prognostic' significance. CONCLUSION: TF may be involved in tumour progression along the MACS of gastric cancer in the European population and is shown to start in precancerous lesions. However, clinical features may differ due to differences in biological features in the two populations, as reflected by differences in TF expression profile.

PEA3/ETV4-related transcription factors coupled with active ERK signalling are associated with poor prognosis in gastric adenocarcinoma.

BACKGROUND: Transcription factors often play important roles in tumourigenesis. Members of the PEA3 subfamily of ETS-domain transcription factors fulfil such a role and have been associated with tumour metastasis in several different cancers. Moreover, the activity of the PEA3 subfamily transcription factors is potentiated by Ras-ERK pathway signalling, which is itself often deregulated in tumour cells. METHODS: Immunohistochemical patterns of PEA3 expression and active ERK signalling were analysed and mRNA expression levels of PEA3, ER81, MMP-1 and MMP-7 were determined in gastric adenocarcinoma samples. RESULTS: Here, we have studied the expression of the PEA3 subfamily members PEA3/ETV4 and ER81/ETV1 in gastric adenocarcinomas. PEA3 is upregulated at the protein level in gastric adenocarcinomas and both PEA3/ETV4 and ER81/ETV1 are upregulated at the mRNA level in gastric adenocarcinoma tissues. This increased expression correlates with the expression of a target gene associated with metastasis, MMP-1. Enhanced ERK signalling is also more prevalent in late-stage gastric adenocarcinomas, and the co-association of ERK signalling and PEA3 expression also occurs in late-stage gastric adenocarcinomas. Furthermore, the co-association of ERK signalling and PEA3 expression correlates with decreased survival rates. CONCLUSIONS: This study shows that members of the PEA3 subfamily of transcription factors are upregulated in gastric adenocarcinomas and that the simultaneous upregulation of PEA3 expression and ERK pathway signalling is indicative of late-stage disease and a poor survival prognosis.

Responses to environmental enrichment differ with sex and genotype in a transgenic mouse model of Huntington's disease.

BACKGROUND: Environmental enrichment (EE) in laboratory animals improves neurological function and motor/cognitive performance, and is proposed as a strategy for treating neurodegenerative diseases. EE has been investigated in the R6/2 mouse model of Huntington's disease (HD), where increased social interaction, sensory stimulation, exploration, and physical activity improved survival. We have also shown previously that HD patients and R6/2 mice have disrupted circadian rhythms, treatment of which may improve cognition, general health, and survival. METHODOLOGY/PRINCIPAL FINDINGS: We examined the effects of EE on the behavioral phenotype and circadian activity of R6/2 mice. Our mice are typically housed in an "enriched" environment, so the EE that the mice received was in addition to these enhanced housing conditions. Mice were either kept in their home cages or exposed daily to the EE (a large playground box containing running wheels and other toys). The "home cage" and "playground" groups were subdivided into "handling" (stimulated throughout the experimental period) and "no-handling" groups. All mice were assessed for survival, body weight, and cognitive performance in the Morris water maze (MWM). Mice in the playground groups were more active throughout the enrichment period than home cage mice. Furthermore, R6/2 mice in the EE/no-handling groups had better survival than those in the home cage/no-handling groups. Sex differences were seen in response to EE. Handling was detrimental to R6/2 female mice, but EE increased the body weight of male R6/2 and WT mice in the handling group. EE combined with handling significantly improved MWM performance in female, but not male, R6/2 mice. CONCLUSIONS/SIGNIFICANCE: We show that even when mice are living in an enriched home cage, further EE had beneficial effects. However, the improvements in cognition and survival vary with sex and genotype. These results indicate that EE may improve the quality of life of HD patients, but we suggest that EE as a therapy should be tailored to individuals.

EndoCinch treatment for gastro-oesophageal reflux disease.

Gastro-oesophageal reflux disease (GORD) is a common disorder which significantly impairs the quality of life. Recently an EndoCinch system has been described, with an approach to the treatment of GORD that would obviate the need for long-term proton pump inhibitors and the cost and potential risk of laparoscopic Nissen fundoplication. We set outto evaluate the status of this new technique for the management of GORD. We review the literatures (publications and abstracts) regarding safety, efficacy, and durability of this new antireflux procedure. On the whole, this new antireflux technique produced significant improvement in GORD symptomatology and quality of life and reduced the use of antireflux medication. However, it failed to normalize acid reflux, long-term durability data are lacking, and some serious side effects have been reported. In conclusion, EndoCinch has the potential to treat patients with this common ailment. However, further studies are necessary to determine what modifications to this antireflux technique are required in order to produce the maximum clinical benefit.