Obstructive sleep apnea (OSA) is a common medical condition that impacts a significant portion of the population. To better understand this condition, research has been conducted on inhaling and ...exhaling breathing airflow parameters in patients with obstructive sleep apnea. A steady-state Reynolds-averaged Navier–Stokes (RANS) approach and an SST turbulence model have been utilized to simulate the upper airway airflow. A 3D airway model has been created using advanced software such as the Materialize Interactive Medical Image Control System (MIMICS) and ANSYS. The aim of the research was to fill this gap by conducting a detailed computational fluid dynamics (CFD) analysis to investigate the influence of cross-sectional areas on airflow characteristics during inhale and exhale breathing in OSA patients. The lack of detailed understanding of how the cross-sectional area of the airways affects OSA patients and the airflow dynamics in the upper airway is the primary problem addressed by this research. The simulations revealed that the cross-sectional area of the airway has a notable impact on velocity, Reynolds number, and turbulent kinetic energy (TKE). TKE, which measures turbulence flow in different breathing scenarios among patients, could potentially be utilized to assess the severity of obstructive sleep apnea (OSA). This research found a vital correlation between maximum pharyngeal turbulent kinetic energy (TKE) and cross-sectional areas in OSA patients, with a variance of 29.47%. Reduced cross-sectional area may result in a significant TKE rise of roughly 10.28% during inspiration and 10.18% during expiration.
Tuberculosis (TB), caused by Mycobacterium tuberculosis (M.tb), remains the leading cause of mortality from a single infectious agent. Each year around 9 million individuals newly develop active TB ...disease, and over 2 billion individuals are latently infected with M.tb worldwide, thus being at risk of developing TB reactivation disease later in life. The underlying mechanisms and pathways of protection against TB in humans, as well as the dynamics of the host response to M.tb infection, are incompletely understood. We carried out whole-genome expression profiling on a cohort of TB patients longitudinally sampled along 3 time-points: during active infection, during treatment, and after completion of curative treatment. We identified molecular signatures involving the upregulation of type-1 interferon (α/β) mediated signaling and chronic inflammation during active TB disease in an Indonesian population, in line with results from two recent studies in ethnically and epidemiologically different populations in Europe and South Africa. Expression profiles were captured in neutrophil-depleted blood samples, indicating a major contribution of lymphocytes and myeloid cells. Expression of type-1 interferon (α/β) genes mediated was also upregulated in the lungs of M.tb infected mice and in infected human macrophages. In patients, the regulated gene expression-signature normalized during treatment, including the type-1 interferon mediated signaling and a concurrent opposite regulation of interferon-gamma. Further analysis revealed IL15RA, UBE2L6 and GBP4 as molecules involved in the type-I interferon response in all three experimental models. Our data is highly suggestive that the innate immune type-I interferon signaling cascade could be used as a quantitative tool for monitoring active TB disease, and provide evidence that components of the patient's blood gene expression signature bear similarities to the pulmonary and macrophage response to mycobacterial infection.
IntroductionFragility fractures, which occur after a low-trauma injury, increases with advancing age. Such fracture doubles the life-time risk of sustaining another fracture. This risk is highest in ...the immediate 18 months after the index fracture. However, most patients do not receive the appropriate risk assessment and intervention to reduce this risk. A coordinated model of care termed Fracture Liaison Service (FLS) has been reported to address this treatment gap. Materials and methodsThis scoping review aims to explore the potential role and delivery of FLS services in Malaysia. Scientific and non-scientific sources relevant to FLS were identified from electronic bibliographic databases, specialist journals and relevant websites. Findings were categorised into themes and presented narratively. ResultsFLS services remain concentrated in the Klang Valley. Even within FLS services, many do not have extensive coverage to risk assess all fracture patients. These services are multidisciplinary in nature where there are links between different departments, such as orthopaedics, osteoporosis expertise, bone densitometry, rehabilitation, falls services and primary care. FLS was able to increase the number of people undergoing fracture risk assessment and treatment. The importance of FLS was highlighted by local experts and stakeholders. Its implementation and delivery are supported by a number of national guidelines. ConclusionFLS is central to our national efforts to reduce the impending fragility fracture crisis in the coming years. Continued effort is needed to increase coverage within FLS services and across the country. Training, awareness of the problem, research, and policy change will support this endeavour.
This paper studies the three dimensional (3D) simulation of fluid flows through the ball grid array (BGA) to replicate the real underfill encapsulation process. The effect of different solder bump ...arrangements of BGA on the flow front, pressure and velocity of the fluid is investigated. The flow front, pressure and velocity for different time intervals are determined and analyzed for potential problems relating to solder bump damage. The simulation results from Lattice Boltzmann Method (LBM) code will be validated with experimental findings as well as the conventional Finite Volume Method (FVM) code to ensure highly accurate simulation setup. Based on the findings, good agreement can be seen between LBM and FVM simulations as well as the experimental observations. It was shown that only LBM is capable of capturing the micro-voids formation. This study also shows an increasing trend in fluid filling time for BGA with perimeter, middle empty and full orientations. The perimeter orientation has a higher pressure fluid at the middle region of BGA surface compared to middle empty and full orientation. This research would shed new light for a highly accurate simulation of encapsulation process using LBM and help to further increase the reliability of the package produced.
The Ki-67 staining index (Ki67-SI) has been associated with prostate cancer patient outcome; however, few studies have involved radiotherapy (RT) -treated patients. The association of Ki67-SI to ...local failure (LF), biochemical failure (BF), distant metastasis (DM), cause-specific death (CSD) and overall death (OD) was determined in men randomly assigned to short term androgen deprivation (STAD) + RT or long-term androgen deprivation (LTAD) + RT.
There were 537 patients (35.5%) on Radiation Therapy Oncology Group (RTOG) 92-02 who had sufficient tissue for Ki67-SI analysis. Median follow-up was 96.3 months. Ki67-SI cut points of 3.5% and 7.1% were previously found to be related to patient outcome and were examined here in a Cox proportional hazards multivariate analysis (MVA). Ki67-SI was also tested as a continuous variable. Covariates were dichotomized in accordance with stratification and randomization criteria.
Median Ki67-SI was 6.5% (range, 0% to 58.2%). There was no difference in the distribution of patients in the Ki-67 analysis cohort (n = 537) and the other patients in RTOG 92-02 (n = 977) by any of the covariates or end points tested. In MVAs, Ki67-SI (continuous) was associated with LF (P =.08), BF (P =.0445), DM (P <.0001), CSD (P <.0001), and OD (P =.0094). When categoric variables were used in MVAs, the 3.5% Ki67-SI cut point was not significant. The 7.1% cut point was related to BF (P =.09), DM (P =.0008), and CSD (P =.017). Ki67-SI was the most significant correlate of DM and CSD. A detailed analysis of the hazard rates for DM in all possible covariate combinations revealed subgroups of patients treated with STAD + RT that did not require LTAD.
Ki67-SI was the most significant determinant of DM and CSD and was also associated with OD. The Ki67-SI should be considered for the stratification of patients in future trials.
By 2050, it is predicted that six million hip fractures will occur each year of which the majority will happen in Asia. Malaysia is not spared from this predicted rise and its rate of increase will ...be one of the highest in this region. Much of this is driven by our unprecedented growth in the number of older people. Characteristics of individuals with hip fractures in Malaysia mirror what has been reported in other countries. They will be older multimorbid people who were already at risk of falls and fractures. Outcomes were poor with at least a quarter do not survive beyond 12 months and in those that do survive have limitation in their mobility and activities of daily living. Reviewing how these fractures are managed and incorporating new models of care, such as orthogeriatric care, could address these poor outcomes. Experts have warned of the devastating impact of hip fracture in Malaysia and that prompt action is urgently required. Despite that, there remains no national agenda to highlight the need to improve musculoskeletal health in the country.
•A pioneering study exploring self-regulatory practices amongst motorcycle riders.•Motorcycle riders were found to be at risk of crash involvement and riding cessation.•Behavioural and psychological ...factors were important contributors to self-regulation.•Interventions should be customised to cater for populations with mixed travel modes.
The ability to drive longer and safely are crucial for many older adults. There is a growing evidence on self-regulatory practices amongst older drivers in developed countries, but limited studies are conducted in developing countries. This study aimed to explore self-regulatory practices amongst older Malaysian car drivers and motorcycle riders.
A cross-sectional study was conducted amongst older adults aged 60 years and above residing in two states located in the west coast of Peninsular Malaysia using a self-administered questionnaire. Stepwise regressions were performed to identify for key factors associated with driving/riding self-regulation and crash involvement. Multilevel modelling was conducted to examine the clustering effect of respondents recruited from the two states.
Six-hundred and thirty-seven respondents completed the questionnaire, with over three-quarters of them still driving/riding at the time of data collection. Physical fitness, behavioural and psychological changes experienced with advancing age were important motivators towards self-regulation. Motorcycle riders were found to be at a higher risk of crash involvement, and they were more prone to cease riding compared to car drivers.
Self-regulatory practices amongst older car drivers and motorcycle riders were found to be different. As such, there is a need to customise evidenced-based approaches to cater for specific age groups and road users, particularly in a developing country like Malaysia, where motorcycle is often considered as an affordable mode of transport and is largely involved in road traffic crashes.
Polyetheretherketone–hydroxyapatite composites were developed as alternative materials for load-bearing orthopedic applications. The amount of hydroxyapatite (HA) incorporated into the ...polyetheretherketone (PEEK) polymer matrix ranges from 5 to 40
vol% and these materials were successfully fabricated by injection molding. This study presents the mechanical and biological behavior of the composite materials developed. It was found that the amount of HA in the composite influenced the tensile properties. Dynamic behavior under tension–tension fatigue revealed that the fatigue-life of PEEK–HA composites were dependent on the HA content as well as the applied load. The biological responses of PEEK–HA composites carried out in vivo verified the biocompatibility and bioactive nature of the composite materials.
Summary Background COX-2 is overexpressed in some cancers, including prostate cancer; however, little is known about the effect of COX-2 overexpression on outcome in radiation-treated patients with ...prostate cancer. We aimed to study COX-2 overexpression and outcome in a well-defined cohort of men who received treatment with short-term androgen deprivation (STAD) plus radiotherapy or long-term androgen deprivation (LTAD) plus radiotherapy. Methods Men with prostate cancer who had participated in the Radiation Therapy Oncology Group (RTOG) 92-02 trial and for whom sufficient diagnostic tissue was available for immunohistochemical staining and image analysis of COX-2 expression were enrolled in this study. Patients in the 92-02 trial had been randomly assigned to treatment with STAD plus radiotherapy or LTAD plus radiotherapy. Multivariate analyses by Cox proportional hazards models were done to assess whether associations existed between COX-2 staining intensity and the RTOG 92-02 primary endpoints of biochemical failure (assessed by the American Society for Therapeutic Radiology and Oncology ASTRO and Phoenix criteria), local failure, distant metastasis, cause-specific mortality, overall mortality, and any failure. Findings 586 patients with sufficient diagnostic tissue for immunohistochemical staining and image analysis of COX-2 expression were included in this study. In the multivariate analyses, the intensity of COX-2 staining as a continuous covariate was an independent predictor of distant metastasis (hazard ratio HR 1·181 95% CI 1·077–1·295, p=0·0004); biochemical failure by two definitions (ASTRO HR 1·073 1·018–1·131, p=0·008; Phoenix HR 1·073 1·014–1·134, p=0·014); and any failure (HR 1·068 1·015–1·124, p=0·011). The higher the expression of COX-2, the greater the chance of failure. As a dichotomous covariate, COX-2 overexpression seemed to be most discriminating of outcome for those who received STAD compared with those who received LTAD. Interpretation To our knowledge, this is the first study to establish an association of COX-2 expression with outcome in patients with prostate cancer who have had radiotherapy. Increasing COX-2 expression was significantly associated with biochemical failure, distant metastasis, and any failure. COX-2 inhibitors might improve patient response to radiotherapy in those treated with or without androgen deprivation. Our findings suggest that LTAD might overcome the effects of COX-2 overexpression. Therefore, COX-2 expression might be useful in selecting patients who need LTAD.
In this study, biodegradable polylactic acid (PLA) composites were reinforced with three different natural fibers, were bamboo (BF), sugarcane (SF), and banana pseudostem (BPF) fibers, and prepared ...at different loadings (10, 20, and 30 wt.%). The solvent casting particulate leaching method was implemented to produce porous composites, and salt was used as the particulate material. The dielectric properties of the PLA/BF, PLA/SF, and PLA/BF composites were studied for different loadings of cellulosic fibers. The composites were observed using scanning electron microscopy (SEM), and the PLA composites with 30 wt.% filler content were analyzed using Fourier transform infrared (FTIR) and thermogravimetric analysis (TGA). According to the dielectric tests, all PLA/BF, PLA/SF, and PLA/BPF composites have low dielectric constants and dielectric loss. The PLA/BF composites exhibited the highest dielectric constant, dielectric loss, and electrical conductivity, followed by the PLA/BF and PLA/SF composites. The morphology of the composites showed their porous structure. The FTIR spectra showed the main constituents presented in the composites, and the PLA/BF showed higher thermal stability than the other composites.
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