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Grey matter abnormalities and neurological soft signs (NSS) have been found in schizophrenia patients and their unaffected relatives. Evidence suggested that NSS are associated with grey matter morphometrical alterations in multiple regions in schizophrenia. However, the association between NSS and structural abnormalities at network level remains largely unexplored, especially in the schizophrenia and unaffected siblings.We used source-based morphometry (SBM) to examine the association of structural brain network characteristics with NSS in 62 schizophrenia patients, 25 unaffected siblings, and 60 healthy controls.Two components, namely the IC-5 (superior temporal gyrus, inferior frontal gyrus and insula network) and the IC-10 (parahippocampal gyrus, fusiform, thalamus and insula network) showed significant grey matter reductions in schizophrenia patients compared to healthy controls and unaffected siblings. Further association analysis demonstrated separate NSS-related grey matter covarying patterns in schizophrenia, unaffected siblings and healthy controls. Specifically, NSS were negatively associated with IC-1 (hippocampus, caudate and thalamus network) and IC-5 in schizophrenia, but with IC-3 (caudate, superior and middle frontal cortices network) in unaffected siblings and with IC-5 in healthy controls.Our results confirmed the key cortical and subcortical network abnormalities and NSS-related grey matter covarying patterns in the schizophrenia and unaffected siblings. Our findings suggest that brain regions implicating genetic liability to schizophrenia are partly separated from brain regions implicating neural abnormalities.

Background The PIONEER-HF trial has demonstrated the safety of Sacubitril-Valsartan initiation during acute decompensated heart failure (ADHF) compared to Enalapril. The efficacy outcome was also addressed by the surrogate end point of reduction in NT-proBNP. However, the safety and efficacy of Sacubitril-Valsartan initiation during ADHF compared to initiation after ADHF was unknown. Objectives (1) To compare the safety and efficacy of Sacubitril-Valsartan initiation during ADHF(inpatient) to initiation after ADHF(outpatient). (2) To explore the echocardiogram parameters associated with Sacubitril-Valsartan initiation during ADHF(inpatient) versus after ADHF(outpatient). Methods We enrolled patients diagnosed with heart failure with reduced ejection fraction (HFrEF) initiated on Sacubitril-Valsartan from February 2017 to December 2018. The baseline characteristics, echocardiogram parameters (changes in LVEF and positive remodeling), composite safety outcomes (hypotension, interruption of Sacubitril-Valsartan and worsening of renal function), and efficacy outcomes (cardiac death, readmission for heart failure) were compared. Results Thirty-seven patients were identified out of which 21 patients started Entresto after ADHF (outpatient group) and 16 patients during ADHF (inpatient group). The median follow-up duration was 196 days (IQR: 105 to 328days). The baseline characteristics were similar between the 2 groups. Outpatient groups achieved a significantly higher maximally tolerable dose of Sacubitril-Valsartan compared to inpatient group (median 400mg/day versus 200mg/day, p = 0.008) despite a similar starting dose (median 100mg/day versus 100mg/day, p = 0.127). The composite efficacy outcomes were similar between the 2 groups (4.8% versus 18.8%, p = 0.296). The composite safety outcome was similar between the groups (18.8% versus 4.8%, HR5.70 p = 0.054, 95%CI 0.967 to 33.60). Both groups achieved a significant improvement in LVEF after initiation of Sacubitril-Valsartan therapy: mean LVEF 23.44 ± 7.88% to 34.30 ± 13.88% (p = 0.001) in outpatient group; mean LVEF 22.99 ± 11.31% to 38.81 ± 13.91% (p = 0.002) in inpatient group. Reverse remodeling (reduction of LVESV≥15%) was similar between the 2 groups (61.9% versus 50.0%, p = 0.506). Conclusions Among patients with HFrEF in ADHF, initiation of Sacubitril-Valsartan therapy during or after ADHF led to similar safety and efficacy. Overall, there was a significant improvement in LVEF and positive remodeling of the LV regardless of the timing of initiation of therapy.

Background: Delayed enhancement cardiovascular magnetic resonance imaging (DeCMRI) has become the preferred method for viability assessment. It is well established that viable dysfunctional myocardium has the potential for functional recovery after revascularization. Objective: Our objective is to evaluate whether viability assessment by DeCMRI affects clinical outcome in daily clinical practice. Methodology:We retrospectively studied 132 consecutive patients (114 male, mean age 59 ± 10 years) with ischaemic cardiomyopathy (Mean LVEF: 29.1 ± 14%) who underwent CMRI viability testing from 1st Jan-31st Dec 2015 in our centre. Patientswere divided into 3 groups: Group A: Viable myocardium- optimal medical therapy only (38.6%); B: Viable myocardium- revascularization done (29.5%); and C: Nonviable myocardium (29.5%). Results: Mean age for groups A, B and C were 61.2, 58.3, 56.2 years respectively, p=0.048. The proportion of triple vessel disease in each of the groups were 56.1%, 54.5% and 38.5% (p=0.44); whereas left main involvement was 31.7%, 21.2% and 19.2% respectively (p=0.43). Majority of group C patients did not undergo revascularisation (90%). Group B had statistically significant EF improvement (5.5%, SD 11.9) compared to Group A (-0.6%, SD 6.7) and Group C (-1.2%, SD 9.8), p value 0.014. Mortality at 1 year was significantly higher in Group A compared to Group Band C (31.4%, 7.7% and 12.8% respectively, p=0.009). MACE rates were also increased in Group A compared to the other two groups (41.2%, 20.5% and 27.0%, p=0.09). Odds Ratio for MACE was 3.01 (95% Cl 1.22 - 7.45) for Group A vs B and 2.8 (95% Cl 1.1 - 6.9) for Group A vs C. Conclusion: Patients with viable myocardium who did not undergo revascularization (group A) had the worst prognosis, even when compared to those with non-viable myocardium; with significantly higher 1-year mortality. Although not statistically significant, there was also a trend towards higher MACE in these patients. These findings emphasize that patients with poor LV function but viable myocardium need to undergo revascularisation and that optimal medical therapy alone is not sufficient.

Background: Coronary artery anomalies (CAAs) are rare. Some anomalies are associated with myocardial ischaemia, heart failure and sudden cardiac death. Objectives: The aims of this study were to determine the incidence of CAAs detected on multidetector computed tomography (MDCT) and their clinical relevance. Methods: We reviewed our center’s MDCT database from January 2005 to December 2015. Results: 76 out of 5677 (incidence 0.01%) patients were reported to have CAAs. They consisted of 44 patients (57.9%) with anomalous origin of right coronary artery (RCA), 7 (9.2%) with anomalous origin of left coronary artery (LCA), 3 (3.9%) with anomalous origin of the left circumflex artery (LCX), 1 (1.3%) with abnormal course of LCX, 15 (19.7%) with coronary artery fistulas, 3 (3.9%) with single coronary artery, 3 (3.9%) with anomalous left coronary artery from pulmonary artery (ALCAPA).We were able to retrieved 26 patients’ (mean age 49 ± 13 years, 17 male) case folder. They consisted of 11 patients with anomalous origin of the RCA (10 from left coronary sinus), 4 with anomalous origin of LCA from right coronary sinus (3 interarterial course), 7 with coronary fistulas (2 large fistulas), 1 with single coronary artery (Lipton LII, anterior course) , 3 with ALCAPA. Out of the 26 patients, 24 (92.3%) were alive and 2 were lost to follow-up. The commonest presenting symptom was chest pain (65.4%), followed by dyspnea (34.6%) and heart failure (11.5%). 3 patients underwent surgery and 1 underwent transcatheter coiling of fistula. 4 patients had positive functional test (2 anomalous origin of RCA, 1 anomalous origin of LCA from right coronary sinus and 1 ALCAPA). Only 1 patient who had positive functional test underwent surgery. The remaining 3 who did not undergo surgery were still alive. The patient with single coronary artery presented with heart failure and remained alive with pharmacotherapy. All 3 ALCAPA patients were alive, with the oldest patient survived to age 71 years. None of them had surgery performed. Conclusions: CAAs are rare. Majority of cases may be benign. Largescale studies are needed to better define the prognosis and optimal treatment of individual forms of CAAs.

Background: Left ventricular (LV) volumes and ejection fraction (EF) from real-time three-dimensional echocardiography (RT3DE) hasbeen shown to be superior to measurements obtained from two dimensional echocardiography (2DE). However, most of these studies were conducted in research setting with high volume 3DE use, selected cohort of patients and experienced sonographers. Objectives: This study aimed to determine the accuracy and reproducibility of RT3DE and 2DE in measuring LV volumes and EF in daily clinical practice. Methods: 30 patients (age 52 ± 12 years, 24 men, 29 in sinus rhythm, 23with good acousticwindow) undergoing clinically indicated cardiac magnetic resonance (CMR) imagingwere prospectively recruited to have transthoracic 2DE and RT3DE performedwithin 4 hours after CMR. To assess inter-observer variability, 2 sonographers performed the same set of measurements independently on the same day. A subgroup of patients (n=10) was studied for intra-observer variability. CMR was the reference standard. Results: The LV end-diastolic volume (EDV), end-systolic volume (ESV), and EF measured from CMR were 194.3 ± 72.5 ml, 125.7± 69.0 ml and 37.8 ± 19.2% respectively. The biases ± SD for RT3DE were -72.7 ± 45.7 ml, - 47.6 ± 38.5 ml and 2.3 ± 9.8% for EDV, ESV and EF respectively. The biases ± SD for 2DE were - 70.5 ± 46.6 ml, - 50.8 ± 42.4 ml and 5.7± 9.5% for EDV, ESV and EF respectively. The difference in bias between RT3DE and 2DE volumeswas statistically not significant (p = 0.54 and p = 0.47 for EDV and ESV respectively). However, the difference in bias between RT3DE and 2D EF was marginally significant (p= 0.05). EF measured by CMR was similar by RT3DE (P= 0.21) but not by 2DE (P = 0.003). The inter- and intra-observer variation in volumes and EF were similar for RT3DE and 2DE. Conclusions: In daily clinical practice, RT3DE and 2DE underestimates LV volumes. Compared to 2DE, RT3DE is more accurate for EF measurement. The reproducibility of RT3DE measurements is similar to that of 2DE.

Background: Primary percutaneous coronary intervention (PCI)is the preferred reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI). However, timely PCI cannot be offered to many patients. Objective: The purpose of this study was to compare the 30-day clinical outcome of primary PCI strategy and fibrinolysis followed by coronary angiography strategy in STEMI patients. Methods: This was a prospective, observational, single center study. All patients admitted for STEMI from 1 January 2016 to 30 November 2016 were screened for the study. Patients were divided into 2 reperfusion strategies: primary PCI or fibrinolysis followed by coronary angiography. Primary outcome was composite of all-cause mortality at 30 days. Results: A total of 178 patients were identified: 33 (18.5%) underwent primary PCI and 145 (81.5%) underwent fibrinolysis first. The median door-to-balloon time in the primary PCI group was 161.0 minutes (IQR 84.5). The median time from fibrinolysis-to-arrival at catheterization lab was 1738 minutes (IQR 901). The median total ischaemic time was 369 min (IQR 524) and 210 (IQR 247) for the primary PCI and fibrinolysis first group respectively (p=0.002). Kaplan-Meier survival analysis for 30-day all-cause mortality was 24.2% vs 9.7% respectively in primary PCI and fibrinolysis group p=0.018). Multivariate Linear Regression showed that Killip Class and LVEF were independent predictors of 30-day all-cause mortality. Reperfusion strategy was not associated with 30-day all-cause mortality (p=0.216). Conclusions: The clinical outcome of primary PCI strategy in STEMI is not better than fibrinolysis followed by coronary angiography strategy when timely PCI cannot be performed.

Background: Cardiovascular magnetic resonance (CMR) is a rapidly emerging noninvasive imaging technique providing high resolution images without any application of radiation. It has broad range of clinical applications and is increasingly been used in clinical practice in Malaysia. A national CMR Registry is needed to assess its practice in Malaysia. Objective: To evaluate indications, safety and impact on patient management of CMR in Sarawak Heart Centre. Materials Methods: A pilot run of CMR Registry in single centre with consecutive patients who underwent clinical CMR from January-June 2015. Retrospective data collection from CMR database and case notes. Results: A total of 169 patients underwent clinical CMR, with 20 did not complete scan; 25% due to claustrophobia. 94% of patients received gadolinium-based contrast agent. Most important indications were viability assessment (54.4%), cardiomyopathy (28.2%), and risk stratification in suspected coronary artery disease (CAD) (4.7%). 6.7% of patients underwent stress MR (adenosine or dobutamine). Severe complications only occurred in 0.7% of the cases (anaphylactic reaction secondary to contrast agent). No mortality during/due to CMR. There was direct impact of CMR on the clinical management by confirming suspected diagnosis (59.1%), excluding suspected diagnosis (21.5%), providing additional information for suspected diagnosis which is confirmed or excluded (18.1%) and providing unsuspected completely new diagnosis (1.3%). Invasive coronary angiogram was avoided and diagnosis were excluded in all patients referred for risk stratification of suspected coronary artery disease. Invasive therapeutic procedures such as PCI, CABG, valve surgerywere triggered in 49.6 % of patients after CMR was done, regardless of indication. Out of 81 patients who underwent CMR for viability study, 76.5% were planned for revascularisation (CABG or PCI) with the restwere planned for optimalmedical therapy only after the CMR. Conclusions: The top indications of CMR in Sarawak are viability assessment, cardiomyopathy and risk stratification in suspected CAD, which differs from the EuroCMR registry results. This demonstrated the importance of establishing a national multicentre CMR registry in Malaysia, and subsequently substudy on specific conditions. With appropriate medical personnel training and patient selection, CMR is safe and has strong impact on clinical management.

Background: NT-proBNP is a useful biomarker in the management of heart failure. However, there is conflicting evidence for the prognostic value of NT-ProBNP in acute myocardial infarction (AMI). Objectives: (1) To explore the association between NT-proBNP and 1-year cardiac related mortality in AMI patients. (2) To explore the association between NT-proBNP and 1-year risk of sudden cardiac death or ventricular arrhythmia, readmission for heart failure, readmission for acute coronary syndrome (ACS) and stroke. Methods: We conducted a multicenter, prospective observational study recruiting patients presenting with AMI between 1-August2016 to 31-January-2017, involving 1 cardiology referral center and 4 non-cardiology hospitals. NT-proBNP levels (Alere Triage®, US) were measured within 24 hours of AMI diagnosis. Patients were followed-up for 1 year.

Background: CRT is indicated for patients with severely impaired left ventricular systolic function and ventricular dyssynchrony who remain symptomatic despite optimal medical therapy. CRT is an expensive treatment with a significant non-responder rate. Objective: To ensure appropriate use of this treatment modality, we decided to investigate whether clinical parameters can predict response to CRT in our patients. Methods: We retrospectively reviewed all CRT patients under responder based on pre-specified ECHO and clinical criteria. An ECHO response would be: relative improvement from baseline left ventricular ejection fraction (EF) of N 15%; and a decrease in End Diastolic Volume index (EDVi) or End Systolic Volume index (ESVi) of N 15%. Clinical response was defined as an improvement of at least 1 NYHA functional class. Patients who fulfil both ECHO and clinical criteria are considered responders our follow-up since 2014. We classified them as responder or non.

Background: Several models have been developed to help the clinician in risk stratification for Acute Coronary Syndrome (ACS),such as the TIMI and GRACE risk scores. However, there is conflicting evidence for the prognostic value of NT-ProBNP in acute myocardial infarction (AMI). Objective: (1) To explore the association of NT-proBNP with 30-day clinical outcome in AMI patients. (2) To compare the prognostic value of NT-proBNP with TIMI and GRACE risk scores in AMI patients. Methods: We conducted a multicenter, prospective observational study recruiting patients presented with AMI between 29-October-2015 and 14-January-2017, involving 1 cardiology referral centre and 4 non-cardiology hospitals. NT-proBNP level (Alere Triage®, US)was measured within 24 hours fromthe diagnosis of AMI. Patientswere followed-up for 1 month. Results: A total of 186 patients were recruited, 143 from tertiary cardiology centre and 43 from non-cardiology hospitals. Mean age was 54.7±10.0 years, 87.6% male and 64% were STEMI. The NT-proBNP level ranged from 60 to 16700pg/ml, with a median of 714pg/ml. Using the 75th centile as the cutoff, Kaplan-Meier survival analysis for the 30-day cardiac related mortality was significantly higher for patient with NT-proBNP level of ≥1600pg/ml (6.4% vs. 0.7%, p=0.02). Cox-regression analysis showed that NT-proBNP level of ≥1600pg/ml was an independent predictor of 30-day cardiac related mortality, regardless of TIMI risk score, GRACE score, LV ejection fraction and study hospitals (HR 9.274, p=0.054, 95%CI 0.965, 89.161). Readmission for heart failure at 30-day was also higher for patient with NT-proBNP level of ≥1600pg/ml (HR 9.308, p=0.053, 95%CI 0.969, 89.492). NT-proBNP level was not associated with all-cause mortality, risk of readmission for ACS, arrhythmia and stroke (pN0.05). By adding 50 score to GRACE risk score for NT-proBNP level of ≥1600pg/ml, combination of GraceNT-proBNP scores of more than 200 appeared to be a better independent predictor for 30-day cardiac related mortality (HR:28.28, p=0.004, 95%CI 2.94, 272.1). ROC analysis showed that this new score had 75% sensitivity and 91.2% specificity in predicting 30-day cardiac related mortality (AUC 0.791, p=0.046). Conclusions: NT-proBNP is a useful point-of-care risk stratification biomarker in AMI. It can be combined to the current risk score model for better risk stratification in AMI patients.

Background: The RXi™ system (ACIST Medical Systems, MN, USA) is a new Fractional Flow Reserve (FFR) technology utilising an ultrathinmonorail microcatheter (Navvus®; ACIST Medical Systems) with an optical pressure sensor located close to the distal catheter tip. FFR measurement using monorail microcatheter is comparable to the conventional pressure wires. However, the predictive value of resting distal coronary artery pressure/aortic pressure (Pd/Pa) on hyperemic FFR value in the real world practice is unknown. Objective: To explore the diagnostic accuracy of resting Pd/Pa in relation to hyperemic FFR using the monorail pressure catheter. Methods: Resting Pd/Pa and FFR were measured using monorail pressure catheter in 67 consecutive patients with intermediate coronary artery lesions (30% to 80% diameter stenoses) between 01-03-2016 to 17-01-2017. Of 121 studied lesions, 29 (23.97%) were excluded because of no hyperemic FFR due to postive resting Pd/Pa (n=17), severe or non-critical stenosis (n=11) and suboptimal acquisition (n=1), leaving 92 lesions for final analysis. Hyperemic FFR was induced with intracoronary adenosine. The selection of coronary wire and the dose of intracoronary nitroglycerine were at the operators’ discretions. Results: Bland-Altman plots showed a moderate degree of scatter between Pd/Pa and FFR value. On average, Pd/Pa exceeded FFR by 0.066 (-0.09 to +0.22). Receiver-operating characteristic curves of the resting Pd/Pa with FFR≤0.80 as the reference variable showed an area under the curve of 0.78 (95% confidence intervals 0.680 to 0.881, pb0.001), with a diagnostic accuracy of 79.3% when the resting Pd/Pa was ≤0.86. Certain cutoff values of Pd/Pa can reliably predict whether hyperemic FFR was positive or negative (FFR cutoff≤0.80). Resting Pd/Pa value of N0.96 had a negative predictive value (NPV) of 100% and sensitivity of 100%; the resting Pd/Pa value of ≤0.82 had a positive predictive value (PPV) of 100% and specificity of 98.3%. These were consistent regardless of coronary vessel, location of lesion or degree of diameter stenosis. Conclusions: Certain range of resting Pd/Pa measured by monorail pressure catheter had excellent NPV and sensitivity or excellent PPV and specificity to predict hyperemic FFR. Clinical outcome studies are required to determine whether the results might obviate the need for hyperemia in selected patients.

Background: High sensitivity troponin (hsTn) has better sensitivity for myocardial tissue injury detection compared to standard troponin assays, despite lower diagnostic specificity and lack of hsTn assay standardization. Objectives: To examine implications of introducing hsTnI in clinical practice. Methods: We retrospectively collected information of patients presented to a single tertiary cardiac referral centre with suspected acute coronary syndrome (ACS), who had ≥1 hsTnI sample (Abbott ARCHITECT STAT), from 1st June 2016-17th August 2016. Upper range limit (URL), i.e. 99th percentile, was defined as 34.2 ng/L, 15.6 ng/L and 26.2 ng/L for male, female and both gender (“overall”) respectively. Patients were divided into 4 groups - Group 1: hsTnURL but b3 times URL, Group 3: hsTn between 3-5 times URL and Group 4: hsTnN5 times URL. Results: Data from 366 patients was analysed: 227(62.0%), 34(9.3%), 13(3.6%), 92(25.1%) in Group 1, 2, 3 and 4 respectively. In Group 1 to 4, the proportion of ACS was 8.8%, 38.0%, 53.8%, 82.6% and proportion of MI were 0.8%, 29.4%, 53.8%. 82.6%. By using N5 times URL as cut-off, hsTnI has higher specificity and PPV, but lower sensitivity and NPV in diagnosis of ACS {(sensitivity:0.66, specificity:0.0.94, PPV0.83, NPV0.85), with ROC curve AUC:0.896, pb0.001, 95% CI:0.861-0.931}. Our analysis showed serial paired hsTn samples increase the PPV of hsTn to detect ACS. There was no significant difference between using hsTn URL “overall” or “gender-specific” for ACS diagnosis. Kaplan-Meier analysis showed 30-day all-cause mortality in the group with maximal hsTn value NURL is significant higher (pb0.001). Multiple-logistic regression showed that URL of hsTn was an independent variable for 30-day all-cause mortality (p

Our group has recently fabricated 3-dimensional scaffolds of unique architecture to mediate favorable cell binding, proliferation, and differentiation. In this study, the osteoconductive and bioactive polycaprolactone-20% tricalcium phosphate (PCL-TCP) scaffolds were assessed for the treatment of critical-sized defects of the mandible, with respect to new bone formation. Platelet-rich plasma (PRP) was combined with some scaffolds to test if bone regeneration could be enhanced.Autologous PRP was prepared from whole blood collected from 8 mongrel dogs. In each dog, 3 defects (18 x 10 x 7 mm) were created at either the left or right mandible and treated with 1 of 2 treatment modalities: 1) grafting with scaffolds alone; or 2) grafting with scaffolds loaded with PRP. The scaffolds were stabilized using 2 dental implants each to prevent rotation. Micro-CT and histologic analysis were carried out on samples after 6 and 9 months.Micro-CT measurements showed that PRP-treated defects had 98.3% and 58.3% more bone volume fraction than defects grafted with scaffolds alone at 6 and 9 months, respectively (P.05). No significant difference was noted between caudal and frontal situated PRP-treated defects, but a significant difference was observed between male and female dogs. Histologic analyses verified the deposition of osteoid and new bone trabeculae throughout the section at 6 months. The defect margins were filled with mature bone trabeculae at 9 months but the middle section of the scaffolds manifested disturbed mineralization. The scaffolds experienced 33% degradation from 6 to 9 months. PRP treatment had negligible effect on the degradation of the scaffolds.The pilot study showed that the treatment of critical-sized defects of the mandible with PCL-TCP scaffolds may be augmented by the addition of PRP.

Our group recently fabricated novel 3D polycaprolactone—20% tricalcium phosphate (PCL-TCP) composite scaffolds for applications in bone engineering. The bioactivity of such synthetic biomaterials can be evaluated by examining its ability to initiate the formation of apatite on its surface when immersed in simulated body fluids (SBF). In this study, the in vitro degradation behaviors of these scaffolds were systematically monitored for varying time periods of 1, 7, 14, 21 and 28 days post-immersion in SBF at 37 °C. Weight loss and water absorption of the samples indicated that PCL-TCP scaffolds were only slowly degraded. Biochemical assays and pH measurements revealed that hydroxyapatite, the main inorganic constituent of bone, commenced to form on the surface of the scaffolds after 17 days of immersion in SBF. Von Kossa assays demonstrated that calcium deposits increased progressively on the surface of the scaffolds after soaking in SBF for 2 weeks. Scanning electron microscopy verified the surface crystallization of the apatite layer formed over the entire period of time. In conclusion, the synergy of PCL with TCP in a composite scaffold confers both bioresorbability as well as bioactivity that offer an exciting approach for bone regeneration purposes.

Aim. This paper reports a study to explore the expectations, attainments and opinions of the participants, the objectives and experiences of nurse facilitators, and the changes in nurse–client relationship after a small-group hypertension health education programme. Background. Effective control of blood pressure among hypertensive patients is essential in the reduction of cerebrovascular-related morbidity and mortality. A ‘small-group hypertension education programme’ has been implemented in all general outpatient clinics in Hong Kong since 2000. In order to identify what aspects of the programme were beneficial and how it benefited clients, a process evaluation study was conducted. Methods. Following implementation of a small-group hypertension health education programme, two focus groups were run to collect data from eight nurse facilitators, and individual semi-structured interviews were conducted with 16 programme participants. The data were collected in 2001. Findings. The findings indicate that both clients and nurses gained a great deal from and enjoyed the process of this health education programme, and their relationships were improved after the programme. About half of the clients reported having adopted health-enhancing behaviour. The study also revealed discrepancies between the nurses and clients in their perceptions of the objectives of the programme. This indicates that there is a need to clarify the objectives with clients to minimize disappointments from unrealistic expectations. Conclusion. There is a need for the nurse facilitators to clarify the goal of the programme as an education group rather than as a support group. Also, needs assessment is suggested before group member recruitment in order to make the group more homogeneous.

We study the morphological instabilities of a dilute binary alloy during directional solidification into a time-periodic, oscillatory molten zone by modulating the solute field. The basic state, in which the flat melt–solid interface advances in a sinusoidal way, is solved analytically by expanding the governing equations in terms of the assumed-small amplitude of modulation. A linear stability analysis is then performed on the interface considering two specific instability modes: synchronous and subharmonic modes. We find the original Mullins–Sekerka instability can be stabilized synchronously by the imposed modulation. The subharmonic mode occurs with smaller wave numbers and is less critical than the synchronous Mullins–Sekerka mode.

In centrifugal atomisation the formation of a solid skull on the atomising disc is a major problem, which has adverse effects on the quality and quantity of the as-produced powder and also on the balance of the disc during atomisation. It is costly and difficult to study the flow behaviour because of the complex interaction between the liquid metal and the atomising disc. A computational fluid dynamics model has been developed using Flow-3D to simulate the thermal development of the liquid metal on the atomising disc. Under a fixed process condition, the liquid metal has a nearly constant solidification rate before the steady state is achieved and a solid skull is formed gradually. The volume of the skull decreases with increasing liquid metal flow rate, initial disc temperature and initial liquid temperature.

Tissue engineering offers an alternative method that can overcome some of the existing drawbacks of current articular defect repair methods because articular cartilage has a limited capacity to respond to injury. The solution may lie in the design of a three-dimensional load-bearing scaffold. Here we describe the tissue engineering of an osteochondral construct by coculturing osteogenic cells and chondrogenic cells on a three-dimensional load-bearing bioresorbable polymer scaffold. Porous polycaprolactone scaffolds were designed and fabricated via fused deposition modeling. Osteogenic cells were seeded and precultured in one-half of the partitioned scaffolds. Chondrogenic cells were later seeded into the other half. The cell-seeded scaffolds were cultured in a coculture medium. Both cell types proliferated, migrated, linked in their scaffold compartments, and integrated at the interface. Osteoblasts and chondrocytes produced different extracellular matrices in each scaffold compartment. Mineralized nodules deposited in the osteogenic cell seeded compartment. High osteocalcin was detected in precultured osteogenic cell supernatant and high alkaline phosphatase was detected in the coculture supernatant of osteochondral constructs. This study suggests that a tissue-engineered osteochondral construct with a three-dimensional polycaprolactone scaffold has the potential for osteochondral defect repair.

The measurement of resilient modulus has become increasingly accepted for characterizing the engineering properties of pavement materials. This paper presents an experimental program utilizing the Florida DOT test-pit facility and laboratory triaxial equipment to conduct the resilient modulus measurement of granular pavement subgrade materials in Florida. The resilient modulus was significantly affected by the moisture content of granular subgrades. A comparison between the resilient moduli measured from the test-pit test and the laboratory test was made. It was experimentally verified that the resilient modulus resulting from the laboratory triaxial test could be used to predict the resilient deformation of the pavement layer.

According to contractors in Florida, construction problems have emerged because pavement soils hold excessive water and are difficult to dry and compact. Recent research on the effects of soil suction and environmental conditions on drying rate characteristics of six types of troublesome granular soils is presented. Two types of tests were conducted for the study: soil suction tests using the thermocouple psy-chrometer method and drying rate tests using an environmental chamber. The experimental results showed that both the soil suction and relative humidity had direct effects on the soil-drying rate. The drying rate decreased with an increase in soil suction for each soil type and also decreased with an increase in the percentage of fines. The influence of relative humidity on the soil-drying rate was much more significant than the effect of the temperature. The rate of water evaporation was extremely low for the soils with a higher percentage of fines when the relative humidity was high. The A-2-4 soils with greater than 20 percent of fines may have such a low drying rate in an environment with high relative humidity that they are difficult to handle during construction.

Following MRI and pre-operative workup, the patient underwent an endoscopic transnasal/transsphenoidal biopsy of the sella lesion with formal histopathology demonstrating malignant tumour cells which were strongly CK7 and thyroid transcription factor-1 positive and GCDFP-15, PR, HER2, CK20, CDX-2 and WT1 negative consistent with a metastasis from a lung primary cancer. The patient underwent staging CT scanning, which demonstrated a right upper lobe lung lesion associated with right hilar adenopathy and a bulky adrenal gland. The patient has commenced stereotactic radiosurgery for the pituitary metastasis and is currently on hormone replacement. Pituitary metastasis is uncommon, comprising of 0.14 to 28.1% of all brain metastases in an autopsy series [1]. The most common primary disease is breast cancer in women and lung cancer in men [2], however, it is rare that a pituitary metastasis is the first manifestation of disease [3]. Patients present with visual disturbance, particularly hemianopia, which can be explained by suprasellar extension of the tumour compressing the optic apparatus. Other cranial nerve deficits are less common but can be seen with tumour extension to the parasellar region and cavernous sinus. In a case series by McCormack et al. 70% of patients presented with diabetes insipidus. This can be attributed to posterior pituitary involvement [4]. In comparison, in the more common pituitary adenoma, diabetes insipidus is reported in only 1% of cases [5]. This also suggests the importance of the inferior hypophyseal artery as the blood supply to the posterior pituitary from the systemic circulation.

In this study, we first investigated the in vitro degradation properties of biodegradable, bioresorbable polycaprolactone-20% tricalcium phosphate (PCL-TCP) composites immersed in simulated body fluid (SBF) and phosphate buffered saline (PBS). Then, the release profiles of the growth factors present in platelet-rich plasma (PRP) loaded onto the composites incubated in SBF and PBS were compared. Composites immersed in both buffers showed water uptake of 13.7%+/-0.75 at day 1, followed by a constant uptake of 12.1%+/-0.3 until day 12. Henceforth the water uptake declined for SBF- and increased for PBS-soaked composites. The weight loss data did not reveal any trend. SBF- and PBS-soaked samples displayed 1-2% weight loss for 2 and 5 of the ten time points measured respectively. The original protein retention (PR) of the composites was 49.1%+/-1.50. After immersion in SBF and PBS for 4 weeks, the PR was augmented to 88.5%+/-1.40 and 69.1%+/-1.40 correspondingly. PRP after activation contained 164.7+/-24.8, 194+/-43 and 18.3+/-4.75 ng/ml of TGF-beta1, PDGF-BB and IGF-1. Microscopic analysis verified the attachment of PRP to the rods and pores of the composites. Interestingly, the buffers played an important role in determining the release profiles of TGF and PDGF. Firstly, PBS-soaked composites manifested a tri-phasic burst-like profile that was absent in SBF. Secondly, SBF-soaked composites experienced delayed release of the growth factors and total release was not achieved (64.4% for TGF and 60.5% for PDGF), whereas total release was realized for PBS-soaked composites. Lastly, release profiles from SBF-soaked composites were growth factor mediated in terms of their amounts and sizes. This was not observed for PBS-soaked composites. IGF-1, on the other hand, exhibited a progressive reduction in levels over the entire experimental period for both buffers. The mechanisms of release were theorized to be a combination of diffusion, degradation and bioactivity. Since SBF is analogous to our body fluids in terms of its ionic constituents, we expect the elution profiles derived from SBF-soaked samples to more accurately emulate the in vivo situation. In conclusion, this study has deemed PCL-TCP composites as suitable delivery systems for platelet-rich plasma.

This study investigated a novel drug delivery system (DDS), consisting of polycaprolactone (PCL) or polycaprolactone 20% tricalcium phosphate (PCL-TCP) biodegradable scaffolds, fibrin Tisseel sealant and recombinant bone morphogenetic protein-2 (rhBMP-2) for bone regeneration. PCL and PCL-TCP-fibrin composites displayed a loading efficiency of 70% and 43%, respectively. Fluorescence and scanning electron microscopy revealed sparse clumps of rhBMP-2 particles, non-uniformly distributed on the rods' surface of PCL-fibrin composites. In contrast, individual rhBMP-2 particles were evident and uniformly distributed on the rods' surface of the PCL-TCP-fibrin composites. PCL-fibrin composites loaded with 10 and 20 microg/ml rhBMP-2 demonstrated a triphasic release profile as quantified by an enzyme-linked immunosorbent assay (ELISA). This consisted of burst releases at 2 h, and days 7 and 16. A biphasic release profile was observed for PCL-TCP-fibrin composites loaded with 10 microg/ml rhBMP-2, consisting of burst releases at 2 h and day 14. PCL-TCP-fibrin composites loaded with 20 microg/ml rhBMP-2 showed a tri-phasic release profile, consisting of burst releases at 2 h, and days 10 and 21. We conclude that the addition of TCP caused a delay in rhBMP-2 release. Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and alkaline phosphatase assay verified the stability and bioactivity of eluted rhBMP-2 at all time points.

A fractured apical fragment of the resilient intramobile element within the IMZ dental implant cylinder is difficult to remove. The continued usefulness of the implant will be compromised if the fractured intramobile element is not removed. Two methods of retrieving the apical fragment without causing damage to the internal threads of the implant cylinder are described.