An optimal de Quervain's tenosynovitis splint with ergonomic thumb support and evenly distributed pressure.

Splinting is a conventional treatment for de Quervain's tenosynovitis (dQt). However, existing splints have problems such as excessive thermal discomfort and poor fit, which have been pointed out in previous studies. This study proposes a new functional splint consisting of both hard and soft materials with the aim of providing wear comfort with a good fit and sufficient stability of the injured hand. Thumb support of the splint is an important component that controls and protects the affected thumb. To develop an ergonomically shaped thumb support, 16 participants with dQt were recruited for three-dimensional (3D) scanning of their hands. The angles of the wrist and the curvature of the thumb were measured using computer software, and the results were used as a reference for the design of the prototype supports. Excessive pressure on particular regions, such as bony areas, may cause discomfort or pain. To ensure the wear comfort of the proposed splint, a finite element model (FEM) was built to simulate the wear process of the splint and hence to predict the pressure distribution exerted from the splint onto the hand of the wearer. The simulated results show that the pressure is evenly distributed over the hand, indicating that patients are likely to wear the proposed splint comfortably during their treatment period.

Label-free sensing of exosomal MCT1 and CD147 for tracking metabolic reprogramming and malignant progression in glioma.

Malignant glioma is a fatal brain tumor whose pathological progression is closely associated with glycolytic reprogramming, leading to the high expression of monocarboxylate transporter 1 (MCT1) and its ancillary protein, cluster of differentiation 147 (CD147) for enhancing lactate efflux. In particular, malignant glioma cells (GMs) release tremendous number of exosomes, nanovesicles of 30 to 200 nm in size, promoting tumor progression by the transport of pro-oncogenic molecules to neighboring cells. In the present study, we found that hypoxia-induced malignant GMs strongly enhanced MCT1 and CD147 expression, playing a crucial role in promoting calcium-dependent exosome release. Furthermore, it was first identified that hypoxic GMs-derived exosomes contained significantly high levels of MCT1 and CD147, which could be quantitatively detected by noninvasive localized surface plasmon resonance and atomic force microscopy biosensors, demonstrating that they could be precise surrogate biomarkers for tracking parent GMs' metabolic reprogramming and malignant progression as liquid biopsies.

Early life insult from cigarette smoke may be predictive of chronic diseases later in life.

Evidence is rapidly accumulating that links cigarette smoke (CS) exposure in utero with the development of a variety of disease pathologies in the older offspring including, type 2 diabetes, obesity, certain childhood cancers and respiratory disorders. The role that the fetal environment plays in these late-onset outcomes and the underlying cellular/molecular mechanisms by which these CS-induced effects may occur are currently unknown. Although we are becoming more aware of the fact that prenatal insult can underlie childhood/adult diseases, critical knowledge gaps still exist including gene-environment interactions, and how a CS-induced imbalance in immune dynamics (i.e. TH1/TH2) might affect asthma development and/or exacerbation later in life. In this mini-review we introduce the concept of sexual dimorphism in CS-induced late-onset disease outcomes, as well as explore the mechanisms by which CS exposure in utero can lead to cardiovascular, cancer and respiratory abnormalities in the exposed offspring. By addressing such questions using animal models, appropriate intervention strategies can be developed that will help to protect children's health and their long-term quality of life.

Case study on the effects of fit and material of sports gloves on hand performance.

Active and sports fashion in the high-end market focuses on fit, superior comfort and functional performance for various end-uses. However, the engineering design of sports gloves in relation to hand anthropometry measurements remains unclear. In this study, two types of ready-to-wear sport gloves, namely, war-gaming glove and hiking glove were purchased from the market. The glove dimensions, fabrication properties and the effect of glove fit on hand and finger dexterity were investigated. Thirty female individuals (20-29 years old) participated a series of hand performance tests and subjective perception rating assessments towards the gloves. Results indicated that the active range of motion of fingers, finger tactile sensitivity, gripping strength and ability to handle pegs and marbles decreased with the use of gloves compared with bare hands. The perceptions of comfort and ease of hand motions decreased with the increased of wear time. The glove fit in terms of finger length dimensions was significantly correlated with hand grip force. The glove fit in hand, wrist and finger circumference dimensions had significant impact on the ability to handle small objects. It is suggested that hand length, hand circumference, finger circumference and the ratio of finger length to palm length should be considered in the design and development of gloves to improve hand performance and comfort.

GnRH agonist and GnRH antagonist in intracytoplasmic injection cycles.

The long agonistic protocol for controlled ovarian hyperstimulation (COH) is effective and used most often, thus is considered the gold standard. Therefore any new regimen has to be compared in its results with those obtained with the long protocol. This report compares the efficacy of GnRH agonist and antagonist in a retrospective study of IVF/ICSI carried out in a tertiary teaching hospital from 2003 to 2006. Only the first COH cycle followed by IVF-ICSI from 200 couples (agonist = 120 and antagonist = 80) were analysed. The end points studied included the number of oocytes recovered, number of mature (MII) oocytes, fertilization, cleavage, morphology based embryo quality, pregnancy rate, quantity and cost of gonadotrophin. The average age of female subjects was 35.1 +/- 4.7 years with 50% being 35 years and above. Major infertility factors were tubal blockage, male factor and endometriosis altogether comprising 68%. GnRH agonist and antagonist cycle parameters were comparable except lesser amount of gonadotrophin was used with lower resultant costs (both p < 0.0005) in antagonistic regime. Antagonist regime produce somewhat more good quality embryos (p = 0.065), an insignificant difference. A clinical pregnancy rate per embryo transfer of 16.3% in agonist and 20.6% in antagonist regime was achieved respectively. In conclusion, GnRH antagonist protocol produced a COH response, embryonic development and pregnancy rates on par to GnRH agonist regime. Moreover GnRH antagonist protocol required a shorter stimulation period plus fewer complications. Hence GnRH antagonist regime provided means for a friendlier, convenient and cost effective protocol for patients.

The empty follicle syndrome.

The empty follicle syndrome (EFS) is a rare complication of in vitro fertilization (IVF) treatment, leading to cycle cancellation. Low human chorionic gonadotropin (hCG) bioavailability and ovarian dysfunction have been implicated with this condition. This case report illustrates a typical case of EFS and several strategies suggested to overcome this problem.

Primary Burkitt lymphoma of the ovary.

A 20 year-old woman presented with features of a twisted ovarian cyst and had an emergency laparotomy Intraoperative findings revealed bilateral, solid ovarian tumors and a left oophorectomy with biopsy of the contralateral ovary performed. Histopathology report confirmed Burkitt lymphoma of ovary. There was no other evidence of lymphoma elsewhere. The primary Burkitt lymphoma of the ovaries was successfully managed with six courses of highly toxic chemotherapy (Berlin-Frankfurt- Munster 1986 protocol). The patient has remained disease free for the last 36 months.

Unbalanced chromosomal translocation: a cause of recurrent spontaneous abortion.

Recurrent spontaneous abortion, defined as three consecutive abortions, occurs in approximately 1% to 2% of couples. Although the cause is unknown in up to 50% of cases, about 5% of these couples are found to be a balanced translocation carrier. We report a case in which the mother was identified to be a translocation carrier following the birth of a baby with multiple congenital abnormalities.

Predictors of intrauterine insemination success.

Intrauterine insemination (IUI) remains a therapeutic option within means of the majority of infertile couples in Malaysia. Therefore additional information on predictors of IUI success in the local context would provide a more concrete basis for counseling patients on expectations and treatment options. A retrospective analysis of 297 couples who underwent 445 IUI cycles from Jan 2005-Mar 2006 was undertaken. Four fifths were Malay with a mean paternal and maternal age of 35.53 +/- 5.82 (range 24-59) and 33.02 +/- 4.69 (range 21-46) years respectively. Causes of infertility were idiopathic (50%), endometriosis (17%) and anovulation/polycystic ovarian syndrome (15%). Almost 10% were oligoastenoteratozoospermic with another 23% oligozoospermic or astenozoospermic. Combined male and female factors occurred in 26%. A pregnancy rate (PR) of 9.4% per cycle; 14.1% per couple with a cumulative PR of 36.7% per 4 cycles was achieved. Those who became pregnant were significantly younger (31.29 +/- 4.43 vs. 33.21 +/- 4.68 years, p = 0.011) and had more follicles (13.95 +/- 9.72 vs. 11.43 +/- 6.67, p = 0.029) at the time of insemination. PR depreciated with maternal age and semen quality. Maternal and paternal age was inversely correlated to the number of follicles recruited (r = -0.30, p < 0.0005) and progressive sperm motility (r = -0.125, p = 0.013) respectively.

Effects of custom-made textile insoles on plantar pressure distribution and lower limb EMG activity during turning.

BACKGROUND: Turning during locomotion involves considerable changes of the body's center of mass and reduced stability, as well as lower limb kinematics and kinetics. However, many previous studies have been carried out to evaluate the effectiveness and applications of orthotic insoles as well as different types of orthotic materials in various clinical symptoms, which are focused primarily on straight line walking. Hence, the influence of custom-made insoles with the use of advanced three-dimensional spacer fabrics on biomechanics parameters in terms of plantar pressure distribution and lower limb electromyography during turning movement was studied. METHODS: Twelve subjects performed 180-degree turning at a speed 3.07-3.74 km/h for five successful trials under 3 insoles conditions: wearing traditional ethylene vinyl acetate insoles and two different spacer-fabricated insoles, with the plantar pressure and lower limb muscle activity collected simultaneously. Turning movement was broken down into 3 phases for analysis: Turning initiation, turn around and turn termination. RESULTS: There was a statistically significance difference in plantar pressure between the traditional insoles and the insoles made of a spacer fabric as the top layer (p < 0.05). Compared to the traditional insoles, insoles made of a spacer fabric reduced the peak pressure (>12 %) and pressure-time integral (>13 %) in toes, metatarsal head 1 and metatarsal heads 2-3 at turning initiation; (>15 %) and (>17 %) in medial midfoot and medial heel at turn around. Insoles with spacer fabrics on the top and middle layer reduced both pressure parameters (>18 %) in toes and MTH 1 at turn termination. In terms of muscle activities, insoles with two-layer spacer fabrics could lower maximum muscle activities of vastus lateralis (>16 %; p < 0.05) at turn around. CONCLUSIONS: Insoles with different fabrications could offer various pressure offloading patterns across the plantar and muscle activity changes while turning. Insoles with a spacer fabric on the top tend to reduce plantar pressure loading at different regions during turn initiation and turn around phases, while two-layer spacer-fabricated insoles may contribute to reduced vastus lateralis muscle activation during turn around. More importantly, this study provides a new dimension in the potential use of the textile-fabricated insoles which may widen the range of insole materials selection in the design and development of insoles so as to enhance the effectiveness of orthotic treatment.

Effects of indoor slippers on plantar pressure and lower limb EMG activity in older women.

Open-toe mule slippers are popular footwear worn at home especially by older women. However, their biomechanical effects are still poorly understood. The objective of this study is to therefore evaluate the physical properties of two typical types of open-toe mule slippers and the changes in plantar pressure and lower limb muscle activity of older women when wearing these slippers. Five walking trials have been carried out by ten healthy women. The results indicate that compared to barefoot, wearing slippers results in significant increases in the contact area of the mid-foot regions which lead to plantar pressure redistribution from metatarsal heads 2-3 and the lateral heel to the midfoot regions. However, there is no significant difference in the selected muscle activity across all conditions. The findings enhance our understanding of slipper features associated with changes in biomechanical measures thereby providing the basis of slipper designs for better foot protection and comfort.

Immunosensor for the differentiation and detection of Salmonella species based on a quartz crystal microbalance.

Immunosensors based on the microgravimetric quartz crystal microbalance (QCM) technique have been developed for the detection of Salmonella species from serogroups A, B and D. Salmonella serogroup-specific murine monoclonal antibodies, respectively, raised against these serogroups were immobilized onto the silver electrodes of piezoelectric (PZ) crystals by cross-linkage via glutaraldehyde (GA) to the electrode surfaces pre-coated with thin polyethyleneimine (PEI) layer. The specific immunosensors developed gave responses in linear ranges from 10(5) to 5x10(8) cells per ml with no significant interference from other strains of Salmonella and Escherichia coli up to 10(8) cells per ml. They showed good repeatability and excellent linear range, achieving detection limits down to 10(4) cells per ml with ability to distinguish different strains of Salmonella. These biosensors exhibited an exquisite specificity evidenced by their ability to discriminate antigens, the structures of which differ only by the isomeric form of di-deoxyhexose. The antibody-modified crystals showed no loss in activity over 4 days under storage at 4 degrees C.

Evaluation of culture enrichment procedures for use with Salmonella detection immunoassay.

To design efficient culture strategies for use with immunoassays to detect Salmonella in food, the growth of these organisms was investigated according to the Bacteriological Analytical Manual (BAM) and enrichment-immunoassay (EI) culture procedures. The cultures were further evaluated using a commercial enzyme-linked immunosorbent assay (ELISA) kit. The BAM procedure includes pre-enrichment in nutrient broth (NB) for 16 h followed by selective enrichment in either Rappaport-Vassiliadis (RV) or tetrathionate brilliant green (TBG) broth for 16 h. The EI procedure includes pre-enrichment in NB for 4 h, selective enrichment in RV for 16 h and post-enrichment in NB for 4 h. The effects of different incubation times for pre- and post-enrichment, and different culture media for selective enrichment (TBG and RV) and post-enrichment in NB and Brain Heart Infusion broth (BHI) on the growth of the bacteria and ELISA titers in the EI procedure were also investigated. Salmonella enteritidis and S. typhimurium inoculated at different initial concentrations between 0.1 and 35 CFU/ml grew to similar concentrations of 10(7) to 10(8) colony forming unit (CFU)/ml in pure culture and generally 2 to 4 fold lower concentrations (P<0.05) in mixed culture using spiked chicken rinse. In the BAM procedure, the concentration of Salmonella cultured in RV was higher (P<0.01) than that in TBG. The cultures in TBG showed positive results for ELISA, but those in RV were generally negative. In the EI procedure, the ELISA titers from cultures post-enriched in NB or BHI were higher (P<0.01) when TBG, as compared to RV, was used for selective enrichment. Post-enrichment in BHI yielded higher numbers of Salmonella and higher ELISA titers than those in NB (P<0.05) for post-enrichment. This study demonstrated that in both culture procedures small numbers of Salmonella could be increased to at least 10(7) CFU/ml which is detectable by most ELISAs, and that the type of the culture media used may have a significant impact on ELISA results.

Reduction of nosocomial infection in a neonatal intensive care unit (NICU).

UNLABELLED: New measures aimed at reducing nosocomial infection in our neonatal intensive care unit (NICU) were introduced over a 3-month period from 1 July to 30 September 1994. OBJECTIVE: The aim of this study was to evaluate the impact of these measures on the incidence of nosocomial infection in our NICU. METHODS: The new measures introduced were: 1. grouping of all blood investigations to allow for fewer blood samplings per baby per day; 2. reduction of routine blood investigations after the acute illness has stabilised, and 3. a system of aseptic delivery of drugs through a central venous catheter, thereby reducing the need for peripheral intravenous lines. Nosocomial infections were defined according to the criteria spelt out in the Centres for Disease Control (CDC) guidelines. Data for the study was obtained from the ongoing surveillance carried out by the hospital's infection control team. Period 1 (1 year duration) was prior to the implementation of the new measures. Period 2 (1 year duration) was after implementation of the new measures. RESULTS: The overall nosocomial infection patient rates (expressed as number of infections per 100 intensive care unit patients) were 17.6 for Period 1 and 7.5 for Period 2. The overall nosocomial infection patient-day rates (expressed as number of infections per 1000 patient-days) were 13.5 and 6.1 respectively (p < 0.01). When the infants' birth weights were stratified as < 1500 g, 1500-2500 g, and > 2500 g, the greatest decline in both the overall nosocomial infection patient rate and nosocomial infection patient-day rate was seen in infants weighing < 1500 g. There was also a significant decline in the rates of blood-stream infections in infants weighing < 1500 g (from 7.5 to 2.8 per 1000 patient-days) (p < 0.05). Ventilator associated pneumonias also showed a decline from 3.3 to 1.0 pneumonia per 1000 ventilator days. The organisms responsible for the majority of blood stream infections in Period 1 were methicillin-resistant Staphylococci Aureus (MRSA), coagulase-negative staphylococci, gram-negative bacilli and candida. In Period 2, coagulase-negative staphylococci was the predominant organism. CONCLUSION: We conclude that there was a reduction in nosocomial infection rates. The new measures introduced may have contributed to this reduction.

A retrospective study of infants with severe persistent pulmonary hypertension (PPHN) managed without extracorporeal membrane oxygenation (ECMO).

We studied 13 consecutive infants admitted to our Neonatal Intensive Care Unit over 37 months from 1 June 1994 to 30 June 1997, who were diagnosed with severe persistent pulmonary hypertension (PPHN) meeting extracorporeal membrane oxygenation (ECMO) criteria as defined by Bartlett and/or Short. They were managed with conservative ventilation strategy, with emphasis on the use of moderate ventilatory pressures whilst avoiding paralysis. Peak inspiratory pressure (PIP) on intermittent mandatory ventilation was adjusted according to adequate chest excursion. High PIP was avoided. Two main ventilatory techniques were used: 1) low ventilatory rate < or = 40/min, PIP 20 to 30 cmH2O, inspiratory time (IT) 0.5 seconds, positive end-expiratory pressure (PEEP) 5 cmH2O, and 2) high ventilatory rate 100/min, PEEP 0 cmH2O, IT 0.3 seconds. The aim was to keep preductal PaO2 > or = 50 mmHg. We did not sought to achieve alkalotic pH or low PaCO2. When PIP requirements exceeded 30 to 35 cmH2O, the use of an alternative rescue therapy such as pulmonary vasodilator, high frequency ventilation and/or surfactant were considered. Only 1 infant died of PPHN. Low mortality due to PPHN can be achieved using this strategy. There is a need for a randomised controlled trial to compare this strategy with other alternative treatment strategies.

2D and 3D anatomical analyses of hand dimensions for custom-made gloves.

Measuring hand anthropometric data for the development of good-fitting gloves is crucial. In pursuing higher accuracy in hand anthropometric measurements, scanning of hand surfaces with the aids of image analysis system to acquire measurements is an alternative to the manual methods. This study proposes a new hand measuring approach by using 2D and 3D scanning which are evaluated through comparisons of manual measurements. Thirty-three dimensions are measured by using (1) tape and calliper measurement; (2) 2D image analysis; (3) 3D image analysis based on ten captures; and (4) 3D image analysis based on three captures, respectively. Repeated-measures ANOVA, correlation analysis and RMSE are used to examine the results. The hand dimensions obtained from the four methods are highly linearly correlated. Hand data taken from 3D image analysis has no significant difference compared with manual measurements on hand and wrist circumferences, length and breadth dimension, regardless of the number of captures.

Comparison between mechanical freezer and conventional freezing using liquid nitrogen in normozoospermia.

INTRODUCTION: This study evaluated the effect of human semen cryopreservation using an ultra-low temperature technique with a mechanical freezer at -85°C as an alternative method to the conventional liquid nitrogen technique at -196°C. METHODS: This was a prospective experimental study conducted in the Medically Assisted Conception unit, Department of Obstetrics and Gynaecology, National University Hospital, Malaysia from January 1, 2006 to April 30, 2007. All normozoospermic semen samples were included in the study. The concentration, motility and percentage of intact DNA of each semen sample were assessed before and after freezing and thawing on Days 7 and 30 post freezing. RESULTS: Sperm cryopreservation at -85°C was comparable to the conventional liquid nitrogen technique for a period of up to 30 days in a normozoospermic sample. There was no statistical difference in concentration (Day 7 p-value is 0.1, Day 30 p-value is 0.2), motility (Day 7 p-value is 0.9, Day 30 p-value is 0.5) and proportion of intact DNA (Day 7 p-value is 0.1, Day 30 p-value is 0.2) between the ultra-low temperature technique and conventional liquid nitrogen cryopreservation at Days 7 and 30 post thawing. CONCLUSION: This study clearly demonstrates that short-term storage of sperm at -85°C could be a viable alternative to conventional liquid nitrogen cryopreservation at -196°C due to their comparable post-thaw results.

Coherent polarization locking of a diode emitter array.

We present our work on the coherent combining of an array of diode emitters in a conventional diode bar configuration using the coherent polarization locking technique. An external laser cavity is designed so that the diode emissions from four diode emitters are spatially overlapped and passively phase locked via a series of birefringent walk-off crystals and a polarizing beam splitter. This concept was experimentally demonstrated up to 1030 mW of coherently combined power and was shown to increase the laser brightness of the diode bar by approximately 50 times.