Transforming Outcomes of Spine Surgery-Exploring the Power of Enhanced Recovery After Surgery Protocol: A Systematic Review and Meta-Analyses of 15 198 Patients.

BACKGROUND AND OBJECTIVES: Enhanced recovery after surgery (ERAS) protocols aim to optimize patient outcomes by reducing the surgical stress response, expediting recovery, and reducing care costs. We aimed to evaluate the impact of implementing ERAS protocols on the perioperative surgical outcomes and financial implications associated with spine surgeries. METHODS: A systematic review and meta-analysis of peer-reviewed studies directly comparing outcome differences between spine surgeries performed with and without utilization of ERAS pathways was conducted along Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Of 676 unique articles identified, 59 with 15 198 aggregate patients (7748 ERAS; 7450 non-ERAS) were included. ERAS-treated patients had shorter operative times (mean difference [MD]: 10.2 mins; P < .01), shorter hospitalizations (MD: 1.41 days, P < .01), fewer perioperative complications (relative risk [RR] = 0.64, P < .01), lower postoperative opioid use (MD of morphine equivalent dose: 164.36 mg; P < .01), and more rapid mobilization/time to first out-of-bed ambulation (MD: 0.92 days; P < .01). Spine surgeries employing ERAS were also associated with lower total costs (MD: $1140.26/patient; P < .01), especially in the United States (MD: $2869.11/patient, P < .01) and lower postoperative visual analog pain scores (MD = 0.56, P < .01), without any change in odds of 30-day readmission (RR: 0.80, P = .13) or reoperation (RR: 0.88, P = .60). Subanalyses based on the region of spine showed significantly lower length of stay in both cervical and lumbar surgeries implementing ERAS. Type of procedure showed a significantly lesser time-to-initiate mobilization in fusion surgeries using ERAS protocols compared with decompression. CONCLUSION: The present meta-analysis indicates that current literature supports ERAS implementation as a means of reducing care costs and safely accelerating hospital discharge for patients undergoing spine surgery.

Cigarette Smoking and Nicotine Dependence Among Dental Students in Riyadh, Saudi Arabia: A Cross-Sectional Study.

INTRODUCTION: Dental professionals have a vital role in promoting tobacco cessation interventions in dental care settings, and despite being aware of the detrimental effects of tobacco products on individuals' health, they are still engaged in using tobacco products. AIM: The aim of this study was to assess the prevalence of cigarette smoking and the level of physical and social nicotine dependence among undergraduate dental students in Riyadh, Saudi Arabia, using standardized tools to develop appropriate tobacco cessation interventions. METHODOLOGY: Dental students from six dental colleges located in Riyadh, Saudi Arabia, were invited to participate in this study. A total of 430 dental students agreed to participate by providing written informed consent. Physical dependence on nicotine was assessed using the Fagerstrom Test for Nicotine Dependence (FTND), and social dependency was assessed using the Kano Test Social Nicotine Dependence (KTSND). RESULTS: Among the 430 participants, 120 (27%) reported smoking. The level of nicotine dependence assessed for the 120 (27%) participants who had reported smoking using FTND showed 24 (20%) with high nicotine dependence and 18 (15%) with very high nicotine dependence. When compared between the genders, five (16%) of the female participants displayed high nicotine dependency, and two (6%) displayed very high nicotine dependency. Among the male participants, 19 (21%) displayed high nicotine dependency, and 16 (18%) displayed very high nicotine dependency. The study participants also displayed high KTSND scores, male participants with a mean score of 18.20 and female participants with a mean score of 17.97. CONCLUSION: Dental students, despite being the facilitators in tobacco prevention and cessation programs, have displayed a high prevalence of cigarette smoking and nicotine dependence. These findings should be considered for designing specific tobacco cessation programs for dental students, along with effective stress management programs. Emphasis should be placed on developing and implementing policies for creating supportive environments in educational institutions. Dental students should be trained and engaged in tobacco prevention and cessation intervention programs for their patients.

A Rare Case of Guillain-Barré Syndrome Post-gastrojejunostomy and Literature Review.

Guillain-Barré syndrome (GBS) is a rare immune-mediated neuropathy causing destruction of the peripheral nervous system, with molecular mimicry playing a major role in its pathophysiology. Despite its rarity, it is considered the most common cause of acute flaccid neuromuscular paralysis in the United States. Although diagnosing GBS depends on the clinical presentation of the patient, cerebrospinal fluid sampling, nerve conduction studies, electromyography, magnetic resonance imaging, and ganglioside antibody screening can be used to confirm the diagnosis and rule out other differentials. Here, we report a rare case of GBS as a postoperative complication after a successful gastrojejunostomy to excise an adenocarcinoma in the second part of the duodenum. Such a complication is rare and not fully understood yet.

Concomitant delivery of doxorubicin and cisplatin through liposome-based thermosensitive nanoparticles: perspective in the treatment of cancer in animal models.

The temperature sensitive liposomal formulations are a promising tool to improve the therapeutic index of the drugs with minimal toxicity. The aim of this study was to investigate the potential of concomitant delivery of cisplatin (Cis) and doxorubicin (Dox) containing thermosensitive liposomes (TSLs) with mild hyperthermia against cancer in vitro and in vivo. The polyethylene glycol coated DPPC/DSPC, thermosensitive and DSPC, non-thermosensitive liposomes incorporating Cis and Dox were prepared and characterized. A conventional Differential Scanning Calorimetry (DSC) technique and Fourier Transform Infrared Spectroscopy (FT-IR) were applied to study drug-phospholipid interaction and compatibility. The chemotherapeutic efficacy of these formulations was evaluated in benzo[a]pyrene (BaP) induced fibrosarcoma under hyperthermic condition. The size diameter of prepared thermosensitive liposomes was measured to be 120 ± 10 nm. The DSC data exhibited the changes in the curves of DSPC + Dox and DSPC + Cis while comparing the pure DSPC and drugs. However, the FITR showed same spectrum of phospholipids and drugs individually and in the mixture as well. The data showed higher efficacy of Cis-Dox-TSL as 84% inhibition in tumor growth was recorded in this group of animals in hyperthermic condition. The Kaplan-Meir curve revealed, 100% and 80% survival of the animals in the groups treated with Cis-Dox-TSL under hyperthermia and Cis-Dox-NTSL without hyperthermia, respectively. However, Cis-TSL as well as Dox-TSL exhibited 50% survival, while only 20% survival was recorded in the groups of animals treated with Dox-NTSL and Cis-NTSL. The flow cytometry analysis revealed that Cis-Dox-NTSL augments the induction of apoptosis in the tumor cells which was recorded as 18%. As expected, Cis-Dox-TSL showed great potential as 39% of cells were measured as apoptotic cells, significantly very high in comparison to Cis-Dox-NTSL, Dox-TSL and Cis-TSL as well. The apoptotic analysis of the cells by flow cytometry clearly indicated the effect of hyperthermia during the treatment while Cis-Dox-TSL formulation was administered. Finally, the immunohistochemical analysis of the tumor tissues by confocal microscopy exhibited several fold increases in the expression of pAkt in the animals treated with vehicles in Sham-NTSL as well as Sham-TSL. However, Cis-Dox-TSL showed great reduction in the expression of Akt, as it declined by 11-fold. The results of the present study directed the role of concomitant delivery doxorubicin and cisplatin containing thermosensitive liposomes under hyperthermic conditions for the development of a novel therapeutic strategy for the treatment of cancer.

Rosai-Dorfman Disease: Case Series and Literature Review.

Rosai-Dorfman Disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is an uncommon histiocytic condition characterized by massive histopathological aggregation of CD1-a negative, CD68-positive, and S100-positive histiocytes. It was initially described by Destombes in 1965 under the term "adenitis with lipid excess." However, it is named after Rosai and Dorfman who reported further histopathological features of the disease in 1969. The diagnosis of this non-Langerhans cell histiocytosis can be challenging and requires high clinical suspicion. The diagnostic process usually involves imaging, tissue biopsies, and genetic testing as needed. In this case series, we are presenting three cases of rare disease. Case 2 had both nodal and extranodal forms, which makes this case rarer than cases 1 and 3, which present with extranodal lesions.

Gender Differences in the Interrelations Among Social Support, Stressful Life Events, and Smoking Cessation in People With Severe Mental Illnesses.

BACKGROUND: Social support and stressful life events (SLEs) have been found to be influential factors for smoking cessation in the general population, but little is known about these factors among smokers with severe mental illnesses (SMIs) and whether their associations with smoking cessation differ by gender. AIMS: To examine the association between social support and smoking cessation as mediated by SLEs in people with SMI and to examine whether the interrelations among social support, SLEs, and smoking cessation differ by gender. METHODS: A population sample of 4,610 American lifetime adult smokers with schizophrenia, bipolar disorder, or major depressive disorder were identified in a limited public use data set of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Four mediation and moderated mediation models were used to examine gender differences in the interrelations among social support (total and three subscales of the Interpersonal Support Evaluation List-12), SLEs (summative score of positive responses to 16 types experienced in past year and related to health, job, death, or legal situations), and smoking status in prior year. RESULTS: Total, appraisal, and tangible support among females exerted indirect effects on smoking cessation via decreasing SLE scores. Among males, only belonging support exerted an indirect effect on smoking cessation via an increased SLE score. CONCLUSIONS: Findings suggest that interventions focusing on improving social support should be a priority for those working with smokers with SMI.

Parotid Gland Tuberculosis: A Case Report and Literature Review.

Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis that primarily affects the lungs. Although TB can affect many organs, involvement of the head and neck is extremely rare and involvement of the salivary glands is even rarer. Clinical diagnosis is challenging and may be misdiagnosed, as it mimics neoplasms on physical exams and imaging. In this paper, we present a case of parotid tuberculosis in a 28-year-old man who presented with a painful left parotid mass, loss of appetite, fever, and weight loss for six months. Suspicion of infection arose, and treatment began with intravenous antibiotics, followed by oral antibiotics, with no improvement. A biopsy of the patient's left parotid gland was performed, and a diagnosis of parotid TB with jaw osteomyelitis due to Mycobacterium tuberculosis infection was made. The patient was started on isoniazid for one week, followed by isoniazid, ethambutol, and rifampicin for six months. Follow-up after six months showed full resolution of the swelling.

Propolis mouthwash for preventing radiotherapy-induced mucositis in patients with nasopharyngeal carcinoma.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is the most common head and neck cancer in Malaysia. The gold standard treatment of NPC is radiotherapy (RT), as NPC is a radiosensitive tumour. Although RT is successful in treating NPC, patients cannot avoid the resulting RT complications. Oral mucositis is the most frequently encountered debilitating complication of RT and has no specific preventive treatment. The aim of this study was to evaluate the efficacy and safety of a 2.5% propolis mouthwash for preventing RT-induced mucositis in patients with NPC. MATERIALS AND METHODS: The study was a prospective, double-arm, randomised control trial with intervention. The patients were randomly divided into an experimental group receiving propolis mouthwash and a placebo group receiving normal saline mouthwash. All patients were instructed to rinse their mouths with 7mL mouthwash three times daily for six weeks. The severity of oral mucositis was then evaluated by the World Health Organization Oral Toxicity Scale at the second, fourth, and sixth weeks of the study. RESULTS: In total, 17 patients completed the study: 10 patients used the propolis mouthwash and seven used the placebo mouthwash. The mean mucositis scores for the propolis mouthwash compared to the placebo at the second, fourth, and sixth weeks were 0.10 vs. 1.14, 0.50 vs. 2.00, and 1.20 vs. 2.86, respectively, and the differences between the two groups were statistically significant (p<0.001). CONCLUSION: A 2.5% propolis mouthwash was both safe and effective for reducing the severity of oral mucositis following RT for NPC.

Optimization of subcritical water pre-treatment for biogas enhancement on co-digestion of pineapple waste and cow dung using the response surface methodology.

The optimal pre-treatment method and conditions depend on the types of lignocellulose present due to the complexity and the variability of biomass chemical structures. This study optimized subcritical water pre-treatment to ensure maximum methane production from pineapple waste prior to anaerobic co-digestion with cow dung using the response surface methodology. A central composite design was achieved with three different factors and one response. A total of 20 pre-treatment runs were performed at different temperatures, reaction times and water to solid ratios suggesting optimum values for subcritical water pre-treatment at 128.52℃ for 5 min with 5.67 to 1 water to solid ratio. Under these conditions, methane yield increased from 59.09 to 85.05 mL CH4/g VS with an increase of 23% biogas yield and 44% methane yield from the untreated. All pre-treatments above 200℃ showed reductions in biogas yield. Compositional analysis showed slight reduction of lignin and increase in α-cellulose content after the pre-treatment. Analysis using Fourier transform infrared spectroscopy and thermogravimetric analysis verified the presence of cellulosic material in pre-treated pineapple waste. Most of the hemicellulose was solubilized in the liquid samples after SCW pre-treatment. The crystallinity index of pineapple waste was reduced from 57.58% (untreated) to 54.29% (pre-treated). Scanning electron microscopy confirmed the structural modification of pre-treated pineapple waste for better microbial attack. Subcritical water pre-treatment is feasible as a promising method to enhance the anaerobic co-digestion process. Further study should be conducted to assess the scale-up of the process from pre-treatment to anaerobic digestion at the pilot plant level.

A Case Report of Severe Osteomalacia in a Young Patient After Bariatric Surgery.

Obesity can promote several metabolic, cardiovascular, and musculoskeletal complications and has been associated with poor quality of life. The treatment of obesity can range from simple lifestyle modifications or medications to complicated bariatric surgeries. Although bariatric surgery has been a proven treatment for morbid obesity, it has also been associated with multiple consequences and complications. Several reports and studies have revealed bone loss or decreased bone mineral density (BMD), fractures, or even several metabolic bone diseases, such as osteoporosis, following bariatric surgery. This case report aims to increase awareness on postoperative patient supplementation compliance and incorporation of early detection and intervention. This case report involves a 39-year-old male who underwent laparoscopic biliopancreatic diversion 10 years prior to presentation. The patient was not compliant with his supplements for over nine years, which lead to multiple fragility fractures, myopathy, and muscle atrophy due to hypocalcemia, vitamin D deficiency, hyperparathyroidism, and other electrolyte disturbances. He has since been treated with supplements and physiotherapy for 10 months and showed clinical improvement. This case report highlights the importance of pre- and postoperative screening of bone loss risks and any vitamin or mineral deficiencies with subsequent correction via supplements. Moreover, it emphasizes the need for more studies on the complications of late post-bariatric surgeries.

Giant Unruptured Internal Carotid Artery Aneurysm.

Headache is among the most frequent symptoms to seek medical care. Careful evaluation by history-taking and appropriate physical examination is needed to exclude the potential secondary causes of headaches. In the elderly population, secondary headaches are more prevalent compared with the younger adult population. We present the case of a 70-year-old man who presented with a three-month history of headache with visual disturbances. He reported that this was the first time he experienced such a headache. The patient had a longstanding history of hypertension, diabetes mellitus, dyslipidemia, and ischemic heart disease. He was a heavy smoker with a 35 pack-years smoking history. In view of the clinical signs and symptoms, the patient underwent a computed tomography scan that revealed a right internal carotid artery aneurysm. For better evaluation, magnetic resonance imaging of the brain was performed and re-demonstrated the saccular aneurysm of the terminal part of the right internal carotid artery aneurysm, measuring 48 x 37 x 31 mm and partially thrombosed with a surrounding mural hematoma. The neck of the aneurysm measured 4 mm. The decision for surgical management was planned. The patient underwent craniotomy with surgical clipping of the aneurysm. No complications occurred during the operation. The patient had an uneventful recovery. Elderly patients with chronic headaches should be carefully evaluated for secondary headaches. A giant cerebral artery aneurysm is an uncommon etiology of secondary headache that needs prompt diagnosis and management.

The use of magnetic resonance phase-contrast cine in Chiari malformation with syringomyelia.

INTRODUCTION: Chiari malformation (CM) is a disorder of mesodermal origin and is commonly associated with syringomyelia. Foramen magnum decompression is the first-line of standard treatment in symptomatic patients with a confirmed radiographic diagnosis. Magnetic resonance (MR) cine allows accurate evaluation of cerebrospinal fluid (CSF) physiology at the craniovertebral junction but often this is under-utilised in Malaysia. METHODS: In this series, we looked into nine cases of CM with syringomyelia from clinical and radiological perspective before and after surgery. The radiological parameters were herniated tonsillar length, syrinx: cord ratio, syrinx length and diameter. Flow velocity and morphologic changes in Chiari were illustrated. RESULTS: Seven patients showed either reduction in syrinx length, syrinx: cord ratio or both postoperatively. Clinical recovery somewhat varied in motor and sensory symptoms. Four patients gained better functional grade in modified Rankin scale (MRS) while the rest remained similar. The study highlighted the advantage of CSF flow dynamics information over MR anatomical radiographic improvement in addressing the neurologic and functional recovery. We also discussed the practicality of cine sequence in preoperative patient selection, syrinx analysis and postoperative flow evaluation in anticipation of clinical outcome. CONCLUSION: Phase-contrast cine MRI is a useful tool dictated by resource availability. We recommend its routine use in preoperative analysis and subsequent observational follow-up after surgery.

DISSOLUTION AND COMPATIBILITY STUDY OF BINARY AND TERNARY INTERACTIVE MIXTURES OF INDOMETHACIN: COMPARISON WITH COMMERCIALLY AVAILABLE CAPSULES.

The main objective of this work was to use Weibull distribution function and Baker-Lonsdale models to study the dissolution kinetics of prepared binary and ternary interactive mixtures containing indomethacin in comparison with three commercially available capsules of indomethacin, namely, Rothacin®, Indomin® and Indylon®. Differential scanning calorimetry (DSC) in conjunction with cloud point method was used to study the compatibility of indomethacin with polyvinylpyrrolidone (PVP) and lactose and to provide an explanation(s) for the insignificant increase in dissolution rate observed in the ternary interactive mixture as well as for the reduction in the dissolution rate observed from the binary system in our previous study. Results showed that the Weibull distribution function equation was the best fit to the dissolution data for all formulations used in this study. DSC curves showed that the decrease in dissolution rate from the binary and ternary interactive mixtures was due to incompatibility of indomethacin with PVP. Also DSC curves showed that lactose was compatible with indomethacin and that lactose was used as excipient in two commercial products (Rothacin® and Indylon®). Results from the cloud point method showed that the addition of indomethacin to 1% PVP solution containing ammonium sulfate (with cloud point at 76°C) reduces the cloud point of PVP indicating that there is an interaction between indomethacin and PVP, while the cloud point of 1% PVP containing ammonium sulfate was not affected by the addition of lactose.

Efficacy of Neutral Electrolyzed Water, Quaternary Ammonium and Lactic Acid-Based Solutions in Controlling Microbial Contamination of Food Cutting Boards Using a Manual Spraying Technique.

Bactericidal activity of neutral electrolyzed water (NEW), quaternary ammonium (QUAT), and lactic acid-based solutions was investigated using a manual spraying technique against Salmonella Typhimurium, Escherichia coli O157:H7, Campylobacter jejuni, Listeria monocytogenes and Staphylococcus aureus that were inoculated onto the surface of scarred polypropylene and wooden food cutting boards. Antimicrobial activity was also examined when using cutting boards in preparation of raw chopped beef, chicken tenders or salmon fillets. Viable counts of survivors were determined as log10 CFU/100 cm(2) within 0 (untreated control), 1, 3, and 5 min of treatment at ambient temperature. Within the first minute of treatment, NEW and QUAT solutions caused more than 3 log10 bacterial reductions on polypropylene surfaces whereas less than 3 log10 reductions were achieved on wooden surfaces. After 5 min of treatment, more than 5 log10 reductions were achieved for all bacterial strains inoculated onto polypropylene surfaces. Using NEW and QUAT solutions within 5 min reduced Gram-negative bacteria by 4.58 to 4.85 log10 compared to more than 5 log10 reductions in Gram-positive bacteria inoculated onto wooden surfaces. Lactic acid treatment was significantly less effective (P < 0.05) compared to NEW and QUAT treatments. A decline in antimicrobial effectiveness was observed (0.5 to <2 log10 reductions were achieved within the first minute) when both cutting board types were used to prepare raw chopped beef, chicken tenders or salmon fillets.

Coadministration of doxorubicin and etoposide loaded in camel milk phospholipids liposomes showed increased antitumor activity in a murine model.

Small unilamellar vesicles from camel milk phospholipids (CML) mixture or from 1,2 dipalmitoyl-sn-glycero-3-phosphatidylcholine (DPPC) were prepared, and anticancer drugs doxorubicin (Dox) or etoposide (ETP) were loaded. Liposomal formulations were used against fibrosarcoma in a murine model. Results showed a very high percentage of Dox encapsulation (~98%) in liposomes (Lip) prepared from CML-Lip or DPPC-Lip, whereas the percentage of encapsulations of ETP was on the lower side, 22% of CML-Lip and 18% for DPPC-Lip. Differential scanning calorimetry curves show that Dox enhances the lamellar formation in CML-Lip, whereas ETP enhances the nonlamellar formation. Differential scanning calorimetry curves also showed that the presence of Dox and ETP together into DPPC-Lip produced the interdigitation effect. The in vivo anticancer activity of liposomal formulations of Dox or ETP or a combination of both was assessed against benzopyrene (BAP)-induced fibrosarcoma in a murine model. Tumor-bearing mice treated with a combination of Dox and ETP loaded into CML-Lip showed increased survival and reduced tumor growth compared to other groups, including the combination of Dox and ETP in DPPC-Lip. Fibrosarcoma-bearing mice treated with a combination of free (Dox + ETP) showed much higher tumor growth compared to those groups treated with CML-Lip-(Dox + ETP) or DPPC-Lip-(Dox + ETP). Immunohistochemical study was also performed to show the expression of tumor-suppressor PTEN, and it was found that the tumor tissues from the group of mice treated with a combination of free (Dox + ETP) showed greater loss of cytoplasmic PTEN than tumor tissues obtained from the groups of mice treated with CML-Lip-(Dox + ETP) or DPPC-Lip-(Dox + ETP).

Etoposide incorporated into camel milk phospholipids liposomes shows increased activity against fibrosarcoma in a mouse model.

Phospholipids were isolated from camel milk and identified by using high performance liquid chromatography and gas chromatography-mass spectrometry (GC/MS). Anticancer drug etoposide (ETP) was entrapped in liposomes, prepared from camel milk phospholipids, to determine its activity against fibrosarcoma in a murine model. Fibrosarcoma was induced in mice by injecting benzopyrene (BAP) and tumor-bearing mice were treated with various formulations of etoposide, including etoposide entrapped camel milk phospholipids liposomes (ETP-Cam-liposomes) and etoposide-loaded DPPC-liposomes (ETP-DPPC-liposomes). The tumor-bearing mice treated with ETP-Cam-liposomes showed slow progression of tumors and increased survival compared to free ETP or ETP-DPPC-liposomes. These results suggest that ETP-Cam-liposomes may prove to be a better drug delivery system for anticancer drugs.

Recombinant bromelain production in Escherichia coli: process optimization in shake flask culture by response surface methodology.

Bromelain, a cysteine protease with various therapeutic and industrial applications, was expressed in Escherichia coli, BL21-AI clone, under different cultivation conditions (post-induction temperature, L-arabinose concentration and post-induction period). The optimized conditions by response surface methodology using face centered central composite design were 0.2% (w/v) L-arabinose, 8 hr and 25°C. The analysis of variance coupled with larger value of R2 (0.989) showed that the quadratic model used for the prediction was highly significant (p < 0.05). Under the optimized conditions, the model produced bromelain activity of 9.2 U/mg while validation experiments gave bromelain activity of 9.6 ± 0.02 U/mg at 0.15% (w/v) L-arabinose, 8 hr and 27°C. This study had innovatively developed cultivation conditions for better production of recombinant bromelain in shake flask culture.

Determination of total phenolic content and antioxidant capacity of onion (Allium cepa) and shallot (Allium oschaninii) using infrared spectroscopy.

Total phenolic content (TPC) and total antioxidant capacity (TAC) of four onion varieties (red, white, yellow and sweet) and shallot from selected locations (Washington, Idaho, Oregon, Texas and Georgia) were determined using Fourier transform infrared (FT-IR) spectroscopy (4000-400cm-1). The Folin-Ciocalteu (F-C) assay was used to quantify TPC and three assays were used to determine TAC, including 2,2-diphenyl-picrylhydrazyl (DPPH) assay, Trolox equivalent antioxidant capacity (TEAC) assay and ferric reducing antioxidant power (FRAP) assay. Partial least squares regression (PLSR) with cross-validation (leave-one-out) was conducted on onion and shallot extracts (n=200) and their corresponding F-C, DPPH, TEAC and FRAP values were employed to obtain four independent calibration models for predicting TPC and TAC for the extracts. Spectra from an extra 19 independent extracts were used as an external validation set for prediction. A correlation of r>0.95 was obtained between FT-IR predicted and reference values (by F-C, DPPH, TEAC and FRAP assay) with standard errors of calibration (SEC) and standard errors of cross-validation (SECV) less than 2.85, 0.35 and 0.45µmolTrolox/g FW of extracts for TEAC, FRAP and DPPH assay, respectively; and 0.36mggallic acid/g FW of extracts for the F-C assay. In addition, cluster analysis (principal component analysis (PCA)) and discriminant function analysis (DFA) could differentiate varieties of onions and shallot based upon infrared spectral features. Loading plots for the various chemometrics models indicated that hydroxyl and phenolic functional groups were most closely correlated with antioxidant capacity. The use of mid-infrared spectroscopy to predict the total antioxidant capacity of vegetables provides a rapid and precise alternative to traditional wet chemistry analysis.

Active anterior rhinomanometry analysis in normal adult Malays.

The differences in facial anatomical structures of the major ethnic groups, may also be reflected in nasal resistance. Active anterior rhinomanometry (AAR) is the recommended technique for the objective assessment of nasal airway resistance (NAR). This study comprised of 85 adult Malay subjects. All the subjects had to undergo a primary assessment of relevant symptoms of nasal disease and nasal examination before undergoing AAR assessment. The mean value of total nasal airway resistance (NAR) was 0.19 Pa/cm(3)/s (ranged from 0.09 to 0.55 Pa/cm(3)/s) at 75 Pa pressure point and 0.24 Pa/cm(3)/s (ranged from 0.12 to 0.52 Pa/cm(3)/s) at 150 Pa pressure point. The mean unilateral NAR was 0.46 Pa/cm(3)/s at a reference pressure of 75 Pa and 0.51 Pa/cm(3)/s at a reference pressure of 150 Pa. In this study we presented normal values for NAR in healthy Malay adult subjects. AAR proves to be a valuable clinical method for recording and quantitating nasal resistance.

Clinical presentation of patients with nasopharyngeal carcinoma.

The poor prognosis for patients with nasopharyngeal carcinoma is principally due to its advanced stage at the time of diagnosis. The symptoms and clinical findings at presentation of 56 patients with confirmed nasopharyngeal carcinoma is described and analysed. Recognising the common modes of presentation is essential to diagnose the disease at an early stage.