Microballoons: Osmotically-inflated elastomer shells for ultrafast release of encapsulants and mechanical energy.

HYPOTHESIS: Microcapsules with osmotically-inflated elastic shells exhibit an ultrafast release of encapsulants while mechanically stimulating the microenvironments, akin to popping balloons. EXPERIMENTS: To prepare elastic shells with uniform thickness and size, monodisperse water-in-oil-in-water (W/O/W) double-emulsion drops are produced in a capillary microfluidic device. The polydimethylsiloxane (PDMS)-containing oil phase is thermally cured to create the elastic shell. The elastic shells are inflated by pumping water into the lumen in hypotonic conditions. The inflated microcapsules produced undergo mechanical compression, and their release properties are studied. FINDINGS: By controlling the osmotic pressure difference, Microballoons are inflated into a diameter of 200 µm - 316 µm and shell thickness of 7.8 µm - 0.7 µm, respectively. The inflated shell pops due to mechanical failure when subjected to mechanical stress above a certain threshold, resembling a balloon. During popping, the stretched shell rapidly retracts to the original uninflated state, resulting in an ultrafast release of encapsulants from the lumen within a millisecond. This process converts elastic potential energy stored in the shell into mechanical energy with substantial power. The microballoons mechanically stimulate the local environment, leading to the direct and rapid release of encapsulants. This has the potential to improve absorption efficiency.

Unveiling the mechanism of high sugar diet induced advanced glycosylation end products damage skin structure via extracellular matrix-receptor interaction pathway.

BACKGROUND: AGEs accumulate in the skin as a result of a high-sugar diet and play an important role in the skin aging process. OBJECTIVES: The aim of this study was to characterize the mechanism underlying the effect of a high-sugar diet on skin aging damage at a holistic level. METHODS: We established a high-sugar diet mouse model to compare and analyze differences in physiological indexes. The effect of a high-sugar diet on skin aging damage was analyzed by means of a transcriptome study and staining of pathological sections. Furthermore, the differences in the protein expression of AGEs and ECM components between the HSD and control groups were further verified by immunohistochemistry. RESULTS: The skin in the HSD group mice tended toward a red, yellow, dark, and deep color. In addition, the epidermis was irregular with anomalous phenomena, the epidermis was thinned, and the dermis lost its normal structure and showed vacuolated changes. Transcriptomics results revealed significant downregulation of the ECM-receptor interaction pathway, significant upregulation of the expression of AGEs and significant downregulation of the expression levels of COLI, FN1, LM5, and TNC, among others ECM proteins and ECM receptors. CONCLUSIONS: High-sugar diets cause skin aging damage by inducing the accumulation of AGEs, disrupting the expression of ECM proteins and their receptors, and downregulating the ECM-receptor interaction pathway, which affects cellular behavioral functions such as cell proliferation, migration, and adhesion, as well as normal skin tissue structure.

Endoplasmic reticulum stress in skin aging induced by UVB.

Aging is a normal and complex biological process. Skin is located in the most superficial layer of the body, and its degree of aging directly reflects the aging level of the body. Endoplasmic reticulum stress refers to the aggregation of unfolded or misfolded proteins in the endoplasmic reticulum and the disruption of the calcium ion balance when cells are stimulated by external stimuli. Mild endoplasmic reticulum stress can cause a series of protective mechanisms, including the unfolded protein response, while sustained high intensity stimulation leads to endoplasmic reticulum stress and eventually apoptosis. Photoaging caused by ultraviolet radiation is an important stimulus in skin aging. Many studies have focused on oxidative stress, but increasing evidence shows that endoplasmic reticulum stress plays an important role in photoaging. This paper reviews the development and mechanism of endoplasmic reticulum stress (ERS) in skin photoaging, and provides research directions for targeting the ERS pathway to slow aging.

Active Ingredients of Schisandra chinensis Fruit Oil and their Effect on Propionibacterium acnes-Induced Inflammation in HaCaT Cells.

BACKGROUND: Propionibacterium acnes causes upregulation of inflammatory factors, such as cycloxygenase-2, prostaglandin E2, interleukin-1ß, and tumor necrosis factor-alpha, increased levels of reactive oxygen species (ROS) and inward flow of calcium ions. This causes increased levels of the antimicrobial peptide LL-37 and inflammation of the skin, leading to redness, swelling, itching and other symptoms. Schisandra chinensis fruit oil (SCO) is rich in lignan active ingredients with various antioxidant and anti-inflammatory properties. METHODS: In this study, SCO is obtained by supercritical CO2 fluid extraction. SCO's anti-inflammatory actions were investigated using P. acnes-induced inflammation HaCaT cells model. A method based on reversed-phase high-pressure liquid chromatography with a diode array detector was developed and validated for the simultaneous detection of five lignan components. Levels of inflammatory factors and LL-37 were measured by ELISA kit and western blot respectively. Ca2+ and ROS levels detected by flow cytometry. RESULTS: The experimental results show that the contents of schisanol A, schisanol B, schisanin A, schisanin B, and schisanin C were 33.89 ± 0.24, 14.89 ± 0.45, 8.92 ± 0.02, 29.14 ± 0.67, and 4.74 ± 0.09 mg/g, respectively. Studies have demonstrated that SCO can alleviate skin inflammation by inhibiting the COX-2/PGE2 and NF-κB signalling pathway. In addition, SCO can inhibit ROS production, significantly block inward Ca2+ flow, alleviate cell damage, and modulate the content of the antimicrobial peptide LL-37. CONCLUSIONS: In summary, our study elucidated the anti-inflammatory activity of SCO in a cell model and provided a scientific basis for its application as a raw material in skin care.

Acne and its post-inflammatory hyperpigmentation treatment by applying anti-acne dissolving microneedle patches.

OBJECTIVE: Acne is a significant problem in young people. At present, most acne treatment products are topically applied cosmetics, whose efficacy is limited by the stratum corneum. The dissolving microneedle technique can effectively deliver drug molecules into the body. In this study, dissolving microneedles containing anti-acne ingredients were tested for human efficacy and safety. METHODS: We conducted a 28-day clinical efficacy and safety trial on 30 individuals with visible facial acne. During the trial, anti-acne microneedle (AA-DMN) patches were applied to designated skin areas once daily for 28 consecutive days. Skin pigmentation was measured using a Courage + Khazaka skin melanin and hemoglobin test probe Mexameter MX18. Acne volume was measured using a Canfieldsci skin rapid optical imaging system PRIMOS. In addition, skin irritation was evaluated via self-report and dermatologist's examination. RESULTS: The AA-DMN patches showed good efficacy including improvement of skin pigmentation and reduced acne volume. Acne volume was reduced by 12.34% after 3 days of patch use and further reduced by 10.01% after 7 continuous days of use. After 28 days of treatment, skin melanin decreased by 5.88% and heme decreased by 7.83%. No adverse reactions were observed in any of the participants. CONCLUSIONS: Anti-acne microneedle patches showed an excellent effect in reducing acne and post-inflammatory hyperpigmentation (PIH), without adverse skin reactions. The novel AA-DMN patch is a safe and effective anti-acne treatment.

Investigating Psychological Differences Between Nurses and Other Health Care Workers From the Asia-Pacific Region During the Early Phase of COVID-19: Machine Learning Approach.

BACKGROUND: As the COVID-19 pandemic evolves, challenges in frontline work continue to impose a significant psychological impact on nurses. However, there is a lack of data on how nurses fared compared to other health care workers in the Asia-Pacific region. OBJECTIVE: This study aims to investigate (1) the psychological outcome characteristics of nurses in different Asia-Pacific countries and (2) psychological differences between nurses, doctors, and nonmedical health care workers. METHODS: Exploratory data analysis and visualization were conducted on the data collected through surveys. A machine learning modeling approach was adopted to further discern the key psychological characteristics differentiating nurses from other health care workers. Decision tree-based machine learning models (Light Gradient Boosting Machine, GradientBoost, and RandomForest) were built to predict whether a set of psychological distress characteristics (ie, depression, anxiety, stress, intrusion, avoidance, and hyperarousal) belong to a nurse. Shapley Additive Explanation (SHAP) values were extracted to identify the prominent characteristics of each of these models. The common prominent characteristic among these models is akin to the most distinctive psychological characteristic that differentiates nurses from other health care workers. RESULTS: Nurses had relatively higher percentages of having normal or unchanged psychological distress symptoms relative to other health care workers (n=233-260 [86.0%-95.9%] vs n=187-199 [74.8%-91.7%]). Among those without psychological symptoms, nurses constituted a higher proportion than doctors and nonmedical health care workers (n=194 [40.2%], n=142 [29.5%], and n=146 [30.3%], respectively). Nurses in Vietnam showed the highest level of depression, stress, intrusion, avoidance, and hyperarousal symptoms compared to those in Singapore, Malaysia, and Indonesia. Nurses in Singapore had the highest level of anxiety. In addition, nurses had the lowest level of stress, which is the most distinctive psychological outcome characteristic derived from machine learning models, compared to other health care workers. Data for India were excluded from the analysis due to the differing psychological response pattern observed in nurses in India. A large number of female nurses emigrating from South India could not have psychologically coped well without the support from family members while living alone in other states. CONCLUSIONS: Nurses were least psychologically affected compared to doctors and other health care workers. Different contexts, cultures, and points in the pandemic curve may have contributed to differing patterns of psychological outcomes amongst nurses in various Asia-Pacific countries. It is important that all health care workers practice self-care and render peer support to bolster psychological resilience for effective coping. In addition, this study also demonstrated the potential use of decision tree-based machine learning models and SHAP value plots in identifying contributing factors of sophisticated problems in the health care industry.

Osmosis-Mediated Microfluidic Production of Submillimeter-Sized Capsules with an Ultrathin Shell for Cosmetic Applications.

There is a demand for submillimeter-sized capsules with an ultrathin shell with high visibility and no tactile sensation after release for cosmetic applications. However, neither bulk emulsification nor droplet microfluidics can directly produce such capsules in a controlled manner. Herein, we report the microfluidic production of submillimeter-sized capsules with a spacious lumen and ultrathin biodegradable shell through osmotic inflation of water-in-oil-in-water (W/O/W) double-emulsion drops. Monodisperse double-emulsion drops are produced with a capillary microfluidic device to have an organic solution of poly(lactic-co-glycolic acid) (PLGA) in the middle oil layer. Hypotonic conditions inflate the drops, leading to core volume expansion and oil-layer thickness reduction. Afterward, the oil layer is consolidated to the PLGA shell through solvent evaporation. The degree of inflation is controllable with the osmotic pressure. With a strong hypotonic condition, the capsule radius increases up to 330 µm and the shell thickness decreases to 1 µm so that the ratio of the thickness to radius is as small as 0.006. The large capsules with an ultrathin shell readily release their encapsulant under an external force by shell rupture. In the mechanical test of single capsules, the threshold strain for shell rupture is reduced from 75 to 12%, and the threshold stress is decreased by two orders for highly inflated capsules in comparison with noninflated ones. During the shell rupture, the tactile sensation of capsules gradually disappears as the capsules lose volume and the residual shells are ultrathin.

Impact of polyphenols extracted from Tricholoma matsutake on UVB-induced photoaging in mouse skin.

BACKGROUND: Despite Tricholoma matsutake has been used as natural health products with multiple medicinal properties, detailed information about its polyphenolic composition as sources of anti-photoaging agents remains to be determined. OBJECTIVE: To investigate the impact of polyphenols extracted from Tricholoma matsutake (TME) on Ultraviolet B (UVB)-induced skin photoaging. MATERIALS AND METHODS: Various factors of oxidative stress and inflammation as well as histological and immunohistochemical analysis in the mouse dorsal skin were determined after UVB radiation. RESULTS: Topical administration with TME suppressed the UVB-induced skin thickness, wrinkles and erythema, and increased skin collagen content. Furthermore, TME decreased reactive oxygen species (ROS) level, upregulated glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and glucose-6-phosphate dehydrogenase (G6PDH) activities and inhibited the expression of IL-1, IL-6, IL-8, and TNF-α in mice irradiated with UVB. TME could reduce UVB-induced p38 mitogen-activated protein kinase (p38 MAPK) phosphorylation and effectively inhibited the activity of the transcriptional factor nuclear factor-kappa B (NF-κB), thereby reducing the cyclooxygenase-2 (COX-2) expression, which is an important mediator of inflammatory cascade leading to the inflammatory response. CONCLUSION: Our data demonstrated that TME had various beneficial effects on UVB-induced skin photoaging due to its antioxidant and anti-inflammatory activities, and it might be exploited as a promising natural product in skin care, anti-photoaging and the therapeutic intervention of skin disorders related to both oxidative stress and inflammation.

Improvement of Skin Barrier Dysfunction by Phenolic-containing Extracts of Lycium barbarum via Nrf2/HO-1 Regulation.

Lycium barbarum have received an increasing popularity due to its powerful biological activity and medicinal use. However, the effect of Lycium barbarum on skin remains largely uncharacterized. The general purpose of this paper was to characterize the phenolic compounds in Lycium barbarum extract (LBE) using LC-HRMS/QTOF method and to investigate whether topical administration of LBE can repair skin barrier dysfunction in mice. Our data demonstrated that LBE could not only decrease ROS level and matrix metalloproteinase expression, but also strengthen intrinsic antioxidant defense system including SOD, GSH-Px and CAT, thereby resulting in increased skin collagen content and an improvement of UV-induced skin erythema, thickness and wrinkles. Improved skin barrier functions were highly correlated with increased expression of filaggrin, involucrin and loricrin as well as antioxidant proteins such as Nrf2 and HO-1 in UV-irradiated mice, suggesting that LBE may be promising natural products at a lower cost for the topical application in the treatment of skin diseases with defective barrier function.

Efficacy and safety testing of dissolving microarray patches in Chinese subjects.

OBJECTIVES: There is a lack of clinical research in the Chinese market concerning dissolving microarray (DMA) patches in cosmetic applications. In this study, the clinical efficacy and safety tests of DMA patch technology were performed on Chinese consumers. METHODS: A 4-week clinical efficacy and safety evaluation was conducted on 30 Chinese female subjects with crow's feet and eye bags. DMA patches loaded with hyaluronic acid (HA-DMA) were applied under the eyes and corners of the eyes of the subjects three times a week over four consecutive weeks. Skin firmness and dermal layer strength were measured using ultrasound, and changes in skin wrinkles were detected using VISIA-CR and Primos Lite. Eye bag ratings were evaluated by professional dermatologists based on the 0-6 grades of eye bags in the "Skin Aging Atlas Volume 2: Asian Type." RESULTS: HA-DMA patches produced good clinical improvements on both crow's feet and eye bags in the study participants. HA-DMA effectively increased skin firmness while reducing the number, area, and volume of crow's feet, along with reducing eye bag ratings. The reductions in all metrics were statistically significant with positive effects evident in as little as 1 week of treatment. There were no adverse effects related to the treatments observed during the test period. CONCLUSIONS: In a clinical efficacy trial of 30 Chinese female subjects, HA-DMA showed excellent therapeutic benefits without adverse effects while reducing crow's feet and eye bags. HA-DMA is expected to be a safe, effective, and novel cosmetic for improving the appearance of aging skin.

Randomised, controlled trial of erenumab for the prevention of episodic migraine in patients from Asia, the Middle East, and Latin America: The EMPOwER study.

OBJECTIVE: EMPOwER, a double-blind, randomised, phase 3 study, evaluated the efficacy and safety of erenumab in adults with episodic migraine from Asia, the Middle East, and Latin America. METHODS: Randomised patients (N = 900) received monthly subcutaneous injections of placebo, erenumab 70 mg, or 140 mg (3:3:2) for 3 months. Primary endpoint was change from baseline in monthly migraine days at Month 3. Other endpoints included achievement of ≥50%, ≥75%, and 100% reduction in monthly migraine days, change in monthly acute migraine-specific medication treatment days, patient-reported outcomes, and safety assessment. RESULTS: At baseline, mean (standard deviation) age was 37.5 (9.9) years, 81.9% were women, and monthly migraine days was 8.2 (2.8). At Month 3, change from baseline in monthly migraine days (primary endpoint) was -3.1, -4.2, and -4.8 days for placebo, erenumab 70 mg, and erenumab 140 mg, respectively, with a statistically significant difference for erenumab versus placebo (P = 0.002 [70 mg], P < 0.001 [140 mg]). Both erenumab doses were also significantly superior to placebo on all secondary endpoints, including the proportion of patients achieving ≥50% reduction from baseline in monthly migraine days, change from baseline in monthly acute migraine-specific medication treatment days and change from baseline in the Headache Impact Test-6™ scores. The safety profile of erenumab was comparable with placebo; no new safety signals were observed. CONCLUSIONS: This study of erenumab in patients with episodic migraine from Asia, the Middle East, and Latin America met all primary and secondary endpoints. A consistent numerical benefit was observed with erenumab 140 mg versus erenumab 70 mg across all efficacy endpoints. These findings extend evidence of erenumab's efficacy and safety to patients under-represented in previous trials.ClinicalTrials.gov identifier: NCT03333109.

Elaeagnus L gum polysaccharides alleviate the impairment of barrier function in the dry skin model mice.

BACKGROUND: Dry skin is a common skin condition caused by reduction of water-holding capacity, which is regulated by skin barrier function. Dry skin can also be a symptom that indicates a more serious diagnosis. There are a number of moisturizers on the market, which play an important role in dermatologic and cosmetic therapies. However, the demand for these products with good and therapeutic efficiency is still growing. AIMS: It remains necessary to investigate the effects of Elaeagnus L gum polysaccharides (EAP), which are prepared from gum of Elaeagnus angustifolia L. on the epidermal permeability barrier function and their possible underlying mechanisms. PATIENTS/METHODS: EAP were purified, analyzed, and tested on human keratinocyte cell line (HaCaT) and then on the skin in vivo to evaluate their antiinflammatory activities and their impacts on impaired skin barrier function. RESULTS: Histological analyses revealed that topical administration with EAP effectively attenuated dryness-like skin condition, including less percutaneous water loss rate, less infiltrate inflammation cells, and less epidermal thickening. Moreover, EAP inhibited the production of various inflammatory mediators and increased AQP-3, FLG, and LOR expression. CONCLUSION: Our results indicated that EAP enhances epidermal permeability barrier function, and they can be used as a promising adjuvant agent in skin care cosmetics and in treating some skin disorders characterized by cutaneous inflammation and abnormal barrier function.

Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers. AIMS: In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes. METHOD: From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country. RESULTS: A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries. CONCLUSIONS: This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.

Acute Ischaemic Stroke Successfully Treated with Thrombolytic Therapy and Endovascular Thrombectomy with Non-Contrast Computed Tomography and Computed Tomography Angiogram Protocol.

Early endovascular thrombectomy leads to improved outcomes for patients with proximal occlusions when started within 6 h from onset of symptoms. We present a case illustrating the flow of events for a patient who underwent endovascular thrombectomy in our centre after conventional imaging - a brain non-contrast computed tomography (NCCT) and CT angiogram (CTA) - achieving a door-to-groin time of 195 min. The patient is a 65-year-old who presented with signs and symptoms of a left middle cerebral artery (MCA) territory infarct. His National Institute of Health Stroke Scale (NIHSS) score was 15 on presentation and his brain NCCT showed an Alberta Stroke Programme Early CT Score (ASPECTS) of 8. His CTA showed a left MCA distal M1 occlusion with focal calcification and stenosis of the proximal left internal carotid artery. He was subsequently thrombosed and underwent thrombectomy successfully, with a door-to-groin-puncture time of 195 min. A TICI 2b reperfusion was achieved. His NIHSS score improved to 9 over the next 2 days. For cases with straightforward NCCT and CTA with no contraindications, endovascular thrombectomy should be pursued without delay. A review of the current available literature for the usage of NCCT and CTA as well as the importance of ASPECTS scoring in patient selection for endovascular thrombectomy was included.

Mechanical Thrombectomy for Life-Threatening Cerebral Venous Thrombosis: A Case Report.

Cerebral venous thrombosis (CVT) is a rare cause of stroke worldwide with a wide range of clinical presentations. Anticoagulation therapy has been regarded as the first line of management of CVT to prevent the progression of thrombosis and to re-establish the venous flow. We present a case of severe CVT who did not respond to conventional anticoagulation therapy but responded well to mechanical thrombectomy (MT). This report highlights the features of CVT to consider for early MT.

Cough-Induced Extracranial Internal Carotid Artery Dissection.

BACKGROUND: Coughing due to respiratory tract infections may lead to internal carotid artery (ICA) dissection. AIM: We are presenting a patient with an unusual cough-induced ICA dissection. CASE REPORT: A 42-year-old health care worker presented with bilateral hand numbness which resolved spontaneously. This initial episode was followed 9 days later with intermittent episodes of right hand and leg weakness with speech difficulty. Two days later, he had another episode of speech difficulty. One week prior to the first presentation, he had upper respiratory tract infection with ongoing strong bouts of coughing. Magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) of the brain showed early ischaemic changes at the left frontal and left parietal regions. MR angiography (MRA) showed high signal intensity at the left proximal ICA and poor flow beyond the left carotid bulb. Cerebral angiography revealed left ICA dissection. CONCLUSION: Proper identification of cough-induced extracranial ICA dissection is important because this is treatable.

Fucoidan from Undaria pinnatifida Ameliorates Epidermal Barrier Disruption via Keratinocyte Differentiation and CaSR Level Regulation.

The epidermal barrier acts as a line of defense against external agents as well as helps to maintain body homeostasis. The calcium concentration gradient across the epidermal barrier is closely related to the proliferation and differentiation of keratinocytes (KCs), and the regulation of these two processes is the key to the repair of epidermal barrier disruption. In the present study, we found that fucoidan from Undaria pinnatifida (UPF) could promote the repair of epidermal barrier disruption in mice. The mechanistic study demonstrated that UPF could promote HaCaT cell differentiation under low calcium condition by up-regulating the expression of calcium-sensing receptor (CaSR), which could then lead to the activation of the Catenin/PLCγ1 pathway. Further, UPF could increase the expression of CaSR through activate the ERK and p38 pathway. These findings reveal the molecular mechanism of UPF in the repair of the epidermal barrier and provide a basis for the development of UPF into an agent for the repair of epidermal barrier repair.

Association between non-alcoholic fatty liver disease evaluated by transient elastography with extracranial carotid atherosclerosis in a multiethnic Asian community.

BACKGROUND AND AIM: There is not much data on the association between non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis assessed using Fibroscan with carotid intima-media thickness (CIMT) in the general population. The objective of this study was to evaluate the association between NAFLD and advanced fibrosis, as diagnosed by Fibroscan, with an increased CIMT in the Malaysian population. METHODS: A cross-sectional study of government officers and their family members attending a health screening at a public healthcare facility was conducted. All subjects underwent clinical evaluation, biochemical testing, anthropometry, ultrasound carotid Doppler, and Fibroscan examination. RESULTS: Data for 251 subjects were analyzed (mean age 47.1 ± 12.4 years, 74.1% male). Prevalence of NAFLD and advanced fibrosis were 57.4 and 17.5%, respectively. Independent factors associated with NAFLD were waist circumference (odds ratio [OR] = 1.077, 95% confidence interval [CI] 1.038-1.118, P < 0.001) and serum alanine aminotransferase (ALT) (OR = 1.039, 95% CI 1.005-1.074, P = 0.024). Independent factors associated with advanced fibrosis were male gender (OR = 4.847, 95% CI 1.369-17.155, P = 0.014) and serum aspartate aminotransferase (AST) (OR = 1.057, 95% CI 1.003-1.113, P = 0.036). Prevalence of increased CIMT was 29.0%. Independent factor associated with increased CIMT was older age (OR = 1.146, 95% CI 1.067-1.231, P < 0.001). Of the subjects, 34.5% with NAFLD had increased CIMT compared to 19.1% of the subjects without NAFLD (P = 0.063). Advanced fibrosis was not associated with increased CIMT. CONCLUSIONS: Prevalence of NAFLD, advanced liver fibrosis, and increased CIMT were high. NAFLD and advanced liver fibrosis appeared not to be associated with increased CIMT. However, a larger sample size is needed to demonstrate whether there is any association.

Prevalence of extracranial carotid atherosclerosis in the patients with coronary artery disease in a tertiary hospital in Malaysia.

There is limited information regarding the prevalence of extracranial carotid atherosclerosis in the patients with coronary artery disease (CAD) undergoing coronary artery bypass graft (CABG) surgery in South East Asia. The primary objective was to assess the prevalence of extracranial carotid stenosis, raised carotid intima media thickness (CIMT), and plaques in the patients with CAD undergoing elective CABG. The secondary objective was to evaluate the risk factors for extracranial carotid atherosclerosis.A total of 119 consecutive patients with CAD undergoing elective CABG in a tertiary hospital in Malaysia were recruited. Data on the demographic characteristics and risk factors were collected. The ultrasound carotid Doppler findings comprising of raised CIMT, plaques, and stenosis in the extracranial carotid vessels were recorded.The mean age of the patients was 64.26 ±â€Š10.12 (range 42-89). Most of the patients were men (73.1%). The patients consisted of 44 (37%) Malays, 26 (21.8%) Chinese, and 49 (41.2%) Indians.A total of 67 (56.3%) patients had raised CIMT, 89 (74.8%) patients had plaques, and 10 (8.4%) patients had stenosis in the internal and common carotid arteries. The mean age of patients with plaques was higher compared to those without plaques (66.00 ±â€Š9.63 vs 59.10 ±â€Š9.92, P = .001). The body mass index (BMI) of patients with stenosis was higher compared to those without stenosis (28.35 ±â€Š4.92 vs 25.75 ±â€Š3.16, P = .02).The patients with plaques were more likely to be older, whereas the patients with carotid stenosis were more likely to have higher BMI.

Geographical Differences in Trigger Factors of Tension-Type Headaches and Migraines.

In this review, we discussed the types and frequencies of trigger factors of primary headache [migraine and tension-type headache (TTH)] among adult patients. We assessed the influence of geographical location, ethnicity and gender on the various trigger factors of a migraine and a TTH. We also evaluated the trigger factors among the multi-ethnic Southeast Asian adult patients. In a recent study, odor triggered more migrainous headaches compared to the other primary headaches. Odor was observed to be specific of migraines. Moreover, stress is one of the most common trigger factors for patients with migraines and TTHs worldwide. Migrainous patients have an increased sensitivity in comparison to non-migrainous patients. Furthermore, these patients have much difficulty in adapting to the high level of sensitivity, and the sensitized brain is therefore more vulnerable to trigger factors. In addition, the presence of one trigger factor may increase the exposure of other trigger factors. This phenomenon is more marked in the patients with migraines who have stress and menstruation as triggers, predisposing them to be more sensitive to other triggers. In conclusion, the geographical location factor has an influence on the trigger factors of headaches. Ethnicity may have an effect due to the cultural differences. Change in weather and sunlight are important commonly identified trigger factors for headaches. Moreover, gender differences in some trigger factors are present among the patients with headaches, especially sunlight and sleep deprivation. More research studies can be conducted to have a better understanding on trigger factors in the future. This will enable proper identification of trigger factors, leading to a decrease in the number of headache episodes and an improvement in quality of life for patients.