Eosinophilic gastroenteritis: Clinical profiles and treatment outcomes, a retrospective study of 18 adult patients in a Singapore Tertiary Hospital.

BACKGROUND: Eosinophilic gastroenteritis (EG) can mimic symptoms of common gastrointestinal (GI) disorders but responds well to appropriate treatment. Accurate diagnosis is central to effective management. Data on EG in Southeast Asia is lacking. We aim to describe the clinical profiles and treatment outcomes of adult patients with EG in a Singapore Tertiary Hospital. MATERIALS AND METHODS: This retrospective study involved archival search of patients with GI biopsies that showed eosinophilic infiltration from January 2004 to December 2012. Patients' clinical data from computerised hospital records and clinical notes was reviewed. Diagnostic criteria for EG included presence of GI symptoms with more than 30 eosinophils/high power field on GI biopsies. Patients with secondary causes for eosinophilia were excluded. RESULTS: Eighteen patients with EG were identified (mean age 52 years; male/female: 11/7). Fifteen patients (83%) had peripheral blood eosinophilia. Seven patients (39%) had atopic conditions. Most common symptoms were diarrhoea and abdominal pain. Small intestine was the most common site involved. Endoscopic finding was non-specific. Ten patients were treated with corticosteroids (nine prednisolone, one budesonide): eight patients (89%) responded clinically to prednisolone but four patients (50%) relapsed following tapering-off of prednisolone and required maintenance dose. One patient each responded to diet elimination and montelukast respectively. Half of the remaining six patients who were treated with proton-pump inhibitors, antispasmodic or antidiarrheal agents still remained symptomatic. CONCLUSION: Prednisolone is an effective treatment though relapses are common. Small intestine is most commonly involved. EG should be considered in the evaluation of unexplained chronic recurrent GI symptoms.

Myxoid perineurioma in a transplanted kidney.

Perineuriomas are rare, benign peripheral nerve sheath tumors, most commonly found in the extremities and trunks. A handful of cases have been reported to arise from the retroperitoneum and in kidneys. To our knowledge, this is the first reported case of a myxoid perineurioma arising from a transplanted kidney. The patient is a 40-year-old Chinese male with end-stage kidney disease secondary to chronic sclerosing glomerulonephritis. He has a nonfunctioning renal graft in his right iliac fossa and a functioning graft in the left. Routine imaging found a mass in the nonfunctioning graft which was increasing in size. He underwent graft nephrectomy and histology revealed a myxoid perineurioma with no atypical features or malignancy.

Design and simulation of a poly(vinyl alcohol)-bacterial cellulose nanocomposite mechanical aortic heart valve prosthesis.

In this study, a polymeric aortic heart valve made of poly(vinyl alcohol) (PVA)-bacterial cellulose (BC) nanocomposite is simulated and designed using a hyperelastic non-linear anisotropic material model. A novel nanocomposite biomaterial combination of 15 wt % PVA and 0.5 wt % BC is developed in this study. The mechanical properties of the synthesized PVA-BC are similar to those of the porcine heart valve in both the principal directions. To design the geometry of the leaflets an advance surfacing technique is employed. A Galerkin-based non-linear finite element method is applied to analyse the mechanical behaviour of the leaflet in the closing and opening phases under physiological conditions. The model used in this study can be implemented in mechanical models for any soft tissues such as articular cartilage, tendon, and ligament.

Foetal rhabdomyoma with fine-needle aspirate cytology correlation.

A case of intermediate form of foetal rhabdomyoma with cytological correlation is reported in a ten-year-old girl who presented with a lump in the right neck region. Fine-needle aspirate of the lump was performed. Cytological findings were that of spindled cells and rhabdomyoblasts with abundant eosinophilic cytoplasm. The lesion was subsequently excised. Histology showed a well-circumscribed cellular lesion composed of oval- to spindle-shaped cells. There were interspersed immature skeletal muscle cells with uniform nuclei and eosinophilic tapered cytoplasm and ganglion-like rhabdomyoblasts. No marked cellular atypia or prominent mitoses was noted. Immunohistochemically, the tumour cells showed positivity for muscle specific actin, myoglobin and myogenin. There was focal positivity for desmin. The patient showed no evidence of local recurrence or metastasis after a 32-month follow-up. This is believed to be the first case report of cytological findings in an intermediate form of foetal rhabdomyoma.

A finite element model on effects of impact load and cavitation on fatigue crack propagation in mechanical bileaflet aortic heart valve.

Pyrolytic carbon mechanical heart valves (MHVs) are widely used to replace dysfunctional and failed heart valves. As the human heart beats around 40 million times per year, fatigue is the prime mechanism of mechanical failure. In this study, a finite element approach is implemented to develop a model for fatigue analysis of MHVs due to the impact force between the leaflet and the stent and cavitation in the aortic position. A two-step method to predict crack propagation in the leaflets of MHVs has been developed. Stress intensity factors (SIFs) are computed at a small initiated crack located on the leaflet edge (the worst case) using the boundary element method (BEM). Static analysis of the crack is performed to analyse the stress distribution around the front crack zone when the crack is opened; this is followed by a dynamic crack analysis to consider crack propagation using the finite element approach. Two factors are taken into account in the calculation of the SIFs: first, the effect of microjet formation due to cavitation in the vicinity of leaflets, resulting in water hammer pressure; second, the effect of the impact force between the leaflet and the stent of the MHVs, both in the closing phase. The critical initial crack length, the SIFs, the water hammer pressure, and the maximum jet velocity due to cavitation have been calculated. With an initial crack length of 35 microm, the fatigue life of the heart valve is greater than 60 years (i.e. about 2.2 x 10(9) cycles) and, with an initial crack length of 170 microm, the fatigue life of the heart valve would be around 2.5 years (i.e. about 9.1 x 10(7) cycles). For an initial crack length greater than 170 microm, there is catastrophic failure and fatigue cracking no longer occurs. A finite element model of fatigue analysis using Patran command language (PCL custom code) in MSC software can be used to evaluate the useful lifespan of MHVs. Similar methodologies can be extended to other medical devices under cyclic loads.

Use of degradable and nondegradable nanomaterials for controlled release.

Drug-delivery devices are fundamentally important in improving the pharmacological profiles of therapeutic molecules. Nanocontrolled-release systems are attracting a lot of attention currently owing to their large surface area and their ability to target delivery to specific sites in the human body. In addition, they can penetrate the cell membrane for gene, nucleic acid and bioactive peptide/protein delivery. Representative applications of nanodrug-delivery systems include controlled-release wound dressings, controlled-release scaffolds for tissue regeneration and implantable biodegradable nanomaterial-based medical devices integrated with drug-delivery functions. We review the present status and future perspectives of various types of nanocontrolled-release systems. Although many of the well-established degradable and nondegradable controlled-release vehicles are being investigated for their processing into nanocarriers, several new emerging nanomaterials are being studied for their controlled-release properties. The release of multiple bioactive agents, each with its own kinetic profile, is becoming possible. In addition, integration of the nanocontrolled-release systems with other desirable functions to create new, cross-discipline applications can also be realized.

Anisotropic polyvinyl alcohol hydrogel for cardiovascular applications.

Polyvinyl alcohol (PVA) is a hydrophilic polymer with various characteristics desired for biomedical applications and can be transformed into a solid hydrogel by physical crosslinking, using a low-temperature thermal cycling process. As with most polymeric materials, the mechanical properties of the resultant PVA are isotropic, as oppose to most soft tissues, which are anisotropic. The objective of this research is to develop a PVA-based hydrogel that not only mimics the nonlinear mechanical properties displayed by cardiovascular tissues, but also their anisotropic behavior. By applying a controlled strain to the PVA samples, while undergoing low-temperature thermal cycling, we were able to create oriented mechanical properties in PVA hydrogels. The oriented stress-strain properties of porcine aorta were matched simultaneously by a PVA hydrogel prepared (10% PVA, cycle 3, 75% initial strain). This novel technique allows the controlled introduction of anisotropy to PVA hydrogel, and gives a broad range of control of its mechanical properties, for specific medical device applications.

The polyvinyl alcohol-bacterial cellulose system as a new nanocomposite for biomedical applications.

Finding materials suitable for soft tissue replacement is an important aspect for medical devices design and fabrication. There is a need to develop a material that will not only display similar mechanical properties as the tissue it is replacing, but also shows improved life span, biocompatibility, nonthrombogenic, and low degree of calcification. Polyvinyl alcohol (PVA) is a hydrophilic biocompatible polymer with various characteristics desired for biomedical applications. PVA can be transformed into a solid hydrogel with good mechanical properties by physical crosslinking, using freeze-thaw cycles. Hydrophilic bacterial cellulose (BC) fibers of an average diameter of 50 nm are produced by the bacterium Acetobacter xylinum, using a fermentation process. They are used in combination with PVA to form biocompatible nanocomposites. The resulting nanocomposites possess a broad range of mechanical properties and can be made with mechanical properties similar to that of cardiovascular tissues, such as aorta and heart valve leaflets. The stress-strain properties for porcine aorta are matched by at least one type of PVA-BC nanocomposite in both the circumferential and the axial tissue directions. A PVA-BC nanocomposite with similar properties as heart valve tissue is also developed. Relaxation properties of all samples, which are important for cardiovascular applications, were also studied and found to relax at a faster rate and to a lower residual stress than the tissues they might replace. The new PVA-BC composite is a promising material for cardiovascular soft tissue replacement applications.

Time-dependent analysis of leaflets in mechanical aortic bileaflet heart valves in closing phase using the finite strip method.

BACKGROUND AND AIMS OF THE STUDY: Mechanical heart valves (MHV) are widely used to replace dysfunctional and failed heart valves. The bileaflet MHV design is very popular due to its superior hemodynamics. Since their introduction in 1977, the hemodynamics of bileaflet prostheses has been extensively studied. In this study the dynamic behaviour during the closing phase of a bileaflet MHV under normal physiological conditions has been investigated. METHODS: Fluid analysis is based on the control volume with moving boundaries in the vicinity of the occluder. Unsteady continuity equation, unsteady momentum equation on the control volume and unsteady Bernoulli's equation have been used to calculate velocity of blood flow and force on the occluder tip. To solve the governing equations for the calculation of pressure and the related force, the finite strips method has been implemented. Only 32 strips are sufficient to calculate the force due to pressure on the leaflets. The equations of motion have been solved using the Runge-Kutta method in the fourth order. RESULTS: The maximum velocity of the leakage flow in the closing phase falls within the range of 3.5-4.4 m/s. The maximum velocity of the occluder tip is in the range of 2.4-3.2 m/s. The backflow also exhibits oscillation similar to that of the occluder with net backflow rate in the range of 9.7-12.3 ml/beat. The impact force between occluder and its housing is in the range of 80-140 N and impact occurs during 33.1-41.0 ms and the leaflets are completely settled at 108-115 ms in the closing phase. CONCLUSION: The finite strip method was implemented to study the closing phase of a bileaflet MHV. Results are consistent with the previous experimental data. This method is of general applicability to study dynamic behaviour of MHVs.

Atomic force microscopy investigation of the dependence of cellular elastic moduli on glutaraldehyde fixation.

Summary The atomic force microscope (AFM) has provided nanoscale analyses of surfaces of cells that exhibit strong adhesive and cell spreading properties. However, it is frequently reported that prior fixation is required for reliable imaging of cells with lower adhesive properties. In the present study, the AFM is used to assess the effects of fixation by glutaraldehyde on the elastic modulus of a human rhabdomyosarcoma transfectant cell line RDX2C2. Our results show a sharp increase in the elastic modulus for even mild fixation (0.5% glutaraldehyde for 60 s), accompanied by a dramatic improvement in imaging reproducibility. An even larger increase is seen in NIH-3T3 mouse fibroblasts, although in that case fixation is not typically necessary for successful imaging. In addition, our results suggest that treatment with glutaraldehyde restricts the content of the resulting images to features nearer to the cell surface.

Optimizing the tensile properties of polyvinyl alcohol hydrogel for the construction of a bioprosthetic heart valve stent.

Although bioprosthetic heart valves offer the benefits of a natural opening and closing, better hemodynamics, and avoidance of life-long anticoagulant therapy, they nevertheless tend to fail in 10-15 years from tears and calcification. Several authors, including the present ones, have identified the rigid stent as a factor contributing to these failures. The ultimate solution is an artificial heart valve that has mechanical properties that allow it to move in conformity with the aortic root during the cardiac cycle, has superior hemodynamics, is nonthrombogenic, will last more than 20 years, and mitigates the need for anticoagulants. We have identified a polymer, polyvinyl alcohol (PVA) hydrogel, that has mechanical properties similar to soft tissue. The purpose of this research is to match the tensile properties of PVA to the porcine aortic root and to fabricate a stent prototype for a bioprosthetic heart valve with the use of the PVA hydrogel. Specimens of 15% w/w PVA were prepared by processing through 1-6 cycles of freezing (-20 degrees C) at 0.2 degrees C/min freeze rate and thawing (+20 degrees C) at different thawing rates (0.2 degrees C/min and 1 degrees C/min), for different holding times (1 and 6 h) at -20 degrees C. Subsequently tensile tests and stress-relaxation tests were conducted on the specimens. The different holding times at -20 degrees C demonstrated no difference in the result. The slower thawing rate improved the tensile properties but did not produce significant changes on the stress-relaxation properties. The nonlinear stress-strain curve for the PVA after the fourth freeze-thaw cycle matched the porcine aortic root within the physiological pressure range. The stress-relaxation curve for PVA also approximated the shape of the aortic root. The complex geometry of an artificial heart valve stent was successfully injection molded. These results, in combination with other preliminary findings for biocompatibility and fatigue behavior, suggest that PVA hydrogel is a promising biomaterial for implants, catheters, and artificial skin.

Effect of distal graft anastomosis site on retrograde perfusion and flow patterns of native coronary vasculature.

BACKGROUND: To select the site of a target vessel for distal anastomosis surgeons use different approaches. Some try to place the graft as close to the stenosis as possible, whereas others routinely anastomose the graft onto the distal portion. In this latter case the proximal portion and its tributaries are perfused from the graft in a retrograde rather than an antegrade fashion. The aim of this study was to investigate the effect of local hemodynamics associated with the different location of distal anastomoses on flow patterns in the proximal native artery and its branches. METHODS: Computational fluid dynamic and in vitro model studies were carried out in a control model composed of a straight tube (host) with a 45E side branch and models in which the proximal end of the host had various degrees of stenosis; a 45E end-to-side "graft" anastomosis was introduced either proximal (upstream) or distal (downstream) to the branch. RESULTS: Placing the graft proximal to the branch largely preserved the flow patterns that were seen in the control model. Placing the graft distal to the branch, however, introduced an extensive region of relatively stagnant flow in the native vessel near the branch. Such regions are known to promote thrombus formation that could ultimately lead to occlusion of the retrograde portion of the host vessel. CONCLUSIONS: This study suggests that, although often less convenient surgically, long-term outcome of coronary artery bypass grafting may be improved by placing grafts in the most proximal portion of the native vessel, as close to the occlusion or stenosis as possible for better preservation of a proximal artery and its branches.

The pericardial bioprosthesis: altered tissue shear properties following glutaraldehyde fixation.

BACKGROUND AND AIM OF THE STUDY: Glutaraldehyde-fixed bovine pericardial tissue used in the construction of valvular bioprostheses undergoes repeated bending stress during the cardiac cycle. To bend smoothly, internal tissue shearing is required. The effect of glutaraldehyde fixation on internal shear properties of this material was examined. METHODS: Pericardium from each of 12 bovine hearts was cut into two pieces; one piece was retained as fresh tissue, the other was glutaraldehyde-fixed. Circular samples were then mounted and installed in a shear testing apparatus. For each sample, the shear stress versus shear strain characteristics were measured in circumferential and radial directions at strain rates of 1.0, 0.1 and 0.02 s(-1) while immersed in a 20 degrees C bath; similar measurements were made on six fresh and six fixed samples at 37 degrees C. In addition, the stress relaxation properties were measured by holding the tissue at maximum shear for 100 s after each of the three shear deformations, and recording force generated with time. RESULTS: The shear stress-strain test on fresh tissue (n = 12) showed non-linear behavior at the three shear rates. The shear modulus for fresh tissue increased from <1.0 kPa to 5 kPa at a shear strain approaching 1.0, and results were identical in radial or circumferential directions. For glutaraldehyde-fixed pericardium (n = 12), shear modulus increased promptly to 15-20 kPa at a strain of 0.2, and did not vary with strain rate. Shear relaxation was similar in fresh and fixed tissue. CONCLUSION: Fresh pericardium sheared easily at low shear stresses, with minimal resistance developing until the shear strain exceeded 0.5, while glutaraldehyde-fixed tissue displayed a marked resistance to shearing, with an immediate rise in shear stress at low strain. No differences were detected in shear properties between radial and circumferential directions. Such marked tissue stiffening may be a factor in collagen fiber disruption, leading to bioprosthetic heart valve failure.

Effect of acupuncture at Hsien-Ku (St-43) on the pulse spectrum and a discussion of the evidence for the frequency structure of Chinese medicine.

We investigated the pulse spectrum variation of the human radial artery when Hsien- Ku (St 43), an acupoint on the stomach meridian, was needled and compared the results with the acupuncture effects of two other acupoints, Tsu-San-Li (St-36) and Tai-Shih (K-3), reported previously. For Hsien-Ku, the harmonic proportions were redistributed: the second harmonic (C2) decreased, C3, C5, C6, C7, C8 and C9 increased, C3, C6 and C9 became the relative peaks to their neighboring harmonics and C2, C4 became the relative minimums. The phase angles of the 2nd harmonic (P2) and 5th harmonic (P5) decreased, propagating faster. These effects were similar to that of Tsu-San-Li which is also on the stomach meridian. A totally different pattern was found for Tai-Shih on the kidney meridian. These results strengthen the theory that a meridian can be classified according to its effects on the pulse spectrum, and that all the meridian related effects such as those caused by acupuncture or meridian specific herbs are frequency specific.

Measurement of drug distribution in vascular tissue using quantitative fluorescence microscopy.

Quantitative tools to assess vascular macromolecular distributions have been limited by low signal-to-noise ratios, reduced spatial resolution, postexperimental motion artifact, and the inability to provide multidimensional drug distribution profiles. Fluorescence microscopy offers the potential of identifying exogenous compounds within intact tissue by reducing autofluorescence, the process by which endogenous compounds emit energy at the same wavelength as fluorescent labels. A new technique combining fluorescence microscopy with digital postprocessing has been developed to address these limitations and is now described in detail. As a demonstration, histologic cross-sections of calf carotid arteries that had been loaded endovascularly with FITC-Dextran (20 kD) ex vivo were imaged at two different locations of the electromagnetic spectrum, one exciting only autofluorescent structures and the other exciting both autofluorescent elements and exogenous fluorescent labels. The former image was used to estimate the autofluorescence in the latter. Subtraction of the estimated autofluorescence resulted in an autofluorescence-corrected image. A standard curve, constructed from arteries that were incubated until equilibrium in different bulk phase concentrations of FITC-Dextran, was used to convert fluorescent intensities to tissue concentrations. This resulted in a concentration map with spatial resolution superior to many of the previous methods used to quantify macromolecular distributions. The transvascular concentration profiles measured by quantitative fluorescence microscopy compared favorably with those generated from the proven en face serial sectioning technique, validating the former. In addition, the fluorescence method demonstrated markedly increased spatial resolution. This new technique may well prove to be a valuable tool for elucidating the mechanisms of macromolecular transport, and for the rational design of drug delivery systems.

Gender differences in colour naming performance for gender specific body shape images.

Males are increasingly subjected to pressures to conform to aesthetic body stereotypes. There is, however, comparatively little published research on the aetiology of male body shape concerns. Two experiments are presented, which investigate the relationship between gender specific body shape concerns and colour-naming performance. Each study comprised a between subject design, in which each subject was tested on a single occasion. A pictorial version of a modified Stroop task was used in both studies. Subjects colour-named gender specific obese and thin body shape images and semantically homogeneous neutral images (birds) presented in a blocked format. The first experiment investigated female subjects (N = 68) and the second investigated males (N = 56). Subjects also completed a self-report measure of eating behaviour. Currently dieting female subjects exhibited significant colour-naming differences between obese and neutral images. A similar pattern of colour-naming performance was found to be related to external eating in the male subjects.