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1.  Technical and instrumental prerequisites for single-port laparoscopic solo surgery: State of art 
With the aid of advanced surgical techniques and instruments, single-port laparoscopic surgery (SPLS) can be accomplished with just two surgical members: an operator and a camera assistant. Under these circumstances, the reasonable replacement of a human camera assistant by a mechanical camera holder has resulted in a new surgical procedure termed single-port solo surgery (SPSS). In SPSS, the fixation and coordinated movement of a camera held by mechanical devices provides fixed and stable operative images that are under the control of the operator. Therefore, SPSS primarily benefits from the provision of the operator’s eye-to-hand coordination. Because SPSS is an intuitive modification of SPLS, the indications for SPSS are the same as those for SPLS. Though SPSS necessitates more actions than the surgery with a human assistant, these difficulties seem to be easily overcome by the greater provision of static operative images and the need for less lens cleaning and repositioning of the camera. When the operation is expected to be difficult and demanding, the SPSS process could be assisted by the addition of another instrument holder besides the camera holder.
PMCID: PMC4402291  PMID: 25914453
Camera holder; Laparoscopy; Single-port laparoscopic surgery; Single-port solo surgery; Solo surgery
2.  Total knee arthroplasty: good agreement of clinical severity scores between patients and consultants 
Nearly 20,000 patients per year in the UK receive total knee arthroplasty (TKA). One of the problems faced by the health services of many developed countries is the length of time patients spend waiting for elective treatment. We therefore report the results of a study in which the Salisbury Priority Scoring System (SPSS) was used by both the surgeon and their patients to ascertain whether there were differences between the surgeon generated and patient generated Salisbury Priority Scores.
The Salisbury Priority Scoring System (SPSS) was used to assign relative priority to patients with knee osteoarthritis as part of a randomised controlled trial comparing the standard medial parapatellar approach versus the sub-vastus approach in TKA. The operating surgeons and each patient completed the SPSS at the same pre-assessment clinic. The SPSS assesses four criteria, namely progression of disease, pain or distress, disability or dependence on others, and loss of usual occupation. Crosstabs and agreement measures (Cohen's kappa) were performed.
Overall, the four SPSS criteria showed a kappa value of 0.526, 0.796, 0.813, and 0.820, respectively, showing moderate to very good agreement between the patient and the operating consultant. Male patients showed better agreement than female patients.
The Salisbury Priority Scoring System is a good means of assessing patients' needs in relation to elective surgery, with high agreement between the patient and the operating surgeon.
PMCID: PMC1552065  PMID: 16879741
3.  Evaluation of SOVAT: An OLAP-GIS decision support system for community health assessment data analysis 
Data analysis in community health assessment (CHA) involves the collection, integration, and analysis of large numerical and spatial data sets in order to identify health priorities. Geographic Information Systems (GIS) enable for management and analysis using spatial data, but have limitations in performing analysis of numerical data because of its traditional database architecture.
On-Line Analytical Processing (OLAP) is a multidimensional datawarehouse designed to facilitate querying of large numerical data. Coupling the spatial capabilities of GIS with the numerical analysis of OLAP, might enhance CHA data analysis. OLAP-GIS systems have been developed by university researchers and corporations, yet their potential for CHA data analysis is not well understood. To evaluate the potential of an OLAP-GIS decision support system for CHA problem solving, we compared OLAP-GIS to the standard information technology (IT) currently used by many public health professionals.
SOVAT, an OLAP-GIS decision support system developed at the University of Pittsburgh, was compared against current IT for data analysis for CHA. For this study, current IT was considered the combined use of SPSS and GIS ("SPSS-GIS"). Graduate students, researchers, and faculty in the health sciences at the University of Pittsburgh were recruited. Each round consisted of: an instructional video of the system being evaluated, two practice tasks, five assessment tasks, and one post-study questionnaire. Objective and subjective measurement included: task completion time, success in answering the tasks, and system satisfaction.
Thirteen individuals participated. Inferential statistics were analyzed using linear mixed model analysis. SOVAT was statistically significant (α = .01) from SPSS-GIS for satisfaction and time (p < .002). Descriptive results indicated that participants had greater success in answering the tasks when using SOVAT as compared to SPSS-GIS.
Using SOVAT, tasks were completed more efficiently, with a higher rate of success, and with greater satisfaction, than the combined use of SPSS and GIS. The results from this study indicate a potential for OLAP-GIS decision support systems as a valuable tool for CHA data analysis.
PMCID: PMC2438346  PMID: 18541037
4.  Sugar Profile, Mineral Content, and Rheological and Thermal Properties of an Isomerized Sweet Potato Starch Syrup 
Currently, corn is used to produce more than 85% of the world's high fructose syrup (HFS). There is a search for alternative HFS substrates because of increased food demand and shrinking economies, especially in the developing world. The sweet potato is a feasible, alternative raw material. This study isomerized a high glucose sweet potato starch syrup (SPSS) and determined its sugar profile, mineral content, and rheological and thermal properties. Rheological and thermal properties were measured using a rheometer and DSC, respectively. Sweet potato starch was hydrolyzed to syrup with a mean fructose content of 7.6 ± 0.4%. The SPSS had significantly higher (P < 0.05) mineral content when compared to commercial ginger and pancake syrups. During 70 days of storage, the SPSS acted as a non-Newtonian, shear-thinning liquid in which the viscosity decreased as shear stress increased. Water loss temperature of the SPSS continually decreased during storage, while pancake and ginger syrups' peak water loss temperature decreased initially and then increased. Further and more detailed studies should be designed to further enhance the fructose content of the syrup and observe its stability beyond 70 days. The SPSS has the potential to be used in human food systems in space and on Earth.
PMCID: PMC4745497  PMID: 26904593
5.  Prevalence of Hand Disorders in Type 2 Diabetes Mellitus and its Correlation with Microvascular Complications 
Physicians have long recognized the association between diabetes mellitus and several pathologic conditions of the hand. The most commonly recognized maladies are limited joint mobility (LJM), Dupuytren's disease (DD), trigger finger (TF), and carpal tunnel syndrome (CTS). Incidence of these hand disorders has increased in the setting of diabetes. Collectively, these are described as diabetic hand syndrome.
The aims were to find out the prevalence of hand disorders in diabetic patients, and to study the relation of these hand disorders with microvascular complications.
Subjects and Methods:
This is an observational cross-sectional case-control study done over a period of 1 year Patients of type 2 DM, of age < 65 years, who visited Gandhi Memorial Hospital, Lucknow were enrolled and were described as cases. Age- and sex-matched nondiabetic individuals were taken in the control group. The data were analyzed using software SPSS. SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc. Means and standard deviations were computed; the Student t-test and Chi-square (χ2) test were used as appropriate.
A total of 400 subjects were studied, 200 each in the case and control groups. Of total 200 diabetic patients, 30% (60/200) patients had neuropathy, 37.5% (75/200) had nephropathy, and 44.5% (89/200) patients had retinopathy. In the study population, 67% patients were having one or more hand disorders, in which LJM was found in 40.5% (81/200) patients, DD was found in 19% (38/200) patients, TF in 16.5% (33/200), and CTS in 14% (28/200) patients.
This study shows a high prevalence of hand disorders in diabetic patients and also correlates with the duration of type 2 DM, LJM being the most common hand disorder and more common in patients who have microvascular complications.
PMCID: PMC3793438  PMID: 24116312
Carpal tunnel syndrome; Dupuytren's disease; Limited joint mobility; Trigger finger
6.  Effect of Progressive Muscle Relaxation in Female Health Care Professionals 
Increasing population, fast paced industrialization, increased, competitiveness, unanticipated problems in the work place have increased the stress among the females working in health care in recent times.
The aim of the following study is to detect the stress levels among female health care professionals in the age group of 25-35 years and its impact on health.
Subjects and Methods:
A prospective cross-sectional pilot project was conducted in a tertiary care hospital in Eastern part of India, after receiving approval from the Institutional Ethics Committee and informed consent form was taken from the subjects. Stress level in the subjects was assessed according to the presumptive life event stress scale. Females with scores above 200 were selected. For these, initial assessment of anthropometric measurement, electrocardiogram and lipid profile analysis, resting pulse rate, blood pressure, physical fitness index (PFI), breath holding time (BHT), isometric hand grip (IHG) test results were evaluated and recorded. All subjects were given training of progressive muscle relaxation (PMR) for 3 months. After 3 months, the lipid profile and vital parameters, Perceived Stress Scale values were re-evaluated and subjects were asked to repeat the same exercises and data thus recorded were analyzed using Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.).
Significant decrease in resting heart rate, blood pressure and Perceived Stress Scale levels was seen after PMR training in the subjects. Results of BHT, IHG tests and PFI were significantly increased after PMR training. There was a significant decrease in total cholesterol, triglyceride and low-density lipoprotein cholesterol in subjects after practicing PMR for 3 months.
Increasing stress among female health care professionals is a cause for concern and there is a need to adopt early life-style modification by practicing relaxation exercises to ameliorate stress and to improve not only their quality-of-life in general, but patient care in particular.
PMCID: PMC4199176  PMID: 25328795
Female stress; relaxation techniques; health care professionals
7.  Suprascapular nerve block for the treatment of frozen shoulder 
Saudi Journal of Anaesthesia  2012;6(1):52-55.
The aim of our study was to compare the effects of suprascapular nerve block in patients with frozen shoulder and diabetes mellitus unresponsive to intraarticular steroid injections.
Settings and Design:
Ten patients without improvement of sign and symptoms after intraarticular injections were made a suprascapular nerve block.
Pain levels and active range of movement of patients were recorded at initial attendance and after 1, 4, and 12 weeks. All patients’ simple pain scores, total pain scores, and range of motion of their shoulders were improved significantly after suprascapular nerve block.
Statistical Analysis:
In this study, the statistical analyses were performed by using the SPSS 8.0 program (SPSS Software, SPSS Inc., USA). To compare pre- and post-injection results of simple pain score, total pain score, shoulder abduction and external rotation, Wilcoxon test was used.
Patient's simple pain scores, total pain scores also abduction, external rotation and internal rotation angles were improved significantly after suprascapular nerve block.
Effective results after suprascapular nerve blockage was obtained for the treatment of refractory frozen shoulder cases.
PMCID: PMC3299117  PMID: 22412778
Frozen shoulder; nerve block; suprascapular nerve
8.  KMWin – A Convenient Tool for Graphical Presentation of Results from Kaplan-Meier Survival Time Analysis 
PLoS ONE  2012;7(6):e38960.
Analysis of clinical studies often necessitates multiple graphical representations of the results. Many professional software packages are available for this purpose. Most packages are either only commercially available or hard to use especially if one aims to generate or customize a huge number of similar graphical outputs. We developed a new, freely available software tool called KMWin (Kaplan-Meier for Windows) facilitating Kaplan-Meier survival time analysis. KMWin is based on the statistical software environment R and provides an easy to use graphical interface. Survival time data can be supplied as SPSS (sav), SAS export (xpt) or text file (dat), which is also a common export format of other applications such as Excel. Figures can directly be exported in any graphical file format supported by R.
On the basis of a working example, we demonstrate how to use KMWin and present its main functions. We show how to control the interface, customize the graphical output, and analyse survival time data. A number of comparisons are performed between KMWin and SPSS regarding graphical output, statistical output, data management and development. Although the general functionality of SPSS is larger, KMWin comprises a number of features useful for survival time analysis in clinical trials and other applications. These are for example number of cases and number of cases under risk within the figure or provision of a queue system for repetitive analyses of updated data sets. Moreover, major adjustments of graphical settings can be performed easily on a single window.
We conclude that our tool is well suited and convenient for repetitive analyses of survival time data. It can be used by non-statisticians and provides often used functions as well as functions which are not supplied by standard software packages. The software is routinely applied in several clinical study groups.
PMCID: PMC3376120  PMID: 22723912
9.  Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux 
Yonsei Medical Journal  2012;53(4):748-752.
Many pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses.
Materials and Methods
We retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)].
Breakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0±8.2 months) than in boys (5.8±4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean±SD age at diagnosis of VUR in patients with breakthrough infection (1.14±3.14) was significantly younger than in those without breakthrough infection (5.05±3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028).
Our data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.
PMCID: PMC3381488  PMID: 22665341
Vesico-ureteral reflux; radioisotope scanning; urinary tract infections; antibiotic prophylaxis
10.  The relationship between binocular vision symptoms and near point of convergence 
Indian Journal of Ophthalmology  2013;61(7):325-328.
Aim and Background:
Due to the relatively high prevalence of binocular vision anomalies, a regular examination including tests for assessment and determination of these anomalies is necessary. The aim of this study was to assess the relationship between near point of convergence (NPC) and near binocular vision symptoms and finding of an NPC cutoff point for symptoms in university students.
Materials and Methods:
In this cross-sectional study, 124 students of different majors of Zahedan University of Medical Sciences were randomly selected. If they met the inclusion criteria, they were divided into two groups (symptomatic and asymptomatic) according to the convergence insufficiency symptom survey questionnaire. For NPC measurement, a small isolated letter E of approximately 20/30 size on a metal rod was used. After data collection, data were analyzed in SPSS.17 software (SPSS for Windows, SPSS Inc., Chicago, IL) using descriptive and analytical statistics, including Mann–Whitney U test and receiver operating characteristic (ROC) curve.
The mean NPC findings in the symptomatic and asymptomatic groups were 11.7 ± 5.0 and 8.4 ± 3.4 cm, respectively, with a significant difference between the two groups (P < 0.001). The ROC curve suggests an NPC cutoff point of 9.5 cm for the presence of symptoms with the testing procedures used in this study.
The determination of NPC is helpful in the differentiation of symptomatic from asymptomatic subjects.
PMCID: PMC3759101  PMID: 23552348
Binocular vision; near point of convergence; visual symptoms
11.  Medicaid Policies and Practices in US State Prison Systems 
American journal of public health  2014;104(3):418-420.
Medicaid is an important source of health care coverage for prison-involved populations. From 2011 to 2012, we surveyed state prison system (SPS) policies affecting Medicaid enrollment during incarceration and upon release; 42 of 50 SPSs participated.
Upon incarceration, Medicaid benefits were suspended in 9 (21.4%) SPSs and terminated in 28 (66.7%); 27 (64.3%) SPSs screened prisoners for potential Medicaid eligibility.
Although many states supported Medicaid enrollment upon release, several did not. We have considered implications for Medicaid expansion.
PMCID: PMC3953759  PMID: 24432881
12.  Estimation of Dental and Facial Proportions Using Height as Criteria 
Ideal dental restoration is one which not only restores optimal functions but also confirm to standard dental and facial relations. This is important to achieve long term patient satisfaction both with regard to esthetics as well as functions. Objective was to find a credible relationship between dental and facial proportions using height of individuals as the criteria in a specific group of population. To determine a regression equation for determination of various dental and facial proportions using height.
Materials and Methods:
One hundred and forty-four (n = 144) students, of which 91 were males (n = 91) and 53 were females (n = 53) of the dental college participated in this study. Height of the individual, the lower facial height, inter-incisal and inter-canine and inter-commissural width was measured as per protocol and resulting data was analyzed using SPSS 17 (SPSS Statistics for Windows, Version 17.0. Chicago SPSS Inc. Released 2008) version software regression equations were obtained.
The study included 144 college students significant correlations were found between height of the individuals, inter-canine distance and lower facial height using Pearson correlation coefficient. The calculated values of t-test were significant. Regression equations were determined for determination of various parameters using height as the sole criteria.
There exists a definite relationship between height of the individual and their dental and facial parameters in this group of population and values of maxillary anterior teeth can be determined using regression equations.
PMCID: PMC4148568  PMID: 25214728
Height; inter-canine distance; maxillary anterior teeth
13.  Self-Confidence in Women with and without Polycystic Ovary Syndrome 
Objective: To compare self-confidence in woman with and without PCOS according to their ages.
Materials and methods: This comparative study was conducted on 400 women (100 with and 300 without PCOS) in clinics of Shahid Akbar-Abadi and Firouzgar Hospitals, from July 2012 to February 2013. SPSS-16 used for statistical analysis (SPSS; SPSS Inc., Chicago, IL, USA).
Results: This study showed 98% of PCOS and 93% in non-PCOS groups had average self-confidence with scores of 15-25. None of women in PCOS group and 6.7% of non-PCOS group had high self-confidence (score>25). There was a significant difference between two groups in term of self-confidence level (p< 0.001). There was no significant difference in self-confidence between age group ≤ 30 and age group> 30 in both group, but in PCOS group, self-confidence were significantly higher in both age group under 30 (p<0.0001) and 30 and higher (p<0.0001).
Conclusion: Impaired self-confidence in PCOS groups (under 30 and 30 and higher age groups) in comparison with related value of non-PCOS group shows that mental health status in women with PCOS requires urgent psychological attention and support.
PMCID: PMC4275552  PMID: 25628720
Polycystic Ovary Syndrome; PCOS; Self-Confidence; Self-Reliance
14.  Analysis of Road Traffic Crashes–Related Maxillofacial Injuries Severity and Concomitant Injuries in 201 Patients Seen at the UCH, Ibadan 
The objective of this study was to determine the prevalence of road traffic crashes (RTC)–related maxillofacial injuries, the concomitant injuries occurring with them, and to assess the relationship between the severity of maxillofacial and concomitant injuries. This was a prospective study involving 201 victims of RTC seen at the Accident and Emergency Department of the University College Hospital, Ibadan with maxillofacial injuries during the study period. Demographic data of the patients, the types of maxillofacial injuries, and concomitant injuries sustained were recorded. Severity of maxillofacial injury was determined using the maxillofacial injury severity scale (MFISS), while the severity of concomitant injuries was based on the ISS. Correlations between types and severity of maxillofacial injury and types and severity of concomitant injury were conducted to determine the predictability of concomitant injuries based on maxillofacial injury severity. Data were processed using SPSS Statistical software (SPSS, version 20.0 for windows, IBM SPSS Inc, Chicago, IL).
Maxillofacial injuries constituted 25.4% of RTC-related admission by the Accident and Emergency Department. A total of 151 (75.1%) patients who presented with concomitant injuries participated in the study. Eighty-one (53.6%) sustained injuries to more than one body region. Head injury was the commonest (99, 65.6%) concomitant injury, followed by orthopedic injury (69, 45.7%). Increasing severity of maxillofacial injury showed a positive correlation with increasing ISS. Also, positive correlation was noted with increasing severity of maxillofacial injury and presence of polytrauma (p = 0.01), traumatic brain injury (p = 0.034), and eye injuries (p = 0.034). There was a high prevalence of maxillofacial injuries in victims of RTC. There was a high incidence of concomitant injuries noted with these maxillofacial injuries. Significantly, this study showed a direct relationship between the severity of maxillofacial injury and head, ocular and polytrauma. This study further emphasizes the need for thorough examination of patients presenting with RTC-related maxillofacial injuries.
PMCID: PMC4221143  PMID: 25383148
road traffic crashes; concomitant injuries; severity
15.  Quantum key distribution over 120 km using ultrahigh purity single-photon source and superconducting single-photon detectors 
Scientific Reports  2015;5:14383.
Advances in single-photon sources (SPSs) and single-photon detectors (SPDs) promise unique applications in the field of quantum information technology. In this paper, we report long-distance quantum key distribution (QKD) by using state-of-the-art devices: a quantum-dot SPS (QD SPS) emitting a photon in the telecom band of 1.5 μm and a superconducting nanowire SPD (SNSPD). At the distance of 100 km, we obtained the maximal secure key rate of 27.6 bps without using decoy states, which is at least threefold larger than the rate obtained in the previously reported 50-km-long QKD experiment. We also succeeded in transmitting secure keys at the rate of 0.307 bps over 120 km. This is the longest QKD distance yet reported by using known true SPSs. The ultralow multiphoton emissions of our SPS and ultralow dark count of the SNSPD contributed to this result. The experimental results demonstrate the potential applicability of QD SPSs to practical telecom QKD networks.
PMCID: PMC4585911  PMID: 26404010
16.  Need for enforcement of ethicolegal education – an analysis of the survey of postgraduate clinical trainees 
BMC Medical Ethics  2005;6:8.
The number of medical lawsuits in Japan was between 14 and 21 each year before 1998, but increased to 24 to 35 per year after 1999. There were 210 lawsuits during this 10-year period. There is a need for skills and knowledge related to ethics, which is as fundamental to the practice of medicine as basic sciences or clinical skills. in Japan education in ethics is relatively rare and its importance is not yet recognized. Establishing ethics education using legal precedents, which has already been achieved in Western countries, will be a very important issue in Japan. In the present study, a questionnaire survey was conducted among graduate intern doctors, in order to investigate whether ethics education using precedents might have a positive effect in Japan.
In 2002, a questionnaire survey entitled Physicians' Clinical Ethics was carried out in a compulsory orientation lecture given to trainees before they started clinical practice in our hospital. The attendees at this lecture were trainees who came from colleges in various districts of Japan. During the lecture, 102 questionnaires were distributed, completed by attendees and collected. The recovery rate was 100%. The questionnaire consisted of 22 questions (in three categories), of which 20 were answered by multiple choices, and the other two were answered by description. The time required to complete the questionnaire was about 10 minutes.
The recovered questionnaires were analyzed using statistical analysis software (SPSS for Windows, Release 10.07J-1/June/2000), in addition to simple statistical analysis. answers using multiple choices for the 20 questions in the questionnaire were input into SPSS. The principal component analysis was performed for each question. As a result, the item that came to the fore was "legal precedent". Since many intern doctors were interested in understanding laws and precedents, learning about ethical considerations through education using precedents might better meet with their needs and interests.
We applied a new method in which the results of principal component analysis and frequencies of answers to other questions were combined. From this we deduced that the precedent education used in Western countries was useful to help doctors acquire ethical sensitivity and was not against their will. A relationship was found between reading precedents and the influence of lawsuits, and it was thought that student participation-type precedent education would be useful for doctors in order to acquire ethical sensitivity.
PMCID: PMC1192799  PMID: 16083505
17.  Prognostic factors in primary adenocarcinoma of the small intestine: 13-year single institution experience 
Adenocarcinoma of the small bowel is a relatively rare malignancy as compared to the other malignancies of the gastrointestinal tract. Nonspecific presentation and infrequent occurrence often leads to a delay in diagnosis and consequent poor prognosis. Various other factors are of prognostic importance while managing these tumors.
The medical records of a total of 27 patients treated for adenocarcinoma of the small bowel at Providence Hospital and Medical Centers from year 1990 through 2003 were reviewed retrospectively. Data were analyzed using SPSS software (version 10.0; SPSS, Inc., Chicago, IL). Survival analyses were calculated using the Kaplan Meier method with the log rank test to assess the statistical significance. The socio-demographics (age, gender) were calculated using frequency analyses.
The patients included nine males and eighteen females with a median age at diagnosis of 62 years. Only 48% of the patients had an accurate preoperative diagnosis while another 33% had a diagnosis suspicious of small bowel malignancy. None of the patients presented in stage 1. The cumulative five-year survival was 30% while the median survival was 3.3 years. There was no 30-day mortality in the postoperative period in our series.
The univariate analysis demonstrated that tumor grade, stage at presentation, lymph nodal metastasis and resection margins were significant predictors of survival.
PMCID: PMC2253527  PMID: 18237404
18.  Weak or no association of TCF7L2 variants with Type 2 diabetes risk in an Arab population 
BMC Medical Genetics  2008;9:72.
The rs7903146 and rs12255372 variants of TCF7L2 have been strongly associated with type 2 diabetes (T2D) risk in most populations studied to date. Meta-analysis of 27 different studies has resulted in a global OR of 1.46 [1.42–1.51] (rs7903146 variant). Thus far, despite a high incidence of T2D, the role of this variant in Arabs has not been established.
We performed a case-control association study using 522 Saudi T2D patients (WHO criteria), and 346 controls (age > 60; fasting plasma glucose < 7 mmol/L). Genotyping was performed by pyrosequencing. Statistical analyses were performed using SPSS version 13.0 for Windows (SPSS, Chicago, IL, USA).
For rs7903146, the T allele frequency of the cases (0.415) was not different from that observed in the controls (0.405). The crude odds ratio (OR) was 1.04 with a 95% CI of 0.86–1.27 (P = 0.675). For rs12255372, the T allele frequency of the cases (0.368) was not different from that observed in the controls (0.355). Retrospective power calculations based upon an OR of 1.46 reported in a comprehensive meta-analysis of TCF7L2 risk, indicated this study was sufficiently powered (96.92%; α = 0.05) to detect an effect of similar magnitude to that reported for rs7903146.
Our study is consistent with weak or no association of T2D in Arabs with the two TCF7L2 variants, however it cannot rule out an effect of other SNPs in this gene. Future studies in this population are required to confirm our findings and may indicate the presence of yet to be defined genetic risk factors for T2D.
PMCID: PMC2515290  PMID: 18655717
19.  Using Paid Radio Advertisements to Promote Physical Activity Among Arkansas Tweens 
Preventing Chronic Disease  2005;2(Spec No):A08.
The level of physical activity among children is a growing concern. Evidence shows that many children aged 9 to 13 years (tweens) do not participate in any organized physical activity during their nonschool hours, and some do not engage in any free-time physical activity. Physical inactivity is associated with a host of chronic diseases such as diabetes and cardiovascular disease. Paid media advertisements have been an effective method of promoting physical activity.
From March 10, 2003, through June 29, 2003, we aired paid radio advertisements in six major Arkansas metropolitan areas to promote physical activity among tweens. In September 2003, we surveyed 295 Arkansas tweens by telephone to assess their exposure to the advertisements and the impact of the advertisements on their intent to participate in physical activity. In the same telephone survey, we also asked questions about the respondents' physical activity level. The data were weighted so that the results would be representative of the areas surveyed. The statistical analysis was performed using SPSS, version 11.5 (SPSS Inc, Chicago, Ill).
Of the tweens surveyed, 56.4% (95% confidence interval [CI], 50.7%–62.1%) reported hearing the radio advertisements. Of the tweens who heard the advertisement messages, 76.1% (95% CI, 69.4%–82.8%) said the messages made them more likely to get involved in physical activity. Younger tweens (aged 9 and 10 years) were less likely to have heard the advertisements than older tweens (aged 11 to 13 years). However, the advertisements were more likely to cause younger tweens to want to get involved in physical activity (odds ratio [OR] = 6.89, P = .003) than older tweens. Of the tweens surveyed, 74.9% (95% CI, 70.0%–79.8%) reported that they were involved in nonschool-sponsored sports, and 45.3% (95% CI, 39.6%–51.0%) were involved in school-sponsored sports.
Paid media advertisements may be an effective way to promote physical activity among tweens. More rigorous evaluations of the impact of paid media advertisements among tweens, with larger samples and additional media markets, are needed. Future physical activity promotion efforts should focus on encouraging participation in school-sponsored sports and creating community environments conducive to physical activity.
PMCID: PMC1459469  PMID: 16263041
20.  Canadian home total parenteral nutrition registry: Preliminary data on the patient population 
Long-term administration of home total parenteral nutrition (HTPN) has permitted patients with chronic intestinal failure to survive for prolonged periods of time. However, HTPN is associated with numerous complications, all of which increase morbidity and mortality. In Canada, a comprehensive review of the HTPN population has never been performed.
To report on the demographics, current HTPN practice and related complications in the Canadian HTPN population.
This was a cross-sectional study. Five HTPN programs in Canada participated. Patients’ data were entered by the programs’ TPN team into a Web site-based registry. A unique confidential record was created for each patient. Data were then downloaded into a Microsoft Excel (Microsoft Corp, USA) spreadsheet and imported into SPSS (SPSS Inc, USA) for statistical analysis.
One hundred fifty patients were entered into the registry (37.9% men and 62.1% women). The mean (± SD) age was 53.0±14 years and the duration requiring HTPN was 70.1±78.1 months. The mean body mass index before the onset of HTPN was 19.8±5.0 kg/m2. The primary indication for HTPN was short bowel syndrome (60%) secondary to Crohn’s disease (51.1%), followed by mesenteric ischemia (23.9%). Complications: over one year, 62.7% of patients were hospitalized at least once, with 44% of hospitalizations related to TPN. In addition, 28.6% of patients had at least one catheter sepsis (double-lumen more than single-lumen; P=0.025) and 50% had at least one catheter change. Abnormal liver enzymes were documented in 27.4% of patients and metabolic bone disease in 60% of patients, and the mean Karnofsky score was 63.
In the present population sample, the data suggest that HTPN is associated with significant complications and health care utilization. These results support the use of a Canadian HTPN registry to better define the HTPN population, and to monitor complications for quality assurance and future research.
PMCID: PMC2658131  PMID: 17948134
Complications; Demography; Nutrition; Parenteral; Registry
21.  Association of apolipoprotein A1-C3 gene cluster polymorphisms with gallstone disease 
Genetic polymorphisms in apolipoprotein genes may be associated with alteration in lipid profile and susceptibility to gallstone disease.
To determine the association between apolipoprotein A1 (APOA1) (−75 guanine [G] to adenine [A] and +83/84 M2+/−, MspI) and apolipoprotein C3 (APOC3) (SstI) polymorphisms with gallstone disease.
MspI polymorphisms of the APOA1 gene and SstI polymorphisms of APOC3 were analyzed in DNA samples of 214 gallstone patients and 322 age- and sex-matched healthy controls. All statistical analyses were performed using SPSS version 11.5 (SPSS, USA) and Arlequin version 2.0 (Arlequin, Switzerland).
The APOA1 −75 G/A polymorphism was significantly associated with gallstone disease. Patients with the GG genotype (P=0.015) and G allele carriers (P=0.004) had a significantly higher risk of gallstone disease (1.087-fold and 1.561-fold, respectively), whereas patients with AA genotypes (P=0.011) and A allele carriers (P=0.004) were protected (OR 0.230 and 0.641, respectively) against gallstone disease. APOA1 +83 M2+/− and APOC3 SstI polymorphisms were not associated with gallstone disease. Case-control analysis of haplotypes showed a significant association in males only. G-M2+-S1 conferred risk for gallstone disease (P=0.036; OR 1.593, 95% CI 1.029 to 2.464), while A-M2+-S1 was protective (P=0.002; OR 0.370, 95% CI 0.197 to 0.695) against gallstone disease. In APOA1−75-APOA1+83 bilocus haplotypes, G-M2+ was associated (P=0.0001) with very high risk (OR 3.173, 95% CI 1.774 to 5.674) for gallstone disease in males only. APOA1−75-APOC3SstI haplotypes also showed significant association while APOA1+83-APOC3SstI haplotypes showed no association with gallstone disease.
The APOA1 −75 G/A polymorphism is associated with gallstone disease and shows sex-specific differences. On the other hand, APOA1 M2+/− and APOC3 SstI polymorphisms may not be associated with gallstone disease. Haplotype analysis is a better predictor of risk for gallstone disease.
PMCID: PMC2657985  PMID: 17853951
APOA1-C3haplotype; APOA1 MspIpolymorphism; APOC3 SstIpolymorphism; Gallstone disease; Gene polymorphisms
22.  Mast cell gastritis: Children complaining of chronic abdominal pain with histologically normal gastric mucosal biopsies except for increase in mast cells, proposing a new entity 
Diagnostic Pathology  2009;4:34.
Mast cells reside within the connective tissue of a variety of tissues and all vascularized organs. Since 1996, few studies have been performed on mast cell density in gastrointestinal biopsies, mainly in adult age group. We recently studied mast cell density in pediatric age group on rather larger number of cases in a referral children hospital. Mast cell density was 12.6 ± 0.87 in 0.25 mm2 (range: 0-81) in our study.
Since we frequently encounter cases with rather normal gastric biopsies with no H.pylori, which mainly complain of chronic abdominal pain, we gathered those cases with mast cell density more than 30/0.25 mm2. from 895 gastric biopsies and wanted to study their clinical and endoscopic findings and propose a new entity.
Between April 2005 and May 2008, 895 children (< 14 years old), with gastrointestinal complaints who underwent endoscopy were selected and antral biopsies were obtained for histological examination. Among these children, those who had normal or erythematous (but not nodular or ulcerative) gastric mucosa on endoscopic view, plus pathologic report of normal mucosa or mild gastritis in addition to mast cell count more than 30/25 mm2, were chosen and a questionnaire was filled for each patient including clinical, endoscopic and pathologic findings.
The statistical analysis was performed using SPSS, version 13 (SPSS Inc., Chicago, IL, USA).
Over a 3 year period of study, of 895 selected children, 86 patients fulfilled the entrance criteria. The major complaint of patients was recurrent abdominal pain. The mean mast cell density was 45.59 ± 13.81 in 0.25 mm2 (range: 30-93). Among our cases, about 67.4% (n = 58) had 30 to 49, 23.3% (n = 20) had 50 to 69, 8.1% (n = 7) had 70 to 89 and 1.2% (n = 1) had 93 mast cells/0.25 mm2 in their specimens
In 29% of our cases, neither endoscopic nor pathologic change was detected and only increase in mast cell number was reported and in others endoscopic and histopathological findings were negligible except increase in mast cells. In updated Sydney system (classification and grading of gastritis), no term is introduced which is in concordance with this group but we think that increased density of mast cells in these cases should not be overlooked and it may contribute to clinical manifestations in some way. We hope that further studies will direct us to institute therapeutic measurements in this regard.
PMCID: PMC2761861  PMID: 19799799
23.  Overweight and Obesity and their Association with Dietary Habits, and Sociodemographic Characteristics Among Male Primary School Children in Al-Hassa, Kingdom of Saudi Arabia 
To assess the magnitude of obesity and overweight among male primary school children, and to find the possible association between obesity/overweight and dietary habits and sociodemographic differentials among them.
Study design and Methods:
A cross-sectional descriptive study, including 1139 Saudi male children enrolled in the 5th and 6th grades in public primary schools in Al Hassa, Kingdom of Saudi Arabia (KSA), was conducted. The test included a multistage random sampling technique, based on interview using Youth and Adolescent Food Frequency Questionnaire, gathering data regarding dietary intake, dietary habits, followed by anthropometric measurements with the calculation of body mass index (BMI), the interpretation of which was based on Cole's tables for the standard definition of overweight and obesity. Sociodemographic data were collected through a parental questionnaire from. Data analysis was performed using the SPSS 12 software (SPSS Inc. Chicago, IL, USA); both univariate and multivariate analyses were performed.
The age of the school children ranged from 10–14 years. The prevalence of overweight among the subjects was 14.2%, while that of obesity was 9.7%; the prevalence was more in the urban, older age students. The mothers of obese and overweight children were less educated and more working. Missing and or infrequent intake of breakfast at home, frequent consumption of fast foods, low servings per day of fruits, vegetables, milk and dairy products, with frequent consumption of sweets/candy and carbonated drinks were all predictors of obesity and overweight among the schoolchildren studied.
The prevalence of childhood obesity is escalating and approaching figures that have been reported till now from the developed countries. Less healthy dietary habits and poor selection of food may be responsible for this high prevalence.
PMCID: PMC2763675  PMID: 19876479
Body mass index; childhood obesity; dietary habits; Saudi Arabia
24.  Methods for analysing cardiovascular studies with repeated measures 
Netherlands Heart Journal  2009;17(11):429-433.
Background. Repeated measurements in a single subject are generally more similar than unrepeated measurements in different subjects. Unrepeated analyses of repeated data cause underestimation of the treatment effects.
Objective. To review methods adequate for the analysis of cardiovascular studies with repeated measures.
Results. (1) For between-subjects comparisons, summary measures and random-effects mixedlinear models are possible. Examples of summary measures include the area under the curve of drug time-concentration and time-efficacy curves, maximal values, mean values, and changes from baseline. A problem is that precision is lost because averages, rather than individual data, are applied. Random-effects mixed-linear models, available in SPSS statistical software and other software programmes, provide better precision for that purpose. (2) For within-subjects comparisons, repeated-measures ANOVAs are available in SPSS and other software programmes. Subgroup factors such as gender differences and age class can be included.
Discussion. For non-Gaussian data, Wilcoxon's and Friedman's tests are available, for binary data McNemar's tests can be used in case of two repeated observations. No standard methods are available for repeated binary measures with more than two observations. The purpose of this review was not to present a complete report but, rather, to underline that ample efforts should be made to account for the special nature of repeated measures. (Neth Heart J 2009;17:429-33.19949712)
PMCID: PMC2779480  PMID: 19949712
repeated-measures analysis-of-variance (ANOVA); random-effects mixed-linear models
25.  Protein Microarray Analysis of Disease Activity in Pediatric Inflammatory Bowel Disease Demonstrates Elevated Serum PLGF, IL-7, TGF-β1, and IL-12p40 Levels in Crohn’s Disease and Ulcerative Colitis Patients in Remission versus Active Disease 
Cytokines and growth factors play a major role in the dysregulated immune response in inflammatory bowel disease (IBD). We hypothesized that significant differences exist between the serum cytokine and growth factor profiles of pediatric IBD patients with active disease (AD) and those in remission, and that levels of some of these soluble mediators may be used to define regulators in IBD and determine disease activity.
Eighty-eight, consecutive patients with confirmed Crohn’s disease (CD) and ulcerative colitis (UC) seen at the Duke Children’s Hospital were prospectively enrolled and a serum sample was obtained. Data were recorded at the time of serum collection to calculate disease activity indices. The relative expression of 78 cytokines, growth factors, and soluble receptors was determined using proprietary antibody-based protein microarrays amplified by rolling circle amplification. SPSS 8 (SPSS Inc., Chicago, IL) was used to compare protein profiles for CD and UC patients in clinical remission (CR) versus AD.
Sixty-five CD patients and 23 UC patients were enrolled. Forty-one CD patients had available samples and PCDAI results. Twenty-two patients were in remission PCDAI ≤ 12.5 (median 5), 19 patients had disease activity >15 (median 30). Univariate analysis revealed that PLGF, IL-7, IL-12p40, and TGF-β1 cytokine levels were significantly elevated for patients in CR versus AD (p < 0.01). Twelve UC serum samples had Seo/Truelove Witt AI for analysis. Five patients were in remission by TW AI and Seo AI ≤ 110 and 7 patients had active mild-to-severe disease by TW and Seo AI >110. Only one cytokine, IL12p40, showed significance between CR versus AD (p < 0.02).
Surprisingly, we found no differences in circulating levels of proinflammatory cytokines but found that pediatric IBD patients in remission compared to those with AD had higher levels of specific circulating cytokines, including the regulatory cytokines IL-12p40, and TGF-β1. It may be that these cytokines directly regulate intestinal inflammation in IBD or reflect the activity of T regulatory cells in negatively regulating the inflammatory response. Further studies will be needed to validate our results to define the molecular pathways involved in the intestinal immune response in man.
PMCID: PMC1586185  PMID: 15667502

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