Molecular and aflatoxigenicity analyses of Aspergillus flavus isolates indigenous to grain corn in Malaysia; potentials for biological control.

AIMS: The present work aimed to distinguish the indigenous Aspergillus flavus isolates obtained from the first (pioneer) grain corn farms in Terengganu, Malaysia, into aflatoxigenic and non-aflatoxigenic by molecular and aflatoxigenicity analyses, and determine the antagonistic capability of the non-aflatoxigenic isolates against aflatoxigenic counterparts and their aflatoxin production in vitro. METHODS AND RESULTS: Seven A. flavus isolates previously obtained from the farms were characterized molecularly and chemically. All isolates were examined for the presence of seven aflatoxin biosynthesis genes, and their aflatoxigenicity was confirmed using high performance liquid chromatography with fluorescence detector. Phylogenetic relationships of all isolates were tested using ITS and ß-tubulin genes. Of the seven isolates, two were non-aflatoxigenic, while the remaining were aflatoxigenic based on the presence of all aflatoxin biosynthesis genes tested and the productions of aflatoxins B1 and B2. All isolates were also confirmed as A. flavus following phylogenetic analysis. The indigenous non-aflatoxigenic isolates were further examined for their antagonistic potential against aflatoxigenic isolates on 3% grain corn agar. Both non-aflatoxigenic isolates significantly reduced AFB1 production of the aflatoxigenic isolates. CONCLUSION: The indigenous non-aflatoxigenic A. flavus strains identified in the present work were effective in controlling the aflatoxin production by the aflatoxigenic A. flavus isolates in vitro and can be utilized for in situ testing.

Efficacy of Benson's Relaxation Technique on Stress and Pain Among Patients Undergoing Maintenance Hemodialysis: A Systematic Review.

Introduction: Stress and pain are high among patients undergoing hemodialysis. Benson's Relaxation technique affected a wide range of physical and psychological signs and symptoms among patients undergoing hemodialysis. Objective: To evaluate the effectiveness of Benson's Relaxation Technique in reducing stress and pain among patients undergoing maintenance hemodialysis. Materials and Methods: A systematic review of randomized controlled trials was conducted. A systematic literature search was carried out from 2000 to 2023. Searched databases included EBSCO-Host "Academic Search, Cochrane, CINAHL, Health Business, MEDLINE, Psychology and Behavioral Sciences, SPORTDiscus", PubMed, Ovid, and Google Scholar. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were conducted. RCTs were critically appraised using the Cochrane's Risk of Bias Tool. Four RCTs met the inclusion criteria and included in this review since they were applicable to practice. Results: Four randomized controlled trials were identified supporting the use of Benson's relaxation technique as a nursing treatment in managing stress and pain among patients undergoing maintenance hemodialysis, as it achieved a significant decrease in stress and pain scores. The overall quality of the randomized controlled trials was judged to be low to relatively moderate. Conclusions: Most of the randomized controlled trials lacked details on intervention adherence. It is recommended to conduct additional longitudinal randomized controlled trials in different countries with bigger sample sizes, to provide more evidence for generalizing outcomes.

Piper sarmentosum Roxb. Inhibits Angiotensin-Converting Enzyme Activity in Phorbol 12-Myristate-13-Acetate-Induced Endothelial Cells.

Angiotensin-converting enzyme (ACE) plays a crucial role in the pathogenesis of hypertension. Piper sarmentosum Roxb., an herb known for its antihypertensive effect, lacks a comprehensive understanding of the mechanism underlying its antihypertensive action. This study aimed to elucidate the antihypertensive mechanism of aqueous extract of P. sarmentosum leaves (AEPS) via its modulation of the ACE pathway in phorbol 12-myristate-13-acetate (PMA)-induced human umbilical vein endothelial cells (HUVECs). HUVECs were divided into five groups: control, treatment with 200 µg/mL AEPS, induction 200 nM PMA, concomitant treatment with 200 nM PMA and 200 µg/mL AEPS, and treatment with 200 nM PMA and 0.06 µM captopril. Subsequently, ACE mRNA expression, protein level and activity, angiotensin II (Ang II) levels, and angiotensin II type 1 receptor (AT1R) and angiotensin II type 2 receptor (AT2R) mRNA expression in HUVECs were determined. AEPS successfully inhibited ACE mRNA expression, protein and activity, and angiotensin II levels in PMA-induced HUVECs. Additionally, AT1R expression was downregulated, whereas AT2R expression was upregulated. In conclusion, AEPS reduces the levels of ACE mRNA, protein and activity, Ang II, and AT1R expression in PMA-induced HUVECs. Thus, AEPS has the potential to be developed as an ACE inhibitor in the future.

First report of Pantoea anthophila causing shoot dieback disease of Ceylon ironwood (Mesua ferrea Linn.) in Malaysia.

Ceylon ironwood (Mesua ferrea Linn.) or Penaga lilin is one of Asia's most popular tropical herbal plants, including Malaysia (Sharma et al., 2017). The trees are cultivated for their aesthetic value and pharmacological properties, especially as traditional remedies for asthma, dermatopathy, inflammation, and rheumatic conditions (Adib et al., 2019). In August 2022, a disease survey was conducted on Ceylon ironwood trees ranging from 5 to 12 years old in Botanical Park, Putrajaya, Malaysia, with 80% exhibiting shoot dieback disease of the 15 trees exhibiting shoot dieback disease. Symptoms include irregular, water-soaked with brown lesions on young leaves and shoots, where the small lesion coalesced and formed broad necrotic regions, subsequently causing dieback and gradual defoliation. Three infected shoots were collected from each tree, excised into small pieces (10 to 20 mm), immersed with 75% ethanol for 3 min, washed with 2% NaOCl solution for 1 min, and rinsed twice for 1 min in sterilized distilled water. A 10 µl aliquot of the sample suspension was streaked onto nutrient agar (NA) and incubated for 24 h to 48 h at 35 °C. A total of 15 isolates with similar morphology were obtained, and each isolate was re-streaked three times to obtain pure colonies that were round, smooth, with irregular edges, and produced yellow pigment in culture. All isolates were Gram-negative, negative for indole production, and utilized glucose, maltose, trehalose, sucrose, D-lactose, and pectin. Three representative isolates (C001, C002, and C003) with similar morphology were selected for further characterization. The total genomic DNA of all isolates was extracted from overnight cultures using Geneaid™ DNA Isolation Kit (Geneaid Biotech Ltd., Taiwan). PCR amplification of 16S rDNA (Zhou et al., 2015) and species-specific infB (Brady et al., 2008) genes was performed, and each of the ~1500 bp and ~900 bp amplicons were sequenced. BLASTn and phylogenetic analyses revealed all isolates were 100% identical to Pantoea anthophila (P. anthophila) LGM 2558 strains (Accession Nos. NR_116749 and NR_116113) for the 16S rDNA gene. They were 99% identical to P. anthophila CL1 strain (Accession Number CP110473) for infB gene. These sequences were later deposited in the GenBank (Accession Nos. OQ772233, OQ772234, and OQ772235 for 16S rDNA gene, and OQ803527, OQ803528, and OQ803529 for infB gene). For the pathogenicity test, healthy Ceylon ironwood seedlings' shoots were inoculated with 10 mL of each isolate suspension (1 x 108 CFU/ml) by spraying the inoculum on the young shoots using a sterilized spray bottle. Control seedlings were inoculated with sterile water. The inoculated shoots were covered with a sealed plastic bag to maintain the moisture and were kept in the greenhouse with temperatures ranging from 26 to 35 °C. The experiments were repeated twice, with three replicates for each treatment. Inoculated shoots showed dieback symptoms like natural infection, including irregular, water-soaked, and brown lesions on leaves and young shoots at 10 days post-inoculation. Control seedlings remained asymptomatic. The pathogen was re-isolated and identified via sequencing of the 16S rDNA and infB genes, thus fulfilling Koch's postulates. Previously, P. anthophila has been reported to cause soft rot in wampee plants in China (Zhou et al., 2015) and leaf blight of cotton in Pakistan (Tufail et al., 2020). To our knowledge, this is the first report of P. anthophila causing shoot dieback disease of Ceylon ironwood trees in Malaysia. Plant disease management strategies need to be established to reduce losses due to P. anthophila infection since the pathogen could limit Ceylon ironwood tree production in Malaysia.

Modified-Malay Eating Behavior and Pattern Questionnaire (Malay-EBPQ): translation and validation among Malaysian women.

BACKGROUND: Eating behavior primarily depends on eating patterns which are largely influenced by interactions between physiology, environment, psychology, culture and socio-economic status. This study was designed to translate and validate the Eating Behavior Pattern Questionnaire (EBPQ) among Malaysian women. METHODS: A cross-sectional study involving translation and validation of the English version of EBPQ. The original questionnaire, contained 51 items extracted into six domains was translated in Malay using forward and backward translation, pre-tested and validated among conveniently sampled female healthcare personnel. Vegetarians, pregnant ladies and women in confinement were excluded due to special daily dietary plans. Construct validity, reliability and feasibility were analyzed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). RESULTS: During translation, item modifications were made and subjected to field testing among 394 women. The original questionnaire was used as a reference to identify the positioning of items in constructs. Fifteen items were removed due to poor correlation with items within constructs. Seven factors were extracted using Varimax rotation with Kaiser-Meyer-Olkin (KMO) value range from 0.725-0.872 and significant Bartlett's test of Sphericity (p < 0.001). The item-loading of the items within the constructs ranged between 0.415-0.812 (explained variation = 62.7%). Cultural and lifestyle behavior was relabeled to lifestyle and behavioral eating, and snacking on sweets was relabeled as snacking pattern. Emotional eating was divided into two sub-factors as snacking behavior and emotional influence. CFA resulted with an acceptable fit with no presence of floor and ceiling effects. Intra-class correlation coefficient (ICC) for all the constructs were reported good and excellent. The overall internal consistency was reported as good. CONCLUSION: The modified 36-item Malay-EBPQ had moderate internal consistency, reliable and fit with multi-dimensional measures of eating behaviors and dietary patterns among women in the multi-racial population with cultural diversity.

A laudable strategy to manage bacterial panicle blight disease of rice using biocontrol agents.

Bacterial panicle blight (BPB) disease is a dreadful disease in rice-producing countries. Burkholderia glumae, a Gram-negative, rod-shaped, and flagellated bacterium was identified as the primary culprit for BPB disease. In 2019, the disease was reported in 18 countries, and to date, it has been spotted in 26 countries. Rice yield has been reduced by up to 75% worldwide due to this disease. Interestingly, the biocontrol strategy offers a promising alternative to manage BPB disease. This review summarizes the management status of BPB disease using biological control agents (BCA). Bacteria from the genera Bacillus, Burkholderia, Enterobacter, Pantoea, Pseudomonas, and Streptomyces have been examined as BCA under in vitro, glasshouse, and field conditions. Besides bacteria, bacteriophages have also been reported to reduce BPB pathogens under in vitro and glasshouse conditions. Here, the overview of the mechanisms of bacteria and bacteriophages in controlling BPB pathogens is addressed. The applications of BCA using various delivery methods could effectively manage BPB disease to benefit the agroecosystems and food security.

Mycotoxigenic fungal growth inhibition and multi-mycotoxin reduction of potential biological control agents indigenous to grain maize.

The present work investigated the potential of fungal species from grain maize farms in Malaysia as antagonists against the indigenous mycotoxigenic fungal species and their subsequent mycotoxin production. Dual-culture assay was conducted on grain maize agar (GMA) with 12 strains of potential fungal antagonists namely Bjerkandra adusta, Penicillium janthinellum, Schizophyllum commune, Trametes cubensis, Trichoderma asperelloides, Trichoderma asperellum, Trichoderma harzianum, and Trichoderma yunnanense against seven mycotoxigenic strains namely Aspergillus flavus, Aspergillus niger, Fusarium verticillioides, and Fusarium proliferatum producing aflatoxins, ochratoxin A, and fumonisins, respectively. Based on fungal growth inhibition, Trichoderma spp. showed the highest inhibitory activity (73-100% PIRG, Percentage Inhibition of Radial Growth; 28/0 ID, Index of Dominance) against the tested mycotoxigenic strains. Besides, B. adusta and Tra. cubensis showed inhibitory activity against some of the tested mycotoxigenic strains. All fungal antagonists showed varying degrees of mycotoxin reduction. Aflatoxin B1 produced by A. flavus was mainly reduced by P. janthinellum, Tra. cubensis, and B. adusta to 0 ng/g. Ochratoxin A produced by A. niger was mainly reduced by Tri. harzianum and Tri. asperellum to 0 ng/g. Fumonisin B1 and FB2 produced by F. verticillioides was mainly reduced by Tri. harzianum, Tri. asperelloides, and Tri. asperellum to 59.4 and 0 µg/g, respectively. Fumonisin B1 and FB2 produced by F. proliferatum were mainly reduced by Tri. asperelloides and Tri. harzianum to 244.2 and 0 µg/g, respectively. This is the first study that reports on the efficacy of Tri. asperelloides against FB1, FB2, and OTA, P. janthinellum against AFB1, and Tra. cubensis against AFB1.

Inoculation and colonization of the entomopathogenic fungi, Isaria javanica and Purpureocillium lilacinum, in tomato plants, and their effect on seedling growth, mortality and adult emergence of Bemisia tabaci (Gennadius).

Entomopathogenic fungi (EPF) are natural enemies which affect insect population and have long been recognized as biological control agents against many insect pests. Some isolates have also been established as endophytes, benefiting their host plants without causing any symptoms or negative effects. Here we demonstrated two entomopathogenic fungal species, Isariajavanica (Frieder. & Bally) Samson & Hywel-jone 2005 and Purpureocillium lilacinum (Thom) Luangsa-ard, Hou-braken, Hywel-Jones & Samson (2011) as endophytes in tomato plants by using the seed inoculation method and examined their effect on plant growth, B. tabaci mortality, and adult emergence. Our study indicated that tomato seeds treated with a fungal suspension of I. javanica and P. lilacinum enabled their recovery from plant tissues (root, stem and leaf) up to 60 days after inoculation (DAI). Both endophytic isolates also caused significant mortality of adult B. tabaci on seedlings inoculated with, I. javanica (51.92±4.78%), and P. lilacinum (45.32±0.20%) compared to the control treatment (19.29±2.35). Adult emergence rates were significantly high in the control treatments (57.50±2.66%) compared to I. javanica (15.00±1.47%) and P. lilacinum (28.75±4.78%) treatments. This study provides evidence that endophytic isolates of I. javanica and P. lilacinum have a biocontrol potentials for used against whiteflies and could also explored as plant growth promoters.

Knowledge of Sarcopenia and Associated Factors Among the Malaysian General Public: A Cross-sectional Study.

OBJECTIVES: Sarcopenia has emerged as a significant aging-related disease that affects many facets of societal-level and patient-level public health. This study analysed knowledge of sarcopenia and associated socio-demographic factors among the general public of Malaysia in order to effectively improve its prevention and countermeasures. METHODS: A cross-sectional online survey was conducted in Selangor, Malaysia, using Google Forms among 202 Malaysian adults from January 1, 2021 to March 31, 2021. Descriptive statistics were used to analyse the socio-demographic characteristics and knowledge scores. The continuous variables were evaluated using the independent t-test, Mann-Whitney test, and one-way analysis of variance test. The Spearman correlation coefficient was employed to determine the correlation between socio-demographic characteristics and knowledge score levels. RESULTS: The final analysis included 202 participants. The mean±standard deviation age was 49.03±12.65. Only 6.9% of participants had good knowledge of sarcopenia and were aware of sarcopenia's characteristics, consequences, and treatments. Post-hoc comparisons using the Dunnett T3 test showed statistical significance in mean knowledge score and age group (p=0.011) and education level (p≤0.001). The Mann-Whitney test revealed that gender (p=0.026) and current smoking status (p=0.023) significantly influenced knowledge scores. CONCLUSIONS: The general public's knowledge of sarcopenia was found to be poor to moderate and associated with age and education status. Therefore, education and interventions by policymakers and healthcare professionals to improve public knowledge of sarcopenia in Malaysia are needed.

Wearable Two-Dimensional Nanomaterial-Based Flexible Sensors for Blood Pressure Monitoring: A Review.

Flexible sensors have been extensively employed in wearable technologies for physiological monitoring given the technological advancement in recent years. Conventional sensors made of silicon or glass substrates may be limited by their rigid structures, bulkiness, and incapability for continuous monitoring of vital signs, such as blood pressure (BP). Two-dimensional (2D) nanomaterials have received considerable attention in the fabrication of flexible sensors due to their large surface-area-to-volume ratio, high electrical conductivity, cost effectiveness, flexibility, and light weight. This review discusses the transduction mechanisms, namely, piezoelectric, capacitive, piezoresistive, and triboelectric, of flexible sensors. Several 2D nanomaterials used as sensing elements for flexible BP sensors are reviewed in terms of their mechanisms, materials, and sensing performance. Previous works on wearable BP sensors are presented, including epidermal patches, electronic tattoos, and commercialized BP patches. Finally, the challenges and future outlook of this emerging technology are addressed for non-invasive and continuous BP monitoring.

Quality of Life vs. Supportive Care Needs for Oral Cancer Caregivers: Are They Related?

Caregivers providing care for their family members with oral cancer usually endure the caregiving burden in silence, which affects their quality of life and necessitates the need for supportive care. The aim of this study is to determine the relationship between the quality of life (QOL) of oral cancer caregivers and their supportive care needs (SCN) in Malaysia. The Malaysian versions of the Caregiver Oncology Quality of Life Questionnaire (M-CarGOQoL) and the Comprehensive Needs Assessment Tool for Cancer Caregivers (M-CNAT-C) were self-administered by 56 family caregivers of oral cancer patients from five tertiary hospitals throughout Peninsular Malaysia and Sarawak between October and December 2021. Correlation and multiple regression analyses were employed, and the significance level was set at p < 0.05. The mean score for the QOL of caregivers was 76.16 ± 16.01, with the lowest scores in the psychological well-being (64.87 ± 30.12) and self-esteem (68.64 ± 28.29) domains. The mean score for SCN of caregivers was 36.42 ± 24.16, with the highest scores in the healthcare staff (58.44 ± 33.80) and information (55.35 ± 29.98) domains. The correlation between QOL and SCN was moderately inversed, (r(54) = 0.58, p < 0.01). There was a significant effect of caregiving duration (<3 h/day versus >3 h/day) on the combined dependent variables (QOL and SCN), F(2, 53) = 5.006, p < 0.01, partial η2 = 0.16. QOL and caregiving duration accounted for a significant 43% of SCN, R2 = 0.43, adjusted R2 = 0.41, F(2, 53) = 20.32, p < 0.01. In conclusion, oral cancer caregivers with poorer QOL have higher SCN. It is recommended that oral cancer caregivers be recognized by healthcare providers in order to deliver holistic patient care.

High referral accuracy for oral cancers and oral potentially malignant disorders using telemedicine.

OBJECTIVE: To evaluate the accuracy of MeMoSA®, a mobile phone application to review images of oral lesions in identifying oral cancers and oral potentially malignant disorders requiring referral. SUBJECTS AND METHODS: A prospective study of 355 participants, including 280 with oral lesions/variants was conducted. Adults aged ≥18 treated at tertiary referral centres were included. Images of the oral cavity were taken using MeMoSA®. The identification of the presence of lesion/variant and referral decision made using MeMoSA® were compared to clinical oral examination, using kappa statistics for intra-rater agreement. Sensitivity, specificity, concordance and F1 score were computed. Images were reviewed by an off-site specialist and inter-rater agreement was evaluated. Images from sequential clinical visits were compared to evaluate observable changes in the lesions. RESULTS: Kappa values comparing MeMoSA® with clinical oral examination in detecting a lesion and referral decision was 0.604 and 0.892, respectively. Sensitivity and specificity for referral decision were 94.0% and 95.5%. Concordance and F1 score were 94.9% and 93.3%, respectively. Inter-rater agreement for a referral decision was 0.825. Progression or regression of lesions were systematically documented using MeMoSA®. CONCLUSION: Referral decisions made through MeMoSA® is highly comparable to clinical examination demonstrating it is a reliable telemedicine tool to facilitate the identification of high-risk lesions for early management.

The Effectiveness of Benson's Relaxation Technique on Pain and Perceived Stress Among Patients Undergoing Hemodialysis: A Double-Blind, Cluster-Randomized, Active Control Clinical Trial.

Benson's relaxation affects many symptoms among hemodialysis patients. A cluster-randomized active control clinical trial with three repeated measures; pre, 1-week, and 1-month post-intervention sought to evaluate the effectiveness of Benson's Relaxation on pain and perceived stress (P&PS) among hemodialysis patients. Two governmental hospitals were randomly assigned to intervention and control. Thirty-six participants were randomly selected; 18 were intervention, and 18 were controlled. The intervention group performed Benson's Relaxation twice a day for 10 minutes for 8 weeks after a training session. The control group received an educational session about Progressive Relaxation. Findings revealed a statistically significant reduction in the PSS-10 and PRI scores between pre-intervention and 1 month after-intervention (p < .001) and at 1 week after intervention and 1 month after-intervention (p < .001). A non-statistically significant reduction between pre-intervention and 1 week after-intervention (p > .05). Benson's Relaxation significantly relieved P&PS among hemodialysis patients but not after only 1 week of practicing.

Overexpression of gamma glutamyl hydrolase predicts extranodal extension in squamous cell carcinoma of the oral cavity.

OBJECTIVE: Extranodal extension (ENE) is an important prognostic factor in oral squamous cell carcinoma (OSCC). However, ENE is only confirmed postoperatively by histologic assessment of the lymph nodes after neck dissection. Accurate identification of ENE preoperatively would help in management of OSCC. STUDY DESIGN: We determined the expression of molecular markers gamma glutamyl hydrolase (GGH), cyclin-dependent kinase inhibitor-3 (CDKN3), and chromobox homolog-7 (CBX7) using immunohistochemistry in OSCC clinical samples (n = 35). The intensity of staining was scored using a semiquantitative index (HSCORE). The association between clinicopathologic parameters and expression of molecular markers with ENE status was analyzed using chi-square test. RESULTS: The number of positive nodes and the highest anatomic level of nodal involvement significantly correlated with ENE (P < .05). High GGH expression was significantly associated with ENE (P < .05), with an increased risk for ENE (odds ratio [OR] 9.9, 95% CI 1.08-91.47, P = .04), whereas no significant association was seen for CDKN3 and CBX7 expression with ENE. However, a trend toward significance was observed with a high level of CDKN3 and a low level of CBX7 expression with ENE. CONCLUSIONS: Gamma glutamyl hydrolase offers potential as a predictor for ENE in OSCC, whereas the role of CDKN3 and CBX7 need to be validated in a larger sample.

Streptomyces-mediated growth enhancement and Bacterial Panicle Blight disease suppression in rice plants under greenhouse conditions.

Streptomyces corchorusii TKR8, Streptomyces corchorusii JAS2 and Streptomyces misionensis TBS5 were previously obtained from rice fields and have been studied as a biocontrol agent against the causal agent of Bacterial Panicle Blight (BPB) disease on rice, Burkholderia glumae, and rice plant growth promoter. This study evaluated the potential of plant growth-promoting Streptomyces (PGPS) to control B. glumae and promote rice plants' growth under greenhouse conditions. PGPS were further characterized based on their phenotypic and biochemical differences. Multilocus sequence analysis (MLSA) by amplifying gyrB, rpoB and trpB using PCR was conducted to identify the PGPS further. The antimicrobial activity of PGPS against B. glumae was investigated using a survival assay and microscopic analysis. Result indicates that JAS2 (61.2 %) utilized the highest number of carbohydrates tested, followed by TKR8 (53.1 %) and TBS5 (40.8 %) as analyzed using API 50 CH. Based on MLSA analysis of the concatenated partial sequences (1520 bp) from three housekeeping genes, the neighbor-joining tree identified JAS2 and TKR8 as S. corchorusii. Meanwhile, TBS5 as S. misionensis. Antimicrobial activity of PGPS against B. glumae has found that the supernatant of Streptomyces reduced the survival viability of B. glumae up to 50.7-70.3 %. SEM images showed that substantial morphological changes happened in cell membranes of B. glumae after the Streptomyces treatment. The highest vigor index of inoculated seedlings was determined when rice seeds were treated with a spore suspension of 1 × 107 spore/mL (for JAS2 and TKR8) and 1 × 106 spore/mL (for TBS5). Under greenhouse conditions, Streptomyces-treated plants showed improvement in rice plants' growth and grain yield and reduced the BPB disease severity. Results suggest that the S. corchorusii TKR8, S. corchorusii JAS2 and S. misionensis TBS5 should be promoted as biocontrol agents against B. glumae and bioformulations for rice crops.

Prognostic Abilities of Pre- and Post-Treatment Inflammatory Markers in Oral Squamous Cell Carcinoma: Stepwise Modelling.

Background and Objectives: Studies examining the importance of inflammatory markers before treatment as prognosticators of OSCC are available, but information on post-therapy inflammatory markers and their prognostic significance is limited. This study aimed to evaluate the prognostic abilities of pre- and post-treatment inflammatory markers in patients with OSCC. Materials and Methods: In this retrospective analysis, information on 151 OSCC patients' socio-demographic, clinico-pathological, recurrence, metastasis, and survival data were gathered from clinical records. A multivariable Cox proportional hazards regression (stepwise model) was conducted to identify the prognostic predictors of OS and DFS. The multivariable models' performances were evaluated using Harrell's concordance statistics. Results: For OS, high pre-treatment LMR (HR 3.06, 95%CI 1.56, 5.99), and high post-treatment PLC (HR 3.35, 95%CI 1.71, 6.54) and PLR (HR 5.26, 95%CI 2.62, 10.58) were indicative of a poor prognosis. For DFS, high pre-treatment SII (HR 2.59, 95%CI 1.50, 4.48) and high post-treatment PLC (HR 1.92, 95%CI 1.11, 3.32) and PLR (HR 3.44, 95%CI 1.98, 5.07) were associated with increased mortality. The fitness of the OS and DFS stepwise Cox regression models were proven with a time-dependent AUC of 0.8787 and 0.8502, respectively. Conclusions: High pre-treatment levels of LMR and SII and high post-treatment levels of PLC and PLR are independent predictors of a poor prognosis for patients with OSCC.

Recent Advances in Non-Invasive Blood Pressure Monitoring and Prediction Using a Machine Learning Approach.

Blood pressure (BP) monitoring can be performed either invasively via arterial catheterization or non-invasively through a cuff sphygmomanometer. However, for conscious individuals, traditional cuff-based BP monitoring devices are often uncomfortable, intermittent, and impractical for frequent measurements. Continuous and non-invasive BP (NIBP) monitoring is currently gaining attention in the human health monitoring area due to its promising potentials in assessing the health status of an individual, enabled by machine learning (ML), for various purposes such as early prediction of disease and intervention treatment. This review presents the development of a non-invasive BP measuring tool called sphygmomanometer in brief, summarizes state-of-the-art NIBP sensors, and identifies extended works on continuous NIBP monitoring using commercial devices. Moreover, the NIBP predictive techniques including pulse arrival time, pulse transit time, pulse wave velocity, and ML are elaborated on the basis of bio-signals acquisition from these sensors. Additionally, the different BP values (systolic BP, diastolic BP, mean arterial pressure) of the various ML models adopted in several reported studies are compared in terms of the international validation standards developed by the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS) for clinically-approved BP monitors. Finally, several challenges and possible solutions for the implementation and realization of continuous NIBP technology are addressed.

Evaluating the Change Process of a Brief Cognitive Behavior Therapy Workshop for Psychological Distress Among Primary Care Self-Referrals in Selangor, Malaysia.

Despite the high prevalence of psychological distress in primary care, only a limited number of individuals can benefit from early and evidenced-based psychological approach. Barriers to help-seeking attributable to stigma, lack of proper care pathway to evidence-based psychological interventions, and a high volume of primary care attendees are among the factors that contribute to the inadequate psychological treatments. This study examined the implementation of a change process using a brief cognitive behavioral therapy (b-CBT) workshop as a potential approach in managing psychological distress among 73 primary care self-referrals using purposive sampling. One-way repeated-measures multivariate analysis of variance (ANOVA) was used to analyze changes in psychological distress within a non-randomized quasi-experimental study. Results revealed significant differences in psychological distress using Depression, Anxiety, and Stress Scale-21 items at three time points (pre-intervention, post-intervention, and 1-month follow-up). Implementation of the b-CBT workshop showed positive changes for psychological distress, suggesting the possibility of integrating brief, non-stigmatized, and evidence-based psychological approach at the primary care level. However, the self-referral characteristics of the attendees remain unknown. Factors such as potential feasibility, participant's usability and satisfaction, and implementation of b-CBT workshop to improve psychological distress are discussed in this study.

First report of Burkholderia gladioli causing bacterial panicle blight of rice in Malaysia.

Rice (Oryza sativa) is a staple food for most of the world's populations, particularly in Asia (Gumma et al. 2011). The rice sector provides Malaysians with a food supply, food sufficiency, and income for growers (Man et al. 2009). From January to February 2022, panicle samples showing symptoms of bacterial panicle blight (BPB) disease, including reddish-brown, linear lesions with indistinct margins on flag-leaf sheaths and blighted, upright, grayish straw-colored florets with sterile and aborted grains on panicles were collected in granary areas in Sekinchan, Selangor, Malaysia with 90% disease incidence in fields. Surface-sterilization of infected leaf tissue was performed using 75% ethanol and 1% sodium hypochlorite, followed by rinsing three times in sterilized water. Leaf tissue was macerated in sterilized water and aliquots were spread on King's B agar medium, then cultured for 24 h to 48 h at 35 °C. All isolated bacteria were Gram-negative rods, positive for catalase and gelatinase but negative for indole, oxidase and hydrogen sulfide (H2S), and utilized sucrose, inositol, mannitol, glucose, and citrate. Colonies were circular and smooth-margined, producing a diffusible yellowish-green pigment on King's B agar medium, which are characteristics of Burkholderia species (Keith et al. 2005). Five representative isolates (UPMBG7, UPMBG8, UPMBG9, UPMBG15, UPMBG17) were selected for molecular and pathogenicity tests. PCR using specific primers targeting the gyrB gene for molecular characterization was performed, and the ∼470 bp amplicons were sequenced (Maeda et al. 2006) and deposited in GenBank (OM824438 to OM824442). A BLASTn analysis revealed that the five isolates were 99% identical to the B. gladioli reference strains MAFF 302533, GRBB15041, and LMG19584 in GenBank (AB190628, KX638432, and AB220898). A phylogenetic tree using Maximum-likelihood analysis of the gyrB gene sequences showed that the five isolates were 99% identical to B. gladioli reference strains (AB190628, KX638432, and AB220898). To verify the identification of these isolates, the 16S rDNA gene was amplified using 16SF/16SR primers (Ramachandran et al. 2021), producing ~1,400 bp amplicons. The resulting sequences of the five isolates (OM869953 to OM869957) were 98% identical to the reference strains of B. gladioli (NR113629 and NR117553). To confirm pathogenicity, 10 ml suspensions of the five isolates at of 108 CFU/ml were inoculated into the panicles and crowns of 75-day-old rice seedlings of local rice varieties MR269 and MR219 grown in a glasshouse with temperatures ranging from 37 °C to 41 °C (Nandakumar et al. 2009). Control rice seedlings were inoculated with sterilized water. All isolates produced BPB disease symptoms like those originally found in the rice fields at four weeks after inoculation. Control seedlings remained asymptomatic. To fulfill Koch's postulates, the bacteria were reisolated from symptomatic panicles and were confirmed as B. gladioli by sequence analysis of the gyrB and 16S rDNA genes. To our knowledge, this is the first report of B. gladioli causing BPB disease of rice in Malaysia. Since BPB disease causes a significant threat to the rice industry, it is crucial to investigate the diversity of this destructive pathogen for effective disease management strategies in Malaysia.

Do Clear Cell Changes in Oral Squamous Cell Carcinoma Warrant It Being Recognised as a Variant?

Histological variants of oral squamous cell carcinoma (OSCC) include verrucous, basaloid, spindle cell, adenosquamous, papillary, and acantholytic types. Clear-cell changes in OSCC are rare. We report a case of a 65-year-old male Chinese patient who presented with a swelling in the lower-left mandible for three weeks, causing ill-fitting of his lower denture and an ulcer on the floor of the mouth. Histologically, the lesion showed a dense proliferation of malignant tumor cells arranged in islands and sheets consisting of squamoid cells intermixed with signet ring-shaped clear cells. The clear cells were negative for mucicarmine, periodic acid Schiff (PAS), periodic acid Schiff-diastase (PAS-D), and alcian blue (AB). Immunohistochemistry showed the tumor cells were immuno-positive for cytokeratin (CK) and p63, but CK7, CK20, and S100 were immuno-negative. Therefore, a metastatic tumor in the oral cavity was suggested. However, the CT scan did not show any primary tumors in other sites. Histopathologically, the surgical specimen showed signet-ring-shaped clear cells in the stroma with squamoid cells invading the underlying connective tissue from the surface epithelium, suggesting a diagnosis of clear cell changes in OSCC. Follow-up showed recurrent OSCC at the base of the tongue with lymph node metastasis and distant metastasis in the lung. Only a few cases of clear-cell changes have been reported, with most having a poor prognosis. This case report adds one more case of clear cell changes in the OSCC with a poor prognosis. We reviewed the literature to understand their clinical behavior. Due to the rarity of its (clear cell changes) occurrence, further research is required in order to obtain a better understanding of the clinical behavior and prognosis of these clear cell changes seen in OSCC.