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Sarah Samsudin,1,2 Mairin Dulasi,2 Salina Sany,2,3 Kathirgamanathan Balanathan,2 Soon Eu Chong,4,5 Anizah Ali1 1Department of Obstetrics and Gynaecology, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia; 2Obstetrics and Gynaecology Department, Hospital Seberang Jaya, Ministry of Health, Perai 13700, Penang, Malaysia; 3Cluster of Oncology & Radiological Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas 13200, Penang, Malaysia; 4Cluster of Regenerative Medicine, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas 13200, Penang, Malaysia; 5Department of Anaesthesiology and Critical Care School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, MalaysiaCorrespondence: Anizah AliDepartment of Obstetrics and Gynaecology, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, MalaysiaEmail dr.anizahali@ppukm.ukm.edu.mySalina SanyCluster of Oncology & Radiological Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas 13200, Penang, MalaysiaEmail salinasany@usm.myObjective: This study aimed to compare the efficacy, side effects, and clinical outcomes between parenteral iron sucrose complex (ISC) and low-molecular-weight iron dextran (LMWID) for iron deficiency anemia (IDA) in pregnancy.Methods: The study was conducted in a Malaysian tertiary hospital for a period of 1 year. Forty pregnant women with IDA between 24 and 38 weeks of gestation were randomized into two groups receiving treatment with either ISC or LMWID.Results: No significant difference was found between the groups in terms of demographic data, parity, and mean gestational age. A mean total of 835 ± 150 mg doses of ISC and 656 ± 382 mg doses of LMWID were administered (P = 0.0001). Adverse events were reported in five patients who received LMWID and none in those treated with ISC (P = 0.024). The mean hemoglobin (Hb) level increment 2 weeks post treatment was higher among those who received ISC than in those who received LMWID. The ISC group demonstrated an increase of 1.91 ± 1.10 g/dL (from 8.43 ± 1.03 g/dL to 10.29 ± 0.90 g/dL) compared with the LMWID group at 1.39 ± 0.54 g/dL (from 8.61 ± 0.70 g/dL to 9.92 ± 0.88 g/dL, P = 0.023). All participants in both groups delivered at term. The estimated blood loss during delivery was significantly higher in the LMWID group (359 ± 247 mL) than in the ISC group (280 ± 100 mL, P = 0.026). Otherwise, no significant difference was observed in terms of Hb level during delivery and the perinatal outcomes for both groups.Conclusion: Parenteral ISC is more effective than LMWID in treating maternal IDA, and it is associated with fewer adverse events.Keywords: iron deficiency anemia treatment, pregnancy, iron dextran, iron sucrose, maternal and perinatal outcomes

Background: In the realm of Chinese medicine, quality control and pharmacodynamics are crucial to ensure the consistency in scaled-up process from the laboratory to commercial operations. This study aims to analyse bioactivity consistency between laboratory observations and commercial processes. Method: The preparation of BPAid (5: 2: 9: 1 for Uncaria rhynchophylla (UR): Pueraria thomsonii (PT): Panax notoginseng (PN): Alisma orientale (AO) was divided into three methods: laboratory-scale maceration (BPAidM), industrial-scale flash extract method (BPAidFE), decoction method (BPAidD). The vasodilatory and antihypertensive effects of the extracts were examined through ex vivo and in vivo studies. The chemical fingerprint of each extract was analysed using tri-step FTIR spectroscopy, and UPLC-MS/MS was used for standard marker quantification. Results: BPAidM exhibited the highest vasodilatory effect, followed by BPAidFE, and BPAidD with EC50 values of 11.25 ± 2.30 mg/mL, 39.23 ± 12.55 mg/mL, 24.33 ± 6.26 mg/mL, and 198.71 ± 127.21 mg/mL: RMAX values of 106.53 ± 7.95%, 82.92 ± 5.22%, 76.35 ± 4.51%, and 60.62 ± 5.7%, respectively. In in vivo antihypertensive studies, all extracts significantly reduced the blood pressure of Spontaneously Hypertensive rats (SHRs). The tri-step FTIR revealed the presence of phenolic compounds, esters, and saccharides in BPAid extracts. BPAidM contained the highest total standard marker in the UPLC-MS/MS quantification, followed by BPAidFE, and BPAidD. Conclusion: Ultimately, the flash extract technique is recommended to produce BPAid to meet the global demand.

Abstract Co‐locating solar photovoltaics with vegetation could provide a sustainable solution to meeting growing food and energy demands. However, studies quantifying multiple co‐benefits resulting from maintaining vegetation at utility‐scale solar power plants are limited. We monitored the microclimate, soil moisture, panel temperature, electricity generation and soil properties at a utility‐scale solar facility in a continental climate with different site management practices. The compounding effect of photovoltaic arrays and vegetation may homogenize soil moisture distribution and provide greater soil temperature buffer against extreme temperatures. The vegetated solar areas had significantly higher soil moisture, carbon, and other nutrients compared to bare solar areas. Agrivoltaics in agricultural areas with carbon debt can be an effective climate mitigation strategy along with revitalizing agricultural soils, generating income streams from fallow land, and providing pollinator habitats. However, the benefits of vegetation cooling effects on electricity generation are rather site‐specific and depend on the background climate and soil properties. Overall, our findings provide foundational data for site preservation along with targeting site‐specific co‐benefits, and for developing climate resilient and resource conserving agrivoltaic systems.

Background and Aims: A 35-year-old patient with secondary infertility underwent oocyte freezing at Alpha IVF in January 2021. She had 13 oocytes retrieved, of which, only 3 were mature and vitrified on Day 0 (Day0-MII) while the remaining 10 immature oocytes were left to mature overnight. On the following day, 8 mature oocytes (Day1-MII) were vitrified. This case report describes a live birth following frozen embryo transfer (FET) of a Day 7 euploid blastocyst derived from vitrified-warmed Day1-MII oocytes. Method: All of the patient’s MII oocytes were vitrified and warmed using Cryotec method (Cryotech, Japan). The oocytes were inseminated using PIEZO-ICSI (Japan) and were cultured up to 7 days. Usable blastocysts (with at least a Gardner’s score of BB) had their trophectoderm biopsied and subsequently vitrified. Biopsied cells were subjected to preimplantation genetic testing-aneuploidy (PGT-A) using next generation sequencing (Ion Torrent, USA). Finally, a euploid blastocyst was warmed and transferred. Results: Of the 11 vitrified MII oocytes, 10 survived post-warmed and 7 fertilized post-insemination: 2 from Day0-MII oocytes; 5 from Day1-MII oocytes. After 7 days of culture, none of the vitrified-warmed Day0-MII oocytes became usable blastocysts. Out of the 5 fertilised Day1-MII oocytes, 2 developed into usable blastocysts (1 day 6 blastocyst; 1 day 7 blastocyst) and were subjected to PGT-A and vitrification. Of the 2 blastocysts analysed, only the day 7 blastocyst was a euploid. Subsequently, this blastocyst was warmed and transferred in June 2022 which led to a clinical pregnancy. In February 2023, the patient underwent an uneventful delivery at 38 weeks of pregnancy. Conclusion: This case report demonstrated that a day 7 blastocyst derived from vitrified-warmed Day1-MII oocytes can result in a healthy live birth. We advocate that the salvaging of immature oocytes on Day 0 should be practiced.

Suicide has been the subject of exploration in psychoanalysis. From Freud's internalized aggression and self-objectification in melancholic depression to contributions from object relation and self-psychology theorists, several of these central clinical concepts seem to share the commonality that one encounters an inhibition of thinking in a suicidal state of mind. Their freedom of thought is inhibited unswervingly despite the notion that we are born to think. Most psychopathologies, including suicide, relate to how we are often stuck with our thoughts. Thinking beyond this sense comes with significant emotional resistance. This case report follows through an attempt to integrate the hypothesized inhibitions on one's capability to think, involving one's own core conflicts and dysfunctional mental processing from the traditional psychoanalytic and mentalizing perspectives. The author hopes that further conceptualizations and research will empirically investigate these assumptions, potentially improving suicide risk assessment and prevention and enhancing psychotherapeutic outcomes.

Chrysin, a bioflavonoid belonging to the flavone, occurs naturally in plants such as the passionflower, honey and propolis. Few studies have demonstrated that chrysin can promote vasorelaxant activities in rats' aorta and mesenteric arteries. To date, no research has explored the signalling system routes that chrysin may utilise to produce its vasorelaxant action. Therefore, this study aimed to investigate the underlying mechanisms involved in chrysin-induced vasorelaxant in rats' aortic rings and assess the antihypertensive effect of chrysin in spontaneously hypertensive rats (SHRs). The findings revealed that chrysin utilised both endothelium-dependent and endothelium-independent mechanisms. The presence of L-NAME (endothelial NO synthase inhibitor), ODQ (sGC inhibitor), methylene blue (cGMP lowering agent), 4-AP (voltage-gated potassium channel inhibitor), atropine (muscarinic receptors inhibitor) and propranolol (β-adrenergic receptors inhibitor) significantly reduced the chrysin's vasorelaxant action. Furthermore, chrysin can reduce intracellular Ca2+ levels by limiting the extracellular intake of Ca2+ through voltage-operated calcium channels and blocking the intracellular release of Ca2+ from the sarcoplasmic reticulum via the IP3 receptor. These indicate that chrysin-induced vasorelaxants involved NO/sGC/cGMP signalling cascade, muscarinic and β-adrenergic receptors, also the potassium and calcium channels. Although chrysin had vasorelaxant effects in in vitro studies, the in vivo antihypertensive experiment discovered chrysin does not significantly reduce the blood pressure of SHRs following 21 days of oral treatment. This study proved that chrysin utilised multiple signalling pathways to produce its vasorelaxant effect in the thoracic aorta of rats; however, it had no antihypertensive effect on SHRs.

Solar photovoltaic (PV) technology is being deployed at an unprecedented rate. However, utility-scale solar energy development is land intensive and its large-scale installation can have negative impacts on the environment. In particular, solar energy infrastructure can require extensive landscape modification that transforms soil ecological functions, thereby impacting hydrologic, vegetative, and carbon dynamics. However, reintroducing native vegetation to solar PV sites may be a means of restoring their soils. To this end, we investigated critical soil physical and chemical parameters at a revegetated photovoltaic array and an adjacent reference grassland in Colorado, United States. Seven years after revegetation, we found that carbon and nitrogen remained lower in the PV soil than in the reference soil and contained a greater fraction of coarse particles. We also found that the PV modules introduced heterogeneity in the soil moisture distribution, with precipitation accumulating along the lower edges of panels. The redistribution of soil moisture by panel arrays could potentially be used in concert with planting strategies to maximize plant growth or minimize soil erosion, and should be considered when evaluating the potential to co-locate vegetation with solar infrastructure.

We report on the crystal improvement of semi-polar (112¯2) gallium nitride epitaxy layer on m-plane (101¯0) sapphire substrate by changing the flux rate at a fixed V/III ratio. The high-resolution X-ray diffraction (HR-XRD) analysis showed that lower flux rate enhanced the crystal quality of GaN epitaxy with the lowest FWHM values of 394 and 1173 arc seconds at [11¯23] and [11¯00] planes, respectively. In addition, Raman spectroscopy showed that flux rate did not affect the stress state of the GaN crystal. However, atomic force microscopy (AFM) micrograph depicted an anomalous trend where the lowest flux rate produces roughest surface with RMS roughness of 40.41 nm. Further analysis of AFM results on the undulation period length along [11¯23] and [11¯00] directions is carried out. It shows that as the growth rate decreases, the average undulation period along [11¯23] and [11¯00] directions increases from 2.59 µm and 1.90 µm to 3.52 µm and 3.52 µm, respectively. The mechanism for the surface roughening at the lower flux rate is then explained by using the adatom surface diffusion relation L ~ Dτ.

Objective: Needle visibility is an important factor in the success of ultrasoundguided supraclavicular brachial plexus block (USG SCBPB). This study aimed to compare needle visibility, block performance duration and block success of two echogenic needles, the Echoplex+® and the Stimuplex® Ultraline 360°. Methods: Seventy patients scheduled for upper limb surgery under USG SCBPB were randomised into two groups: Group E (n = 35) was blocked using an Echoplex+® needle and Group S (n = 35) was blocked using a Stimuplex® Ultraline 360° needle. The needle visibility, block performance duration and block success were recorded. Results: Needle visibility was comparable between the groups, with a higher percentage of good visibility in Group S than in Group E (65.7% vs 45.7%; p = 0.241). The medians of the block performance duration (11.0 [IQR 6] vs. 10.0 [IQR 4]; p = 0.278) and the percentages of adequate blocks (88.6% vs 88.6%; p = 0.565) were also comparable between Group E and Group S. Conclusions: The Echoplex+® and the Stimuplex® Ultraline 360°, were comparable in needle visibility, block performance duration and block success during USG SCBPB. Hence, both were equally effective for the performance of the block. [ABSTRACT FROM AUTHOR]

Background: There are limited data on the long-term adverse clinical outcomes of adults with metabolic dysfunction-associated fatty liver disease (MAFLD)., Methods: This is a single-centre prospective study of a well-characterized cohort of MAFLD patients who underwent liver biopsy and followed every 6-12 months for adverse clinical outcomes., Results: The data for 202 patients were analyzed [median age 55.0 (48.0-61.3) years old; male, 47.5%; obese, 88.6%; diabetes mellitus, 71.3%; steatohepatitis, 76.7%; advanced fibrosis, 27.2%]. The median follow-up interval was 7 (4-8) years. The cumulative incidence of liver-related events, cardiovascular events, malignancy and mortality was 0.43, 2.03, 0.60 and 0.60 per 100 person-years of follow-up, respectively. Liver-related events were only seen in patient with advanced fibrosis at 9.1% vs 0% in patient without advanced liver fibrosis (p < 0.001). The cumulative incidence of liver-related events among patients with advanced fibrosis was 1.67 per 100 person-years of follow-up. When further stratified to bridging fibrosis and cirrhosis, the cumulative incidence of liver-related events was 1.47 and 3.85 per 100 person-years of follow-up, respectively. Advanced fibrosis was not significantly associated with cardiovascular events, malignancy or mortality. The cumulative incidence of liver-related events, cardiovascular events, malignancy and mortality were not significantly different between patients with and without steatohepatitis and between obese and non-obese patients. However, liver-related events were only seen among obese patients., Conclusion: Overall, the cumulative incidence of liver-related event is low in patients with MAFLD, but it is much higher among those with advanced fibrosis. However, there is a relatively high cumulative incidence of cardiovascular event among patients with MAFLD., (© 2023. Asian Pacific Association for the Study of the Liver.)

Introduction and Objectives: The Hepamet fibrosis score was introduced for the diagnosis of advanced liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). To date, external validation is limited, and its utility in combination with liver stiffness measurement (LSM) has not been explored., Material and Methods: This is a cross-sectional study on NAFLD patients who had a liver biopsy and LSM on the same day. The diagnostic performance of the Hepamet fibrosis score was evaluated using the area under the receiver operating characteristic curve (AUROC)., Results: The data for 196 patients were analyzed (mean age 50 ± 11 years old, 50% men, 56.6% Malay, 27.6% Chinese, 15.8% Indian, 67.9% NASH, 15.8% advanced liver fibrosis). The AUROC of Hepamet fibrosis score for the diagnosis of advanced liver fibrosis was 0.85 (95% CI, 0.80 - 0.91). Using the <0.12 and ≥0.47 cut-offs from the original study, the sensitivity, specificity, positive predictive value, negative predictive value, the proportion of indeterminate results and misclassification rate were 81.8%, 91.8%, 47.4%, 98.2%, 32.1% and 6.1%, respectively. Using LSM <10 kPa and ≥15 kPa for the diagnosis of absence and presence of advanced liver fibrosis, respectively, in patients with Hepamet fibrosis score ≥0.47 (i.e., the two-step approach) reduced indeterminate results and misclassification to 16.1% and 3.6%, respectively., Conclusions: We found the Hepamet fibrosis score to have good diagnostic accuracy in a population that was largely unrepresented in earlier work and demonstrated its utility in a two-step approach with LSM for the diagnosis of advanced liver fibrosis., (Copyright © 2022 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.)

Currently, coronary artery disease (CAD) has been identified as the leading cause of mortality in Malaysia and in other countries worldwide. Genetic predisposition and comorbidities such as hypertension and diabetes mellitus, gender, lifestyle, and several other risk factors can contribute to the development of CAD. Pharmacological and surgical treatments play a vital role in improving the quality of life of patients with CAD. New surgical techniques and continuous interventions have been introduced to improve the treatment outcome. Recently, cardiothoracic teams from Universiti Teknologi MARA (UiTM) and Universiti Sains Malaysia (USM) have conducted a 2-day live workshop on off-pump coronary artery bypass (OPCAB) surgery. In this brief communication, we share the highlights and clinical tips of the OPCAB surgery gained from the collaboration., Competing Interests: Conflict of Interest None., (© Penerbit Universiti Sains Malaysia, 2022.)

We have developed a cell penetrating peptide (CPP) system with high selectivity and penetrability at nanomolar concentrations with a combination of an HER2-selective affibody, Z HER2:342 (Z HER2 ), and a dimeric α-helical leucine- and lysine-rich peptide, LK-2. Z HER2 and LK-2 are linearly fused together and expressed in a prokaryotic system to create the LK-2-Z HER2 protein, which can successfully distinguish and penetrate HER2-overexpressing cancer cells at nanomolar concentrations. LK-2-Z HER2 has the ability to intracellularly deliver doxorubicin as a conjugate form to enhance its anti-cancer effect on HER2-overexpressing breast cancer cells with a great selectivity. The selective penetrability was confirmed in vitro , in 3D spheroids, and in in vivo models. LK-2-Z HER2 has the capability to overcome the weak points of current CPPs, such as poor penetrability at low concentrations and a lack of selectivity, by combining powerful CPP and affibody sequences.

Competing Interests: Competing interests: The authors declare no conflicts of interest, and have completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author).

We developed a pH-activatable cell-penetrating peptide dimer LH 2 with histidine residues, which can penetrate cells, specifically in weak acidic conditions, even at few tens of nanomolar concentrations. LH 2 effectively delivered paclitaxel into triple-negative breast cancer cells, MDA-MB-231, via formation of non-covalent complexes (PTX-LH 2 (M)) or covalent conjugates (PTX-LH 2 (C)). Moreover, LH 2 showed prolonged circulation in the body and enhanced accumulation in tumors. Both PTX-LH 2 (M) and PTX-LH 2 (C) showed strong antitumor effects in a triple-negative breast cancer grafted mouse model at an extremely low dosage., (Copyright © 2020 Elsevier B.V. All rights reserved.)

A new vehicle is designed for the intracellular delivery of antibodies at nanomolar concentrations by combination of domain Z, a small affibody with strong binding affinity to Fc regions of immunoglobulin G (IgG), and the multimers of LK sequences, α-helical cell penetrating peptides (CPP) with powerful cell penetrating activities. Domain Z and multimeric LK are fused together to form LK-domain Z proteins. The LK-domain Z can bind with IgG at a specific ratio at nanomolar concentrations by simple mixing. The IgG/LK-domain Z complexes can successfully penetrate live cells at nanomolar concentration and the delivery efficiency is strongly dependent upon the concentrations of IgG/LK-domain Z complex as well as the species and subclasses of IgGs. The IgG/LK-domain Z complexes penetrate cells via ATP-dependent endocytosis pathway and the majority of delivered IgG seems to escape endosome to cytosol. Remarkably, the delivered IgGs are able to control the targeted intracellular signaling pathway as shown in the down-regulation of pro-survival genes by the delivery of anti-NF-κB using an LK-domain Z vehicle with a cathepsin B-cleavable linker between the LK sequence and domain Z. The simple but very efficient intracellular delivery method of antibodies at nanomolar concentrations is expected to facilitate profound understanding of cell mechanisms and development of new future therapeutics on the basis of intracellular antibodies., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Photothermal therapy (PTT) exploits nanomaterials with optimal heat conversion and cellular penetration using near-infrared (NIR) laser irradiation. However, current PTT agents suffer from inefficient heat conversion, poor intracellular delivery, and a high dose of probes along with excessive laser irradiation, causing limited therapeutic outcomes. Here, bumpy Au triangular nanoprisms (BATrisms) are developed for increasing the surface area, improving cell penetration, shifting the absorption peak to the NIR region, and enhancing the photothermal conversion efficiency (∼86%). Further, leucine (L)- and lysine (K)-rich cell-penetrating peptides (LK peptides) were employed to largely improve their cellular uptake efficiency. Importantly, a significant in vivo therapeutic efficacy with LK-BATrisms was demonstrated in a triple-negative breast cancer xenograft mice model. A very small dose of LK-BATrism (2.5 μg Au) was enough to exert antitumor efficacy under very low laser power (808 nm, 0.25 W/cm 2 ), causing minimal tissue damages while very efficiently killing cancer cells.

In this study, we propose a reversible covalent conjugation method for peptides, proteins, and even live cells based on specific recognition between natural amino acid sequences. Two heptad sequences can specifically recognize each other and induce the formation of a disulfide bond between cysteine residues. We show the covalent bond formation and dissociation between peptides and proteins in cell-free conditions and on the surface of live cells. Because heptad sequences consist of natural amino acids, they are expressed in cells without additional preparation and can be used to selectively conjugate peptides, proteins, and cells.

Background: Many biobanks rely upon patients' willingness to donate biospecimens and healthcare professionals to initiate opt-in consent processes. This study explored if: (1) patients accept opt-in or opt-out consent models with varying levels of professional involvement; (2) professionals discuss participation with specific patient groups; and (3) this discussion is associated with patient knowledge of biobanking processes., Methods: Outpatients completed surveys at a tertiary cancer center in New South Wales, Australia. Eligible participants were English-speaking adults who recently had cancer-related surgery. Participants completed 27 questions exploring acceptable consent models, biobanking experiences, knowledge, and willingness. Logistic regression and chi-square tests examined differences in the characteristics and knowledge of participants who were offered the opportunity to participate versus those who were not., Results: A total of 113 outpatients participated (97% response). Most participants (92%) found opt-out, patient-initiated consent acceptable; however, high acceptability was reported for all models except for opt-in, patient-initiated consent (58%). University or technical qualifications (P  =  0.001) was associated with increased odds (OR = 4.5) of being offered biobanking. The majority did not know what occurred to samples after surgery (59.3%) or pathology review (81.4%) and ability to answer these questions was associated with discussion of participation (P < 0.001). Of the few outpatients who discussed biobanking with their doctor (29%), all consented., Conclusion: Professional-initiated, opt-in consent resulted in a few educated patients being approached; greater professional initiation of consent would be fruitful as most patients were willing to participate if asked. However, other consent approaches minimizing professional involvement were as acceptable to participants warranting further consideration., (© 2018 John Wiley & Sons Australia, Ltd.)

Background: Massive bleeding is one of the commonest salvageable causes of death. The search for an ideal haemostatic agent during massive bleeding is still ongoing. One of the novel haemostatic medications is recombinant activated factor VII (rFVIIa). To date, the usage of rFVIIa during massive haemorrhage among non-haemophiliac patients remains off-label. The aim of this study is to report our experience in using rFVIIa to treat refractory bleeding., Methods: Medical records of all patients treated with rFVIIa for massive bleeding over an eleven-year period in a single institution were recorded. Treatment indications, 24-h and 30-day mortality, changes in transfusion needs and coagulation profiles after rFVIIa administration were analysed., Results: rFVIIa were administered in 76 patients. Of these, 41 (53.9%) were non-surgical bleeding, followed by 22 patients (28.9%) with trauma, other surgery bleedings in 9 patients (11.8%) and 4 patients (5.4%) with peripartum haemorrhage. Total survival rate was 78.9% within 24 h and 44.7% over 30 days. Among all these patients who had received rFVIIa due to life-threatening haemorrhage, blood and blood product requirements were significantly reduced ( P  < 0.001), and the coagulation profiles improved significantly ( P  < 0.05). Two patients with preexisting thromboembolism were given rFVIIa due to intractable bleeding, both survived. No thromboembolic events were reported after the administration of rFVIIa., Conclusions: rFVIIa significantly improved coagulation parameters and reduced blood product requirements during refractory haemorrhage. Additionally, usage of rFVIIa in trauma and peripartum haemorrhage patients yield better outcomes than other groups of patients. However, the overall mortality rate remained high., Competing Interests: The authors declare that they have no competing interests.For this retrospective non-interventional study, the need for informed consent for data collection has been waived and was approved by the institutional review board, the Human Ethics Committee of Universiti Sains Malaysia (Reference number: USM/JEPeM/16120535). Patient privacy and confidentiality was protected with data anonymization in the data collection forms. Unauthorised person had no access to the collected data from medical record and chart review.Not applicable.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Postlaparotomy management for elderly patients with underlying comorbidities is always a challenge because of poor cardiorespiratory reserves and prolonged effect of anesthetic drugs. For these reasons, such patients usually require intensive care unit (ICU) admission in the postoperative period. We report a case of an 85-year-old chronic smoker with controlled diabetes mellitus who needed an emergency laparotomy for a perforated gastric ulcer. Unfortunately, there was a shortage of ICU backup. With the successful conduct of an early surgery using combined general and regional anesthesia, the use of sugammadex (Bridion, Merck Sharp & Dohme Corp, Oss, the Netherlands) as a reversal agent, a skilled surgeon, and good postanesthesia care, the patient did not require ICU admission. He recovered fast and was discharged home 4 days after surgery. This case study aims to contribute to the literature on experience of a successful conduct of anesthesia in a high-risk geriatric patient when ICU facilities are limited., (Copyright © 2017 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

An amphipathic leucine (L) and lysine (K)-rich α-helical peptide is multimerized based on helix-loop-helix structures to maximize the penetrating activities. The multimeric LK-based cell penetrating peptides (LK-CPPs) can penetrate cells as protein-fused forms at 100-1000-fold lower concentrations than Tat peptide. The enhanced penetrating activity is increased through multimerization by degrees up to the tetramer level. The multimeric LK-CPPs show rapid cell penetration through macropinocytosis at low nanomolar concentrations, unlike the monomeric LK, which have slower penetrating kinetics at much higher concentrations. The heparan sulfate proteoglycan (HSPG) receptors are highly involved in the rapid internalization of multimeric LK-CPPs. As a proof of concept of biomedical applications, an adipogenic transcription factor, peroxisome proliferator-activated receptor gamma 2 (PPAR-γ 2), is delivered into preadipocytes, and highly enhanced expression of adipogenic genes at nanomolar concentrations is induced. The multimeric CPPs can be a useful platform for the intracellular delivery of bio-macromolecular reagents that have difficulty with penetration in order to control biological reactions in cells at feasible concentrations for biomedical purposes.

Biobanking consent processes should accord with patients' preferences and be offered in a consistent and systematic manner. However, these aims can be difficult to achieve under healthcare professionals' (HCPs) time-constrained workflows, resulting in low participation rates. This current perspective provides a brief overview of HCP involvement in consent and reports new data on participant attrition at each step of the biobanking consent process as experienced by 113 patients at an Australian tertiary cancer centre. To determine attrition in this HCP-driven consent process, we reviewed medical records for the following events: inclusion of biobanking consent forms; visible patient and HCP signatures; consent status selected (decline or accept) and specimen registration with local biobank. Accessible medical records revealed the following data: 75 of 85 records included viewable forms; 22 of 85 records included patient and 19 of 85 included HCP signatures; 15 of 85 records included signed and completed forms and 3 of 85 had samples banked with annotated clinical data. We compared these data with self-reported experiences of being approached to participate by HCPs. Of the 15 participants (17.6%) who successfully completed consent, only five could recall being asked and providing consent. The low enrolment rate is a considerable lost opportunity because most patients (59%) who were not asked to participate indicated they would have consented if asked. Furthermore, in comparing self-reported experiences with medical records, we believe cancer patients' preferences for participation are mismatched with actual biobanking enrolment, which has considerable attrition at each step in the consent process., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In Malaysia, melioidosis is commonly encountered as this infection is known as part of the endemic area for the disease. Managing cases of positive Burkholderia pseudomallei infection can involve multidisciplinary unit mainly, microbiologist, infectious disease team and intensive care as it may be quite difficult to distinguish melioidosis from a number of other diseases on the clinical setting alone. Laboratory diagnosis plays a vital role in determining the direction of management. Investigations such as culture, polymerase chain reaction (PCR) and serology should be evaluated once the disease is suspected. In this particular case, the patient is a young adult involved in a road traffic accident. Unlike any other cases with melioidosis, he had no potential risk factors which may have contributed to the severity of the disease and it is likely that the site of the accident was the source of acquisition of this gram negative bacterium.

Background: Dengue and malaria are two common, mosquito-borne infections, which may lead to mortality if not managed properly. Concurrent infections of dengue and malaria are rare due to the different habitats of its vectors and activities of different carrier mosquitoes. The first case reported was in 2005. Since then, several concurrent infections have been reported between the dengue virus (DENV) and the malaria protozoans, Plasmodium falciparum and Plasmodium vivax. Symptoms of each infection may be masked by a simultaneous second infection, resulting in late treatment and severe complications. Plasmodium knowlesi is also a common cause of malaria in Malaysia with one of the highest rates of mortality. This report is one of the earliest in literature of concomitant infection between DENV and P. knowlesi in which a delay in diagnosis had placed a patient in a life-threatening situation., Case Presentation: A 59-year old man staying near the Belum-Temengor rainforest at the Malaysia-Thailand border was admitted with fever for 6 days, with respiratory distress. His non-structural protein 1 antigen and Anti-DENV Immunoglobulin M tests were positive. He was treated for severe dengue with compensated shock. Treating the dengue had so distracted the clinicians that a blood film for the malaria parasite was not done. Despite aggressive supportive treatment in the intensive care unit (ICU), the patient had unresolved acidosis as well as multi-organ failure involving respiratory, renal, liver, and haematological systems. It was due to the presentation of shivering in the ICU, that a blood film was done on the second day that revealed the presence of P. knowlesi with a parasite count of 520,000/μL. The patient was subsequently treated with artesunate-doxycycline and made a good recovery after nine days in ICU., Conclusions: This case contributes to the body of literature on co-infection between DENV and P. knowlesi and highlights the clinical consequences, which can be severe. Awareness should be raised among health-care workers on the possibility of dengue-malaria co-infection in this region. Further research is required to determine the real incidence and risk of co-infection in order to improve the management of acute febrile illness.

Mask ventilation is one of the most important skills in airway management. Difficulty in mask ventilation can become life threatening if it is associated with difficulty in intubation during general anesthesia. We report a potential impossible ventilation condition which was safely and easily overcome with appropriate innovative modification of an Opsite adhesive film., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Although bleeding into the intestinal lumen may occur in strangulating intestinal obstruction, haematemesis is infrequently encountered. We report on a patient who presented with haematemesis and who had, in addition, clinical and radiological features of small bowel obstruction. Upper gastrointestinal endoscopy did not locate the source of bleeding. At laparotomy, which was performed because of clinical deterioration, gangrenous strangulated small bowel secondary to adhesive obstruction was found. In a patient with non-resolving intestinal obstruction, a deterioration in the condition is a clear indication for exploration. Haematemesis occurring concurrently may be a marker of intestinal strangulation, adds strength to the indication and highlights the urgency of the need for exploration.