Limitations of the Perioperative Cardiovascular Evaluation for Assessing Coronary Artery Disease: A Case Report

INTRODUCTION The American College of Cardiology (ACC) and the American Heart Association (AHA) publ ished pre-operative risk stratification guidelines in 2014. These guidelines have routinely been used by physicians to pre-operatively risk stratify patients. In this case report, a patient was found to have multi-vessel coronary artery disease post-operatively in the setting of unremarkable cardiac work-up preoperatively. This case highlights a limitation of the 2014 ACC/AHA guidelines

Coronary Subclavian Steal Syndrome

INTRODUCTION Coronary subclavian steal (CSS) syndrome is a rare complication of coronary artery bypass graft surgery (CABG) involving the left internal mammary artery (LIMA) graft to the left anterior descending (LAD) artery. It results from stenosis of the left subclavian artery proximal to the LIMA, which compromises myocardial blood flow. The incidence of CSS syndrome is between 0.1-3.4% in the United States.1 Most cases occur as a result of long-standing subclavian stenosis due to progres-sion of the stenosis following CABG. We report a case of CSS syndrome, which presented as a non-ST elevation myocardial infarction (NSTEMI)

Purification and characterization of cyclodextrin glucanotransferase from alkalophilic Bacillus sp. G1

A cyclodextrin glucanotransferase (CGTase) was successively purified by ammonium sulphate precipitation, and affinity chromatography on a-CD (epoxy)-Sepharose 6B column. The specific activity of the CGTase was increased approximately 2200-fold, from 8.43 U/mg protein to 18,866 U/mg protein. SDS-PAGE showed that the purified CGTase was homogeneous and the molecular weight of the purified CGTase was about 75 kDa. The molecular weight of the enzyme that was estimated by gel filtration under native condition was 79 kDa. This has indicated that Bacillus sp. G1 CGTase is a monomeric protein. The isoelectric point (pI) of the enzyme was about 8.8. Characterization of the enzyme exhibited optimum pH and temperature of 6.0 and 60 8C, respectively. The enzyme was stable from pH 7.0 to 9.0 and retained its high activity up to 60 8C. However, in the presence of 20 mM Ca2+, the purified CGTase is able to prolong its thermal stability up to 70 8C. CGTase was strongly inhibited by ZnSO4, CuSO4, CoCl2, FeSO4, FeCl3 and EDTA. Km and Vmax for the purified enzyme were 0.15 mg/ml and 60.39 mg bcyclodextrin/( ml min), respectively, with soluble starch as substrate. In cyclodextrin production, tapioca starch was found to be the best substrate used to produce CDs. The enzyme produced g- and b-CD in the ratio of 0.11:0.89 after 24 h incubation at 60 8C, without the presence of any selective agents

Marketing analysis of the higher education service sector in Malaysia: consumer perspective

Like many other service organizations, higher education institutions may want to review their marketing strategies in order to complete in the increasingly competitive market. It is crucial that higher learning institutions understand the perceptions and expectations of students and translate them into marketing activities that would attract and retain students. The objective of the research is to explore student view on important criteria in selecting higher education institutions. Personal interviews with 210 student from both public and private higher learning institutions in Malaysia were carried out. Variables used include: academic programme, academic staff, facilities, pricing, and promotion. Data were analysed using Factor Analysis and Comparison of Means. Based on the study, students consider personal factors (job opportunities, availability of course, time required for completion, entry requirements, availability of part-time studies, marketability of degree); academic quality and facilities (quality of teaching, library collection, institution's reputation, facilities, programme structure); campus (campus size and layout, campus attractiveness, number of students); socialization (extra curricular activities, opportunity to meet friends); and financial aid & procedures (scholarship/financial aid, procedures and policies) as important criteria in selecting a higher learning institution. Based on Comparison of Means, rankings of variables influencing college choice decision by importance are as follows: quality of teaching, institution's reputation, marketability of degree, job opportunities, tuition fees, programme structure, time required for completion, facilities, availability of courses, and entry requirements

Complications of Decompressive Craniectomy

Introduction: Persistent elevation of intracranial pressure (ICP), if untreated, may lead to brain ischemia or lack of brain oxygen and even brain death.1-6,10 When standard treatments for elevated ICP are exhausted without any signs of improvement, decompressive craniectomy can be an effective alternative solution.7,19 Decompressive craniectomies (DC) have been used as a method of controlling intracranial pressure in patients with cerebral edema secondary to cerebral ischemia, subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI), among others. 8-10 Several studies over the years have demonstrated the efficacy of this procedure.7-9,11,35,36 However, consensus is still lacking in the utility of DC as an effective first tier treatment for intractable intracranial pressure due to the rudimentary neurological outcome assessments, and the many complications associated with this procedure.11,12,59 There are a limited number of studies that have looked at complications secondary to the procedure itself.13-18 The majority of these studies only investigated the impact of this procedure in patients with traumatic brain injury. The purpose of this study is to investigate the rates of various complications associated with the decompressive craniectomy procedure in patients that did not suffer from traumatic brain injury, and to determine whether the same associations between preoperative parameters and development of complications can be made

Discrepancy in patient-rated and oncologist-rated performance status on depression and anxiety in cancer: a prospective study protocol

Objective: Psychological distress is common in patients with cancer. We need a rapid means of screening for and identifying depression and anxiety in patients with cancer. The present study evaluates the potential of the Eastern Cooperative Oncology Group (ECOG) performance status (PS) scoring as a brief screening tool to assess psychological distress in routine cancer care. The ECOG PS is widely used by oncologists and the WHO, as a standardised measure to assess general well-being in patients with cancer and quality of life in cancer trials. We examine the discrepancy between patient-rated and oncologist-rated PS scores on the ECOG in a comparative assessment against the Hospital Anxiety and Depression Scale (HADS). Methods and design: This is a prospective evaluation of approximately 500 ambulatory adult cancer patients from a large academic medical centre. Participants will be asked to assess their own ECOG PS on a scale of 0–4, which will be compared to ECOG PS as rated by their oncologists. Higher ECOG PS scores indicate poorer daily functioning. Both patient-rated and oncologist-rated ECOG PS and their absolute differences will be tested for predictive and concurrent validity against the HADS. A HADS cut-off ≥15 will be used. Ethics approval for this study has been secured from the institutional ethics board. Outcomes are re-evaluated at 4-week to 6-week and 1-year follow-up. Conclusion: This study holds practical significance for rapid screening of psychological distress in the cancer clinic with the use of the ECOG PS scoring. Given the high prevalence of anxiety and depression in patients with cancer, screening is important to increase its recognition, which will, in turn, help to direct referrals and deliver appropriate intervention. This study also generates greater insight into the association between psychosomatic complaints and psychological distress. Trial registration number MEC 896.52

Influence of bath temperature and PH value on properties of chemically deposited CU4SNS4 thin films.

Thin films of Cu4SnS4 semiconductors were prepared by chemical bath deposition technique in aqueous solutions. The effects of various bath temperatures (40, 50 and 60 °C) and pH values (pH 0.5, pH 1.0 and pH 1.5) on growth of films were reported. The structure and morphology characteristics of thin films of Cu4SnS4 grown on indium tin oxide glass substrates were investigated by X-ray diffraction and atomic force microscopy techniques. The optical properties were measured to determine the transition type and band gap value. The thin films produced were found to be polycrystalline with orthorhombic structure. The X-ray diffraction data showed that the most intense peak at 20 = 30.2° which belongs to (221) plate of Cu4SnS4. The films deposited at 50 °C were found to have the best photoresponse activity and smaller crystal size. At pH 1.5, the film showed well-covered entire substrate surface and the highest absorption values in AFM and optical study, respectively. The best condition to prepare good quality thin films can be carried out at 50 °C with pH 1.5. The bandgap value was found to be 1.4 eV with direct transition