Porcine dermal collagen mesh (Permacol™) as a bioprosthesis in the ligation of intersphincteric tract (BioLIFT) procedure.

BACKGROUND: Ligation of intersphincteric tract (LIFT) is a sphincter-saving technique used to treat anal fistulas. Incorporation of a bioprosthesis in LIFT (BioLIFT) aims to improve healing. The use of cross-linked porcine dermal collagen mesh Permacol™ in BioLIFT has never been investigated. The aim of this study was to compare the healing rates and outcome of LIFT and BioLIFT for complex anal fistulas using the Permacol™ biological mesh. METHODS: A retrospective analysis of all patients having LIFT or BioLIFT for complex fistulas from January 2010 to November 2019 was performed in a tertiary referral centre. Patient data from a prospectively collected database of all patients having LIFT or BioLIFT were analyzed. RESULTS: LIFT and BioLIFT were performed in 48 (82.8%) and 10 (17.2%) patients, respectively. All BioLIFT patients had previous interventions for their fistulas compared to 30 (62.5%) of patients who had LIFT, p = 0.023. The primary healing rate for LIFT was 87.5% (42/48) compared to 80% (8/10) in BioLIFT, (p = 0.42). Eight (13.8%) patients developed complications, 6 (12.5%) in the LIFT group vs 2 (20%) in the BioLIFT group (p = 0.62). On univariate analysis, the number of previous operations was predictive of complications (p = 0.03). BioLIFT was not associated with complication (OR = 1.75, 95% CI: 0.30-10.3, p = 0.54) or primary healing (OR = 0.57, 95% CI: 0.97-3.36, p = 0.54). There was no significant difference in recurrence (LIFT 12.5% vs BioLIFT 0%, p = 0.58). Kaplan-Meier analysis found no difference in time to recurrence between the two groups (p = 0.65). CONCLUSION: Permacol™ mesh in BioLIFT is feasible and achieves a high primary healing rate of 80%. Prospective evidence is needed to establish the benefits of BioLIFT and determine whether Permacol™ is superior to the non-cross-linked porcine submucosal mesh.

Utilization of reduced graphene oxide/cadmium sulfide-modified carbon cloth for visible-light-prompt photoelectrochemical sensor for copper (II) ions.

A newly developed CdS/rGO/CC electrode was prepared based on a flexible carbon cloth (CC) substrate with cadmium sulfide (CdS) nanoparticles and reduced graphene oxide (rGO). The CdS was synthesized using an aerosol-assisted chemical vapor deposition (AACVD) method, and the graphene oxide was thermally reduced on the modified electrode surface. The existence of rGO in the CdS-modified electrode increased the photocurrent intensity of the CdS/rGO/CC-modified electrode by three orders of magnitude, compared to that of the CdS/ITO electrode and two orders of magnitude higher than the CdS/CC electrode. A new visible-light-prompt photoelectrochemical sensor was developed based on the competitive binding reaction of Cu(2+) and CdS on the electrode surface. The results showed that the effect of the Cu(2+) on the photocurrent response was concentration-dependent over the linear ranges of 0.1-1.0 µM and 1.0-40.0 µM with a detection limit of 0.05 µM. The results of a selectivity test showed that this modified electrode has a high response toward Cu(2+) compared to other heavy metal ions. The proposed CdS/rGO/CC electrode provided a significantly high potential current compared to other reported values, and could be a practical tool for the fast, sensitive, and selective determination of Cu(2+).

Immunobullous disease and ulcerative colitis: a case series of six patients.

Cases of immunobullous skin disease associated with ulcerative colitis (UC) have been previously reported in the literature. There is no clear explanation for this association. In this series, we report six cases of immunobullous disease in patients with UC and discuss potential mechanisms of pathogenesis proposed to explain these concomitant diseases. The clinical presentation, immunopathology and treatment of six new cases are described and analysed. We report six patients, two with linear IgA bullous dermatosis (LABD), one with bullous pemphigoid (BP), one with mucous membrane pemphigoid (MMP) and two with IgA pemphigus. The patients' ages ranged from 33 to 66 years at the onset of their skin disease, and all but one case had a documented age of UC onset, confirmed with colonoscopy, prior to the development of skin disease. Direct immunofluorescence results in these patients demonstrated IgA basement membrane zone (BMZ) antibodies in the LABD cases, IgG antibodies at the BMZ in the BP and MMP cases, and IgA cell surface antibodies in the patients with IgA pemphigus. Additionally, indirect immunofluorescence was positive in one of the patients with LABD, the patient with BP and both of the patients with IgA pemphigus. The temporal association of UC and skin disease, in addition to the resolution of skin disease with total colectomy in one case, suggests colonic mucosal antigenic stimulation driving immune activation and leading to immunobullous skin disease.

Public perceptions of obesity and bariatric surgery in Singapore: a pilot study.

INTRODUCTION: Obesity is a real and dangerous problem with rising incidence. This study aimed to examine public perceptions of obesity as a disease, as well as the community's impression of the various modalities in the management of obesity, particularly bariatric surgery, in Singapore. METHODS: Volunteers from the public were approached in 2010 to complete a questionnaire that collected both their demographic data and perceptions on obesity, management of obesity and bariatric surgery. The perceptions of the respondents were analysed based on various demographic factors. RESULTS: The incidence of obesity was 16.8%. Consistent with previous studies in developed countries, the highest mean body mass index was noted in the age range of 41-50 years. 95.6% of the population surveyed were aware that obesity was related to significant medical conditions. 60% of the population surveyed had attempted weight loss in the past, with 41.7% expressing lack of success, and 58.4% expressed that they had not heard of surgery as a modality. CONCLUSION: This study shows that the majority of the population understands the significance of obesity as a medical problem and would take steps to combat it. However, there is suboptimal knowledge of the various modalities of managing obesity as a disease, especially with regard to surgical options. More education on the modalities available and access to them would help in the combat of this obesity epidemic.

A new xanthone from Garcinia nitida.

A detailed chemical study on the stem bark of Garcinia nitida has led to the isolation of five xanthones. They are 1,6-dihydroxy-5-methoxy-6,6-dimethylpyrano[2',3':2,3]-xanthone (1), inophyllin B (2), osajaxanthone (3), 3-isomangostin (4) and rubraxanthone (5). The structures of these compounds were established using mainly 1-D and 2-D NMR spectroscopy ((1)H, (13)C, DEPT, COSY, HMBC and HMQC) while molecular masses were determined via MS techniques; 1 is a new compound.

Self-expanding metallic stents for acute left-sided large-bowel obstruction: a review of 130 patients.

AIM: The aim of this study was to evaluate the outcomes of self-expanding metallic stent (SEMS) placement in acute left-sided large-bowel obstruction. METHOD: From 1997 to 2008, 130 patients [mean 67 (SD 14.7)] underwent SEMS insertion for acute left-sided large-bowel obstruction. One-hundred and one procedures were palliative, and 29 patients underwent stent insertion as a bridge for surgery. The success rate and the outcome were analysed. RESULTS: The chief causes of obstruction were primary (67%) and recurrent (16%) colorectal carcinoma. The success rate was 88% after insertion of the first stent. In nine patients, insertion of a second stent was required. Complications occurred in 20% of the insertions, with migration (10.8%) being the most common. Perforation occurred in two patients and one developed a colovesical fistula. In patients with palliative stenting, 14 (13.9%) required subsequent surgery, with a stoma placed in all except three. Among the 29 patients who underwent SEMS insertion as a bridge to surgery, subsequent surgical resection was performed in 26 patients at a mean interval of 12 days (SD 18.0). Primary anastomosis was performed in 24 patients. The mean survival for those who underwent SEMS insertion as a bridge to surgery was 40 (95% confidence interval: 24-55) months. CONCLUSION: SEMS placement is safe and effective in relieving acute left-sided colonic obstruction. It allows subsequent definitive surgery on an elective setting and also serves as good palliation for advanced or disseminated disease.

Body contouring surgery for military personnel following massive weight loss.

The burgeoning global obesity epidemic extends to the military service, where 6-53% of military personnel are overweight. Obese military personnel who adhere to a strict training and diet regime may potentially achieve and maintain significant weight loss. They may however face physical problems such as excess skin folds causing discomfort, difficulty in uniform fitting, personal hygiene, interference with full physical activities and psychological issues such as body image dissatisfaction, low self esteem and difficulty in social acceptance. We present a case report of a highly motivated military conscript who achieved and maintained significant weight loss but had physical defects following Massive Weight Loss. Body contouring surgery was successfully utilised to correct his physical defects and allowed him to return to full physical duties.

Multiple primary melanoma: the impact of atypical naevi and follow up.

BACKGROUND: Patients with melanoma are especially encouraged to have regular follow- up visits with their dermatologist and to perform total-body skin examination on a routine basis to identify new pigmented lesions or detect significant changes in existing naevi. OBJECTIVES: To identify main risk factors (sex, age, number of common and atypical naevi, family history, phototype) associated with multiple primary melanomas (MPM) and to investigate the association between regular follow up and tumour thickness of a second primary melanoma. METHODS: We performed a retrospective analysis of patients with MPM in order to evaluate risk factors for developing a second primary melanoma. Medical records of patients with melanoma who developed a second primary melanoma were selected from a database of all patients with histopathologically confirmed melanoma treated at the dermatology clinic of the University of Florence, Italy, from 2000 to 2004. Medical data culled from the patient records were as follows: medical history, number of typical naevi, presence of atypical naevi, Breslow thickness, Clark level and histotype of the melanomas, site of the melanomas and patient adherence to 6-month follow-up examinations. RESULTS: The presence of atypical naevi was associated with a higher risk of developing MPM (adjusted odds ratio 3·28, 95% confidence interval 1·35­7·44). Moreover, in the subjects who did not attend follow up, we noted that the thickness of the second melanoma was significantly higher, with a mean thickness of 1·22 mm, in comparison with patients with a careful adherence to follow up in whom the mean thickness was 0·36 mm (P = 0·0189). CONCLUSIONS: For the first time, the validity of this clinical approach has been supported by real comparison of thickness levels of second melanoma in patients with or without periodical follow up. Results obtained from this analysis show that follow up is an effective method for early detection of melanoma.

Gastrocolic fistula: a rare complication of gastric carcinoma.

Malignant gastrocolic fistula formation is a rare complication of gastric carcinoma. We report a cachectic 82-year-old woman who presented with upper abdominal pain, diarrhoea, loss of weight and loss of appetite. Further investigation of her symptoms revealed a gastrocolic fistula connecting the ulcerated tumour of the body of the stomach to the splenic flexure of the colon.

Androgen disruption of early development in Qurt strain medaka (Oryzias latipes).

Androgen disrupting chemicals (ADCs) are widespread in the aquatic environment, where they may pose a risk to aquatic organisms during critical periods of development. In this study, static renewal 96-h toxicity tests were followed over a 3-month growth period to investigate the endocrine disrupting effects of the androgen 11-ketotestosterone (11-KT), and the antiandrogen flutamide (FLU) on 1-week-old Qurt strain medaka larvae. The measured endpoints included: survival, growth performance (i.e., body weight, body length, condition index), and histopathology. There was no significant acute mortality, except for males treated with the highest FLU concentration (96 h-LC(50)=1.92 mg/l). Gender-specific effects in growth were identified after 11-KT and FLU treatments. Histopathological alterations including thyroid follicular hypertrophy (TFH), germ cell necrosis (GCN), ovarian atresia (OA), and testis-ova (TO) were observed in medaka at 90-day post-exposure. We observed TFH in all 11-KT treatment levels. The incidence of TFH in males was double that in females 11-KT or FLU treatment. Females showed GCN at lower 11-KT concentrations (0.01, 0.1mg/l) than males (1.0mg/l). Severe OA was observed at low (0.01 mg/l) and high (1.0mg/l) 11-KT concentrations in females. Flutamide induced TO (0.32, 1.0mg/l), ovarian cell necrosis (0.32 mg/l), and disrupted spermatogenesis (3.2mg/l) in males. The lowest observed effective concentration (LOEC) for TO induction in Qurt medaka males was 0.32 mg/l. The present study underscores the importance of fish early life stage tests for detecting the interaction of ADCs with the reproductive and thyroid glands in both genders.

Silk fibroin as an organic polymer for controlled drug delivery.

The pharmaceutical utility of silk fibroin (SF) materials for drug delivery was investigated. SF films were prepared from aqueous solutions of the fibroin protein polymer and crystallinity was induced and controlled by methanol treatment. Dextrans of different molecular weights, as well as proteins, were physically entrapped into the drug delivery device during processing into films. Drug release kinetics were evaluated as a function of dextran molecular weight, and film crystallinity. Treatment with methanol resulted in an increase in beta-sheet structure, an increase in crystallinity and an increase in film surface hydrophobicity determined by FTIR, X-ray and contact angle techniques, respectively. The increase in crystallinity resulted in the sustained release of dextrans of molecular weights ranging from 4 to 40 kDa, whereas for less crystalline films sustained release was confined to the 40 kDa dextran. Protein release from the films was studied with horseradish peroxidase (HRP) and lysozyme (Lys) as model compounds. Enzyme release from the less crystalline films resulted in a biphasic release pattern, characterized by an initial release within the first 36 h, followed by a lag phase and continuous release between days 3 and 11. No initial burst was observed for films with higher crystallinity and subsequent release patterns followed linear kinetics for HRP, or no substantial release for Lys. In conclusion, SF is an interesting polymer for drug delivery of polysaccharides and bioactive proteins due to the controllable level of crystallinity and the ability to process the biomaterial in biocompatible fashion under ambient conditions to avoid damage to labile compounds to be delivered.

Treatment of obesity with laparoscopic adjustable gastric banding in Singapore: an initial experience.

INTRODUCTION: Laparoscopic adjustable gastric banding (LAGB) has been used for the treatment of obesity, being shown in western populations to be a safe and effective option. We present the results of our experience in the use of LAGB in the treatment of obesity. METHODS: A retrospective review of all patients who underwent LAGB from February 1999 to June 2004 was made from a prospectively collected database. Pre-operative comorbidities, height, weight and body mass index (BMI) were recorded and compared with post-operative results. Operative times, length of stay and complications were also noted. RESULTS: 38 consecutive patients underwent LAGB. The 16 male and 22 female patients had a mean age of 37.6 years (range 19 to 62 years) and a mean BMI of 42.7 kg per square metre (range 28.8 to 78.4 kg per square metre). Nine were done utilising the perigastric approach, and the other 29 with the pars flaccida approach. There were no open conversions. Overall peri-operative morbidity was encountered in two (5.3 percent) patients, with a minor liver laceration and a capsular splenic laceration in separate patients. There were no post-operative complications. One (2.7 percent) patient had the band removed at 29 months post-operatively on request. There were no mortalities. Mean follow-up period was 13 months (range one to 56 months). Mean BMI decreased to 40.7, 38.7, 37.4, 34.1 and 32.9 kg per square metre, respectively, at one week, one, six, 12 and 18 months post-operatively. CONCLUSION: LAGB is a feasible modality in the multifaceted approach to treatment of morbid obesity. The results from our follow-up are comparable to larger series in western populations, with a similar safety profile.

Transcriptional changes underlying the secretory activation phase of mammary gland development.

The secretory activation stage of mammary gland development occurs after parturition and converts inactive lobuloalveoli to active milk secretion. This process is triggered by progestin withdrawal and depends upon augmented prolactin (Prl) signaling. Little is known about the Prl-induced transcriptional changes that occur in the mammary gland to drive this process. To examine changes in the mammary transcriptome responsible for secretory activation, we have used transcript profiling of three mouse models that exhibit failure of secretory activation: knockout of galanin (a regulator of pituitary Prl production and a mammary cell autonomous modulator of Prl action); treatment with S179D Prl (a phosphoprolactin mimic); and knockout of a single Prl receptor allele. A significant reduction in expression was observed in genes belonging to 46 gene ontologies including those representing milk proteins, metabolism, lipid, cholesterol and fatty acid biosynthetic enzymes, immune response, and key transcription factors. A set of 35 genes, commonly regulated in all three models, was identified and their role in lactogenesis was validated by examining their expression in response to Prl stimulation or signal transducer and activator of transcription 5 knockdown in the HC11 mouse mammary cell culture model. The transcript profiles provided by these experiments identify 35 key genes (many for the first time) involved in the secretory activation phase of mammary gland development, show that S179D acts as an antagonist of Prl action, and provide insight into the partial penetrance of failed lactation in Prl receptor heterozygous females.

A case of tuberculosis verrucosa cutis--undiagnosed for 44 years and resulting in fixed-flexion deformity of the arm.

Tuberculosis verrucosa cutis (TBVC) is a paucibacillary form of cutaneous tuberculosis caused by exogenous re-infection in previously sensitized individuals. Here, we report an unusual case of TBVC in a 53-year-old Chinese woman that had been present for 44 years and resulted in fixed-flexion deformity of her arm and functional disability. The diagnosis was made by a positive culture for Mycobacterium tuberculosis and she responded well to antituberculous therapy. To our knowledge, this is the first such case of TBVC reported in the English literature with sequelae of functional impairment of the arm.

Domestic violence in Singapore: a ten year comparison of victim profile.

INTRODUCTION: To investigate whether the profile of female victims of domestic violence in Singapore has changed over the past ten years. METHODS: 163 female victims of domestic violence presenting to an emergency department in Singapore were surveyed. The survey included information on the victims' demographics, assault characteristics and knowledge of help services. The results were compared against a similar survey done locally ten years ago, which involved 233 victims. RESULTS: There were no significant differences in the racial composition, marital status, weapon use and admission rates of victims ten years on. However, a significantly higher proportion of female victims in 2002 knew where to seek help, compared to a decade ago (50.9 percent versus 20.6 percent, p-value is less than 0.0001). CONCLUSION: The proportion of victims with an awareness of community and legal help services has more than doubled over the past ten years.