A real-world experience of a prescribing policy for SGLT2-inhibitors in HFrEF in a Malaysian public tertiary cardiac centre.

A prescribing policy for SGLT2-inhibitors was implemented in a local public tertiary cardiology centre in Sabah to improve access for heart failure (HF) patients. The study evaluated 169 HF patients with reduced ejection fraction (HFrEF) who met the policy criteria. After starting SGLT2- inhibitors, a significant proportion of patients experienced decreased NTproBNP levels, indicating a positive response. HF hospitalisation rates within 1 year were lower compared to the previous year. No adverse events were reported, suggesting that the treatment is safe. Findings demonstrates the benefits of implementing prescribing policies to enhance treatment accessibility and generate valuable real-world data at the local healthcare level..

Application of xenogeneic anti-canine distemper virus antibodies in treatment of canine distemper puppies.

OBJECTIVE: The clinical feasibility of passive immunotherapy has not been demonstrated in dogs naturally infected with canine distemper. In this study, porcine anti-canine distemper virus IgG and F(ab')2 antibody fragments were used to treat infected puppies. METHODS: A total of 41 naturally infected puppies (age Äsix months) exhibiting severe respiratory signs, but lacking neurological signs, were enrolled in the study. Twenty-five puppies were treated with a combination of IgG or F(ab')2 antibody fragments (Group 1) and supportive therapy and 16 puppies received routine supportive care only (Group 2). RESULTS: The survival rate of dogs in Group 1 (19/25; 76%) was significantly higher than that in Group 2 (5/16; 31·3%) (P<0·05). During the therapy, 8 of the 25 dogs (32%) in Group 1 developed neurological signs versus 12 of the 16 dogs (75%) in Group 2 (P<0·05). Adverse reactions were limited to elevated body temperature in dogs that received IgG antibodies. CLINICAL SIGNIFICANCE: Porcine anti-canine distemper virus antibodies improved survival in puppies affected with canine distemper with minimal adverse effects. Therefore, this therapy could be considered for treatment of endangered animal species infected with canine distemper virus.

PPARγ regulates the mitochondrial dysfunction in human neural stem cells with tumor necrosis factor alpha.

Peroxisome proliferator-activated receptor gamma (PPARγ) belongs to a family of ligand-activated transcription factors, and its ligands are known to control many physiological and pathological conditions. The hypothesis of our study was that the PPARγ agonist (rosiglitazone) could mediate tumor necrosis factor alpha (TNFα) related to the regulation of human neural stem cells (hNSCs), by which TNFα possibly fulfills important roles in neuronal impairment. The results show that PPARγ mediates the cell viability of hNSCs via the downregulation of the activity of caspase 3, indicating that this rescue effect of PPARγ could improve the reduced levels of two mitochondrial regulators, adenosine monophosphate-activated protein kinase (AMPK) and Sirtuin 1 (SIRT1) in the hNSCs with TNFα. The stimulation of mitochondrial function by PPARγ was associated with activation of the PPAR coactivator1 alpha (PGC1α) pathway by up-regulation of oxidative defense and mitochondrial systems. The above protective effects appeared to be exerted by a direct activation of the rosiglitazone, because it protected hNSCs from TNFα-evoked oxidative stress and mitochondrial deficiency. Here we show that the rosiglitazone protects hNSCs against Aß-induced apoptosis and promotes cell survival. These findings extend our understanding of the central role of PPARγ in TNFα-related neuronal impairment, which probably increases risks of neurodegenerative diseases. The anti-inflammatory effects of PPARγ in the hNSCs with TNFα, and the involved mechanisms were also characterized.

Vertical InGaN light-emitting diode with a retained patterned sapphire layer.

We present an efficient vertical InGaN light-emitting diode (LED) in which the proposed vertical LEDs were fabricated with patterned sapphire substrates (PSS) using thinning techniques. After the thinning of sapphire substrate, selective dry etching process was performed on the remainder sapphire layer to expose the n-GaN contact layer instead of removing the sapphire substrate using the laser lift-off technique. These processes feature the LEDs with a sapphire-face-up structure and vertical conduction property. The PSS was adopted as a growth substrate to mitigate the light-guided effect, and thereby increase the light-extraction efficiency. Compared with conventional lateral GaN LEDs grown on PSS, the proposed vertical LEDs exhibit a higher light output power and less power degradation at a high driving current. This could be attributed to the fact that the vertical LEDs behave in a manner similar to flip-chip GaN/sapphire LEDs with excellent heat conduction.

Hyaluronic acid instillation following arthroscopic anterior cruciate ligament reconstruction: a double-blinded, randomised controlled study.

PURPOSE: To assess the effect of hyaluronic acid instillation after arthroscopic anterior cruciate ligament (ACL) reconstruction for improving pain, range of movement, and function of the knee. METHODS: 28 men and 4 women underwent arthroscopic ACL reconstruction for isolated ACL rupture (partial or complete) and instability after recreational sports injury 2 to 120 months earlier. They were randomised to undergo arthroscopic ACL reconstruction followed by intra-articular viscoseal instillation (13 men and 3 women) or arthroscopic ACL reconstruction alone (15 men and 1 woman). The knee injury osteoarthritis outcome score (for pain, symptoms, activities of daily living, sport and recreation function, and quality of life), range of movement, knee circumference, and analgesic use were assessed on days -1, 1, and 2, and weeks 2, 6 and 12. RESULTS: Patient demographics were similar at baseline. At postoperative days 1 and 2, all subscales of the knee injury osteoarthritis outcome score (except for quality of life) were significantly higher in the viscoseal group. At weeks 2, 6, and 12, improvement in both groups equalised. Knee swelling (change in knee circumference) was significantly less in the viscoseal group at days 1 and 2 (p=0.009 and p=0.038, respectively, Mann-Whitney U test). Only one patient in the viscoseal group had a limited range of movement. No patient developed any adverse reaction. CONCLUSION: Intra-articular viscoseal instillation improved pain control and swelling 2 days after arthroscopic ACL reconstruction.

Preventive vertebroplasty for adjacent vertebral bodies: a good solution to reduce adjacent vertebral fracture after percutaneous vertebroplasty.

BACKGROUND AND PURPOSE: Adjacent VCF frequently occurs after percutaneous vertebroplasty. Our aim was to evaluate PrVP in the prevention of PVNO-adjacent VCF. MATERIALS AND METHODS: Radiographs of 68 patients who initially presented with a single-level unhealed fracture and underwent vertebroplasty were retrospectively reviewed for the occurrence of PVNO fracture. Patients in the nonpreventive group (n = 33) underwent TVP only for a vertebra with an unhealed fracture. The preventive group (n = 35) underwent PrVP combined with TVP. We injected bone cement into the caudal part of the superior adjacent vertebra and the cephalic part of the inferior adjacent vertebra to perform PrVP. RESULTS: The incidences of PVNO fracture in adjacent vertebra next to a vertebra cemented at the patient's first vertebroplasty (within 6 months: 24% versus 3%, P = .012; within 1 year: 30% versus 3%, P = .006; >4 years: 39% versus 3%, P = .006) markedly decreased in the preventive group compared with the nonpreventive group. PVNO fracture was found in 26% of vertebrae adjacent to the first TVP level in the nonpreventive group and in 2% of vertebrae adjacent to a PrVP level in the preventive group after inclusion of all PrVP procedures. Approximately 33% of patients in the nonpreventive group underwent repeat vertebroplasty, mainly due to adjacent fractures. Only 3% of patients in the preventive group underwent repeated procedures. None of the vertebrae cemented for PrVP or TVP developed PVNO refracture. CONCLUSIONS: Preventive vertebroplasty for the adjacent vertebra combined with TVP for the fractured vertebra is effective in the prevention of propagation of PVNO adjacent fractures, thus reducing the necessity of multiple repeat vertebroplasty procedures.

Vertical InGaN light-emitting diode with a retained patterned sapphire layer.

We present an efficient vertical InGaN light-emitting diode (LED) in which the proposed vertical LEDs were fabricated with patterned sapphire substrates (PSS) using thinning techniques. After the thinning of sapphire substrate, selective dry etching process was performed on the remainder sapphire layer to expose the n-GaN contact layer instead of removing the sapphire substrate using the laser lift-off technique. These processes feature the LEDs with a sapphire-face-up structure and vertical conduction property. The PSS was adopted as a growth substrate to mitigate the light-guided effect, and thereby increase the light-extraction efficiency. Compared with conventional lateral GaN LEDs grown on PSS, the proposed vertical LEDs exhibit a higher light output power and less power degradation at a high driving current. This could be attributed to the fact that the vertical LEDs behave in a manner similar to flip-chip GaN/sapphire LEDs with excellent heat conduction.

Coexistence of exchange bias and magnetization pinning in the MnO(x)/GaMnAs system.

Coexistence of exchange bias (H(E)) and magnetization (M) shift was observed in as-grown and field-annealed MnO(x)/Ga(0.95)Mn(0.05)As bilayers. It was found that H(E) initially decreases with the annealing time t(a) and then increases when t(a) > 30 min, while the M shift remains almost unchanged with t(a). X-ray photoelectron spectroscopy (XPS) analysis reveals that MnO(x) is composed of MnO and Mn(3)O(4), and the volume amount ratio of Mn(3)O(4) to MnO increases with increasing t(a). A simple model based on a uniform MnO-Mn(3)O(4) interface with constant 'pinned' uncompensated interfacial spins is proposed to account for the observed exchange-biased phenomena in the bilayers.

Factors affecting mortality in Hong Kong patients with upper limb necrotising fasciitis.

OBJECTIVE: To identify predictive factors for mortality of patients with upper limb necrotising fasciitis. DESIGN: Retrospective study. SETTING: Six hospitals in Hong Kong. PATIENTS: Clinical records of 29 patients treated in the hospitals were traced and analysed. MAIN OUTCOME MEASURES: Possible predictive factors for mortality as evaluated by application of Fisher's test. RESULTS: Overall mortality was 28%. Digital infections conferred a lower mortality, but progressive necrosis necessitated amputation. Vibrio vulnificus was the commonest organism identified in association with marine injury and in patients with cirrhosis. Prognostic indicators with decreasing significance include deranged renal and liver function, thrombocytopaenia, proximal involvement (elbow or above) initially, and presence of hypotension upon admission. CONCLUSION: With a P value of less than 0.05, deranged renal and liver function, thrombocytopaenia, initial proximal involvement, and hypotension on admission were predictors of mortality in necrotising fasciitis affecting the upper limbs. The ALERTS (Abnormal Liver function, Extent of infection, Renal impairment, Thrombocytopenia, and Shock) score with a cutoff of 3 appeared to predict mortality.

A versatile method for treating intracranial wide-neck aneurysms: catheter-assisted technique of three variations.

Successful management of aneurysms of complex morphology depends primarily on adjunct use of balloons or stents. However, these two methods are technically demanding and have higher complication rates. As an alternative to these two techniques, we have used a catheter-assisted technique with a number of cases. It is simple, versatile, and less demanding technically. This technique should be considered as an alternative strategy in cases of wide-necked aneurysms.

Stonefish envenomation with acute carpal tunnel syndrome.

Stonefish envenomation is a common marine sting. Although stonefish injuries are commonly sustained during maritime activities, this local delicacy can also be considered a regional occupational hazard for chefs. The availability and consumption of stonefish in local restaurants has increased the risk of acute carpal tunnel syndrome after a stonefish injury. This case report describes acute carpal tunnel syndrome following stonefish envenomation. An excellent recovery was achieved after surgical decompression of the carpal tunnel syndrome. Standard management of stonefish injuries should therefore take into account the possibility that this orthopaedic emergency may complicate the injury.

Comparison of total knee arthroplasty using computer-assisted navigation versus conventional guiding systems: a prospective study.

PURPOSE: To compare knee alignments in total knee arthroplasty (TKA) using computer-assisted navigation versus conventional guiding systems. METHODS: Five men and 49 women aged 49 to 79 years underwent TKA for primary osteoarthritis of the knee with varus deformity. All valgus knees were associated with inflammatory arthritis and thus excluded. Computer-assisted navigation was used for the first 35 TKAs, whereas conventional extramedullary tibial and intramedullary femoral guiding systems were used for the next 35 TKAs. The mechanical axis, coronal tibial and femoral angles, sagittal tibial and femoral angles in the 2 groups were compared. RESULTS: Sagittal tibial and femoral angles aligned more optimally in TKAs using computer-assisted navigation. In the respective computer-assisted navigation and conventional guiding systems, 33 (94%) and 26 (74%) of the TKAs attained a postoperative mechanical axis of <3 degrees varus/valgus. CONCLUSION: Computer-assisted navigation gives a more consistent alignment correction and reduces outliers during implant positioning.

Posterior lumbar apophyseal ring fractures in adolescents: a report of four cases.

Posterior lumbar apophyseal ring fractures are rare in adolescents. We report 4 such cases in Chinese adolescents. Two of the patients had a slipped capital femoral epiphysis; 3 of them were overweight/obese. All presented with low back pain and radicular pain. Apophyseal fractures of the upper lumbar spine usually involve the lower end plate, whereas those of the lumbar sacral spine usually involve the upper end plate. The radiological features and pathophysiology are discussed. Two of the patients were treated with laminotomy and diskectomy after conservative treatment failed. All patients had complete resolution of their neurological deficits at a mean follow-up of 2 years. Despite its benign nature, long-term follow-up is necessary to define the natural course and prognosis of the disease. A high index of suspicion is needed to diagnose these fractures in adolescents.

Clinical results of early active mobilisation after flexor tendon repair.

Between 2005 and 2006, ten patients with flexor digitorum profundus zone II injuries were included. The mean age was 41 (19-84) years. One thumb, two index, four middle, one ring and two little fingers were injured. Repair method comprised four-strand core suture and 6-0 circumferential sutures. Post-operative rehabilitation included immediate active extension, progressive passive full flexion and active hold in dorsal block splint. Follow-up was four (three to seven) months. Grip strength, pinch strength, ROM was 90% (70%-90%), 90% (60%-110%) and 90% (80%-100%) of normal digit, respectively. Mayo wrist scores were five excellent, two good and three fair. All patients were satisfied. Compared with another group of ten patients with the same suture method and Kleinert splintage, grip strength, pinch strength and ROM were 50%, 40% and 40% of normal side, respectively. All differences between these two groups were statistically significant (p < 0.01) by paired samples T-test. There was no re-rupture.

Hypofractionated CyberKnife stereotactic radiosurgery for acoustic neuromas with and without association to neurofibromatosis Type 2.

CyberKnife stereotactic radiosurgery (CKSRS) has been proved effective in treating intra-cranial lesions. To treat acoustic neuroma (AN) patients with or without neurofibromatosis Type 2 (NF2) associations, the functional preservation of hearing, trigeminal nerve, and facial nerve are important. Twenty-one patients were treated with hypofractionated CKSRS. Fourteen non-NF2 and seven NF2 patients were enrolled. Cranial nerve function, audiograms, and magnetic resonance images (MRI) were monitored. Mean follow-up was 15 month. Tumors with volumes ranging from 0.13 to 24.8 cm3 (mean 5.4 cm3) were irradiated with the marginal dose 1800-2000 cGy/3 fractions. Tumors were treated with an 80 to 89% isodose line (mean 83%) and mean 97.9% tumor coverage. Two patients experienced hearing deterioration (16.7%) in the non-NF2 group, and 3 patients (50%) in the NF2 group. No facial or trigeminal dysfunction, brain stem toxicity, or cerebellar edema occurred. Tumor regression was seen in 9 patients (43%) and stable in 12 patients (57%). 100% tumor control rate was achieved. Hypofractionated CKSRS was not only effective in tumor control but also excellent in hearing preservation for non-NF2 AN. But for NF2 patients, although the tumor control was remarkable, hearing preservation was modest as in non-NF2 patients.

A review on adolescent childbearing in Taiwan: its characteristics, outcomes and risks.

In Taiwan, the age-specific fertility rate for adolescent girls aged 15-19 years has remained at 14-18/1,000 births during the past two decades, which is the highest among developed countries in Asia. There was a surprisingly high age-specific fertility rate for married women aged 15-19 years at 726 per 1,000 in 1994, much higher than that of the United States. Adolescent childbearing causes many adverse outcomes including unwanted and unstable marriage, repeated childbearing during adolescence, and increased risks of having low birth weight and preterm births and neonatal mortality. Studies in Taiwan showed that adolescent childbearing is associated with their poor knowledge but open attitude and behaviour on sexuality, the inadequate contraceptive services for the adolescents in need, some risk-taking behaviors, family dysfunction and low socioeconomic status of the adolescents' families. About two-thirds of the fathers of infants born to adolescent girls were adults, even old adults with a low education level Effective strategies for adolescent childbearing prevention range from sex education, the direct provision of contraceptive supplies, and to life options programmes, especially for the adolescents with high risk of adolescent pregnancy. Reducing the incidence of adolescent childbearing by active use of contraception is more important and practical than prohibiting adolescent sexual activity.

Breakage of intramedullary femoral guide rod during total knee arthroplasty: a case report.

We report a rare complication during primary total knee arthroplasty. An intramedullary femoral guide rod was broken during insertion. The broken part jammed into the isthmus of the femur. An initial attempt to push the broken rod via the proximal femur by a guide wire to the distal femur was unsuccessful because the broken rod was lodged in the isthmus. Ultimately, the isthmus was opened using a flexible 9-mm end-cutting reamer, and the broken rod was pushed down to the distal femoral entry site in an antegrade fashion under image intensification. Selecting a more medial entry site on the intercondylar notch with a smaller valgus cutting angle and using a shorter guide rod can avoid such a breakage.

Microstructure and corrosion behavior of porous coatings on titanium alloy by vacuum-brazed method.

The microstructural evolution and electrochemical characteristics of brazed porous-coated Ti-6Al-4V alloy were analyzed and compared with respect to the conventionally 1300 degrees C sintering method. The titanium filler metal of low-melting-point (934 degrees C) Ti-15Cu-15Ni was used to braze commercially pure (CP) titanium beads onto the substrate of Ti-6Al-4V alloy at 970 degrees C for 2 and 8 h. Optical microscopy, scanning and transmission electron microscopy, and X-ray diffractometry (XRD) were used to characterize the microstructure and phase of the brazed metal; also, the potentiostat was used for corrosion study. Experimental results indicate that the bead/substrate contact interface of the 970 degrees C brazed specimens show larger contact area and higher radius curvature in comparison with 1300 degrees C sintering method. The microstructure of brazed specimens shows the Widmanstätten structure in the brazed zone and equiaxed alpha plus intergranular beta in the Ti-6Al-4V substrate. The intermetallic Ti2Ni phase existing in the prior filler metal diminishes, while the Ti2Cu phase can be identified for the substrate at 970 for 2 h, but the latter phase decrease with time. In Hank's solution at 37 degrees C, the corrosion rates of the 1300 degrees C sintering and the 970 degrees C brazed samples are similar at corrosion potential (E(corr)) in potentiodynamic test, and the value of E(corr) for the brazed sample is noble to the sintering samples. The current densities of the brazed specimens do not exceed 100 microA/cm2 at 3.5 V (SCE). These results suggest that the vacuum-brazed method exhibits the potentiality to manufacture the porous-coated specimens for biomedical application.

Thumb polydactyly: clinical outcome after reconstruction.

PURPOSE: To evaluate clinical and cosmetic outcomes of reconstruction in thumb polydactyly and prognostic value of the Wassel classification. METHODS: Between 1993 and 2000 inclusive, out of the patients with thumb polydactyly (involving 80 thumbs) operated on, 34 patients (36 thumbs) were available for review and underwent clinical and radiological assessment. Outcomes in terms of the Tada score and complications were recorded. RESULTS: The mean age of patients at the time of operation was 2.8 (range, 0.6-47) years. The mean follow-up period was 5 (range, 2.4-10) years. According to the Wassel classification, 12 were type-II thumb polydactyly, 3 type-III, 11 type-IV, 6 type-V, one type-VI, and 3 type-VII. There was no perioperative mortality or wound infection. More than 88% of the patients were satisfied or very satisfied with functional and cosmetic outcomes. Postoperative complications such as scar hypertrophy, pulp atrophy, joint deformity, and instability were common but minor. Ridge nail deformity after the Bilhaut Cloquet procedure was amenable to secondary corrective procedures. All types of operated thumb polydactyly achieved similar mean Tada scores (14.7- 16.6 out of 20). The Wassel classification category, age, and surgical procedures were found to have no prognostic value with regard to the Tada score and presence of complications. CONCLUSION: Surgery on thumb polydactyly is rewarding. The Wassel classification category can be used as a guide for treatment, although it fails to predict the occurrence of postoperative complications or Tada scores. Our patients' results can serve as guidelines of expected outcomes after reconstructive procedures in different sub-types of thumb polydactyly.

Reliability of Hong Kong Chinese version of the Patient-rated Forearm Evaluation Questionnaire for lateral epicondylitis.

OBJECTIVE: To determine the reliability and validity of a dedicated assessment tool for lateral epicondylitis after translation into Hong Kong Chinese. DESIGN: Cross-sectional study. SETTING: District hospital, Hong Kong. PATIENTS: Seventy-four patients, 12 of whom were bilingual, were recruited (total of 82 elbows). MAIN OUTCOME MEASURES: Translation equivalence and reliability were measured with the test-retest method. Validity was measured against the Roles and Maudsley outcome score and mean maximal grip strength. RESULT: The Patient-rated Forearm Evaluation Questionnaire had high English-Chinese equivalence (Spearman's rho correlation coefficient=0.926; P<0.001). It was also very reliable (intraclass correlation coefficient=0.99; P<0.001). Validity according to the Roles and Maudsley outcome score and mean of maximal grip strength was significant (P<0.01). CONCLUSION: The Hong Kong Chinese version of Patient-rated Forearm Evaluation Questionnaire is a reliable and valid assessment tool for chronic lateral epicondylitis. Its equivalence to the original English version makes outcome assessment across cultural barrier feasible.