Optimization of scanning time of 18F-FDG whole body PET/CT imaging in obese patients using quadratic dose protocol.

INTRODUCTION: 18F-FDG imaging of overweight and obese patients is often challenging due to higher scattering and attenuation. Degradation of positron emission tomography (PET) image quality as the body weight increases is best overcome by using the quadratic dose protocol. Previously the implementation of this protocol on a Bismuth Germanium Oxide (BGO) scintillation crystal-based PET/CT system at Institut Kanser Negara (IKN), Malaysia practices using the linear dose protocol (Tmin=2.5 minutes). Hence, this study aims to optimize the Tmin of the quadratic dose protocol for 18F-FDG PET/CT. MATERIALS AND METHODS: This study was conducted based on the guideline published by the European Association of Nuclear Medicine (EANM) version 2.0 FDG-PET/CT and conducted in two phases. Firstly, 100 whole-body scan 18FFDG PET/CT images were selected for the average coefficient of variation (COV) analysis in the liver region. Second, a NEMA 2012/IEC2008 phantom was used to obtain the relationship between the COVphantom and the scanning time. Finally, the images acquired using the two Tmin were quantitatively compared using contrast recovery coefficient (QH), signal to noise ratio (SNR), and visibility (VH). Independent t-test between each image quality parameter performed with p-value <0.05 considered significant. RESULTS: The average COV of the liver was 17.7%. Currently, this value was clinically accepted to produce appropriate image quality at IKN. Interpolation at COV=17.7% gave a Tmin value of 2.9 minutes. Comparisons show that the two Tmin yielded equivalent PET/CT image quality (p-value of QH=0.774, SNR=0.780 and VH=0.915). CONCLUSION: The optimal Tmin defined in this study was 2.9 minutes, 27.6% shorter than the Tmin previously defined based on COV=15%. Despite the higher average COV, the shorter Tmin beneficial in the lower total 18F-FDG activity administered, reduce the internal dose to the patient while producing equivalent image quality.

Plasma Circulating Mirnas Profiling for Identification of Potential Breast Cancer Early Detection Biomarkers.

OBJECTIVE: This study aimed to characterize the miRNA expression profiles from plasma samples of our local breast cancer patients in comparison to healthy control by using miRNA PCR Array. METHODS: In this study, plasma miRNA profiles from eight early-stage breast cancer patients and nine age-matched (± 2 years) healthy controls were characterized by miRNA array-based approach, followed by differential gene expression analysis, Independent T-test and construction of Receiver Operating Characteristic (ROC) curve to determine the capability of the assays to discriminate between breast cancer and the healthy control. RESULTS: Based on the 372-miRNAs microarray profiling, a set of 40 differential miRNAs was extracted regarding to the fold change value at 2 and above. We further sub grouped 40 miRNAs of breast cancer patients that were significantly expressed at 2-fold change and higher. In this set, we discovered that 24 miRNAs were significantly upregulated and 16 miRNAs were significantly downregulated in breast cancer patients, as compared to the miRNA expression of healthy subjects. ROC curve analysis revealed that seven miRNAs (miR-125b-5p, miR-142-3p, miR-145-5p, miR-193a-5p, miR-27b-3p, miR-22-5p and miR-423-5p) had area under curve (AUC) value > 0.7 (AUC p-value < 0.05). Overlapping findings from differential gene expression analysis, ROC analysis, and Independent T-Test resulted in three miRNAs (miR-27b-3p, miR-22-5p, miR-145-5p). Cohen's effect size for these three miRNAs was large with d value are more than 0.95. CONCLUSION: miR-27b-3p, miR-22-5p, miR-145-5p could be potential biomarkers to distinguish breast cancer patients from healthy controls. A validation study for these three miRNAs in an external set of samples is ongoing.
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Perceptions of nurses on inter-shift handover: A descriptive study in Hospital Kuala Lumpur, Malaysia.

INTRODUCTION: The quality of information and efficiency in the practice and care environments are important aspects of nursing care. The use of a reliable and valid scale can monitor the quality of handover and provide information for continuous improvement of practice. This study aims to describe the perception of nurses, on the domains of quality of information, efficiency, interaction and support and patient involvement. METHOD: A cross-sectional descriptive study was conducted among 450 nurses from 37 wards in Hospital Kuala Lumpur. Nurses on shift duty were recruited by convenience sampling from the Medical, Surgery, Obstetrics & Gynaecology, Orthopaedic and Paediatric wards. Using a validated questionnaire (Handover Evaluation Scale), nurses self-rated their perceptions using a 7-point scale and provided open-ended responses to the strengths and challenges that they faced. Descriptive and inferential analyses were done while open-ended questions were summarised based on key themes. RESULTS: A total of 414 nurses completed the survey (92.0% response rate). Nurses had an overall mean (SD) perception score of 5.01 (SD 0.56). They perceived good interaction and support during handover and on the quality of information that they received, with mean scores of 5.54 (SD 0.79) and 5.19 (SD 0.69), respectively. There was an association between the departments where the nurses worked and their overall perceptions on nursing handover (p<0.001). Interruptions being the most common theme emerged from the open-ended section. CONCLUSION: Despite having substantial interaction and support amongst nurses, opportunities for improvements were noted. Improvements in the quality of handover information and reducing interruptions should be the main emphases as these were perceived to be essential in the current handover practices by nurses.

Erratum to: The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections.

[This corrects the article DOI: 10.1186/s13017-017-0141-6.].

Knowledge of Good Blood Culture Sampling Practice among Healthcare Staffs in An Emergency Department - Are We Getting It Right?

BACKGROUND: Although a vital test, blood culture is often plagued with the problem of contamination and false results, especially in a chaotic emergency department setting. The objectives of this pilot study is to find out the level of understanding among healthcare staffs in emergency department, Hospital Universiti Sains Malaysia (HUSM) regarding good blood culture sampling practice. METHODS: All healthcare staffs in emergency department, HUSM who consented to this study were given a set of selfadministered anonymous questionnaire to fill. RESULTS: More than half (53.1%) of the 64 participants are emergency medicine residents. Majority of them (75%) have been working in the emergency medicine, HUSM for more than 2 years. More than half of them were able to answer correctly the amount of blood volume needed for culture in adult and pediatric patients. When asked what are the factors required to improve the true yield as well as to reduce the risk of culture contamination, the four commonest answers given were observing proper aseptic technique during blood sampling, donning sterile glove, proper hand scrubbing as well as ensuring the sterility of the equipments. DISCUSSION AND CONCLUSION: This study suggests that there is a lack of proper knowledge of good blood culture sampling practice among our healthcare staffs in emergency department.

Effect of curcumin on aortic changes in ovariectomized rats fed with repeatedly heated soy oil: a preliminary electron microscopic study.

BACKGROUND AND AIMS: Consumption of repeatedly heated soy oil has been linked with incidence of atherosclerosis particularly in oestrogen deficient states. In the present study, effect of curcumin extract on the prevention of atherosclerosis was evaluated. MATERIALS AND METHODS: Forty eight female Spraque-Dawley rats (weighing 200-250 gm) were divided into eight groups. All groups were fed with 2% cholesterol diet. The sham control groups consisted of vitamin E free-RBD Olein (IV62) that acted as vehicle, and curcumin treated groups without undergoing ovariectomy. The other six groups were subjected to ovariectomy and later treated with vehicle-only, curcumin-only, once heated soy oil (1HSO) with vehicle, 1HSO with curcumin, five times heated soy oil (5HSO) with vehicle and 5HSO with curcumin. Curcumin was administered orally at a dose of 50 mg/kg which was commenced two weeks following ovariectomy. Following four months, the rats were sacrificed and serial sections of arch of aorta were harvested and processed for electron microscopic studies (EM). RESULTS: EM studies showed thickened tunica intima, fenestration of internal elastic lamina and migration of smooth muscle cells from tunica media to tunica intima in the ovariectomized control, 1HSO and 5HSO treated groups, with the latter being most prominent. There were no significant ultra structural changes in the curcumin-treated groups compared to the non-treated groups. CONCLUSION: Oral administration of curcumin at a dose of 50 mg/ kg body weight did not show any changes in the aorta of the ovariectomized rats fed with 2% cholesterol and heated soy oil.

The anomalous origin and branches of the obturator artery with its clinical implications.

The obturator artery (OA) originates from the internal iliac artery. Variation in the origin of the OA may be asymptomatic in individuals and occasionally be detected during routine cadaveric dissections or autopsies. In the present study, we observed the origin and the branching pattern of the OA on 34 lower limbs (17 right sides and 17 left sides) irrespective of sex. The bifurcation of the common iliac artery into internal and external iliac from the sacral ala varied between 4.3-5.3 cm. The distance of the origin of the anterior division of internal iliac artery from the bifurcation of common iliac artery varied between 1-6 cm. The distance of the origin of the posterior division of the internal iliac artery from the point of bifurcation of the common iliac artery varied between 0-6 cm. Out of 34 lower limbs studied, two specimens (5.8%) showed anomalous origin of the OA originating from the posterior division of the internal iliac artery. Of these two, one limb belonged to the right side while the other was from the left side. The anomalous OA gave off an inferior vesical branch to the prostate in both the specimens. No other associated anomalies regarding the origin or branching pattern of the OA were observed. Prior knowledge of the anatomical variations may be beneficial for vascular surgeons ligating the internal iliac artery or its branches and the radiologists interpreting angiograms of the pelvic region.

The formation and characterisation of an asymmetric nanofiltration membrane for ammonia-nitrogen removal: effect of shear rate.

The focus of this research is to study the potential of nanofiltration membrane technology in removing ammonia-nitrogen from the aquaculture system. One of the major fabrication parameters that directly affect the separation performance is shear rate or casting rate during membrane fabrication. In this study, asymmetric polyethersulfone (PES) nanofiltration membranes were prepared at five different shear rates within the range of 67-400 s(-1). Membrane productivity and separation performance were assessed via pure water, salt and ammonia-nitrogen permeation experiments, and their structural properties were determined by employing the combination of the irreversible thermodynamic (IT) model, solution diffusion model, steric hindrance pore (SHP) model and Teorell-Meyers (TMS) model. The study reveals that the alteration of shear rate enormously affects the membrane morphology and structural parameters, hence subsequently significantly influencing the membrane performance. It was found that, membrane produced at the shear rate 200 s(-1) or equivalent to 10s of casting speed during membrane fabrications managed to remove about 68% of ammonia-nitrogen, in which its separation performance is the most favourable by means of highest flux and rejection ability towards unwanted solutes. Besides, from the research findings, nano-membrane technology is a potential candidate for the treatment of aquaculture wastewater.

A study on the optimal hydraulic loading rate and plant ratios in recirculation aquaponic system.

The growths of the African catfish (Clarias gariepinus) and water spinach (Ipomoea aquatica) were evaluated in recirculation aquaponic system (RAS). Fish production performance, plant growth and nutrient removal were measured and their dependence on hydraulic loading rate (HLR) was assessed. Fish production did not differ significantly between hydraulic loading rates. In contrast to the fish production, the water spinach yield was significantly higher in the lower hydraulic loading rate. Fish production, plant growth and percentage nutrient removal were highest at hydraulic loading rate of 1.28 m/day. The ratio of fish to plant production has been calculated to balance nutrient generation from fish with nutrient removal by plants and the optimum ratio was 15-42 gram of fish feed/m(2) of plant growing area. Each unit in RAS was evaluated in terms of oxygen demand. Using specified feeding regime, mass balance equations were applied to quantify the waste discharges from rearing tanks and treatment units. The waste discharged was found to be strongly dependent on hydraulic loading rate.

Isolation and characterization of a Pseudomonas diesel-degrading strain from Antarctica.

A diesel-degrading bacterium from Antarctica has been isolated. The isolate was tentatively identified as Pseudomonas sp. strain DRYJ3 based on partial 16S rDNA molecular phylogeny and Biolog GN microplate panels and Microlog database. Growth on diesel was supported optimally by ammonium sulphate, nitrate and nitrite. The bacterium grew optimally in between 10 and 15 degrees C, pH 7.0 and 3.5% (v/v) diesel. The biodegradation of diesel oil by the strain increased in efficiency from the second to the sixth day of incubation from 1.4 to 18.8% before levelling off on the eighth day n-alkane oxidizing and aldehyde reductase activities were detected in the crude enzyme preparation suggesting the existence of terminal n-alkane oxidizing activity in this bacterium.

Characterization of a diesel-degrading strain isolated from a hydrocarbon-contaminated site.

A diesel-degrading bacterium has been isolated from a diesel-polluted site. The isolate was tentatively identified as Staphylococcus aureus strain DRY11 based on partial 16S rDNA molecular phylogeny and Biolog GP microplate panels and Microlog database. Isolate 11 showed an almost linear increase in cellular growth with respect to diesel concentrations with optimum growth occurring at 4% (v/v) diesel concentration. Optimization studies using different nitrogen sources showed that the best nitrogen source was potassium nitrite. Sodium nitrite was optimum at 1.2 g l(-1) and higher concentrations were strongly inhibitory to cellular growth. The optimal pH that supported growth of the bacterium was between 7.5 to 8.0 and the isolate exhibited optimal broad temperature supporting growth on diesel from 27 to 37 degrees C. An almost complete removal of diesel components was seen from the reduction in hydrocarbon peaks observed using Solid Phase Microextraction Gas Chromatography analysis after 5 days of incubation. The characteristics of this bacterium suggest that it is suitable for bioremediation of diesel spills and pollutions in the tropics.

Model studies on granular activated carbon adsorption in fixed bed filtration.

The removal of natural organic matter (NOM) using a continuous flow fixed bed granular activated carbon (GAC) column was studied and the results were then fitted with the Adams-Bohart, Bed-Depth-Service-Time and Clarks models. The GAC, KI-6070 and KI-8085 used in the study had external surface areas of 277 m2/g and 547 m2/g, respectively. Adsorption of NOM by the GAC was complex and involved more than one rate-limiting step. The critical bed depths for KI-6070 and KI-8085 were 0.24 m and 0.3 m, respectively. The Clark model was more effective in simulating the absorbent breakthrough process as compared to the Adams-Bohart model. The lower empty bed contact time (EBCT) i.e. 15 minutes gave a better fit to the Clark Model as compared to EBCT of 20 and 30 minutes.

Performance of an extended aeration-microfiltration (EAM) reactor in treating high strength industrial wastewater.

A laboratory study was conducted on an Extended Aeration-Microfiltration (EAM) reactor in treating a food industry wastewater. The reactor contained horizontally laid hollow fibre microfiltration (MF) units that were fully submerged. The MF units were connected to a peristaltic pump that was used to extract permeate continuously under suction pressure. Continuous aeration from beneath the modules provided the crossflow effect to the MF units. Active activated sludge was used in the start-up where the sludge was mixed together with the feed water at a Food/Microorganisms (F/M) value of about 0.1. Primary effluent with Chemical Oxygen Demand (COD) values ranged between 1,500 and 3,000 mg/l was used as feed water. The EAM reactor was operated for nearly three months without initiating cleaning of the MF units. A suction pressure of 0.9 bar and Mixed Liquor Suspended Solids (MLSS) of over 5,500 mg/l were reached when nearing the end of the three month operation period. Permeate COD and turbidity reduction of over 97% and 99% respectively, were achieved. Prior to this, the MF module arrangements were studied; where vertically arranged modules were found to perform poorly as compared to the horizontally laid modules, in terms of clean water permeate flux.