Proposal for the Sungminiaceae fam. nov. (Ralfsiales, Phaeophyceae) for Sungminia gen. nov. with three new species based on molecular and morphological analyses.

Based on morphological and molecular analyses, five families have been recognized within the crustose brown algal order Ralfsiales. Our morphological and molecular sequence data were used to assess the establishment and phylogenetic relationship of Sungminia gen. nov. Phylogenies based on rbcL and concatenated rbcL and COI-5P genes support the recognition of Sungminia composed of three distinct lineages, Sungminia gladiata sp. nov., S. pyriformis sp. nov., and S. asiatica sp. nov. We consider that the Sungminia group is clearly distinct at the family level and propose to place Sungminia in a new family, the Sungminiaceae fam. Nov. Our phylogenetic analyses show that the Sungminiaceae forms a strongly supported monophyletic clade with probable sister relationship to the Mesosporaceae. The Sungminiaceae is characterized by perithallial erect filaments moderately adhered, the rod-shaped perithallial erect filaments, plurangia terminated with single sterile cell, and unangia terminally inserted on 1-2 celled stalk that is lateral-basal or sessile to a paraphysis.

Haemophilia care and outcome in a major haemophilia treatment centre in Malaysia.

INTRODUCTION/OBJECTIVE: The management of potential treatment-related complications and bleeding events in haemophilia is challenging in developing countries. Providing optimal care among these patients improve their quality of life (QOL) and life expectancy. This study explores the demographic characteristics and treatment outcome in a major haemophilia treatment centre in Malaysia. MATERIALS AND METHODS: A total of 260 patients were recruited in this retrospective cross-sectional analysis. Clinical data, including treatment regimens and outcome, were collected and analysed. RESULTS: A total of 211 patients were diagnosed with haemophilia A (HA) (severe disease, 72.5%) and 49 patients had haemophilia B (HB) (severe disease, 65.3%). The median age was 31 (IQR;2-84) years. Majority of the patients had at least one episode of musculoskeletal bleeding since diagnosis. The mean annual bleeding event (ABE) was 4.91 (SD±6.07) in 2018. Target joints were identified in 80.4% of the patients. Chronic arthropathy and synovitis collectively accounted for more than half of the musculoskeletal complications. 30.1% of the patients had contracted hepatitis C with less than half received treatment. Thirty-one patients (16.8%) with severe haemophilia developed inhibitor and 12 patients successfully underwent immune tolerance induction. More than three-quarters of the severe haemophilia patients were treated with factor concentrate prophylaxis. The mean prophylaxis dose for HA and HB were 41.3 (SD±19.1) and 48.6 (SD±21.5) IU/kg/week, respectively. In patients with severe disease, prophylaxis significantly reduced the ABE (5.45,9.03;p=0.005). CONCLUSION: The importance of utilising a low to moderate dose regimen as prophylaxis in haemophilic patients is highlighted in our study. Future studies should include QOL assessment will further improve the management in haemophilia.

Identification of small peptides and glycinamide that inhibit melanin synthesis using a positional scanning synthetic peptide combinatorial library.

BACKGROUND: Antimelanogenic peptides are potentially useful to treat hyperpigmentation, but many peptides have limited application because of high cost and/or low activity. OBJECTIVES: To identify small and potent peptide inhibitors of cellular melanin synthesis that are useful for cosmetic and medical applications. METHODS: A positional scanning synthetic tetrapeptide combinatorial library was used for screening of potentially active peptides. Antimelanogenic activities of the peptide pools and individual peptides were evaluated in B16-F10 melanoma cells and human epidermal melanocytes treated with alpha-melanocyte-stimulating hormone (α-MSH). RESULTS: Predicted active tetrapeptide sequences were R-(F/L)-(C/W)-(G/R)-NH2 . Of the individual tetrapeptides tested, D3 (RFWG-NH2 ) and D5 (RLWG-NH2 ) exhibited high antimelanogenic activities. Tetrapeptide D9 (FRWG-NH2 ) with a sequence identical to that of a portion of α-MSH also showed antimelanogenic activity. Of the tripeptides tested, E5 (FWG-NH2 ), E6 (LWG-NH2 ) and E7 (RWG-NH2 ) were relatively more active. Dipeptide F1 (WG-NH2 ) and monopeptide G1 (G-NH2 , glycinamide) retained activity, but G2 (Ac-G-NH2 ) and G3 (glycine) did not. The antimelanogenic activities of peptides D3, E5, F1 and G1 were verified in α-MSH-stimulated human epidermal melanocytes. Commercially available G-NH2 ·HCl suppressed the phosphorylation levels of cAMP-responsive element binding protein, protein levels of microphthalmia-associated transcription factor and tyrosinase, l-tyrosine hydroxylase activity of tyrosinase, and the melanin levels in stimulated cells. CONCLUSIONS: Small peptides, including glycinamide and tryptophanyl glycinamide, are potent antimelanogenic agents with potential value for the treatment of skin hyperpigmentation.

Persistent thrombocytopenia following dengue fever: What should we do?

Thrombocytopenia is a common laboratory finding in dengue infection. However, it usually resolves as the patient recovers from the infection. Persistent thrombocytopenia following dengue infection requires further investigation. Here, we present a case of immune thrombocytopenic purpura (ITP) following dengue infection complicated by intracranial bleeding.

Human skin-depigmenting effects of resveratryl triglycolate, a hybrid compound of resveratrol and glycolic acid.

OBJECTIVES: Resveratryl triglycolate (RTG) is a hybrid compound derived by the esterification of resveratrol with glycolic acid. This compound has been previously shown to inhibit cellular melanin synthesis in vitro. This study aimed to examine the in vivo skin-depigmenting efficacy of RTG in human participants. METHODS: In total, 22 women aged between 25 and 49 years with Fitzpatrick skin type III or IV were enrolled. Their forearms were exposed to UV to induce artificial pigmentation. The test product containing 0.4% RTG or the control product was applied twice daily for up to 8 weeks after the artificial pigmentation. The participants visited the research centre every 2 weeks and were subjected to skin assessments. RESULTS: Visual assessment of pigmentation degree and instrumental analysis of melanin index, skin lightness (L* value) and skin colour (individual typology angle, ITAo ) indicated enhanced depigmentation of the skin in the test group, compared with the control group, in Weeks 6 and 8 (P < 0.05). No adverse skin reactions were observed in any of the participants during the entire test. CONCLUSION: This study demonstrated the skin-depigmenting effects of RTG in human participants.

Stress and burnout syndrome in health-care providers treating dengue infection: A cross-sectional study.

INTRODUCTION: Increased prevalence of dengue fever had led to increase stress in providing optimal care for patients. This has been identified as a potential factor that may lead to negative health effects on medical doctors. This study was designed to review the prevalence and associated factors of burnout syndrome (including depression, anxiety, and stress level) among clinicians in the setting of increasing cases of dengue in Malaysia. METHODS: A cross-sectional, multi-centre study was carried out among doctors in contact with patients with dengue infection from four major hospitals in Malaysia in 2015 using Maslach Burnout Inventory and DASS-21 questionnaire. RESULTS: A total of 313 respondents were included in this study with 15.9% of the respondents experiencing high burnout syndrome. Long working hours, depression, anxiety, and stress were significantly associated with high degree of burnout syndrome (p<0.05). However, number of dengue cases reviewed was not significantly associated with the degree of burnout syndrome. Depression and stress were among factors identified as the predictors for burnout syndrome. CONCLUSION: High degree of burnout syndrome among clinicians with significant correlations with symptoms of depression and stress will require early identification to enable early measures to resolve, as well as prevent it. Future studies with more hospitals involvement should be conducted to establish the relationship between the degree of burnout syndrome and prevalence of dengue infection.

Pulmonary actinomycosis masquerading as lung cancer: A case report.

Pulmonary actinomycosis is a rare yet important and challenging diagnosis to make. It is commonly confused with other lung diseases, such as tuberculosis and bronchogenic carcinoma, leading to delay diagnosis or misdiagnosis. A 49-year-old man presented with a chronic cough, hemoptysis, and pleuritic chest pain. His initial imaging studies including computed tomography (CT) was suggestive of bronchogenic carcinoma. A subsequent CTguided biopsy was consistent with pulmonary actinomycosis and excluded the possibility of bronchogenic carcinoma. He was treated with antibiotic therapy and achieved remission with complete radiological resolution upon follow-up.

Bilateral optic neuritis with maculopathy: A rare manifestation of dengue fever.

Dengue fever is a common mosquito-borne disease, which is endemic in tropical and subtropical countries. Bilateral optic neuropathy is a relatively unusual dengue-related ocular complication. Here, we present a case of bilateral optic neuritis with maculopathy complicating dengue infection.

A comparison of dabigatran and warfarin for stroke prevention in elderly Asian population with nonvalvular atrial fibrillation: An audit of current practice in Malaysia.

INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia with significant morbidity and mortality in relation to thromboembolic stroke. Our study aimed to evaluate the safety and efficacy of dabigatran in stroke prevention in elderly patient with nonvalvular AF with regard to the risk of ischemic stroke and intracranial haemorrhage (ICH) in real-world setting. METHODS: A retrospective cohort study of 200 patients on dabigatran and warfarin from January 2009 till September 2016 was carried out. Data were collected for 100 patients on dabigatran and 100 patients on warfarin. RESULTS: The mean follow-up period was 340.7±322.3 days for dabigatran group and 410.5±321.2 days for warfarin group. The mean time in therapeutic range (TTR) was 52±18.7%. The mean CHA2DS2 -VASc score for dabigatran group was 4.4±1.1 while 5.0±1.5 for warfarin group. None in dabigatran group experienced ischemic stroke compared to one patient in warfarin group (p=0.316). There was one patient in dabigatran group suffered from ICH compared to none in warfarin group (p=0.316). Four patients in warfarin group experienced minor bleeding, while none from dabigatran group (p=0.043). CONCLUSION: Overall bleeding events were significantly lower in dabigatran group compared to warfarin group. In the presence of suboptimal TTR rates and inconveniences with warfarin therapy, non-vitamin-K antagonist oral anticoagulants (NOAC) are the preferred agents for stroke prevention in elderly Asian patients for nonvalvular AF.

Antimelanogenic effects of luteolin 7-sulfate isolated from Phyllospadix iwatensis Makino.

BACKGROUND: Abnormal deposition of melanin may cause an aesthetic skin problem; therefore, the control of unwanted excessive melanin synthesis is the major goal of cosmetic research. OBJECTIVES: To identify novel tyrosinase (TYR) inhibitors from marine plants and examine their cellular antimelanogenic effects. METHODS: The extracts of 50 marine plants endemic to Korea were screened against human TYR. Active constituents were then isolated from the selected plant extracts that showed potential and their chemical structures elucidated. Furthermore, their antimelanogenic effects were examined using murine melanoma B16/F10 cells and human epidermal melanocytes (HEM). RESULTS: Among the tested extracts, that of Phyllospadix iwatensis Makino exhibited the strongest human TYR inhibitory activity. The active constituents were purified from the butanol fraction of the P. iwatensis extract and identified as hispidulin 7-sulfate and luteolin 7-sulfate. Luteolin 7-sulfate inhibited human TYR more strongly than hispidulin 7-sulfate, luteolin, hispidulin and arbutin. Furthermore, luteolin 7-sulfate showed lower cytotoxicity than luteolin in both B16/F10 cells and HEM. Luteolin 7-sulfate attenuated cellular melanin synthesis more effectively in B16/F10 cells and HEM stimulated by α-melanocyte-stimulating hormone and l-tyrosine than arbutin. CONCLUSIONS: This study demonstrates that luteolin 7-sulfate isolated from P. iwatensis is a human TYR inhibitor with advantageous antimelanogenic properties, and would be useful for development as a therapeutic agent for the control of unwanted skin pigmentation.

A proposal of a standardized protocol to evaluate waterproof effect of eyeliner and mascara.

OBJECTIVE: Eye make-up products must have waterproofing properties to make sure that their colours do not smudge or wash away easily and remain intact despite water or perspiration. Until now, most research has focused on composition and components of make-up products and not on the level of waterproof. This study aimed to find methods to assess the waterproof degree of eyeliners and mascaras and determine the suitability of these methods. METHODS: Twenty female subjects were selected to test the waterproof of eyeliners, whereas 20 sets of false eyelashes were used to evaluate the waterproof of mascaras. For evaluating water-resistant properties, after test sites where eyeliners and mascaras were applied were immersed in water and natural drying for over 20 min (not artificial drying by drier etc.), L* value of the eyeliners applied on the forearm before and after the immersions, and intensity analysis values of mascaras applied on the false eyelashes were used to calculate the mean percentage waterproof removal ratio (%WPR). A product was hypothesized to be water resistant if the value for the mean %WPR was ≤50%. RESULTS: The non-waterproof eyeliners were not waterproof if their mean %WPR was >50%, whereas the waterproof eyeliners were waterproof if their mean %WPR was <50%. For mascaras, the mean %WPR was <50% after 1- to 2-h marks after immersion in water for both non-waterproof and waterproof products. After 3-4 h, the mean %WPR for the non-waterproof mascaras was >50%, rendering them not waterproof, whereas the mean %WPR for the waterproof mascaras was <50%, making them waterproof. CONCLUSION: We have evaluated the waterproof properties by analysing photographed images of the test sites where eyeliners and mascaras were applied. Results of the comparison between non-waterproof and waterproof eyeliners and mascaras, and the methods used, in particular, will be found useful in evaluating waterproof of other make-up products.

Isolated unilateral sixth cranial nerve palsy: A rare presentation of dengue fever.

Dengue fever is a common mosquito-borne viral infection endemic in tropical and subtropical countries. Neurological manifestations in dengue infection are relatively uncommon, and include encephalitis, encephalopathy, neuromuscular disorders and neuro-ocular disorders. Cranial mononeuropathy is a rare manifestation of dengue infection. A 40-year-old man was diagnosed with isolated, unilateral sixth cranial nerve palsy complicating dengue infection. The patient was managed accordingly, and full ocular recovery was observed. This was the first reported case of isolated sixth cranial nerve palsy associated with dengue fever in Malaysia. It is important for clinicians to consider dengue as a differential diagnosis in patients presenting with fever and sixth cranial nerve palsy.

Simultaneous pancreas-kidney transplantation from living donor using hand-assisted laparoscopic donor surgery: single-center experience.

BACKGROUND: Simultaneous pancreas-kidney (SPK) transplantation has been the fundamental treatment and has shown significant results in selected patients diagnosed with type 1 diabetes with renal insufficiency. Most pancreas transplantations are dependent on deceased donors, yet the waiting time for SPK transplantation from deceased donors is significantly long in Asian countries. METHODS: In 3 cases, living-donor SPK transplantation was performed with the use of hand-assisted laparoscopic donor surgery (HALS). Three cases of patients who underwent SPK transplantation from living donors (LDSPK) with the use of HALS at Korea University Anam Hospital from 2012 to 2013 were retrospectively reviewed regarding patient characteristics and clinical outcomes of donors and recipients. For the donors, the pancreas and renal function had been well preserved postoperatively. RESULTS: One donor had a pancreatic fistula, which was controlled with conservative management. Of the 3 cases of recipient operation, 1 case was performed by ABO incompatibility donor. The levels of creatinine, serum insulin, and C-peptide of recipients were normalized and remained stable at the last follow-up. CONCLUSIONS: LDSPK can be an efficient alternative in cases in which the deceased donor is not present at the proper time, depending on the degree of completion in the operator's skill.

Ucma, a direct transcriptional target of Runx2 and Osterix, promotes osteoblast differentiation and nodule formation.

OBJECTIVE: Runt-related transcription factor 2 (Runx2) and Osterix (Osx) are the master transcription factors in bone formation. Nonetheless, genes acting downstream of both Runx2 and Osx have yet to be fully characterized. Here, we investigate the downstream targets of both Runx2 and Osx in osteoblasts. MATERIALS AND METHODS: DNA microarray analysis was conducted on calvarial RNA from wild-type, Runx2 heterozygous, Osx heterozygous, and Runx2/Osx double heterozygous embryos. Expression and transcriptional responses of the selected target gene were analyzed in MC3T3-E1 osteoblastic cells. RESULTS: The expression of unique cartilage matrix-associated protein (Ucma) was decreased in Runx2/Osx double heterozygous embryos. In contrast, Ucma expression was increased in osteoblasts overexpressing both Runx2 and Osx. Ucma expression was initiated mid-way through osteoblast differentiation and continued throughout the differentiation process. Transcriptional activity of the Ucma promoter was increased upon transfection of the cells with both Runx2 and Osx. Runx2-and Osx-mediated activation of the Ucma promoter was directly regulated by Runx2-and/or Sp1-binding sites within its promoter. During osteoblast differentiation, the formation of mineralized nodules in Ucma-overexpressing stable clones occurred earlier and was more enhanced than that in the mock-transfected control. Mineralized nodule formation was strongly augmented in the cells cultured in a medium containing secretory Ucma proteins. CONCLUSION: Ucma is a novel downstream gene regulated by both Runx2 and Osx and it stimulates osteoblast differentiation and nodule formation.

A quantitative evaluation method of skin texture affected by skin ageing using replica images of the cheek.

OBJECTIVE: Skin texture is a fine structure of skin surface where the hill and furrow were crossed to form a star shape. This study was performed to establish a quantitative evaluation method of skin texture affected by skin ageing using replica images of the cheek. METHODS: After producing replicas of the left cheek areas of 80 female subjects, representative replica images were chosen to establish six-level facial skin texture index. Using this new index, skin texture of different-aged subjects was visually assessed by multiple examiners. The number of star configurations was also analysed using the same replica images. Other factors contributing to skin texture, such as skin elasticity, roughness, dermal density, moisture and gloss, were also analysed. RESULTS: The concordance between skin texture scores evaluated by three researchers was high (0.896), and there was a high correlation between skin texture score and age (r = 0.642). The number of star configurations showed high correlations with skin texture scores (r = 0.753) and with age (r = 0.776). Skin texture scores were highly correlated with skin roughness and dermal density, but not with moisture, gloss and elasticity. CONCLUSION: This study suggests that visual grading of skin texture score based on new facial skin texture index and quantification of star configurations will be useful in evaluating skin ageing.

Screening of plant extracts for human tyrosinase inhibiting effects.

Screening for tyrosinase (TYR) inhibitors potentially useful for control of skin pigmentation has been hampered by the limited availability of human TYR. To overcome this hurdle, we have established human embryonic kidney (HEK293)-TYR cells that constitutively express human TYR. In the current study, we assayed human TYR inhibition activities of 50 plant extracts using the lysates of transformed HEK293-TYR cells. The strongest inhibition of human TYR was shown by the extract of Vaccinium bracteatum Thunberg, followed by the extract of Morus bombycis Koidzumi. The former extract did not inhibit mushroom TYR activity whereas significant inhibition was observed with the latter extract, demonstrating the importance of using human TYR in the screening for human TYR inhibitors. Upon liquid-liquid partitioning of the extract from V. bracteatum, the active constituents were enriched in the ethyl acetate fraction, and the subsequent preparatory thin-layer chromatography identified p-coumaric acid (PCA) as the main active constituent. The hypo-pigmentation of PCA was verified in the MelanoDerm™ Skin Model. This study demonstrates that transformed HEK293-TYR cells could expedite the discovery of human TYR-specific inhibitors from natural sources which might be useful in the control of skin pigmentation.

Effects of a new mild shampoo for preventing hair loss in Asian by a simple hand-held phototrichogram technique.

This study was conducted to evaluate the effects of a commercially available shampoo in Korean subjects with alopecia using a simple hand-held phototrichogram technique. Forty-four subjects with alopecia were enrolled and forty subjects continued for 16 weeks. In the test group, total hair counts increased significantly at weeks 8 and 16, and the number of shedding hair significantly decreased at week 16. Terminal hair counts significantly increased at week 8. In the control group, hair thickness and the number of vellus hairs significantly decreased at week 16. The number of total hairs significantly increased in the test group than in the control group at weeks 8 and 16. The number of shedding hairs significantly decreased in the test group than in the control group at week 16. Visual assessment using clinical digital images showed that the number of total hairs appeared to increase although there was no statistical significance. In this study, it was found that the test shampoo could prevent hair loss.

Effects of p-coumaric acid on erythema and pigmentation of human skin exposed to ultraviolet radiation.

BACKGROUND: It has been recently recognized that p-coumaric acid (PCA) is a strong inhibitor of cellular melanogenesis. AIM: To evaluate the erythema-suppressive and skin-lightening effects of PCA after topical application to human skin. METHODS: The control and PCA cream products were applied twice daily to the skin of the forearm of 21 subjects before and after ultraviolet (UV) irradiation to determine whether they could prevent erythema formation and pigmentation. The cream products were also applied to different areas only after the induction of erythema or pigmentation to determine whether they could have a depigmenting effect. RESULTS: A 7-day application of control and PCA cream products before UV irradiation decreased UV-induced erythema formation by 31% and 77%, respectively, compared with untreated skin. When the PCA cream was applied after UV irradiation, its effects on skin colour or pigmentation were less remarkable. However, the melanin index was significantly decreased at the sites treated with PCA cream for 70 days compared with control sites, and the Individual Typology Angle (ITA°) value was increased significantly. Of the 21 subjects, 2 had mild adverse skin reactions to both the PCA and control creams. CONCLUSION: These results suggest that PCA cream can reduce UV-induced erythema formation and subsequent pigmentation in human skin.