Development, Validation and The Effects of Culturally Specific Guided Imagery and Progressive Muscle Relaxation Audio for Patients With Functional Abdominal Bloating

The Rome Working Team had recommended the use of brain-gut behaviour therapies in treating Disorders of Gut-brain Interaction (DGBI). Mind-body techniques, including Guided Imagery (GI) and Progressive Muscle Relaxation (PMR) has been long used as therapeutic modalities for various disorders. However, its relevance and efficacy in treating patients with DGBI in Malaysia is still unexplored. The study herein aimed to develop, validate, and explore the effects of audio-based GI and PMR techniques on patients with functional abdominal bloating. The study can be divided into three main phases. Phase 1 involves the development and validation of culturally specific GI and PMR audios. Initially, the audio scripts were drafted according to literature reviews and findings from in-depth interviews with participants diagnosed with bloating based on the Rome IV criteria. Scripts were validated using psychometric (content and face validity index) and physiological parameters [(brain event-related potentials (ERP) & heart rate variability (HRV)]. 35/63 participants completed the in-depth interview. The findings include the frequent usage of ‘balloon’ as a synonymous imagery description for bloating, of which the sensation of bloatedness is association with pain. Eventually, the scripts were narrated and compiled with a validated musical backgrounds. Overall, the content and face validity index for PMR and GI ranged from 0.92 - 1.00. For ERP and HRV, 17/20 participants were analysed. For ERP, there were significant difference between GI and PMR for alpha waves (p=0.029), delta waves (p=0.029) and between PMR and control for delta waves (p=0.014). For HRV, both GI and PMR exhibited similar autonomic responses over controls with significant difference among Low Frequency/High Frequency ratio, Total Power, Low Frequency, and Respiratory Rate (overall p<0.05). Phase 2 involves the development and validation of a mobile application that helps to facilitate the delivery of the audios. The validation process involves inviting expert panels, volunteers, and participants with bloating to rate and navigate the application. Feedbacks and comments were noted. Revision was made accordingly. The findings from the Malay-version mHealth App Usability Questionnaire (MAUQ) indicate satisfactory levels (5.45-5.85/7.00). Furthermore, 132 participants were randomly assigned into three groups (GI, PMR, control), each receiving different audios. Findings from 96 participants were analysed. Significant differences were observed in terms of time effect among the Severity General, Severity in 24 hours, Quality of Life, Health-Promoting Behaviour, and anxiety variables. Only anxiety showed significant changes among the group (p=0.027) and time*group interaction (p<0.001)

Photopolymer Holographic Optical Elements for Application in Solar Energy Concentrators

The book chapter reviews recent developments in the design and fabrication of solar concentrators utilising holographic optical elements. The advantages and disadvantages of the use of holographic components in solar energy applications are analysed. In addition, recent experimental results from the recording and characterisation of different types of holographic optical components, such as single spherical and cylindrical lenses, multiplexed holographic gratings with high diffraction efficiency are presented. The results reveal the high potential of photopolymer materials for fabrication of holographic components for solar applications

Disparity between skin perfusion and sublingual microcirculatory alterations in severe sepsis and septic shock: a prospective observational study

Objective: Measurement of central-to-toe temperature difference has been advocated as an index of severity of shock and as a guide for circulatory therapy in critically ill patients. However, septic shock, in contrast to other forms of shock, is associated with a distributive malfunction resulting in a disparity between vascular compartments. Although this disparity has been established between systemic and microcirculatory parameters, it is unclear whether such disparity exists between skin perfusion and microcirculation. To test this hypothesis of disparity, we simultaneously measured parameters of the two vascular compartments, in the early phase of sepsis. Design: Prospective observational study in patients with severe sepsis/septic shock in the first 6 h of ICU admission. Simultaneous measurements of central-to-toe temperature difference and sublingual microcirculatory orthogonal polarization spectral imaging, together with parameters of systemic hemodynamics. Setting: 22 bed mixed-ICU in a tertiary teaching hospital. Patients: 35 consecutive patients in a 12-month period. Measurements and results: In 35 septic patients and a median APACHE II score of 20, no correlation between central-to-toe temperature gradient and microvascular flow index was observed (r(s) =-0.08, p = 0.65). Also no significant correlation between temperature gradient/microvascular flow index and systemic hemodynamic parameters could be demonstrated. Conclusions: During the early phase of resuscitated severe sepsis and septic shock there appears to be no correlation between sublingual microcirculatory alterations and the central-to-toe temperature difference. This finding adds to the concept of a dispersive nature of blood flow under conditions of sepsis between microcirculatory and systemic hemodynamic

Fine-mapping identifies multiple prostate cancer risk loci at 5p15, one of which associates with TERT expression

Associations between single nucleotide polymorphisms (SNPs) at 5p15 and multiple cancer types have been reported. We have previously shown evidence for a strong association between prostate cancer (PrCa) risk and rs2242652 at 5p15, intronic in the telomerase reverse transcriptase (TERT) gene that encodes TERT. To comprehensively evaluate the association between genetic variation across this region and PrCa, we performed a fine-mapping analysis by genotyping 134 SNPs using a custom Illumina iSelect array or Sequenom MassArray iPlex, followed by imputation of 1094 SNPs in 22 301 PrCa cases and 22 320 controls in The PRACTICAL consortium. Multiple stepwise logistic regression analysis identified four signals in the promoter or intronic regions of TERT that independently associated with PrCa risk. Gene expression analysis of normal prostate tissue showed evidence that SNPs within one of these regions also associated with TERT expression, providing a potential mechanism for predisposition to disease

The impact of a nurse led rapid response system on adverse, major adverse events and activation of the medical emergency team

Aim: To identify the relationship between one example of a rapid response system (RRS), specifically, an after-hours Clinical Team Co-Ordinator (CTC), and the incidence of Medical Emergency Team (MET) activations and, adverse and major adverse events in medical patients. Method: A retrospective chart audit of patients' medical records was undertaken. The intervention group consisted of 150 randomly selected medical patients admitted during three months after the introduction of the CTC after-hours service. The control group consisted of 150 randomly selected medical patients admitted before the introduction of the after-hours CTC service. Multiple logistic regression was used to determine which of the potential predictors, along with the after-hours CTC service, were associated with adverse and major adverse events. Results: A total of 130 patients (n = 63, 42% control; n = 67, 45% intervention) exhibited physiological abnormalities that should have activated the MET yet it was only activated five times. In total there were 69 adverse events (n = 32, 21% control; n = 36, 25% intervention) and 25 major adverse events (n = 7, 5% control; n = 18, 12% intervention). There were more adverse and major adverse events identified after the introduction of the CTC after-hours service. Changes in heart rate and reduction in Glasgow Coma Scores (GCS) were significant predictors of an adverse event. A low urine output and a drop of two or more in the GCS were significant predictors of a major adverse event. Conclusions: The introduction of an after-hours CTC service in a specific clinical site was associated with an increase in the identification of adverse and major adverse events in medical patients. Further exploration of nurse-led rapid response systems should be undertaken in different clinical settings

Distinctive features of orbital adipose tissue (OAT) in Graves’ Orbitopathy

Depot specific expansion of orbital-adipose-tissue (OAT) in Graves’ Orbitopathy (GO) is associated with lipid metabolism signaling defects. We hypothesize that the unique adipocyte biology of OAT facilitates its expansion in GO. A comprehensive comparison of OAT and white-adipose-tissue (WAT) was performed by light/electron-microscopy, lipidomic and transcriptional analysis using ex vivo WAT, healthy OAT (OAT-H) and OAT from GO (OAT-GO). OAT-H/OAT-GO have a single lipid-vacuole and low mitochondrial number. Lower lipolytic activity and smaller adipocytes of OAT-H/OAT-GO, accompanied by similar essential linoleic fatty acid (FA) and (low) FA synthesis to WAT, revealed a hyperplastic OAT expansion through external FA-uptake via abundant SLC27A6 (FA-transporter) expression. Mitochondrial dysfunction of OAT in GO was apparent, as evidenced by the increased mRNA expression of uncoupling protein 1 (UCP1) and mitofusin-2 (MFN2) in OAT-GO compared to OAT-H. Transcriptional profiles of OAT-H revealed high expression of Iroquois homeobox-family (IRX-3&5), and low expression in HOX-family/TBX5 (essential for WAT/BAT (brown-adipose-tissue)/BRITE (BRown-in-whITE) development). We demonstrated unique features of OAT not presented in either WAT or BAT/BRITE. This study reveals that the pathologically enhanced FA-uptake driven hyperplastic expansion of OAT in GO is associated with a depot specific mechanism (the SLC27A6 FA-transporter) and mitochondrial dysfunction. We uncovered that OAT functions as a distinctive fat depot, providing novel insights into adipocyte biology and the pathological development of OAT expansion in GO

Dairy products, dietary calcium and the risk of inflammatory bowel disease: results from a European prospective cohort investigation

Background: Dairy products may be involved in the etiology of inflammatory bowel disease by modulating gut microbiota and immune responses, but data from epidemiological studies examining this relationship are limited. We investigated the association between prediagnostic intake of these foods and dietary calcium, and the subsequent development of Crohn's disease (CD) and ulcerative colitis (UC). Methods: In total, 401,326 participants were enrolled in the European Prospective Investigation into Cancer and Nutrition cohort. At recruitment, consumption of total and specific dairy products (milk, yogurt, and cheese) and dietary calcium was measured using validated food frequency questionnaires. Cases developing incident CD (n = 110) or UC (n = 244) during follow-up were matched with 4 controls. Conditional logistic regression analyses were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for total energy intake and smoking. Results: Compared with the lowest quartile, the ORs for the highest quartile of total dairy products and dietary calcium intake were 0.61 (95% CI, 0.32-1.19, p trend = 0.19) and 0.63 (95% CI, 0.28-1.42, p trend = 0.23) for CD, and 0.80 (95% CI, 0.50-1.30, p trend = 0.40) and 0.81 (95% CI, 0.49-1.34, p trend = 0.60) for UC, respectively. Compared with nonconsumers, individuals consuming milk had significantly reduced odds of CD (OR 0.30, 95% CI, 0.13-0.65) and nonsignificantly reduced odds of UC (OR 0.85, 95% CI, 0.49-1.47). Conclusions: Milk consumption may be associated with a decreased risk of developing CD, although a clear dose-response relationship was not established. Further studies are warranted to confirm this possible protective effect

Estrogenic Plant Extracts Reverse Weight Gain and Fat Accumulation without Causing Mammary Gland or Uterine Proliferation

Long-term estrogen deficiency increases the risk of obesity, diabetes and metabolic syndrome in postmenopausal women. Menopausal hormone therapy containing estrogens might prevent these conditions, but its prolonged use increases the risk of breast cancer, as wells as endometrial cancer if used without progestins. Animal studies indicate that beneficial effects of estrogens in adipose tissue and adverse effects on mammary gland and uterus are mediated by estrogen receptor alpha (ERα). One strategy to improve the safety of estrogens to prevent/treat obesity, diabetes and metabolic syndrome is to develop estrogens that act as agonists in adipose tissue, but not in mammary gland and uterus. We considered plant extracts, which have been the source of many pharmaceuticals, as a source of tissue selective estrogens. Extracts from two plants, Glycyrrhiza uralensis (RG) and Pueraria montana var. lobata (RP) bound to ERα, activated ERα responsive reporters, and reversed weight gain and fat accumulation comparable to estradiol in ovariectomized obese mice maintained on a high fat diet. Unlike estradiol, RG and RP did not induce proliferative effects on mammary gland and uterus. Gene expression profiling demonstrated that RG and RP induced estradiol-like regulation of genes in abdominal fat, but not in mammary gland and uterus. The compounds in extracts from RG and RP might constitute a new class of tissue selective estrogens to reverse weight gain, fat accumulation and metabolic syndrome in postmenopausal women

Teacher led school-based surveillance can allow accurate tracking of emerging infectious diseases - evidence from serial cross-sectional surveys of febrile respiratory illness during the H1N1 2009 influenza pandemic in Singapore

10.1186/1471-2334-12-336BMC Infectious Diseases12-BIDM