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1.  Effect of Tualang honey on the anastomotic wound healing in large bowel anastomosis in rats-A randomized controlled trial 
Background
Honey has long been used for the treatment of number of ailments and diseases including surgical wounds. Current study evaluates the effectiveness of Tualang honey (TH) for large bowel anastomotic healing in Wistar rats.
Methods
Thirty male Wistar rats were given a 3 centimeter infra-umbilical laparotomy wound, in`flicted on their abdomen. The colonic transection was performed at 5 cm distal to caecum, with end to end anastomosis of colon segment. They were divided into two groups. Group I was fed with standard rat chow and water. Meanwhile, Group II apart from standard feed, was also given TH 1.0 g/kg every morning until day seven post operatively. Afterwards, anastomotic bursting pressures were measured and histopathological examination on the anastomosis line was performed with light microscopes. The data from two groups were analyzed by Independent paired t test for continuous variables.
Results
It was found that the tensile strength of colon anastomosis (95 % CI; p = <0.001) and the histopathological study including fibroblast count (p = <0.001) and inflammatory cells (p = 0.002) showed statistically significant difference in the favor of TH-treated group. Meanwhile, neovascularization formation was not statistically significant (p = 0.807); however, the overall count in the TH group was high.
Conclusion
Oral treatment with TH enhances anastomotic wound healing by increasing the number of fibroblasts and by decreasing inflammatory cells leading towards increased wound strength.
doi:10.1186/s12906-016-1003-6
PMCID: PMC4724403  PMID: 26803744
Anastomosis; Anastomotic bursting pressures; Honey; Wound healing
2.  Diagnostic accuracy of reused Pronto Dry® test and CLOtest® in the detection of Helicobacter pylori infection 
BMC Gastroenterology  2015;15:101.
Background
Unchanged substrate in a negative rapid urease test may be reused to detect Helicobacter pylori (H. pylori). This could potentially reduce costs and wastage in low prevalence and resource-poor settings. We thus aimed to investigate the diagnostic accuracy of reused Pronto Dry® and CLOtest® kits, comparing this to the use of new Pronto Dry® test kits and histopathological evaluation of gastric mucosal biopsies.
Methods
Using a cross-sectional study design, subjects who presented for upper endoscopy due to various non-emergent causes had gastric biopsies obtained at three adjacent sites. Biopsy samples were tested for H. pylori using a reused Pronto Dry® test, a reused CLOtest®, a new Pronto Dry® test and histopathological examination. Concordance rates, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were then determined.
Results
A total of 410 subjects were recruited. The sensitivity and diagnostic accuracy of reused Pronto Dry® tests were 72.60 % (95 % CI, 61.44 – 81.51) and 94.15 % (95 % CI, 91.44 – 96.04) respectively. For reused CLOtests®, the sensitivity and diagnostic accuracy were 93.15 % (95 % CI 85.95 – 97.04) and 98.29 % (95 % CI 96.52 – 99.17) respectively. There were more true positives for new and reused Pronto Dry® pallets as compared to new and reused CLOtests® when comparing colour change within 30 min vs. 31–60 min (P < 0.001 and P = 0.7 respectively).
Conclusion
Negative Pronto Dry® and CLOtest® kits may be reused in a low prevalence setting where cost issues remain paramount. Reused CLOtest® kits have better accuracy than reused Pronto Dry® tests. Reused Pronto Dry® tests however have a more rapid colour change whilst maintaining diagnostic accuracy.
doi:10.1186/s12876-015-0332-0
PMCID: PMC4534069  PMID: 26264957
3.  Identification of Foot Pathologies Based on Plantar Pressure Asymmetry 
Sensors (Basel, Switzerland)  2015;15(8):20392-20408.
Foot pathologies can negatively influence foot function, consequently impairing gait during daily activity, and severely impacting an individual’s quality of life. These pathologies are often painful and correspond with high or abnormal plantar pressure, which can result in asymmetry in the pressure distribution between the two feet. There is currently no general consensus on the presence of asymmetry in able-bodied gait, and plantar pressure analysis during gait is in dire need of a standardized method to quantify asymmetry. This paper investigates the use of plantar pressure asymmetry for pathological gait diagnosis. The results of this study involving plantar pressure analysis in fifty one participants (31 healthy and 20 with foot pathologies) support the presence of plantar pressure asymmetry in normal gait. A higher level of asymmetry was detected at the majority of the regions in the feet of the pathological population, including statistically significant differences in the plantar pressure asymmetry in two regions of the foot, metatarsophalangeal joint 3 (MPJ3) and the lateral heel. Quantification of plantar pressure asymmetry may prove to be useful for the identification and diagnosis of various foot pathologies.
doi:10.3390/s150820392
PMCID: PMC4570427  PMID: 26295239
foot pathology; gait symmetry; plantar pressure
4.  A simple and inexpensive enteric-coated capsule for delivery of acid-labile macromolecules to the small intestine*  
Understanding the ecology of the gastrointestinal tract and the impact of the contents on the host mucosa is emerging as an important area for defining both wellness and susceptibility to disease. Targeted delivery of drugs to treat specific small intestinal disorders such as small bowel bacterial overgrowth and targeting molecules to interrogate or to deliver vaccines to the remote regions of the small intestine has proven difficult. There is an unmet need for methodologies to release probes/drugs to remote regions of the gastrointestinal tract in furthering our understanding of gut health and pathogenesis. In order to address this concern, we need to know how the regional delivery of a surrogate labeled test compound is handled and in turn, if delivered locally as a liquid or powder, the dynamics of its subsequent handling and metabolism. In the studies we report on in this paper, we chose 13C sodium acetate (13C-acetate), which is a stable isotope probe that once absorbed in the small intestine can be readily measured non-invasively by collection and analysis of 13CO2 in the breath. This would provide information of gastric emptying rates and an indication of the site of release and absorptive capacity. In a series of in vitro and in vivo pig experiments, we assessed the enteric-protective properties of a commercially available polymer EUDRAGIT®L100-55 on gelatin capsules and also on DRcaps®. Test results demonstrated that DRcaps®coated with EUDRAGIT®L100-55 possessed enhanced enteric-protective properties, particularly in vivo. These studies add to the body of knowledge regarding gastric emptying in pigs and also begin the process of gathering specifications for the design of a simple and cost-effective enteric-coated capsule for delivery of acid-labile macromolecules to the small intestine.
doi:10.1631/jzus.B1400290
PMCID: PMC4506949  PMID: 26160716
Breath testing; Pig; Endoscopic capsule; Gastric emptying; Biomarker delivery; Gastrointestinal tract
5.  Sensor Anomaly Detection in Wireless Sensor Networks for Healthcare 
Sensors (Basel, Switzerland)  2015;15(4):8764-8786.
Wireless Sensor Networks (WSN) are vulnerable to various sensor faults and faulty measurements. This vulnerability hinders efficient and timely response in various WSN applications, such as healthcare. For example, faulty measurements can create false alarms which may require unnecessary intervention from healthcare personnel. Therefore, an approach to differentiate between real medical conditions and false alarms will improve remote patient monitoring systems and quality of healthcare service afforded by WSN. In this paper, a novel approach is proposed to detect sensor anomaly by analyzing collected physiological data from medical sensors. The objective of this method is to effectively distinguish false alarms from true alarms. It predicts a sensor value from historic values and compares it with the actual sensed value for a particular instance. The difference is compared against a threshold value, which is dynamically adjusted, to ascertain whether the sensor value is anomalous. The proposed approach has been applied to real healthcare datasets and compared with existing approaches. Experimental results demonstrate the effectiveness of the proposed system, providing high Detection Rate (DR) and low False Positive Rate (FPR).
doi:10.3390/s150408764
PMCID: PMC4431209  PMID: 25884786
wireless sensor networks; healthcare; medical sensors; sensor fault; sensor anomaly detection; prediction
6.  A Real-Time Localization System for an Endoscopic Capsule Using Magnetic Sensors † 
Sensors (Basel, Switzerland)  2014;14(11):20910-20929.
Magnetic sensing technology offers an attractive alternative for in vivo tracking with much better performance than RF and ultrasound technologies. In this paper, an efficient in vivo magnetic tracking system is presented. The proposed system is intended to localize an endoscopic capsule which delivers biomarkers around specific locations of the gastrointestinal (GI) tract. For efficiently localizing a magnetic marker inside the capsule, a mathematical model has been developed for the magnetic field around a cylindrical magnet and used with a localization algorithm that provides minimum error and fast computation. The proposed tracking system has much reduced complexity compared to the ones reported in the literature to date. Laboratory tests and in vivo animal trials have demonstrated the suitability of the proposed system for tracking a magnetic marker with expected accuracy.
doi:10.3390/s141120910
PMCID: PMC4279517  PMID: 25379813
in vivo tracking; magnetic localization system; real-time tracking; gastrointestinal tract; endoscopic capsule
7.  Dietary supplementation with soy isoflavones or replacement with soy proteins prevents hepatic lipid droplet accumulation and alters expression of genes involved in lipid metabolism in rats 
Genes & Nutrition  2013;9(1):373.
Accumulation of hepatic lipid droplet (HLD) is the hallmark pathology of non-alcoholic fatty liver disease (NAFLD). This study examined the effects of soy isoflavones (ISF) and different amounts of soy proteins on the accumulation of HLD, lipid metabolism and related gene expression in rats. Weanling Sprague–Dawley rats were fed diets containing either 20 % casein protein without (D1) or with (D2) supplemental ISF (50 mg/kg diet) or substitution of casein with increasing amounts of alcohol-washed soy protein isolate (SPI, 5, 10, and 20 %; D3, D4, D5) for 90 days. Dietary casein (20 %) induced accumulation of HLD in female, but not in male rats. Both soy proteins and ISF remarkably prevented the formation of HLD. Soy proteins lowered hepatic total cholesterol and triglyceride in a dose-dependent manner. Interestingly, soy proteins but not ISF significantly increased free fatty acids in the liver of the female rats compared to D1. Proteomic analysis showed that at least 3 enzymes involved in lipogenesis were down-regulated and 7 proteins related to fatty acid β-oxidation or lipolysis were up-regulated by soy protein over D1. Additionally, 9 differentially expressed proteins identified were related to amino acid metabolism, 5 to glycolysis and 2 to cholesterol metabolism. Dietary ISF and SPI markedly reduced hepatic-peroxisome-proliferator-activated receptor γ2 (PPARγ2) and fat-specific protein 27 (FSP27) in female rats. Overall, this study has shown that partial or full replacement of dietary casein by soy protein or supplementation with soy ISF can effectively prevent the accumulation of HLD. The potential molecular mechanism(s) involved might be due to suppression of lipogenesis and stimulation of lipolysis and down-regulation of PPARγ2 and FSP27. This suggests that consumption of soy foods or supplements might be a useful strategy for the prevention or treatment of fatty liver diseases.
Electronic supplementary material
The online version of this article (doi:10.1007/s12263-013-0373-3) contains supplementary material, which is available to authorized users.
doi:10.1007/s12263-013-0373-3
PMCID: PMC3896634  PMID: 24292949
Soy proteins; Isoflavones; Fatty liver; Lipid metabolism; Gene expression
8.  Correction: Negligible Colon Cancer Risk from Food-Borne Acrylamide Exposure in Male F344 Rats and Nude (nu/nu) Mice-Bearing Human Colon Tumor Xenografts 
PLoS ONE  2013;8(9):10.1371/annotation/f040499f-8485-4f7f-88bd-6720379064e9.
doi:10.1371/annotation/f040499f-8485-4f7f-88bd-6720379064e9
PMCID: PMC3770789
9.  Negligible Colon Cancer Risk from Food-Borne Acrylamide Exposure in Male F344 Rats and Nude (nu/nu) Mice-Bearing Human Colon Tumor Xenografts 
PLoS ONE  2013;8(9):e73916.
Acrylamide, a possible human carcinogen, is formed in certain carbohydrate-rich foods processed at high temperature. We evaluated if dietary acrylamide, at doses (0.5, 1.0 or 2.0 mg/kg diet) reflecting upper levels found in human foods, modulated colon tumorigenesis in two rodent models. Male F344 rats were randomized to receive diets without (control) or with acrylamide. 2-weeks later, rats in each group received two weekly subcutaneous injections of either azoxymethane (AOM) or saline, and were killed 20 weeks post-injections; colons were assessed for tumors. Male athymic nude (nu/nu) mice bearing HT-29 human colon adenocarcinoma cells-derived tumor xenografts received diets without (control) or with acrylamide; tumor growth was monitored and mice were killed 4 weeks later. In the F344 rat study, no tumors were found in the colons of the saline-injected rats. However, the colon tumor incidence was 54.2% and 66.7% in the control and the 2 mg/kg acrylamide-treated AOM-injected groups, respectively. While tumor multiplicity was similar across all diet groups, tumor size and burden were higher in the 2 mg/kg acrylamide group compared to the AOM control. These results suggest that acrylamide by itself is not a “complete carcinogen”, but acts as a “co-carcinogen” by exacerbating the effects of AOM. The nude mouse study indicated no differences in the growth of human colon tumor xenografts between acrylamide-treated and control mice, suggesting that acrylamide does not aid in the progression of established tumors. Hence, food-borne acrylamide at levels comparable to those found in human foods is neither an independent carcinogen nor a tumor promoter in the colon. However, our results characterize a potential hazard of acrylamide as a colon co-carcinogen in association with known and possibly other environmental tumor initiators/promoters.
doi:10.1371/journal.pone.0073916
PMCID: PMC3764052  PMID: 24040114
10.  Gastric precancerous lesions are associated with gene variants in Helicobacter pylori-susceptible ethnic Malays 
AIM: To identify genes associated with gastric precancerous lesions in Helicobacter pylori (H. pylori)-susceptible ethnic Malays.
METHODS: Twenty-three Malay subjects with H. pylori infection and gastric precancerous lesions identified during endoscopy were included as “cases”. Thirty-seven Malay subjects who were H. pylori negative and had no precancerous lesions were included as “controls”. Venous blood was collected for genotyping with Affymetrix 50K Xba1 kit. Genotypes with call rates < 90% for autosomal single nucleotide polymorphisms (SNPs) were excluded. For each precancerous lesion, associated SNPs were identified from Manhattan plots, and only SNPs with a χ2 P value < 0.05 and Hardy Weinberg Equilibrium P value > 0.5 was considered as significant markers.
RESULTS: Of the 23 H. pylori-positive subjects recruited, one sample was excluded from further analysis due to a low genotyping call rate. Of the 22 H. pylori-positive samples, atrophic gastritis only was present in 50.0%, complete intestinal metaplasia was present in 18.25%, both incomplete intestinal metaplasia and dysplasia was present in 22.7%, and dysplasia only was present in 9.1%. SNPs rs9315542 (UFM1 gene), rs6878265 (THBS4 gene), rs1042194 (CYP2C19 gene) and rs10505799 (MGST1 gene) were significantly associated with atrophic gastritis, complete intestinal metaplasia, incomplete metaplasia with foci of dysplasia and dysplasia, respectively. Allele frequencies in “cases” vs “controls” for rs9315542, rs6878265, rs1042194 and rs10505799 were 0.4 vs 0.06, 0.6 vs 0.01, 0.6 vs 0.01 and 0.5 vs 0.02, respectively.
CONCLUSION: Genetic variants possibly related to gastric precancerous lesions in ethnic Malays susceptible to H. pylori infection were identified for testing in subsequent trials.
doi:10.3748/wjg.v19.i23.3615
PMCID: PMC3691040  PMID: 23801863
Gastric precancerous lesions; Gene polymorphisms; Genome-wide association; Helicobacter pylori; Malays
11.  Barrett's Esophagus in an Area with an Exceptionally Low Prevalence of Helicobacter pylori Infection 
ISRN Gastroenterology  2011;2011:394734.
Objective. This study was undertaken to gain an insight into the relationship between Helicobacter pylori (H. pylori) infection, Barrett's esophagus and reflux esophagitis in an area of exceptionally low prevalence of H. pylori infection. Methods. A total of 1895 consecutive upper endoscopies performed between January 2005 and July 2007 were reviewed. 120 cases of columnar-lined esophagus and endoscopic esophagitis were evaluated. H. pylori infection was determined using the urease test and/or histology. Results. The rate of endoscopic esophagitis was 5.49% (80 Malays, 24 non-Malays) while histological reflux esophagitis was found in 3.75% (56 Malays, 15 non-Malays). Barrett's esophagus was present in 0.79% (11 Malays, 4 non-Malays). H. pylori infection was present in 8/120 or 6.67% subjects. Conclusion. The low rate of Barrett's esophagus in this population does not support the hypothesis that the absence of H. pylori infection is more than a minor risk factor for Barrett's esophagus.
doi:10.5402/2011/394734
PMCID: PMC3168394  PMID: 21991505

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