Appendectomy and asthma: a search for an association in older subjects.

INTRODUCTION: Several risk factors found to be associated with postoperative complications and cancer surgery, which carry a significant morbidity risk to cancer patients. Therefore, prehabilitation is necessary to improve the functional capability and nutritional status of a patient prior to surgery, so that the patient can withstand any postoperative activity and associated deterioration. Thus, this study aims to assess the effectiveness of prehabilitation interventions on the functional status of patients with gastric and oesophageal cancer who underwent esophagectomy and gastrectomy. MATERIAL AND METHODS: An interventional study was carried out among oesophageal and gastric cancer patients who had undergone surgery at the National Cancer Institute of Malaysia. The prehabilitation process took a maximum of two weeks, depending on the patient's optimisation before surgery. The prehabilitation is based on functional capacity (ECOG performance status), muscle function (handgrip strength), cardio-respiratory function (peak flow meter) and nutritional status (calorie and protein). Postoperative outcomes are measured based on the length of hospital stay, complications, and Clavien-Dindo Classification. RESULTS: Thirty-one patients were recruited to undergo a prehabilitation intervention prior to gastrectomy (n=21) and esophagectomy (n=10). Demographically, most of the cancer patients were males (67.7%) with an ideal mean of BMI (23.5±6.0). Physically, the majority of them had physical class (ASA grade) Grade 2 (67.7%), ECOG performance status of 1 (61.3%) and SGA grade B (51.6%). The functional capacity and nutritional status showed a significant improvement after one week of prehabilitation interventions: peak expiratory flow meter (p<0.001), handgrip (p<0.001), ECOG performance (p<0.001), walking distance (p<0.001), incentive spirometry (p<0.001), total body calorie (p<0.001) and total body protein (p=0.004). However, those patients who required two weeks of prehabilitation for optimization showed only significant improvement in peak expiratory flow meter (p<0.001), handgrip (p<0.001), and incentive spirometry (p<0.001). Prehabilitation is significantly associated postoperatively with the length of hospital stay (p=0.028), complications (p=0.011) and Clavien-Dindo Classification (p=0.029). CONCLUSION: Prehabilitation interventions significantly increase the functional capacity and nutritional status of cancer patients preoperatively; concurrently reducing hospital stays and complications postoperatively. However, certain cancer patients might require over two weeks of prehabilitation to improve the patient's functional capacity and reduce complications postoperatively.

[Interpretation of Consolidated Health Economic Evaluation Reporting Standards 2022].

The number of studies related to health economics evaluation is increasing. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) contains 28 items. Based on CHEERS 2013, CHEERS 2022 adds a health economic analysis plan, model sharing, and community, patient, public, and other relevant stakeholders' participation in the statement, taking into account the future development direction of health economics evaluation. It provides a useful review tool for peer reviewers, editors, and readers and supports health technology assessment agencies in establishing standard reporting standards for health economics evaluations. In this study, we briefly introduced and interpreted the CHEERS 2022 statement and analyzed an example of health economics evaluation in infectious disease epidemiology to provide a reference for researchers to report studies regarding health economics evaluation standardly.

The Wave Sign Correlates with the Posterior Horn Medial Meniscus (PHMM) Tear in the Anterior Cruciate Ligament (ACL) Deficient Knee.

Introduction: A posterior horn medial meniscus (PHMM) tear subjects the knee to pathological stresses, especially in the setting of a deficient anterior cruciate ligament (ACL). These PHMM tears have to be surgically addressed, however they remain a diagnostic challenge. Hence, this study aims to evaluate the wave sign as an arthroscopic diagnostic aid for the PHMM tear which may be occult. Materials and methods: This is a retrospective study of 61 consecutive patients (62 ACL-deficient knees) who underwent arthroscopic primary ACL reconstruction between September 2017 and August 2018. We defined PHMM tears as tears located in the posterior one-third of the medial meniscus. Root tears and ramp lesions were included in our analysis. The arthroscopic findings were recorded after a comprehensive arthroscopic survey. Results: In the sample of ACL-deficient knees, 44 (71.0%) had a concomitant medial meniscus tear. The most common location for the tear was in the posterior horn (81.8%). There were seven occult PHMM tears, not described by the radiologist or identified by the operating surgeon on the pre-operative magnetic resonance imaging. The wave sign was identified in 10 (16.1%) knees, all confirming the presence of the PHMM tear. A positive correlation was found between the presence of the wave sign and the PHMM tear. Conclusions: The wave sign has a statistically significant but weak positive correlation with the presence of the PHMM. We view the wave sign as a valuable arthroscopic cue to rule-in the presence of the PHMM tear in the ACL-deficient knee.

The Wave Sign Correlates with the Posterior Horn Medial Meniscus (PHMM) Tear in the Anterior Cruciate Ligament (ACL) Deficient Knee

@#Introduction: A posterior horn medial meniscus (PHMM) tear subjects the knee to pathological stresses, especially in the setting of a deficient anterior cruciate ligament (ACL). These PHMM tears have to be surgically addressed, however they remain a diagnostic challenge. Hence, this study aims to evaluate the wave sign as an arthroscopic diagnostic aid for the PHMM tear which may be occult. Materials and methods: This is a retrospective study of 61 consecutive patients (62 ACL-deficient knees) who underwent arthroscopic primary ACL reconstruction between September 2017 and August 2018. We defined PHMM tears as tears located in the posterior one-third of the medial meniscus. Root tears and ramp lesions were included in our analysis. The arthroscopic findings were recorded after a comprehensive arthroscopic survey. Results: In the sample of ACL-deficient knees, 44 (71.0%) had a concomitant medial meniscus tear. The most common location for the tear was in the posterior horn (81.8%). There were seven occult PHMM tears, not described by the radiologist or identified by the operating surgeon on the preoperative magnetic resonance imaging. The wave sign was identified in 10 (16.1%) knees, all confirming the presence of the PHMM tear. A positive correlation was found between the presence of the wave sign and the PHMM tear. Conclusions: The wave sign has a statistically significant but weak positive correlation with the presence of the PHMM. We view the wave sign as a valuable arthroscopic cue to rule-in the presence of the PHMM tear in the ACLdeficient knee.

[Respiratory drive in acute respiratory distress syndrome: evaluation and control].

Acute respiratory distress syndrome (ARDS) is a common critical disease, which often leads to poor prognosis in critically ill patients. The excessive respiratory drive in ARDS is related to lung injury. Control of excessive respiratory drive is helpful to reduce lung injury and mortality of ARDS. The mechanisms of abnormal increase in respiratory drive in ARDS include hypoxemia, hypercapnia, stretch reflex caused by alveolar collapse and inflammatory stimulation. Respiratory drive should be evaluated by clinical manifestations, physiological parameters and respiratory mechanics indexes. It is particularly important to make individual therapy strategies according to the evaluation of respiratory drive. Analgesia and sedation combined with muscle relaxation, high positive end-expiratory pressure (PEEP) and prone position can be used to control excess respiratory drive. This article reviews the evaluation and management of excess respiratory drive in ARDS patients.

Atrial flutter caused by migration of a superior vena cava stent into the right atrium.

We describe the case of a patient presenting with an atrial flutter mechanically induced by a stent migration from the superior vena cava to the right atrium.

Survey on serum protein electrophoresis and recommendations for standardised reporting.

INTRODUCTION: Serum protein electrophoresis (SPE) is a well-established laboratory technique. However, reporting of results varies considerably between laboratories. The variation in reporting can cause confusion to the clinician with a potential of adversely impacting patient care. The purpose of the survey was to find out the variation in reporting and to prepare recommendations to the Malaysian laboratories based on the survey to reduce both the variation in reporting between laboratories and the risk of misinterpretation of reports. MATERIALS AND METHODS: To determine the extent of variation in reporting of protein electrophoresis results questionnaires were distributed to the pathologists of various laboratories in Malaysia regarding the method, quantification of paraprotein concentrations and immunoglobulin assays, and information regarding current laboratory electrophoresis practices. RESULTS: Variation was found in the following reporting practices: (a) screening protocol; (b) reporting of serum albumin; (c) numerical reporting of protein fractions and paraprotein; (d) co-migration of a paraprotein with a normal serum protein; (e) reporting of multiple paraprotein bands (f) appearance of small abnormal band and oligoclonal bands and (g) communication about of interferences. CONCLUSION: The pathologists of the country made recommendations on the reporting of protein electrophoresis. Harmonised reporting will reduce inconsistency, variation in reporting, improve the quality of the report and most importantly improve patient care.

Release of pro-inflammatory cytokines TNF-α, IFN-γ and IL-6 by Burkholderia pseudomallei- stimulated peripheral blood mononucleocytes of acute myeloid leukemia patients.

Acute myeloid leukemia (AML) is a malignant disease progressed from abnormal production of immature myeloid cells, which is often associated with concurrent infections after diagnosis. It was widely established that infections are the major contributors to mortality in this group due to the prevalency of neutropenia. Gram-negative Burkholderia pseudomallei is the causative agent of melioidosis. This disease had been reported in several neutropenic cancer patients undergoing chemotherapy resulting in severe clinical presentations and high mortalities which is in need of critical attention. Studies show that cytokines are important mediators of melioidosis progression and low neutrophil counts are associated with progression of its severity. However, to date, there are no reports on cytokine production in neutropenic cancer patients who are prone to melioidosis. Hence, here we assessed the cytokine production in neutropenic AML patients by introducing B. pseudomallei to their peripheral blood mononuclear cell (PBMC) culture in vitro. We observed that inflammatory response related cytokines namely TNF-α, IFN-γ IL-6 and IL-10 were highly circulated in infected PBMCs suggesting that these cytokines may play important roles in the progression of severity in melioidosis infected neutropenic patients.

Risk factors for keratoconus progression after treatment by accelerated cross-linking (A-CXL): A prospective 24-month study.

PURPOSE: Identification of potential predictive factors for keratoconus progression after treatment by accelerated Cross-linking (A-CXL) SECONDARY OBJECTIVES: Evaluation of clinical and topographic outcomes for two years following accelerated cross-linking treatment for progressive keratoconus including: best spectacle corrected visual acuity (BSCVA), thinnest pachymetry, maximum keratometry (Kmax), cylinder. STUDY: Prospective, interventional, monocentric study. SITE: Metz-Thionville Regional Medical Center, Lorraine University, Mercy Hospital, Metz, France. PATIENTS AND METHODS: We included 82 eyes of 60 patients between March 2014 and June 2016 who underwent accelerated corneal cross-linking (A-CXL) with epithelial debridement for progressive keratoconus, with a minimum follow-up of 2 years. A complete clinical evaluation and corneal topography were performed before cross-linking, and subsequently at 6, 12 and 24 months post-procedure. The following parameters were monitored during follow-up: best spectacle corrected visual acuity (BSCVA), minimal pachymetry, maximum keratometry (Kmax), mean anterior and posterior curvatures, maximum posterior curvature, presence of optical aberrations, subdivided into spherical aberration, coma, astigmatism, higher order optical aberrations and residual optical aberrations. After a 2-year follow-up, two groups, defined as "responders" and "non-responders" to treatment, were separated for analysis, and their initial characteristics were compared. RESULTS: Data for 82 eyes of 60 patients with progressive keratoconus with a mean age of 24±7 years were studied. Fourteen eyes (17.1%) showed signs of progression after treatment by A-CXL (non-responders), and 68 eyes (82.9%) showed stabilization of the disease (responders). Characteristics of non-responding eyes after A-CXL included a younger mean age (20±5 vs. 25±7 years) (P=0.04) and a lower initial mean BCVA for non-responders of 0.44±0.16 logMAR vs. 0.29±0.19 logMAR (P=0.03). Non-responders also had a higher mean maximal posterior curvature (AKB) of -10.84±1.72D vs. -9.46± 1.12D (P=0.03). They also showed more higher order optical aberrations (3.84±1.72D vs. 2.4±1.02D; P=0.01), including coma (3.85±1.81D vs. 2.1±1.01D; P=0.03) and more residual aberrations than responders (1.05±0.44D vs. 0.45±0.6D; P=0.005). No significant differences were found between responders and non-responders for the other parameters in our study. CONCLUSION: Eyes with progressive keratoconus who did not respond to A-CXL treatment were the most aggressive cases in the youngest patients, with highest maximum corneal curvatures and most pronounced optical aberrations. These patients should be informed in advance of the high risk of non-response to A-CXL treatment, and of the potential need for additional treatment in the future.

Cytochrome c/Multi-walled Carbon Nanotubes Modified Glassy Carbon Electrode for the Detection of Streptomycin in Pharmaceutical Samples.

A novel electrochemical glassy carbon electrode modified with a multi-walled carbon nanotube, cytochrome c (Cyt c) and zinc oxide nanoparticles (ZnONPs) was fabricated to increase the sensitivity of electrode for the detection of streptomycin (STN) in certain pharmaceutical samples. Cyclic voltammetry (CV) and differential pulse voltammetry techniques were used for an electrochemical characterization of the electrode. Furthermore, the electrochemical biosensor construction phases were examined by using X-ray diffraction (XRD), transmission electron microscopy (TEM) and Fourier-transform infrared spectroscopy (FTIR). Under the optimal experimental conditions, the electrode offers a high selectivity and sensitivity signaling in the co-existence method of STN with the linear concentration ranging from 0.02 to 2.2 µM. The detection limits (LOD) and limit of quantification (LOQ) were found to be 0.0028 and 0.0562 µM, respectively. The fabricated sensing electrode has good stability, reproducibility and sensitivity towards STN in the pharmaceutical samples. Preliminary determinations of binding sites within the specified grid box size, which covers both Cyt c and STN, were done by molecular docking analysis. Moreover, density functional theory (DFT) computations were performed to provide insightful information into the optimized geometry of STN.

Evaluation of ostium size following endoscopic dacryocystorhinostomy as a predictive factor of outcome: A prospective study.

INTRODUCTION: Endonasal dacryocystorhinostomy (DCR) is a surgical procedure that aims to increase tear drainage to treat epiphora caused by nasolacrimal obstruction by creating a bypass through the bone between the lacrimal sac and the nasal cavity. A silicone stent is temporarily put in place for 2 months to avoid early obstruction of the rhinostomy. One of the causes of surgical failure is related to progressive stenosis of intranasal ostium, due to fibrosis and new bone growth, inducing a relapse of epiphora and/or dacryocystitis. Few studies have described changes in the size of the intranasal ostium on direct post-DCR measurement or kinetics of its shrinkage. The purpose of this study is to determine whether changes in the size of intranasal ostium might be a predictor of final functional efficacy. MATERIALS AND METHODS: A prospective cohort of eighteen consecutive patients undergoing endonasal DCR for chronic epiphora or chronic dacryocystitis between January 2017 and April 2018 was analyzed. Eight patients who underwent bilateral DCR, and twenty-six intranasal ostia were finally analyzed. Follow-up took place every two months for 1 year, with the silicone tube removed at 2 months. Functional success was defined as absence of recurrent epiphora or dacryocystitis. Ostium size was systematically measured on photos taken during intranasal endoscopy performed every 2 months for 1 year. RESULTS: At 2 months after endonasal DCR, 23 of the 26 ostia (88.5%) were functional, but only 19 (73.1%) of them were directly measurable. The mean horizontal diameter at 2 months was 1.44 (SD 0.61) mm, and the mean vertical diameter was 0.86 (SD 0.37) mm, which corresponded to a mean area of 10 (SD 0.84)mm2. We noted a statistically significant decrease in ostium size and area between 2 and 4 months after the procedure (P -0.001), followed by a stabilization period with no statistical correlation between the size of the ostium and its final functional efficacy. At 6 months after DCR, of the 7 ostia that were not initially measurable, 3 were immediately non-functional at 2 months, 3 had a relapse of epiphora at 4 months, and 1 had a relapse of dacryocystitis at 6 months, i.e., 100% clinical failures at 6 months. The other procedures all remained functional after 1 year of follow-up. CONCLUSION: The intranasal ostium of an endonasal DCR shrinks significantly within the 2 months after removal of the silicone tube and remains stable thereafter. There is no correlation between the size or area of intranasal ostium and its final functional efficacy. However, when the ostium is not measurable at the time of 2-month stent removal, all patients experienced a relapse of epiphora or dacryocystitis within 6 months.

Release of pro-inflammatory cytokines TNF-α, IFN-γ and IL-6 by Burkholderia pseudomallei- stimulated peripheral blood mononucleocytes of acute myeloid leukemia patients

@#Acute myeloid leukemia (AML) is a malignant disease progressed from abnormal production of immature myeloid cells, which is often associated with concurrent infections after diagnosis. It was widely established that infections are the major contributors to mortality in this group due to the prevalency of neutropenia. Gram-negative Burkholderia pseudomallei is the causative agent of melioidosis. This disease had been reported in several neutropenic cancer patients undergoing chemotherapy resulting in severe clinical presentations and high mortalities which is in need of critical attention. Studies show that cytokines are important mediators of melioidosis progression and low neutrophil counts are associated with progression of its severity. However, to date, there are no reports on cytokine production in neutropenic cancer patients who are prone to melioidosis. Hence, here we assessed the cytokine production in neutropenic AML patients by introducing B. pseudomallei to their peripheral blood mononuclear cell (PBMC) culture in vitro. We observed that inflammatory response related cytokines namely TNF-α, IFN-γ IL-6 and IL-10 were highly circulated in infected PBMCs suggesting that these cytokines may play important roles in the progression of severity in melioidosis infected neutropenic patients.

Analysis of associations of FBXL19-AS1 with occurrence, development and prognosis of acute pancreatitis.

OBJECTIVE: The aim of the study was to explore the association between F-box and leucine-rich repeat protein 19-antisense ribonucleic acid 1 (FBXL19-AS1) and acute pancreatitis (AP) and its role in prognostic evaluation. PATIENTS AND METHODS: According to the severity of AP, the patients were classified into mild group, moderate-severe group, and severe group, and the expression of FBXL19-AS1 was compared among the three groups. The associations of FBXL19-AS1 with Atlanta classification, computed tomography severity index (CTSI), acute physiology and chronic health evaluation (APACHE) II score, bedside index for severity in acute pancreatitis (BISAP) and Ranson score were analyzed. The optimal cut-off point of severe hyperlipidemia-induced AP was predicted by the receiver operating characteristic (ROC) curves. Then, the incidence rates of local and systemic complications were compared among AP patients with different levels of FBXL19-AS1. After overexpression of FBXL19-AS1 in AP cells, the quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) results showed that significantly upregulated the mRNA level of interleukin-1ß (IL-1ß), tumor necrosis factor-α (TNF-α), and IL-6. The opposite results were obtained after the knockdown of FBXL19-AS1 in cells. RESULTS: There were no statistical differences in the basic data among the three groups. The FBXL19-AS1 level was increased in severe group than the moderate-severe group and mild group. The area under the curve (AUC) of FBXL19-AS1 in predicting severe AP was 0.9177 (p<0.001). According to the Spearman correlation analysis, the FBXL19-AS1 level had significant positive correlations with the predictive scores of AP severity. The incidence rate of shock, liver dysfunction, and pancreatic necrotic tissue infection was significantly higher in FBXL19-AS1 high-expression group than that in FBXL19-AS1 low-expression group. FBXL19-AS1 could promote the upregulation of inflammatory indexes. CONCLUSIONS: FBXL19-AS1 is highly expressed in the serum of AP patients, and it is positively correlated with the severity of AP. FBXL19-AS1 mediates the inflammatory response and promotes the occurrence and development of pancreatitis, harming the prognosis of patients.

Anxiety and depression in patients with haematological neoplasms in Malaysia.

BACKGROUND: It is not uncommon that anxiety and depression occur in patients with cancers, and past researches have shown that the quality of life of patients is negatively affected. This study aims to determine the prevalence of anxiety and depression of patients with haematological cancers in Malaysia and to investigate the possible association of these psychological symptoms with their quality of life. METHODS: This is a cross-sectional study where patients with haematological cancers attending two major hospitals were recruited. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression scale (HADS). Quality of life (QoL) of these patients was measured using the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ C30). An overall summary QoL score in combination with financial difficulty score and global health score were used for analysis. RESULTS: A total of 319 patients were recruited. Thirty-three percent of patients had anxiety symptoms, 23.5% had depression symptoms. In summary the overall score of QoL is significantly lower in patients with higher scores for depression and anxiety, (p<0.05). Patients who exhibit anxiety symptoms were more frequently female, still undergoing treatment whereas patients who had higher depression scores were older and had acute leukemias or myeloproliferative neoplasms. Patients who have depression are significantly associated with a higher financial difficulty score, p<0.05. CONCLUSION: The poor quality of life in patients who have anxiety and depression should raise awareness amongst the health professions treating them so that additional support can be provided.

Molecular interaction studies of binary systems comprising [C2mim] [BF4] with ethyl acetoacetate or benzaldehyde.

In this work, new data for the binary mixtures containing 1-ethyl-3-methylimidazolium tetrafluoroborate ([C2mim] [BF4]) ionic liquid (IL) with benzaldehyde or ethyl acetoacetate were investigated under atmospheric pressure (p = 0.1 MPa) and at temperatures (293.15-313.15) K. The binary mixtures were completely miscible at all proportions. Densities ( ρ ), viscosities ( η ) as well as speeds of sound ( u ) were conducted across the entire range of mole fraction ( x i = 0 to 1). The excess properties which include excess molar volumes ( V m E ) , intermolecular free length ( L f ), deviations in viscosity ( Δ Î· ), isentropic compressibility ( k s ) , apparent molar isentropic compressibility ( K ϕ ) as well as deviation in isentropic compressibility ( Δ k s ) were determined from the experimentally found results of speed of sound, viscosity and density. The obtained derived properties have been elucidated in terms of solute-solvent interactions taking place in the systems. The investigation of thermophysical properties of organic solvents with ionic liquids is essential as they decide the transformation of ionic liquids from small laboratory scale to large industrial applications. The obtained results are important and essential as they describe the molecular interactions, and can be used in constructing the structure-property correlation as well as molecular modelling that exist between [C2mim] [BF4] with benzaldehyde or ethyl acetoacetate. Redlich-Kister polynomial equation was used to fit the excess values and a good correlation was achieved.

A lignin polymer nanocomposite based electrochemical sensor for the sensitive detection of chlorogenic acid in coffee samples.

In this study, an innovative nanocomposite of multiwalled carbon nanotubes (MWCNTs), copper oxide nanoparticles (CuONPs) and lignin (LGN) polymer were successfully synthesized and used to modify the glassy carbon electrode for the determination of chlorogenic acid (CGA). Cyclic voltammetry (CV) emphasised a quasi-reversible, adsorption controlled and pH dependent electrode procedure. In cyclic voltammetry a pair of well distinct redox peaks of CGA were observed at the LGN-MWCNTs-CuONPs-GCE in 0.1 M phosphate buffer solution (PBS), at pH 2. The synthesized nanoparticles and nanocomposites were characterized by Fourier transformation infrared spectroscopy (FTIR), transmission electron microscopy (TEM) and x-ray diffraction (XRD) analyses. Differential pulse voltammetry (DPV) was applied to the anodic peak and used for the quantitative detection of CGA. Under optimal conditions, the proposed sensor showed linear responses from 5 µM to 50 µM, the linear regression equation Ipa (µA) = 2.6074 C-5.1027 (R2 = 0.995), whilst the limit of detection (LOD) and limit of quantifications (LOQ) were found to be 0.0125 µM and 0.2631 µM respectively. The LGN-MWCNTs-CuONPs-GCE were applied to detect the CGA in real coffee samples with the recovery ranging from 97 to 106 %. The developed sensor was successfully applied for the analysis of CGA content in the coffee samples. In addition, electrophilic, nucleophilic reactions and chlorogenic acid docking studies were carried out to better understand the redox mechanisms and were supported by density functional theory calculations.

Anxiety, depression and quality of life of medical students in Malaysia.

BACKGROUND: Medical education is known to be highly stressful and challenging. Many medical students suffer from psychological stress which may lead to burnout and poor academic performances. Quality of life (QOL) of medical students is also affected. In this study, we aim to determine the prevalence of anxiety and depression of the senior medical students and to assess their QOL. METHODS: This is a cross-sectional study which involved medical students in their final two years of study at a public university in Malaysia. Self-administered Hospital Anxiety and Depression scale (HADS) and World Health Organisation QOL questionnaire (WHOQOL-BREF) were used to assess their psychological symptoms and QOL. RESULTS: A total 149 students participated. The prevalence rates of anxiety and depression were 33% and 11% respectively. Malay students had significantly more anxiety compared to the other ethnic groups, P<0.05. Female students had significantly lower psychological score compared to male; 70.73 vs 66.32(P<0.05). Anxiety and depression were associated with significantly poorer QOL. Students with depression symptoms were associated with lower physical, psychological and environmental domain score whereas those with anxiety had lower psychological, social and environmental scores, P<0.05. Overall QOL score was significantly lower in Chinese students (P<0.05) and those with depression (P<0.001). CONCLUSION: QOL of medical students are significantly affected by the presence of anxiety and depression. It is recommended that medical schools implement measures which can identify students at risk and to offer comprehensive intervention and preventive programmes to improve the students' wellbeing.

Investigation of binding interactions between BSA and [EPMpyr][Sal] through spectroscopy studies, thermophysical and thermodynamic properties.

The intensity of research, probing the interactions between proteins and ionic liquid (IL), has been increasing and parallels the fast-growing applications of ILs in biotechnology. The specific aspects which have attracted the involvement of researchers are stabilization, separation, biochemical and enzymatic reactions of proteins. In this work the synthesis of IL, epoxypropyl and N-methyl substituted 2­oxopyrrolidinium cation with salicylate anion, [EPMpyr][Sal], and its interaction with aqueous BSA{BSA(aq)-[EPMpyr][Sal]}. Measurements of thermophysical properties (density (ρ), and speed of sound (u)) showed that both moderately strong and weak interactions occur on treatment of BSA with that chosen IL. H-bond formation, dipole-dipole interactions and ionic interactions occurring in this system were investigated via thermophysical and thermodynamic properties as well as spectroscopic data. Thermodynamic data (excess molar volume (VmE), isentropic compressibility (ks), deviation in isentropic compressibility (∆ks) and intermolecular free length (Lf)) showed that there were stronger interaction between IL and BSA at higher temperature. The data from all the studies were correlated with Redlich Kister polynomial equation. The blue shift observed in the fluorescent spectra was interpreted to indicate that thetryptophan (Trp) residue of BSA moves to a more hydrophobic environment. It was also observed that the addition of more IL to BSA resulted in denaturation of BSA due to high hydrophobic nature of IL. Circular dichroism studies show that there were significant changes in the fine structure of BSA on interaction with IL. From the FTIR spectra the position of H-bond in the secondary structure of BSA was deduced.

Habenula-prefrontal resting-state connectivity in reactive aggressive men - A pilot study.

Disproportionate anger and reactive aggression in response to provocation are core symptoms of intermittent-explosive disorder (IED). Previous research shows a link between the propensity for aggression in healthy individuals and altered functioning of prefrontal-limbic and default-mode networks (DMN) at rest when no provocation is present. In a pilot study, we used resting-state functional magnetic resonance imaging to investigate the effects of pronounced reactive aggression in men, exemplified by IED, on the functional organization of resting-state brain networks including subcortical nodes such as the habenula previously implicated in aggression in preclinical models. Graph theory was applied to resting-state networks to determine alterations in global efficiency and clustering in high reactive aggressive men compared to low reactive aggressive men (controls). Further, we computed within-group correlations between trait aggression and graph measures, as well as within-group whole-brain seed-to-voxel regression analyses between trait aggression and habenula resting-state functional connectivity (rsFC). Reactive aggressive men compared to controls showed higher global efficiency in the left habenula, the left pulvinar in the thalamus, the left dorso-lateral prefrontal cortex, and the right temporal pole, as well as a trend for decreased clustering in DMN nodes. In the reactive aggressive group, high levels of trait aggression were linked to lower global efficiency of the left habenula, and to lower rsFC between the left habenula and the left ventro-lateral prefrontal cortex, a core region involved in inhibitory control. Together with preclinical evidence, our findings in men underline the relevance of aberrant habenula-prefrontal connectivity for the severity of aggressive behavior. This article is part of the Special Issue entitled 'Current status of the neurobiology of aggression and impulsivity'.