Therapeutic Potential of Thunbergia laurifolia L. Extract in Gestational Diabetes Mellitus: Insights from a Rat Model.

OBJECTIVE: To assess the effects of Thunbergia laurifolia L. extract (TLE) on gestational diabetes mellitus (GDM) in a rat model. METHODS: Thunbergia laurifolin L. leaves were subjected to ethanolic extraction. In vivo study, 50 pregnant rats were randomly divided into 5 groups (10 for each): non-GDM group, GDM induced by streptozotocin (STZ, 60 mg/kg i.p.), metformin (MET) 100 mg/kg, TLE 50, and 500 mg/kg groups. Administration was performed on gestation day 7 until term (day 21). The effects of TLE on blood glucose, insulin levels, lipid profiles, liver enzymes, and maternal performances were assessed. In in vitro study, the effect of TLE was examined using the organ bath for uterine force measurement. RESULTS: In in vivo study, TLE significantly reduced blood glucose as compared to GDM (P<0.05) with gradually increased insulin level. This effect was consistent with islets of Langerhans restoration. Histologically, the uterine muscular layer displayed a marked increase in fiber area in response to both doses as compared to GDM (P<0.05). Additionally, TLE significantly reduced total cholesterol, triglyceride, and alanine transaminase levels (P<0.05). Intriguingly, TLE also led to a notable augmentation in gravid uterus size, live fetuses count, and implantation numbers, while significantly reducing the post-implantation loss rate associated with fetal classification (P<0.05). Thus, GDM improvements were close to those produced by MET. In in vitro study, TLE exerted a concentration-dependent inhibition of spontaneous uterine contractility (half-maximal inhibition concentration=1.2 mg/L). This inhibitory effect extended to potassium chloride depolarization and oxytocin-mediated contractions. When combined with its major constituent, rosmarinic acid, TLE produced an enhanced inhibitory effect (P<0.05). CONCLUSIONS: TLE ameliorated blood glucose levels, enhanced uterine muscular structure, and improved maternal and fetal performance in GDM. TLE also displayed tocolytic properties. These findings underscore the need for further exploration of TLE as a potential tocolytic agent to mitigate GDM-associated complications.

Application of Visceral Adiposity Index and Anthropometry to Identify Preclinical Atherosclerosis in Menopausal Status Women.

Background: Obesity is associated with a major prevalence of cardiovascular risk factors and high risk of cardiovascular events and contributes to the increase in cardiovascular morbidity and mortality worldwide. Abdominal obesity is a main predictive factor of the metabolic syndrome, so it is certain that it represents a preferable marker of cardiovascular risk than generalized obesity. Visceral adiposity index (VAI) has recently been suggested to be used as a surrogate of visceral adiposity. Objective: We compared the predictive abilities of the VAI with those of simple anthropometric measures in preclinical atherosclerosis, as assessed by ultrasonographic measurement of carotid intima media thickness (CIMT). Material and Method: This is observational cross-sectional study involving 130 menopausal status women voluntarily recruited from Suranaree University of Technology Hospital, Thailand. Body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), waist-height ratio (WHtR) and lipid profile were determined. VAI was calculated. CIMT was assessed using a high-resolution B mode ultrasound system. Results: Total 114/130 menopausal status participants, 16 participants were excluded from morbid obesity and high triglyceride >400 mg/dL. About 22.3% had preclinical atherosclerosis on carotid ultrasound. Positive correlation was found between CIMT and WC (r = 0.20, p = 0.04), and WHR (r = 0.25, <0.01) and WHtR (r = 0.24, p = 0.01). However, there was no correlation between VAI and CIMT. Conclusion: Using VAI instead of simple anthropometric measures may lead to loss of much information needed for predicting preclinical atherosclerosis. WC, WHR, and WHtR were both superior to VAI in predicting CIMT.

Clinical Usefulness of Lipid Ratios to Identify Subclinical Atherosclerosis in Perimenopausal/Menopausal Women.

Background: Evidence shows that lipid ratios perform better than individual lipids in predicting cardiovascular risk. The lipid ratio serves as a quick and simple tool for identifying subclinical atherosclerosis. The population at risk especially perimenopausal and menopausal women should be monitoring to prevent cardiovascular disease in the future. Objective: To examine the association between lipid ratios and subclinical atherosclerosis by carotid intima media thickness (CIMT) in perimenopausal/menopausal women. Material and Method: A cross-sectional study was conducted with 130 participants aged 40 to 80 years between February 2015 and January 2016 in Suranaree University of Technology Hospital, Thailand. CIMTs were assessed using a highresolution B mode ultrasound system. Traditional anthropometry, body mass index (BMI), waist circumference (WC), and parameters including blood pressure, fasting plasma glucose, lipid profile [Total cholesterol (TC), Triglyceride (TG), Highdensity lipoprotein cholesterol (HDL-C) and Low-density lipoprotein cholesterol (LDL-C)], and CIMT were assessed in all subjects. All lipid ratios were calculated. Results: One hundred thirty perimenopausal/menopausal participants were included in this study. Of those participants, 41% were central obese phenotype and 22% had abnormal CIMT that can identify atherosclerosis. Age and systolic blood pressure in atherosclerosis group were higher than normal CIMT group; <0.01 and <0.01, respectively. Lipid ratio in normal CIMT was higher than atherosclerotic group but not statistically significance except TG/HDL-C (p = 0.03). All lipid ratios and single lipid parameters lacked prediction for the presence of early atherosclerosis. Conclusion: All of lipid ratios, TC/HDL-C, TG/HDL-C, and LDL-C/HDL-C were not identified as early subclinical atherosclerosis among perimenopausal/menopausal women.

Lipid Accumulation Product and Index of Central Lipid Distributions for Subclinical Atherosclerosis in Perimenopausal/Menopausal Women.

Background: Lipid accumulation product (LAP) is a novel biomarker of central lipid accumulation related to the risk of diabetes and cardiovascular disease (CVD). Consistent with physiologic observations, an alternative index uses waist circumference (WC) and fasting triglycerides (TG) concentrations to describe lipid over accumulation. Objective: Explore the association of LAP with anthropometric parameters and subclinical atherosclerosis in perimenopausal/menopausal women with no evidence of established CVD. Objective: Explore the association of LAP with anthropometric parameters and subclinical atherosclerosis in perimenopausal/menopausal women with no evidence of established CVD. Material and Method: The study was an observational cross-sectional study and included 130 perimenopausal/menopausal participants. The anthropometric parameters used were height, weight, and WC. Laboratory lipid profile and LAP were calculated. High-resolution B-mode ultrasonography was performed to measure carotid intima media thickness (CIMT) and to search for carotid atherosclerosis. Results: One hundred thirty perimenopausal/menopausal women were studied. About 22.3% had an abnormal CIMT. The percentages of normal weight, generalized obesity, and central obesity among study participants were 30.7%, 14.0%, and 55.3%, respectively. LAP was not correlated with CIMT and atherosclerosis. WC and waist-hip ratio (WHR) were correlated with CIMT but were not correlated with atherosclerosis. The other parameters of LAP and body mass index were not predictive of carotid atherosclerosis. Systolic blood pressure, diastolic blood pressure, fasting blood sugar, TG, and highdensity lipoprotein cholesterol were higher with LAP equal or greater than 34.5 than with LAP lower than 34.5. However, CIMT was not statistically different between the two LAP groups (p = 0.99). Conclusion: Central lipid distribution in perimenopausal/menopausal women using anthropometric phenotype WC and WHR was correlated with higher CIMT values. Both LAP index and anthropometric phenotype were not helpful for identifying subclinical atherosclerosis defined by CIMT measurement equal or greater than 0.9 mm.

Mobile Content and Scenario-Based Manikin for Improving Learning Outcomes in Obstetrics of Preclinical Medical Students.

Background: Multimedia programs have emerged in higher education institutions, including medical school. There is no clear evidence that such a movement can improve medical student's learning, application, and self-confidence especially high clinical skill procedures that are required to prepare before clinical year. Objective: To assess learning outcomes of knowledge, skill, application in medical students' performance, and self-confidence in Leopold maneuver after using instructional media, mobile content compared with scenario-base manikin. Material and Method: All of third year medical students received standard objective structural clinical examination guide prior to perform maneuver then self-study with Suranaree University of Technology (SUT) mobile content before traditional lecture and scenario-based manikin in laboratory room. Student's learning outcome, knowledge skill, application, and selfconfidence in obstetrics maneuver were assessed. Paired t-test was used to analyze data. Results: All 60 medical students completed the basic obstetrics, Leopold maneuver in introduction to clinical medicine course. Knowledge about indication, contraindication, and complication in scenario-based manikin, was higher than SUT mobile content significantly (p = 0.03). Clinical skills are statistically significant different between SUT mobile content and scenariobased manikin (p<0.01), except fourth step of Leopold maneuver, fetal heart sound assessment and interpretation. Preparation before procedure in first, second, and third step of Leopold maneuver, scenario-based manikin was significantly higher than SUT mobile content (p = 0.03, p<0.01, p = 0.04 and p = 0.04, respectively). Application in knowledge to publish and selfconfidence is better in scenario-base manikin (p = 0.01 and <0.01, respectively). Teacher has better ability of knowledge transfer to medical students in SUT mobile content than manikin (p = 0.01) but the use of learning time is no different. Conclusion: SUT mobile content has reported increased learning outcomes to performed Leopold maneuver in knowledge and clinical skills. The application in knowledge to interpretation and applied to real practice were not different in both groups. The scenario-based manikin has higher self-confidence than mobile content.

Neck Circumference and Cardio-Metabolic Risk in Normal Exercise Capacity Perimenopausal/Menopausal Women.

Background: Screening tools that include additional biomarkers may yield better predictive value for hypertension, impaired glucose tolerance, and other cardiovascular disease (CVD) risk factors and help identify those individuals who may benefit from more in-depth assessment. Neck circumference (NC) is a simple screening measure for identifying cardio-metabolic risk in perimenopausal and menopausal women. Objective: To determine whether a single measure of NC might be used to identify cardio-metabolic risk. NC for comparing with existing traditional anthropometric parameters such as body mass index (BMI) and waist-hip ratio (WHR). Material and Method: The cross-sectional study with 76 perimenopausal and menopausal participants aged 40 to 70 years were recruited from Suranaree University of Technology Hospital between September 2015 and February 2016. Anthropometric indices, biochemical laboratory, and clinical parameters were measured. The NC of larger than 35 cm parameters was the cut-off in normal NC in women. All participants did exercise stress test. Results: Seventy-six perimenopausal/menopausal women were included in this study. The NC was positively correlated with weight, BMI, and waist circumference (WC) (r = 0.72, 0.72 and 0.65 respectively, all p<0.01) and negatively correlated with high-density lipoprotein cholesterol (HDL-C) (r = -0.44, p<0.01). Other laboratory parameters such as fasting blood sugar (FBS) (r = 0.23, p = 0.04) and triglyceride (TG) (r = 0.31, p<0.01) were also positively correlated. Conclusion: NC measurement is a simple and a time saving screening measure that can be used to identify cardio-metabolic risk associated with simple anthropometric parameters such as BMI, WC, FBS, TG, and HDL-C. Participants with NC equal or greater than 35 cm were correlated with higher weight, BMI, and WC in normal exercise capacity perimenopausal/menopausal women.

Venipuncture Rate of Liver Function Tests for Patients being Treatment with Statin in Clinical Practice: A Therapeutic Dilemma.

Background: Statin or 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors are hypolipidemic agent. Its main functionality is to reduce cholesterol. The low-density lipoprotein cholesterol is the major cause of myocardial infarction. The adverse effect of this medication is hepatotoxicity. Doctors always request patient on statin treatment to obtain blood by venipuncture for liver function tests (LFTs) frequently. There are no researches studying the rate and expenditure of venipuncture for LFTs in patients being treated with statin. Objective: To study unnecessary rate on venipuncture for LFTs in patients being treatment with statin at an outpatient clinic. Material and Method: Retrospective cohort study. Data are collected from medical records that being treatment with statin at an outpatient clinic, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University between March 1, 2012 and March 1, 2014. The 441 patients are divided into two groups. The first group is treated with the appropriate venipuncture for LFTs and the second group is treated with unnecessary venipuncture for LFTs. The expenditure for both groups are used to calculate and compare costs. Results: The number of unnecessary venipuncture in the LFTs group is 308 samples (69.84%). The sample proportions are 85.06% come from staff (262 samples) and 14.94% come from interns (46 samples). The number of appropriate venipuncture for LFTs is 133 samples (30.16%). The sample proportions are 77.44% come from staff (103 samples) and 22.56% come from interns (30 samples). The expenditure of the unnecessary venipuncture for LFTs had a statistically significant difference from the appropriate venipuncture for LFTs [75,500 vs. 4,400 baht (THB)] (p<0.05). Conclusion: The expenditure for the unnecessary venipuncture LFTs in patient being treated with statin at the outpatient clinic is statistically higher than the appropriate venipuncture (p<0.05).

A Body Shape Index versus Traditional Anthropometric Parameters to Identify Subclinical Atherosclerosis in Perimenopausal/Menopausal Women.

Background: The body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) are well-used anthropometric predictors for cardiovascular diseases (CVD), but their validity is regularly questioned. Recently, A body shape index (ABSI) was introduced as an alternative anthropometric index that may better reflect health status. Objective: To assess the ability of ABSI to identify a marker of early atherosclerosis using carotid intima media thickness (CIMT) and determine whether it is superior to traditional anthropometrics: BMI, WC, and WHR. Material and Method: This is a cross-sectional study of 114 participants, aged 40 to 80 years, recruited from the cardiovascular clinic and menopausal clinic between February 2015 and January 2016. CIMTs were measured using B-mode ultrasonography. The novel ABSI, both ABSI [American (A) and Asian or Indonesia formula (I)] and traditional anthropometric parameters (BMI, WC, and WHR) were measured. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDLC), and low-density lipoprotein cholesterol (LDL-C) were assessed in the entire population. Results: There was 114 participants with mean age of 53.75±9.92 years and mean CIMT of 0.70±0.15 mm. The prevalence of abnormal CIMT was 22.3%. ABSI (A), ABSI (I), and BMI were significantly different between normal and atherosclerotic CIMT ≥0.9 mm (p<0.001). Both ABSI (A) and ABSI (I) were correlated with atherosclerosis (r = 0.211, p = 0.024), (r = 0.188, p = 0.046) but there was no correlation with mean CIMT. The anthropometric parameters WC and WHR were correlated with mean CIMT, however they had no correlation with atherosclerosis. Only the traditional anthropometrics BMI was not correlated with CIMT or atherosclerosis. Conclusion: ABSI (A) and ABSI (I) could predict the presence of early atherosclerosis but have no correlation with mean CIMT, as opposed to the anthropometric indices WC and WHR.

Novel Mathematic Indexes to Identify Subclinical Atherosclerosis in Different Obesity Phenotypes of Perimenopausal/Menopausal Women.

Background: Evidence shows that novel adiposity and atherosclerotic index perform better than individual lipids or traditional cardiometabolic risks in predicting cardiovascular disease (CVD). Identifying mathematic indexes both adiposity and atherogenic indexes can serve as a quick and simple tool for identifying subclinical atherosclerosis and monitoring population at risk of CVD. Objective: To examine the relationship between atherogenic index and adiposity index to identify subclinical atherosclerosis using carotid intima media thickness (CIMT) in specific population groups of central obesity and general obesity phenotype in perimenopausal/menopausal women. Results: Data from 130 perimenopausal/menopausal participants with 41% being central obesity phenotype was reviewed. Most adiposity indexes such as visceral adiposity index (VAI), lipid accumulation product (LAP), and atherosclerotic index of plasma (AIP) were different between abdominal obesity and non-abdominal obesity p = 0.01, p<0.01 and p = 0.03, respectively. The body adiposity index (BAI) and a surface-based body shape index (ASBI) were not different. CIMT was higher in abdominal obesity and different obesity phenotype (p<0.01). In abdominal obesity BAI, LAP, and AIP were correlated withCIMT but only AIP was correlated with CIMT in non-abdominal obesity. Conclusion: The presence of early atherosclerosis in perimenopausal/menopausal women with abdominal obesity can be predicted using BAI, LAP, and AIP. In perimenopausal/menopausal women with non-abdominal obesity, only AIP was correlated with CIMT.

Association between Systolic Blood Pressure Recovery Ratio after Treadmill Exercise Stress Testing and Cardio-Metabolic Risk Factors among Menopausal Status.

Background: Exercise Stress Testing (EST) is traditionally analyzed in prediction of the coronary artery disease (CAD). Systolic blood pressure (SBP) during recovery was related directly to risk of cardiovascular death after adjustment for age and other clinical and exercise test variables. Objective: Determine the relationship between systolic blood pressure recovery ratio (SBPRR) and anthropometric and cardio-metabolic factors from laboratory among menopausal status. Material and Method: The cross-sectional study was conducted between September 2015 and February 2016. Seventy-six perimenopausal and menopausal participants were recruited from Suranaree University of Technology Hospital in the study. Anthropometric indices, biochemical laboratory, and clinical parameters were measured. All participants underwent exercise as per Bruce protocol EST. The SBPRR was assessed by calculated SBP at 3 min/SBP at peak ratio. Results: The 76 perimenopausal and menopausal participants had a mean age of 50.26±8.36 years. SBPRR were negatively correlated with HDL-C (r = -0.29, p = 0.02) and positively correlated with fasting blood sugar (FBS) (r = 0.28, p = 0.01). There was no difference among groups of SBPRR in perimenopausal/menopausal women except waist-hip ratio (p = 0.02) and HDL-C (p = 0.02). EST parameter peak rate pressure product, heart rate recovery at 1-minute, and functional capacity were not discriminating between SBPRR groups.

Neck Circumference as Simple Screening Measure for Predicting the Annual Mortality in Menopausal Status Women using Treadmill Exercise Stress Test.

Background: Neck circumference (NC) is a simple screening measure for identifying overweight and obesity. It was recently proposed that the NC may be represent a better parameter of cardiovascular risk, when compared to fat stored in the visceral region. Objective: To determine whether a single measure of NC might be used to identify hemodynamic response, annual mortality rate in treadmill exercise stress test (EST) and traditional anthropometric parameters in perimenopausal/menopausal women. Material and Method: This is a cross-sectional study of 76 perimenopausal/menopausal women. Main indicators included NC, body mass index (BMI), waist circumferences (WC), waist to hip ratio (WHR), average annual mortality rate, and hemodynamic response during treadmill EST. Statistical analysis was done by using student's t-test and Pearson correlation. The p-value was taken as significant at 5% confidence level (p<0.05). Results: The research included 76 perimenopausal/menopausal women with an average age of 50.26±8.36 years. Perimenopausal/menopausal women with lower NC values (<35 cm) presented no difference in EST values when compared to women with higher NC values (≥35 cm). Average annual mortality had inverted correlation with NC (p = 0.04). The other traditional parameters, BMI and WHR did not correlate with the annual mortality rate. The hemodynamic response of the treadmill exercise parameters in rate pressure product, heart rate recovery, and functional capacity did not correlate with NC. Conclusion: NC measurement is simple and timesaving screening measure that may be added to prognostic parameters for prediction of annual mortality. Average annual mortality in treadmill EST had inverted correlation with NC. The other traditional anthropometric parameters did not correlate with prognostic variables of treadmill EST.

Preclinical Medical Students' Achievement to Learning Outcomes in Special Tracts of Rural Doctors.

Background: Preclinical medical students are introduced to application of knowledge in communication skills, and clinical examination in third year of the curriculum including gaining clinical experiences without difference in learning environment and faculty administration to achieving personal and professional success. Objective: To assess perception of medical students and the learning gap between One District One Doctor (ODOD) and Collaborative Project to Increase Production of Rural Doctors (CPIRD) when a special tract is used for rural doctors to achieve learning outcomes and management of the Institute of Medicine to study medicine including academic curriculum, environmental, and social factors. Material and Method: A cross-sectional study of third years students of ODOD and CPIRD groups were recruited for this study. Self-administered questionnaire in domain of learning outcomes, motivation, and self-confidence including faculty administration were given to all the participants to assess and analyze the perception of preclinical students. t-test and bivariate analysis were used to evaluate the results. Results: Thirty-six CPIRD (60%) and 24 ODOD (40%) participants completed the questionnaire. The CPIRD medical students' perceptions were higher in learning outcomes when compared with ODOD in all domains of cognitive, interpersonal skill, professionalism, and ethic aspect but not statistically significant. Grades before admission were different in special tracts of rural doctors; CPIRD medical students had higher examination scores before admission (63.73±3.37 vs. 56.76±5.22, p<0.05) compared with ODOD group. However, there was no difference in Grade point average (GPA)between the two groups (3.32±0.35 vs. 3.23±0.29, p = 0.33) after finishing in preclinical year. There was no difference between the two groups of medical students in perception in faculty administration including teacher preparation, learning environment, and social environment. Conclusion: No learning gap in learning outcomes, learning environment, and faculty administration between two groups of special tracts of rural doctors after finishing preclinical medical year even when the examination score before admission were different in both groups. After studying in the same learning environment, there was no difference of all learning outcomes and GPA in third year of preclinical medical students.

Psychometric Properties of Depression Anxiety and Stress in Preclinical Medical Students.

Background: Medical education and learning outcomes might adversely affect students' mental health in all axes depression, anxiety, and stress. Faculty has a concern regarding the mental well-being of the medical students. Objective: Explore the prevalence of depressive anxiety and stress symptoms, ways of coping, and their relationships to variables among preclinical medical students. Material and Method: A cross-sectional, observational study was conducted in preclinical medical students, Suranaree University of Technology in March 2015. Two hundred thirty medical students (First, second, and third year students) were included and then completed the Self-administered questionnaire, The Depression Anxiety Stress Scale-21 (DASS-21) is a quantitatively measured for distress along the three axes of depression, anxiety, and stress. Results: At the beginning of the study, 230 students enrolled in the study (43.2% male). The overall response rate among medical students was 92.61% (213/230). The prevalence of mild to moderate degree in depression, anxiety, and stress level was 9.4%, 22.5%, and 5.6%, respectively while the prevalence of severe to extremely severe degree in depression, anxiety, and stress level was 0.9%, 3.2%, and 0%, respectively. The second-year medical students exhibited the highest percentage of depression, anxiety, and stress but there was no significant difference among depression, anxiety, and stress between academic year in preclinical medical students. No burnout and suicidal ideation were reported by either males or females. Conclusion: This present indicated that medical students have a low level of depression, anxiety, and stress, however, the data is useful for further planning of prevention in psychometric risks.

Waist to Height Ratio for Predicting Hemodynamic Responses of Treadmill Exercise Stress Test in Perimenopausal/Menopausal Women.

Background: Waist to height ratio (WHtR) is a simple screening measure for identifying overweight and obesity. It was recently proposed that the WHtR may represent a better parameter of cardiovascular risk, when compared to simple anthropometric parameters. Objective: To investigate the hemodynamic responses of treadmill exercise stress test (EST) in perimenopausal and menopausal women with new central obesity parameter as WHtR. Material and Method: This is a cross-sectional study of 76 perimenopausal/menopausal women. Main indicators included WHtR and hemodynamic parameters of treadmill EST. Statistical analysis was done by using Student's t-test and Pearson correlation. The p-value was taken as significant at 5% confidence level (p<0.05). Results: Seventy-six perimenopausal/menopausal women, with average age of 50.26±8.36 years. Perimenopausal/menopausal women with lower WHtR values (<0.5) had different EST values in exercise duration time, functional capacity, rate pressure roduct (RPP), and heart rate recovery (HRR) after treadmill EST when compared to women with greater WHtR (≥0.5). No correlations of WHtR with 5-year survival or average annual mortality. Conclusion: WHtR measurement is a simple and timesaving screening measure for central obesity that can be used to differential hemodynamic response in treadmill EST. WHtR ≥0.5 has abnormal hemodynamic response in HRR, which is associated with a strong adverse prognostic marker in premenopausal/menopausal population. Exercise capacity is lower in central obesity group.

Atherosclerotic Index and Traditional Anthropometry for Predicting Carotid Intima Media Thickness in Perimenopausal/Menopausal Women.

Background: Atherosclerosis is an important pathologic cause of cardiovascular disease (CVD) and a leading cause of morbidity and mortality worldwide. Menopause involves changes in hormonal status that are associated with an increased risk of developing CVD. The atherogenic index of plasma (AIP) has been used as a predictor of atherosclerosis. Atherosclerosis might also be assessed using a surrogate marker, the carotid artery wall intima media thickness (CIMT). Objective: To assess the usefulness of AIP compared with traditional anthropometrics for predicting CIMT in perimenopausal and menopausal women. Material and Method: This is a cross-sectional study involving perimenopausal and menopausal women voluntarily recruited. Lipid profiles, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were assessed and AIP was calculated [log (TG/HDL-C)]. The anthropometric parameters of body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-hip ratio (WHR) were assessed. Pearson Chi-square for AIP and anthropometric parameters relationship to CIMT in perimenopausal and menopausal women. Results: One hundred fourteen perimenopausal and menopausal women were included in this study. The novel atherosclerotic index of AIP and the anthropometric parameter of BMI were correlated with CIMT in both groups (p<0.01). There was no difference in AIP between perimenopausal and menopausal women. Neither WC nor WHR were different between the two groups. CIMT was significantly thicker in the menopausal compared with the perimenopausal group [0.78±0.16 vs. 0.64±0.09, respectively (p<0.01)]. Conclusion: AIP can add significant value when assessing the risk of developing the atherosclerosis marker of thickened CIMT in perimenopausal and menopausal women. A high AIP in menopause may indicate a higher risk of cardiovascular events in spite of no difference in common CVD risk factors such as lipid profile parameters.

Comparison of Cryopreserved Human Sperm between Ultra Rapid Freezing and Slow Programmable Freezing: Effect on Motility, Morphology and DNA Integrity.

BACKGROUND: Cryopreservation of sperm is common methods to preserve male fertility. Sperm freezing, suggest slow programmable freezing caused lower change of sperm morphology than sperm freezing in vapor of liquid nitrogen. Ultra rapid freezing is easy to be worked on, less time, low cost and does not need high experience. OBJECTIVE: To compare the effect on sperm motility, morphology and DNA integrity of post-thawed sperm after ultra rapid freezing and slow programmable freezing methods. MATERIAL AND METHOD: Experimental study at laboratory of infertility unit, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital. Thirty-seven semen samples with normal semen analysis according to World Health Organization (WHO) 1999 [normal sperm volume ( 2 ml) and normal sperm concentration (≥ 20 x10(6)/ml) and sperm motility (≥ 50%)]. Semen samples were washed. Then each semen sample was divided into six cryovials. Two cryovials, 0.5 ml each, were cryopreserved by slow programmable freezing. Four 0.25 ml containing cryovials, were cryopreserved by ultra rapidfreezing method. After cryopreservationfor 1 month, thawedprocess was carried out at room temperature. Main outcomes are sperm motility was determined by Computer-Assisted Semen Analysis (CASA), sperm morphology was determined by eosin-methylene blue staining and sperm DNA integrity was assessed by TUNEL assay. RESULTS: Sperm motility was reduced significantly by both methods, from 70.4 (9.0)% to 29.1 (12.3)% in slowprogrammable freezing and to 19.7 (9.8)% in ultra rapid freezing (p < 0.05). Sperm motility decreased significantly more by ultra rapid freezing (p < 0.001). The percentage of normal sperm morphology and DNA integrity were also reduced significantly by both methods. However, no significant difference between the two methods was found (p > 0.05). CONCLUSION: Cryopreservation of human sperm for 1 month significantly decreased sperm motility, morphology and DNA integrity in both methods. However sperm motility was decreased more by ultra rapid freezing.

Association between Subclinical Atherosclerosis among Hyperlipidemia and Healthy Subjects.

BACKGROUND: The global burden ofcardiovascular disease (CVD) continues to rise as developing nations. Primary prevention is effective in populations traditionally considered low-risk. Carotid intima-media thickness (CIMT) is considered as a surrogate marker for CVD. OBJECTIVE: Correlation between surrogate markers of subclinical atherosclerosis CIMT, carotid plaque and CVD risk factors in hyperlipidemia and healthy group. MATERIAL AND METHOD: Cross sectional study, aged 18-80 years from cardiovascular clinic, Suranaree University of Technology Hospital and measurement CIMT Correlates between CIMT and traditional CVD risk factors age, gender; body mass index (BMI), Waist hip ratio (WHR), total cholesterol, triglyceride, HDL-cholesterol level, LDL-cholesterol level were assessed in the entire population. RESULTS: Population 302 subjects (male 154 [51%]), mean age 47.17 ± 10.95 years were found to be hyperlipidemia 216 (71.5%) and healthy 86 (28.5%) subjects. Comparability between hyperlipidemia and healthy subject not different in BMI, WHR, and FBS. Mean left and right CIMT no difference between hyperlipidemia and healthy subjects. CIMT correlated with hyperlipidemia higher LDL-cholesterol level (r = 0.12, p = 0.03), triglyceride (r = 0.18 p < 0.01), WHR (r = 0.19, p < 0.01) and SBP (r = 0.2 2, p < 0.01). The correlation coefficients were not significantly different between CIMT and traditional risk factors age, gender; BMI, LDL-C and HDL-C. CONCLUSION: The subclinical atherosclerosis CIMTvalues are closely associated with hyperlipidemia along with cholesterol, triglyceride, WHR and SBP.

Plasma Low-Density Lipoprotein Cholesterol/High-Density Lipoprotein Cholesterol Concentration Ratio and Early Marker of Carotid Artery Atherosclerosis.

BACKGROUND: Carotid intima-media thickness (CIMT) is a surrogate markerfor cardiovascular disease (CVD) and LDL-C/ HDL-C ratio is related to CIMT or carotid plaque. Evaluate early atherosclerosis markers whether elevated levels of the LDL-C/HDL-C ratio is a more significant predictor than LDL-C or HDL-C alone. OBJECTIVE: To assess the correlation between early atherosclerosis markers using CIMT carotid plaque, carotidplaque type and LDL/HDL ratio surrogate maker and LDL-C/HDL-C ratio. MATERIAL AND METHOD: Cross sectional study. Aged 18-80 years in cardiovascular clinic, Suranaree University of Technology, Thailand CIMT carotid plaque and carotid plaque type were measured using a B-mode ultrasonography, ratio LDL/HDL, Framingham risk score and traditional CVD risk factors (age, body mass index (BMI), Waist hip ratio (WHR), gender total Cholesterol, triglyceride, HDL-C, LDL-C) were assessed in the entire population. RESULTS: Population of 302 subjects (154 (51%) male) mean age (47.17 ± 10.95 years) was recruited. The mean CIMT 0.71 mm (min 0.46 mm and max 1.22 mm). CIMT correlated with WHR (p < 0.01), SBP (p < 0.01), total cholesterol (p = 0.032), triglyceride (p < 0.01) but not with LDL/HDL ratio, other traditional risk factors BMI, FBS, LDL-C and HDL-C. Carotid plaque showed association only with triglyceride (p = 0.011). Carotid plaque type showed association with age (p < 0.01), sex (0.03), Framingham risk score (p = 0.03), WHR (P = 0.01) and SBP (p < 0.01). CONCLUSION: No association between early atherosclerosis CIMT carotid plaques, carotid plaque type with LDL/HDL ratio identified but closely associated with WHR.

Perceptions of Medical Students and Facilitators of an Early Clinical Exposure Instructional Program.

BACKGROUND: Early introduction to clinical medicine program was use as medical curriculum, Suranaree University since 2007. Today, medical students are learning introduction to patient contact, communication skills and clinical examination in the pre-clinicalyears with the purpose ofgaining early clinical experience. OBJECTIVE: Investigation for pre-clinical students and clinical facilitators' perception through early introduction to clinical medicine. MATERIAL AND METHOD: Third-year medical students were enrolled in the introduction to clinical medicine coursefor 2 weeks. Questionnaires for student andfacilitator versions were distributed to 60 students and 21 facilitators. In the analysis, both t-test analysis and bivariate analysis for mean difference were used, statistical significant p < 0.05. RESULTS: Sixty students (participation rate 100%) and 16 `facilitators (participation rate 76%) completed the questionnaire. Differences in perception between medical students and facilitators were found in domains of professionalism, facilitator's perception were greater than medical students in medical profession were (4.5 vs. 3.87, p = 0.03), domain that medical student's perception were greater than facilitator's in encouragement was (3.95 vs. 3.25, p < 0.01) and pressure in learning environment (3.92 vs. 3.12, p < 0.01). No learning gaps of facilitators and medical students in the other domains ofcognitive, interpersonal skills, ethics, learning, teacher preparation and social environment and overall stratification were identified. CONCLUSION: The students experienced the course as providing them with a valuable introduction to the physician professional role in clinical practice. In medical students' perception, they often experienced encouragement and the learning environment more so thanfacilitators did. Overall stratification was good in perception of facilitators and medical students.