Care for breast cancer survivors in Asian countries: A review of sexual dysfunction

Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.

Briumvi: a breakthrough in the treatment of relapsing multiple sclerosis: a review

Multiple sclerosis (MS) is a chronic systemic autoimmune disorder characterized by plaques of demyelination, autoimmune inflammation, and astrocytic gliosis. The primary cells involved in the pathophysiology of MS are T cells. However, B cells have recently been implicated in the pathophysiology of the disease. Therefore, researchers have been exploring B cell therapy as an alternative treatment option for MS. B cell therapy is based on the targeted depletion of CD20-positive B cells. Rituximab, ocrelizumab, and ofatumumab are anti-CD20 antibodies already approved. Briumvi, the fourth type of anti-CD20 antibody was approved by FDA in December 2022, for the treatment of relapsing types of MS, including relapsing-remitting multiple sclerosis, active secondary progressive multiple sclerosis, and clinically isolated syndromes after the drug was tested in two randomized, double-blind, phase III, ULTIMATE I, and II trials which compared Briumvi (ublituximab) with Aubiago (teriflunomide). Ublituximab was found to have a much lower annual relapse rate in the ULTIMATE II trials than teriflunomide. Briumvi is a chimeric recombinant IgG1 monoclonal antibody directed against human CD20 with potential antineoplastic activity. Its mechanism of action involves several distinct processes that collectively lead to the depletion of B cells and suppression of the immune response. The primary mode of action of Briumvi is its high-affinity binding to CD20. Infusion-related reactions are the most common side effects encountered following intravenous administration of ublituximab.

Multiplicity of infection of Plasmodium knowlesi in Malaysia: an application of Pkmsp-1 block IV

In Malaysia presently, the main cause of human malaria is by the zoonotic monkey parasite Plasmodium knowlesi. A previous study has suggested that the P. knowlesi merozoite surface protein 1 (Pkmsp-1) block IV to be a suitable multiplicity of infection (MOI) genotyping marker for knowlesimalaria. This study therefore aimed to investigate the usefulness of Pkmsp-1 block IV in assessing the MOI of P. knowlesi in clinical isolates from Malaysia. Two allele-specific PCR primer pairs targeting the two allelic families of block IV (T1 and T2) were designed, and used to genotype P. knowlesi in 200 blood samples (100 from Peninsular Malaysia and 100 from Malaysian Borneo). Results showed that the mean MOI in Malaysian Borneo was slightly higher as compared to Peninsular Malaysia (1.58 and 1.40, respectively). Almost half of the total blood samples from Malaysian Borneo (52%) had polyclonal infections (i.e., more than one allele of any family type) as compared to Peninsular Malaysia (33%) samples. The T1 allelic family was more prevalent in Peninsular Malaysia (n=75) than in Malaysian Borneo (n=60). The T2 allelic family, however, was more prevalent in the Malaysian Borneo (n=87 vs n=53 respectively). This study shows that the single locus Pkmsp-1 block IV can serve as a simple alternative genetic marker for estimating knowlesi malaria MOI in a population. Future MOI studies should focus on macaque populations as macaques are the natural host of P. knowlesi.

In-silico analysis of interacting pathways through KIM-1 protein interaction in diabetic nephropathy

Background

Human Kidney Injury Molecule-1, also known as HAVCR-1 (Hepatitis A virus cellular receptor 1), belongs to the cell-surface protein of immunoglobulin superfamily involved in the phagocytosis by acting as scavenger receptor epithelial cells. The study focused on pinpointing the mechanisms and genes that interact with KIM-1.

Methods

This in-silico study was done from March 2019 to December 2019. The Enrichment and protein-protein interaction (PPI) network carefully choose proteins. In addition, the diagramed gene data sets were accomplished using FunRich version 3.1.3. It was done to unveil the proteins that may affect the regulation of HAVCR1 or may be regulated by this protein. These genes were then further considered in pathway analysis to discover the dysregulated pathways in diabetic nephropathy. The long list of differentially expressed genes is meaningless without pathway analysis.

Results

Critical pathways that are dysregulated in diabetic nephropathy patients have been identified. These include Immune System (Total = 237, P < 0.05), Innate Immune System (Total = 140, P < 0.05), Cytokine Signaling Immune system (Total = 116, P < 0.05), Adaptive Immune System (Total = 85) and Neutrophil degranulation (Total = 78).

Conclusion

The top 5 genes that are interacting directly with HIVCR1 include CASP3, CCL2, SPP1, B2M, and TIMP1 with degrees 161, 144, 108, 107, and 105 respectively for Immune system pathways (Innate Immune System, Cytokine Signaling Immune system, Adaptive Immune System and Neutrophil degranulation).

Analyzing the role of meteorological parameters and CO2 emissions towards crop production: empirical evidence from South Asian countries

It is need of the hour to investigate the impacts of climate parameters on agricultural production in a developing region of South Asia. Therefore, this work attempts to explore the climatic indicators on agricultural production for selected South Asian countries over the annual data of 1961-2016. This study estimates the impacts of rainfall, temperature, rural population, land under cereal production, and CO₂ emissions (ECO₂) on agricultural production. For empirical analysis, we applied second-generation unit root tests. After examining the order of integration of time series, we check for the co-integration among the variables. Before the co-integration test, we check for cross-section dependence among the variables. CD and LM tests confirm the existence of cross-section dependence. Afterward, we apply the Westerlund co-integration test to confirm the strong association among the variables. Further, we applied two methods for long-run coefficients of independent variables. Dynamic ordinary least square (DOLS) and fully modified ordinary least square (FMOLS) tests were applied to cross-check the findings. Our findings show that rural population and rainfall are negatively associated with agricultural production. Moreover, temperature, land area under cereal production, and ECO₂ are positively associated with agricultural production. Our findings shed light on some important policy implications for South Asian countries.

The investigation of key factors for successful implementation of sustainable halal food supply chain management

Halal food plays an important role in the economic development in various countries. However, halal food supply chains could threaten the environment in several ways. This study was aimed to analyse the best practice of the implementation of a sustainable halal food supply chain from many data sources. The data then transform into managerial knowledge for the halal food industry. The data was collected using SAS Text Miner and analyzed using the decision tree. The analysis shows four key features of sustainable halal food supply chains: pre-slaughtering, warehousing, halal integrity, and packaging. From these features, the two most important factors of successful sustainability implementation in the halal food supply chain are found to be warehousing and packaging. The present study applies a relational view theory and an analysis theory of natural resource-based view, creating and extending new sustainable strategies of halal food chain management to sustainable halal food chain management.

1029 Evaluation of Significant Polyp and Early Colorectal Cancer (SPECC) MDT In A District General Hospital

Aim

There is an increase in the number of complex SPECC cases presented at colorectal MDT meetings with a wide variation in the treatments offered to patients, many of whom undergo high-risk and life-changing surgical resection. This study aimed to evaluate the detection, diagnosis and treatment of early colorectal cancer since the introduction of a SPECC MDT.

Method

This was a retrospective audit of 108 patients, from the SPECC MDT database from January 2014 to December 2019. Primary outcome assessed the recognition of lesions using endoscopy and radiological evaluation to assess depth of invasion and lymph node involvement. Secondary outcomes included definite treatment, pathological reporting and recurrence.

Results

Overall, mean age of 72, 79% had one or more significant co-morbidity. Clinical presentation; 61 asymptomatic, 46 symptomatic and 31 referred from the national bowel cancer-screening programme. All patients (n = 108) had endoscopic assessment the lesions were, 53% sessile and 47% pedunculated; 78% of the lesions were found in the rectum. We observed surgical management in 31 cases, endoscopic in 28, chemo-radiotherapy in 12 and 3 cases were palliative. However, 17 (n = 108) underwent failed endoscopic resection and required surgical intervention. Recurrence was observed in 17.6% of cases and mortality in 4%.

Conclusions

Pathological reports provide a definitive answer to questions of malignancy but SPECC can be challenging in all areas. A specialist MDT allows for appropriate assessment and treatment of lesions and leads to better patient outcomes.

879 Running a Regional Teaching Programme Through the COVID19 Pandemic

Aim

The COVID19 pandemic has changed medical education and encouraged a more virtual approach. We aimed to assess the effectiveness of developing and running an online regional teaching programme for medical students. In additions, through feedback, we were able to establish the important suggestions which medical students found useful.

Method

We developed a four-month surgical revision teaching programme for medical students in both Nottingham and Leicester Medical Schools. We analyzed the feedback forms we received from medical students attending the teachings in the first three months.

Results

In total, there were 12 teachings and 138 feedback forms across the first three months. The overall rating for teaching programme was 4.8 out of 5. The main comments medical students found useful to improve our teaching were: using pictures to illustrate pathology, including questions during the lecture, simplifying the knowledge and using mnemonics and presenting a case scenario for the topic.

Conclusions

Medical students find revision teaching programmes useful in supporting their medical education. Comments from their feedback are a useful tool in improving teaching sessions. Medical educators can utilize the pointers we received in improving their teaching programmes.

Air pollution and hospitalization in megacities: empirical evidence from Pakistan

Air pollution has become a threat to human health in urban settlements, ultimately leading to negative impacts on overall economic system as well. Already developed nations and still developing countries both are at the risk of air pollution globally. In this scenario, this work aims to investigate the associations of asthma (AS) and acute upper respiratory infection (ARI) patients with satellite-based aerosol optical depth (AOD) and meteorological factors, i.e., relative humidity (RH), temperature (TEMP), and wind speed (WS). We applied second-generation unit root tests to provide empirical evidence. Two sets of unit root tests confirmed mix order of integration, and the other Westerlund co-integration test further showed strong linkages between estimated variables. Fully modified ordinary least square (FMOLS) and dynamic ordinary least square (DOLS) tests were applied, only to explore that TEMP and WS lower the number of AS and ARI patients, but RH and AOD increase the number of patients. Therefore, in accordance with these findings, our study provides some important policy instruments to improve the health status in megacities of Pakistan.

Physicochemical properties of banana peel powder in functional food products

Saba banana is one of the most favourite banana varieties in Malaysia. It also generates a concerning amount of waste as the only value part is the pulp. Banana peel has been proven to have a lot of nutritional content that should not be ignored and wasted. Conversion of banana peel to powder will convert it into a value-added product in the food industry. Preliminary study on the protein, moisture, crude fibre and fat was carried out for 2 different stages of maturity which are stage 2 (light green) and stage 5 (yellow with green tips). Both stages have almost similar proximate analysis values and hence stage 2 of banana was chosen for the next analysis, due to the high waste of banana peel in stage 2 in SME (Small Medium Enterprise) in the production of banana chips. This study characterized the banana peel powder for storage application at different sizes of particles which are 1-125 µm, 126-250 µm and >250 µm. As the particles of the banana peel powder increases, the flowability of the powder decreases. It was found that green banana peel (stage 2) at sample A (1-125 µm) has the highest true density, but sample C (>250 µm) has the highest bulk density. The pH mean value of the three sizes also ranges from 6.15 to 6.46. The powder’s pH (6.15-6.46) is in the standard wheat flour acidity range. Moreover, the study on the water holding capacity at different temperatures identifies that banana peel powder has a high water holding capacity ranging from 3.83 to 6.45 g water/g dry sample. In short, this study is a success in identifying the potential of banana peel powder in food products based on its characteristics.

Pentoxifylline alleviates hypertension in metabolic syndrome: effect on low-grade inflammation and angiotensin system

INTRODUCTION AND OBJECTIVE

Pentoxifylline is a well-tolerated drug used in treatment of vascular insufficiency. We previously showed that pentoxifylline protects from impairment in vascular reactivity in cases of metabolic syndrome. The aim of this study was to investigate the protective effect of pentoxifylline against hypertension in metabolic syndrome rats.

METHODS

Metabolic syndrome was induced by feeding rats a high-fructose, high-fat and high-salt diet for 12 weeks. Pentoxifylline was administered daily (30 mg kg(-1)) during the last 4 weeks of the study, before blood pressure parameters were assessed at the end of study. In addition, serum levels of glucose, fructosamine, insulin, tumor necrosis factor alpha, adiponectin, and lipid profile parameters were determined. Aortic protein levels of angiotensin II and angiotensin receptor 1 were assessed by immunofluorescence.

RESULTS

Pentoxifylline administration prevented excessive weight gain but did not affect hyperinsulinemia or hypertriglyceridemia seen in metabolic syndrome animals. In addition, pentoxifylline prevented the elevations in mean blood pressure associated with metabolic syndrome. Particularly, pentoxifylline prevented elevations in systolic, diastolic, and notch blood pressure; however, elevation in pulse blood pressure was not affected. Further, pentoxifylline alleviated the low-grade inflammation associated with metabolic syndrome, as reflected by the significantly lower serum tumor necrosis factor α and higher serum adiponectin levels metabolic syndrome animals treated with pentoxifylline. Also, pentoxifylline inhibited elevated expression of angiotensin receptor 1 in aortic tissue of metabolic syndrome animals.

CONCLUSION

Pentoxifylline directly alleviated hypertension in metabolic syndrome rats, at least in part, via amelioration of low-grade inflammation and inhibition of angiotensin system.

Novel p53 codon 240 Ser > Thr coding region mutation in the patients of oral squamous cell carcinoma (OSCC)

Chewing habits of tobacco, betel quid (paan), and betel nut (chhaliya) are common traditions in Pakistan. Different other preparations and combination of flavors with tobacco, paan, and chhaliya ingredients are commonly available in the market and have received considerable attention as sources of carcinogens that promote OSCC. Mutagens can damage DNA and generate promutagenic lesions. The germ line mutation/polymorphism of p53 gene has been reported to be involved in multiple steps of carcinogenesis. This study aims to find out the loss of TP53 functions due to mutation/polymorphism caused by genomic alteration and interaction with tobacco-related ingredients.Tissue and blood specimens from 260 OSCC patients were collected and compared with blood samples of 260 age- and sex-matched controls. Mutations in exons 2-11 of p53 gene were examined by PCR-SSCP and directly sequenced.A novel mutation was found in exon 7 of p53 gene. This mutation was observed in the tumors of the OSCC patients. The blood samples of the patients and the controls did not show the nucleotide change in this region. The "AGT" to "ACT" missense mutation was identified at position 719 at TP53. This results in the substitution of amino acid serine with threonine at codon 240 of p53 protein.This novel missence mutation in the DNA-binding domain indicated that the DNA structure may be damaged by the use of exogenous DNA-damaging agents, including tobacco-related carcinogens present in gutka, niswar, and manpuri, which may result in the loss of p53 protein function.

Bedside manners: do we care?

BACKGROUND

Teaching bedside manner might prove to be one of the most challenging tasks in medical education as it is not easy to structure or formalise such training. Besides, the rigorous training process for acquiring clinical and technical skills often overshadows the humanistic aspect of medical care. The aim of this study was to assess the perception of final year medical students as well as the faculty regarding the teaching and practice of bedside manner including a brief evaluation of students' bedside manner.

METHODS

A cross-sectional study was conducted involving final year medical students from five medical colleges (n = 193) and faculty from a single institution (n=29). Sample was selected using systematic random or convenient sampling techniques. Data was collected using self administered, anonymous, structured questionnaire. Data were analysed using SPSS-17.

RESULTS

While evaluating students' bedside manner, 85% of the students reported they always take consent while interacting with a patient whereas, only 17% of the faculty members agreed with this. Only 3% of the faculty members reported that students take care of privacy of patients and none of them thought that students reassure a patient during an encounter whereas the percentages among students were 76% and 48%, respectively. Though students thought they need to improve, majority (56%) of them was confident of their bedside manner. On the other hand, 83% of the faculty members rated students' bedside manner from fair to poor. A large proportion (69%) of the faculty members were not satisfied with the quality of teaching regarding bedside manner, reporting lack of focus on this particular aspect of medical care as the most important cause. Majority of the students (87%) believed doctors have a better bedside manner in private as compared to public hospitals.

CONCLUSION

Students have an inflated evaluation of their bedside manner but majority felt a need to improve. A sharp contrast exists between students' and faculty's opinion regarding the practice of bedside manner by students. An outright lack of focus on bedside manner was reported as the most important cause for inadequate emphasis on teaching this particular aspect of medical care.

Clinical inertia in management of T2DM

Diabetes is highly prevalent and serious chronic debilitating disease and reported to be the fourth main cause of death in Europe. Despite extensive evidence of benefits of tight glycemic control, large proportions of people with diabetes do not achieve target glycemic control. One major reason for this is clinical inertia which is "recognising the problem but failure to act" by health care professionals in primary care. The key issues in the management of people with T2DM include early detection of problems, realistic goal setting, improved patient adherence, better knowledge and understanding of pharmacotherapeutic treatment options and prompt intervention. Health care professionals must need to overcome clinical inertia and need to intensify therapy in an appropriate and timely manner.

Estimation of serum osteocalcin and telopeptide-C in postmenopausal osteoporotic females

A negative correlation of serum C-terminal telopeptide of type I collagen (telopeptide-C) was observed with bone mass density (BMD) in postmenopausal control (r = -0.70, p < 0.05) and osteoporotic females (r = -0.46, p < 0.05) indicating increased bone resorption in these subjects. Since telopeptide-C is a significant determinant of bone loss, it can be used, in combination with bone mass measurement, for the assessment of postmenopausal females.

INTRODUCTION

The aim of this study was to find out the significance of serum osteocalcin, a marker of bone formation, and C-terminal telopeptide of type I collagen, a marker of bone resorption, in evaluating osteoporotic patients and to find out their relationship with bone mass density.

METHODS

One hundred and fifty (150) females; 50 premenopausal (age=31.13 +/- 1.29), 50 postmenopausal (age = 54.36 +/- 0.81) and 50 postmenopausal osteoporotic patients (age = 58.6 +/- 0.701) were included in this study. The postmenopausal subjects, with and without osteoporosis, were selected from different osteoporotic clinics and healthy premenopausal females were selected from general population. Height, weight, BMI, waist/hip ratio, age at menarche, years since menopause in case of postmenopausal women, history of disease, and fracture, if any, were recorded. BMD assessment was done on calcaneous by peripheral ultrasound bone densitometery on Sahara Clinical Bone Sonometer and T-scores were calculated. Serum levels of osteocalcin and C-terminal telopeptide of type I collagen and calcium were measured.

RESULTS

A lower BMD in postmenopausal subjects, with and without osteoporosis (p < 0.001), indicating increased bone loss with aging and menopause, was observed. A negative correlation was found between age and BMD (r = -0.67, p < 0.05). No correlation was found between osteocalcin and BMD among these groups, suggesting heterogeneity of osteocalcin fragments in serum that limits its significance in the evaluation of osteoporosis. A positive correlation was found between osteocalcin and telopeptide-C (r = 0.26, p < 0.05). A positive correlation of telopeptide-C with age (r = 0.45, p < 0.05) and a negative correlation with BMD (r = -0.46, p < 0.05) was observed indicating increased bone resorption in postmenopausal control and postmenopausal osteoporotic patients.

CONCLUSION

C-terminal telopeptide of type I collagen appears to be a significant determinant of bone loss and may be used as a valuable tool in the assessment of postmenopausal osteoporotic patients.

Cost induced by hip fractures

Hip fracture is the most common fracture in the elderly population. Treating hip fractures is a major burden on the Irish Health system. There is no recent Republic of Ireland study detailing hospital costs for such injuries. A comprehensive analysis of 143 patients admitted with a hip fracture was performed to determine current medical expenditure incurred during acute hospitalization for hip fractures during 2005 in a major university hospital. Costs associated with surgery (implant & theatre costs), laboratory, radiology, physiotherapy and ward were calculated on individual basis. All the hip fractures were above 60 years of age (mean 82 years); average stay in the hospital was 11 days. The mean total hospital expenditure per patient was Euro 9236.01 of which ward costs contributed 55.33%, operative costs 39.82% and investigations 4.83%. The result clearly show that hip fractures have a major economic impact arising from the inpatient treatment, most of which relate to length of hospital stay.

Prevention of beta-thalassemia in a large Pakistani family through cascade testing

BACKGROUND

We report cascade testing of a large Pakistani family for beta-thalassemia alleles. The family was still practicing consanguineous marriages and was at risk of having more affected births.

OBJECTIVE

The objective of this study was to show that identification of disease carriers in families with index cases in order to create awareness about disease and provide genetic counseling would result in reduction of the frequency of beta-thalassemia in Pakistan.

METHODS

In this large family with an index case, 27 available living members were tested for beta-thalassemia. Carriers of the disease were detected by measuring hemoglobin indices, and amplification refractory mutation system polymerase chain reaction was used for mutation analysis. Genetic counseling was provided to members of this family.

RESULTS

There were already 3 marriages between the carrier members and 1 between a carrier and noncarrier in this large family; 12 (44.4%) members were found to carry the mutant gene, representing a very high carrier rate compared to the 5.4% carrier frequency of beta-thalassemia in the general population of Pakistan. The family was counseled for prevention of affected births. The initially reluctant family gradually became cooperative and seriously attended the genetic counseling sessions.

CONCLUSION

Cascade testing is more practical than general population screening in a country with limited health facilities where consanguineous marriages are practiced. This report emphasizes the need of extensive testing within families with index cases to identify the carriers of beta-thalassemia in order to reduce disease occurrence through awareness and genetic counseling.

Spectrum of beta-thalassemia mutations in various regions of Punjab and Islamabad, Pakistan: establishment of prenatal diagnosis

We present here an analysis of 888 unrelated beta-thal chromosomes consisting of 444 transfusion dependent children from various regions of Punjab and Islamabad Pakistan. By using Multiplex ARMS- PCR, restriction endonuclease analysis, allele specific oligonucleotide (ASO) hybridization and sequencing, 17 beta-thal mutations and 3 Hb variants were detected in 99.5 % (884/888) of the chromosomes analyzed. First trimester prenatal diagnosis by chorionic villus sampling (CVS) was also carried out in seven pregnancies at risk of beta-thalassemia. Our results indicate that three most common mutations accounted for 86.8% of the beta-thal alleles in this region. These findings have important implications for prevention of beta-thalassemia through genetic counseling and prenatal diagnosis in this part of Pakistan.

Prenatal diagnosis of β-thalassemia in Southern Punjab, Pakistan

Pakistan has a large population of more than 150 million people with an overall carrier frequency of approximately 5.6% for beta-thalassemia. Punjab is the largest province of the country having more than 50% of the population. The state of beta-thalassemia is alarming as consanguinity is very high (>81%) and the literacy rate is low in South Punjab. A thalassemia prevention program is the need of the hour in this part of Pakistan. In this study, we initiated awareness, screening, and characterization of the mutations causing beta-thalassemia as well as a genetic counseling program mainly in the districts of Faisalabad and D.G. Khan to establish prenatal diagnosis, a facility previously unavailable in this region for disease prevention. A total of 248 unrelated transfusion-dependent children and the available members of their families were screened to characterize the mutations and identify the carriers. Genetic counseling was provided to these families and prenatal diagnosis offered. In the samples analyzed, 11 beta-thalassemia mutations and three hemoglobin variants were detected mainly by using the Monoplex and Multiplex ARMS-PCR. First-trimester prenatal diagnosis was carried out through chorionic villus sampling (CVS) in seven pregnancies at risk. As a result of our campaign, 145 carrier couples planning to have more children gave their consent to have retrospective prenatal diagnosis in every pregnancy in future. A cooperative trend and a positive attitude toward the prevention of beta-thalassemia were noticed in the families with affected children and in the general population.

An improved acetabular cementing technique in total hip arthroplasty. Aspiration of the iliac wing

We have evaluated the effect of vacuum aspiration of the iliac wing on the osseointegration of cement into the acetabulum. We entered a total of 40 patients undergoing primary total hip arthroplasty into two consecutive study groups. Group 1 underwent acetabular cement pressurisation for 60 seconds before insertion of the acetabular component. Group 2 had the same pressurisation with simultaneous vacuum suction of the ilium using an iliac-wing aspirator. Standard post-operative radiographs were reviewed blindly to assess the penetration of cement into the iliac wing. Penetration was significantly greater in the group with aspiration of the iliac wing.

Polymerization of fetal fibrin and alterations in fibrin network characteristics during diabetic pregnancy

The present study compares plasma fibrin network characteristics of fetal blood and that of normal and diabetic pregnant women. Plasma fibrinogen concentration, clotting curves, mass-length ratio of the fibrin fibers, gross permeability and tensile strength of the networks, have been measured. Plasma glucose and glycated hemoglobin are used as glycemic index in diabetic gestational women. The fetal plasma has a lower concentration of fibrin and exhibits delayed clotting, the networks are made up of thinner fibers, are more cross-linked, have lower permeability, and increased tensile strength than in normal adults. The tensile strength of the networks prepared from the plasma of diabetic gestational women are more highly crosslinked than those made from plasma of normal women of corresponding length of pregnancy. The fibrin fiber-thickness is increased during the first and second trimester but is significantly reduced during the third trimester in the diabetic gestational women. The gross permeability of the networks is significantly reduced during the second and third trimester in the diabetic gestational women. The SDS-PAGE shows characteristic pattern of alpha, beta, and gamma-polypeptides in both normal and diabetic gestational women.

Studies on fibrin network structure in human plasma. Part II--Clinical application: diabetes and antidiabetic drugs

Using measurements of fibrin fibre thickness (microT) derived from turbidity and permeability (tau) of clotted plasma, it has been found that glucose in vitro added to plasma decreases permeability of the network despite unaltered fibrinogen conversion. Fibrin fibre thickness (microT) in uncontrolled diabetes is found significantly reduced. In diabetic plasma the degree of conversion to fibrin is similar to that in age and sex matched plasma from non-diabetics: the effect on fibrin network and fibre thickness probably arises from glycosylation of fibrinogen. Studies with Gliclazide, Metformin, Glibenclamide and insulin have shown that while all other drugs tested have no effect, Gliclazide increases fibrin fibre thickness (microT) significantly, diminishes tensile strength and reduces permeability. In separate experiments lysability of 125I-labelled fibrin networks developed in the presence of all four hypoglycaemic agents by tissue activator was tested. Networks developed in the presence of Metformin were found to lyse more quickly, followed by insulin and Gliclazide. Alterations induced in fibrin networks in diabetes may be nullified by some oral hypoglycaemic agents such as Gliclazide and not by others. Whether nullification of such changes has long-term effects in reducing the incidence of vascular disease in diabetics remains to be established.

Studies on fibrin network structure in human plasma. Part One: Methods for clinical application

Methods based on turbidity and permeability, for measurement of mass-length ratio of fibrin fibres developed in pure fibrinogen solution, have been evaluated in respect of their applicability to human plasma. Theoretical assumptions made in the calculation of mass-length ratios in plasma have been critically examined. Methods of handling plasma, reproducibility of technique and the influence of age and sex have been investigated. The anticoagulant used, as well as other factors such as time, venepuncture and effects of calcium and fibrinolytic inhibitors are fully explored. With suitable standardization the methods are acceptable for application to clinical studies and are reproducible.

The effects of some plasma proteins on fibrin network structure

Pronounced differences are found between characteristics of networks developed in plasma and those developed in pure fibrinogen solution. Networks in plasma have thicker fibres, are more permeable and have lower tensile strength. In this investigation the role of some plasma proteins as determinants of network structure under physiological conditions of clotting has been examined in an attempt to account for the differences in network structure in plasma and fibrinogen solution. The effect of physiological concentrations of antithrombin III, fibronectin, albumin, alpha globulin and gamma globulin on fibrin network structure was examined using mass-length ratio (muT) from turbidity, bulk network permeability (tau) and kinetics of network development. It was found that differences in fibrin network structure developed in plasma and pure fibrinogen solution could not be accounted for by alterations induced in network properties by albumin, gamma globulin, alpha globulin, fibronectin and antithrombin III. It is concluded that the final network structure is determined by the kinetics of fibrin fibre growth and is highly responsive to the presence of plasma proteins.