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Background: Recent evidence suggested the link between nephrolithiasis and renal function impairment. We aimed to determine the renal function profile and potential factors associated with reduced renal function amongst renal stone formers in multi-ethnic Asians., Methods: We conducted a cross-sectional study involving patients undergoing percutaneous nephrolithotomy between May 2015 and December 2019. Reduced renal function was defined as having estimated glomerular filtration rate < 60 ml/min per 1.73 m2. Renal stone samples were collected and quantified using infrared spectroscopy. Potential factors associated with reduced renal function including age, ethnicity, educational level, history of diabetes, hypertension, gout, hydronephrosis, serum uric acid level, and type of renal stone were evaluated using univariable and multivariable analyses., Results: A total of 1162 patients from a multi-ethnic population (Malays 67%, Chinese 19%, Indians 13% and indigenous people 1%) with median age of 57 years (Interquartile range 48-64) were enrolled in the study. Almost a third of patients were found with reduced renal function. Multivariable analysis showed that the odds of having reduced renal function increased with age, ethnicity, lower educational level, history of diabetes, hypertension, gout, bilateral hydronephrosis, elevated serum uric acid level and infection stone., Conclusions: Reduced renal function varies between ethnicities and all age groups of renal stone formers. In addition to age and ethnicity, cardiovascular risk factors including diabetes and hypertension may also need to be taken into account in managing stone patients with reduced renal function., Competing Interests: The authors have read the journal’s policy and have the following competing interests to declare: Avro Abadi Sdn Bhd provided support for this study by funding the Thermo Scientific Nicolet iS5 Fourier-transform infrared (FT-IR) spectrometer. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.

Purpose: Stent encrustation is not uncommonly encountered with a high number of ureteric stents. The exact pathophysiology is not well understood. Therefore, we investigated the relationship between the use of sodium citrate and likelihood of stent encrustation., Methods: This prospective, randomised, intervention study was conducted between October 2018 and October 2019 in a tertiary hospital. Overall, 115 patients with ureteral stents that were inserted after lithotripsy surgeries were recruited. The study subjects were randomised into two groups: one group was administered sodium citrate (Utix sachets) three times per day until stent removal (intervention group), and the second group was not administered Utix sachets (control group). Stents were removed after 1 month and inspected under macroscopic visualisation from the proximal to distal end for any crystallisation; a second inspection was done with a 60 × magnification lens. Any crystallisation observed was considered to be encrustation., Results: Patients who had Utix sachets post-insertion of a ureteric stent constituted 50.4% of the study cohort. The rate of encrustation in the control group was 52.6%. In the intervention group, the rate of encrustation was 46.6%. The difference was not statistically significant with the chi-squared test (p value, 0.514)., Conclusion: Alkaline citrate medications had no significant effect on stent encrustation rate. More studies are needed to elucidate different agents and their roles in reducing stent encrustation as it incurs high morbidity., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: To predict prostate cancer using novel biomarker ratios and create a predictive scoring system., Materials and Methods: Data of a total of 703 patients who consulted Urology Department of Selayang Hospital between January 2013 and December 2017 and underwent prostate biopsy were screened retrospectively. Prostate specific antigen (PSA) levels, prostate volumes (PV), neutrophil and lymphocyte counts, neutrophil-to-lymphocyte ratio (NLR), Prostate specific antigen density (PSAD) and histopathology were evaluated., Results: Ages ranged from 43 to 89 years, divided into 2 groups as per biopsy results; positive for prostate cancer (n = 290, 41.3%) and negative for malignancy (n = 413; 58.7%). Intergroup comparative evaluations were performed. Independent variables with p < 0.001 in the univariate analysis were age, DRE, PV, NLR, PSAD. A scoring system was modelled using NLR < 0.9, PSAD > 0.4, Age > 70 and DRE. A score of 2 or more predicted prostate cancer with a Sensitivity of 83.8% and Specificity of 86.4%., Conclusions: NLR is shown to be good predictor for prostate cancer its usage in this scoring system affords more disease specificity as compared to PSA alone., (© 2022. The Author(s).)

Prostate cancer is the third most common cancer in Malaysia with the lifetime risk of 1 in 117 men. Here, we initiated a longitudinal Malaysia Prostate Cancer (M-CaP) Study to investigate the clinical and tumour characteristics, treatment patterns as well as disease outcomes of multi-ethnic Asian men at real-world setting. The M-CaP database consisted of 1839 new patients with prostate cancer diagnosed between 2016 and 2018 from nine public urology referral centres across Malaysia. Basic demographic and clinical parameters, tumour characteristics, primary treatment, follow-up and vital status data were retrieved prospectively from the hospital-based patients' case notes or electronic medical records. Primary endpoints were overall survival (OS) and biochemical progression-free survival (bPFS). The median age at diagnosis of M-CaP patients was 70 years (interquartile range, IQR 65-75). Majority of patients were Chinese (831, 45.2%), followed by Malays (704, 38.3%), Indians (124, 6.7%) and other races (181, 9.8%). The median follow-up for all patients was 23.5 months (IQR 15.9-33.6). Although 58.1% presented with late-stage cancer, we observed ethnic and geographic disparities in late-stage prostate cancer diagnosis. Curative radiotherapy and primary androgen deprivation therapy were the most common treatment for stage III and stage IV diseases, respectively. The median OS and bPFS of stage IV patients were 40.1 months and 19.2 months (95% CI 17.6-20.8), respectively. Late stage at presentation remains a challenge in multi-ethnic Asian men. Early detection is imperative to improve treatment outcome and survival of patients with prostate cancer., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Nocturia is widely prevalent condition with detrimental effects on quality of life and general health. In Malaysia, there is a lack of up-to-date prevalence study on nocturia. This study aimed to investigate the prevalence of nocturia and awareness pertaining to nocturia among Malaysian adults., Methods: A cross-sectional population-based study was conducted among Malaysian adults aged ≥ 18 years old. The data was collected by mixed mode self-administered questionnaire from May 2019 to September 2019. Nocturia was defined as one or more voids at night., Results: There were a total of 4616 respondents with 74.5% of response rate. The overall prevalence of nocturia among Malaysian adults was found to be 57.3%. In multivariate analysis, respondents aged 31-40 (1.91 [1.52-2.40]) or > 60 years old (2.03 [1.48-2.71]), and those who presented with hypertension (2.84 [2.28-3.53]), diabetes mellitus (1.78 [1.42-2.25]), renal disease (3.58 [1.93-6.63]) or overactive bladder (1.61 [1.10-2.35]) were associated with higher prevalence of nocturia. A significantly lower disease prevalence (p < 0.05) was noted among those aged 41-50 (0.73 [0.59-0.91]), male (0.78 [0.69-0.88]) and Chinese (0.47 [0.30-0.74]) or Indian (0.34 [0.21-0.54]) ethnicities. A total of 37.3% of respondents with nocturia reported that they faced sleeping difficulty about half the time or more after waking up in the middle of night. Those who had ≥ 2 voids per night experienced significantly higher mean bother score than those who had 1 void per night (p < 0.001). Approximately half (56.7%) of all respondents were not aware that night time urination is a medical condition. Only 25.2% of respondents with nocturia had sought medical attention for their nocturia., Conclusions: The prevalence of nocturia among Malaysian adults is high and strongly influenced by age, sex, race and comorbidities. However, the general awareness pertaining to nocturia being a health issue remains low among Malaysians. The findings also highlighted the impact of nocturia on sleep and the need for nocturia education to better address this disease.

"Nerveside", a phosphopeptide extracted from ox and dog brains by Toh, was injected into one lateral ventricle of four rats previously prepared for the injection as well as for recordings of the EEG of the dorsal hippocampus (field CA1) and sensorimotor cortex. "Nerveside" in doses of 150 and 300 micrograms/animal induced a transient stereotyped behaviour and longer lasting alterations of the EEG activity and vigilance pattern. Wakefulness was increased, slow wave sleep and REM-sleep were diminished. The vigilance pattern was characterized by rapid shifts between all three vigilance states. The effects of "nerveside" were visible for about three hours.

Ten patients, all below 30 years of age (8 females and 2 males) developed Stokes-Adams attacks from complete heart block due to acute nonspecific myocarditis. Coexisting thyrotoxicosis was present in two patients and cardiogenic shock was seen in four. Temporary transvenous pacing was instituted in all but one patient. Except for two patients who developed permanent complete heart block, normal A-V conduction returned in between 1 to 12 hours after ventricular pacing in seven patients and after 12 hours of isoprenaline therapy in the final patient. The ECG returned to normal in six patients and all 10 patients survived their acute illness.

Aneurysms of the aortic sinus of Valsalva (ASV) are uncommon. This study describes eight cases of ruptured aneurysms of the congenital variety observed over a 10-year period in Singapore. Although ASV is classically diagnosed at the time of rupture, only one patient in this series presented with acute chest pain and dyspnea. All eight patients had continuous murmurs. The clinical diagnosis was confirmed by cardiac catheterization and angiography in eight patients and by thoracotomy in six. In six patients, the aneurysm had ruptured into the right ventricle and in two into the right atrium. In the five patients where the site of the aneurysm could be definitely determined, four arose from the right coronary and one from the noncoronary sinus. This marked preponderance of right coronary sinus over noncoronary sinus aneurysm in Singapore is more in accordance with the Japanese rather than the Western experience. A systolic gradient due to the aneurysm pressing on the right ventricular outflow tract was established in four patients during cardiac catheterization and angiography and confirmed in three patients at thoracotomy. Six patients underwent operation and were alive and well from 7 months to 3 years later.

The incidence of aortic incompetence complicating ventricular septal defect has been estimated as varying from 2-5% (Glasser et alii, 1972) to 5% (Nadas et alii, 1964). Although numerous publications have appeared describing the clinical, pathological and surgical aspects of this syndrome in different parts of the world, documentation of its occurrence in Asian patients has been rare except for reports from Japan (Tatsuno et alii, 1973; Mizuno and Saegusa, 1967). This paper describes our experience of 12 cases collected over 10 years.

1. In the rabbit jejunum nerveside causes alternating contractions of the longitudinal and circular muscles, which are similar to the peristaltic reflex produced by distension of the gut. These effects are abolished by dibucaine (Nupercaine) and tetrodotoxin. The site of action is located in Auerbach's plexus.2. Circular muscle contractions due to nerveside are blocked by hexamethonium, nicotine, morphine, atropine and hyoscine. There is no circular response to nerveside after removal of Auerbach's plexus. It is suggested that nerveside acts by stimulating presynaptic nerve terminals which are cholinergic and that the circular muscle is innervated by cholinergic nerve fibres.3. Longitudinal muscle contractions due to nerveside are not affected by hexamethonium but can be blocked by paralysis of myenteric ganglia with nicotine. They are not abolished by morphine or by cholinolytic drugs. It is suggested that nerveside acts by stimulating either receptors insensitive to acetylcholine in ganglion cells or non-cholinergic presynaptic nerve terminals. It is further suggested that the longitudinal muscle of the rabbit gut is supplied by non-cholinergic as well as cholinergic nerve fibres.

1. The nerve-stimulating phosphopeptide, nerveside, is present mainly in the cerebrum and brain stem, while the cerebellum contains only a trace amount of it.2. Nerveside is uniformly distributed over all parts of the cerebral cortex.3. The cerebral cortex contains the greatest concentration of nerveside. If the nerveside activity of 1 g cerebral cortex is expressed as 100 then the relative activities of the other parts of the C.N.S. are hippocampus 41, caudate nucleus 21, diencephalon (without hypothalamus) 24, midbrain 19, pons 7, medulla 12 and cerebellum 6.4. The nerveside activity of the hypothalamus is the same as that of the cerebral cortex.5. The pattern of distribution of nerveside in the C.N.S. suggests that it may be part of a corticipetal or corticifugal system.

1. An enzyme which can be extracted from brain inactivates nerveside in the optimum pH range 5.8-7.0.2. The polybasic acids trypan blue and its analogue trypan red, bromphenol blue and its analogue bromthymol blue at concentrations of 0.22 mM and ethylenediaminetetra-acetic acid (EDTA) at a concentration of 1 mM are strong inhibitors of the enzyme.3. Penicillin which is a monobasic carboxylic acid also inhibits the enzyme but only if concentrations as high as 3.6 mM are used. The antibiotic streptomycin which is a basic substance does not inhibit the enzyme.4. Caffeine at a concentration of 7.2 mM only weakly inhibits the enzyme.5. Chymotrypsin and wheat germ acid phosphatase also inactivate nerveside at pH 5.9 and are inhibited by the acidic dyes and penicillin. EDTA inhibits wheat germ phosphatase but activates chymotrypsin.6. Inactivation of nerveside by the brain enzyme and by wheat germ phosphatase is different from the action of chymotrypsin. Nerveside solutions incubated with chymotrypsin completely lose all biological activity whereas if incubation is carried out with either the brain enzyme or wheat germ acid phosphatase a residual biological activity remains even when the concentration of these two enzymes is increased. This residual biological activity is due to a peptide as it is destroyed by chymotrypsin.7. The manner in which nerveside is inactivated by the brain enzyme is uncertain as the preparation of the latter contained phosphodiesterase and protease activities which were similarly inhibited by the acid dyes, penicillin and EDTA.8. Pentylenetetrazole, picrotoxin, strychnine and tetanus toxin do not inhibit the brain enzyme.9. The nerveside-inactivating enzyme is not identical with the Substance P-inactivating enzyme in brain as the former is inhibited by EDTA while the latter is not.

Besides histamine another smooth muscle stimulating substance has been found in the nasal mucosa of dog and sheep. It is an acid which is readily oxidized by neutral aqueous potassium permanganate and osmium tetroxide, and is thermostable at pH 10.8 but not at pH 2.8. The purification of this acid has been followed by using the atropinized tortoise intestine as a test object, which is insensitive to acetylcholine, 5-hydroxytryptamine and small amounts of histamine. Both the tortoise intestine and rat colon are contracted by this acidic substance. The amount of histamine found in sheep nasal mucosa ranged from 12 to 23 mug./g. tissue and in dog nasal mucosa from 6 to 13 mug./g. tissue.

Of 127 hypertensive patients aged 12 to 40 investigated by intravenous pyelography, abdominal aortography, and renal biopsy an underlying cause was found in 57%. The proportion with secondary hypertension was higher in young patients and in those with severe hypertension. Primary arteritis of the aorta was an important cause of renovascular hypertension in an Asian population.