Explore the vast range of titles available.

Mild sleep deprivation is widespread in many societies worldwide. Electroencephalography (EEG) microstate analysis provides information on spatial and temporal characteristics of resting brain network, serving as an indicator of neurophysiological activities at rest. This study seeks to investigate potential neural markers in EEG following mild sleep deprivation of a single night using EEG microstate analysis. Six-minute resting EEG was conducted on thirty healthy adults within 6 hours of waking in the morning and after at least 18 h of sleep deprivation. Translated and validated Malay language Karolinska Sleepiness Scale was used to assess the participants’ degree of sleepiness. Microstate characteristics analysis was conducted on the final 24 subjects based on four standard microstate maps. Microstate C shows a significant increase in mean duration, coverage and occurrence, while microstate D has significantly higher occurrence after sleep deprivation. This study demonstrates notable changes in resting state EEG microstates following mild sleep deprivation. Present findings deepen our understanding of the brain's spatiotemporal dynamics under this condition and suggest the potential utility of neural markers in this domain as components of composite markers for sleep deprivation.

Background Accurate assessment of stroke severity, precise neuroimaging diagnosis, and seamless coordination among stakeholders are crucial in ensuring prompt diagnosis and treatment during acute stroke activation. The study aimed to assess how the telestroke tool JOIN enhances time metrics in acute stroke care, specifically by improving decision-making speed and thereby enhancing patients’ clinical outcomes. Methods This prospective cohort study was conducted at Seberang Jaya Hospital and Umum Sarawak Hospital in Malaysia. It included adult ischaemic stroke patients who arrived within 4.5 h of stroke onset at one of the two locations. Patients were divided into two groups: the pre-JOIN period using conventional communication versus the JOIN period using JOIN. Time metrics were collected from medical records and/or social networking services (pre-JOIN), and timestamp data (JOIN). Analysis was performed using the Statistical Package for the Social Sciences, with a total sample size of 120 patients. Results With 60 patients in each group (pre-JOIN and JOIN), the mean (SD) ages were 57 (12.6) and 60 (14.1) respectively. Patients in both groups were similar at baseline, showing comparable stroke subtypes, events, and severity, primarily Lacunar Anterior Circulation Infarct with mild stroke as their initial occurrence. Both median door-to-imaging time and door-to-decision time were reduced by 6 min with JOIN, although the difference was not statistically significant. Thrombolysis rates and symptomatic intracranial haemorrhages were similar between groups, but door-to-needle time was significantly shorter with JOIN (78 [28.0] minutes versus 45 [42.0] minutes, p  = 0.008). Most patients were discharged alive with similar modified Rankin Scale scores between the groups. Conclusions Door-to-needle time was shorter in the post-JOIN period than in the pre-JOIN period, suggesting that the implementation of JOIN may contribute to improved time metrics in acute stroke care. Its safety, affordability, ease of use, and additional features make it a promising telestroke tool, crucial for handling high patient volumes with limited resources. Trial registration This study was registered with the Malaysian National Medical Research Register and received ethical approval (NMRR ID-21-02363-XFT) from the Medical Research and Ethics Committee, Ministry of Health Malaysia dated 30-March-2023.

Background High on-treatment platelet reactivity (HOTPR) may undermine the efficacy of antiplatelet therapy in acute stroke. This study aimed to assess platelet reactivity and HOTPR status during the acute phase of ischaemic stroke following antiplatelet initiation, and to determine their associations with stroke outcomes in a Malaysian cohort. Methods This prospective, observational study enrolled patients with acute ischaemic stroke at Sarawak General Hospital. Platelet reactivity was measured at baseline and on Days 1 and 3 post-antiplatelet therapy using Multiplate ® Analyser. HOTPR was defined by ASPItest (> 30 U) or ADPtest (> 46 U) values. The primary outcome was recurrent stroke at one year, while secondary outcomes included early neurological deterioration (END), poor functional outcome (mRS ≥ 2) at three months, and all-cause mortality at one year. Cox and logistic regression models adjusted for clinical covariates were used, with Firth’s correction applied for rare events and model non-convergence. Results A total of 198 participants were enrolled, with a mean age of 59.8 years; 66.7% were male. At one year, 9.1% experienced recurrent stroke, 9.6% had died, 9.2% experienced END during admission, and 21.6% had mRS ≥ 2 at three months. HOTPR rates decreased by Day 3 (aspirin: Day 1 20.0% to Day 3 6.6%; clopidogrel: 50.5–28.0%), with persistent HOTPR in 11.8% (aspirin) and 39.2% (clopidogrel). Some initially normal responders developed HOTPR by Day 3 (aspirin 5.4%, clopidogrel 16.3%). Platelet reactivity and HOTPR status on Days 1 and 3 were not significantly associated with recurrent stroke at one year or END. However, higher ADPtest values on Day 1 [OR 1.05 (95% CI 1.00, 1.09), p  = 0.037], clopidogrel HOTPR on Days 1 and 3 [OR 20.99 (95% CI 1.53, 7089.91), p  = 0.017; OR 16.58 (95% CI 1.57, 24326.82), p  = 0.017], and persistent clopidogrel HOTPR on both days [OR 45.25 (95% CI 2.34, 21861.76), p  = 0.007] were significantly associated with poor functional outcomes. Conclusion Platelet reactivity and HOTPR status were not associated with recurrent stroke and END. However, higher ADPtest values and clopidogrel-related HOTPR were associated with poor functional outcomes. Further studies are needed to evaluate the clinical utility of platelet reactivity monitoring in acute stroke management.

Background Translation into clinical practice for use of intravenous thrombolysis (IVT) for the management of ischemic stroke remains a challenge especially across low- and middle-income countries, with regional inconsistencies in its rate. This study aimed at identifying factors that influenced the provision of IVT and the variation in its rates in Malaysia. Methods A multiple case study underpinning the Tailored Implementation for Chronic Diseases framework was carried out in three public hospitals with differing rates of IVT using a multiple method design. Twenty-five in-depth interviews and 12 focus groups discussions were conducted among 89 healthcare providers, along with a survey on hospital resources and a medical records review to identify reasons for not receiving IVT. Qualitative data were analysed using reflective thematic method, before triangulated with quantitative findings. Results Of five factors identified, three factors that distinctively influenced the variation of IVT across the hospitals were: 1) leadership through quality stroke champions, 2) team cohesiveness which entailed team dynamics and its degree of alignment and, 3) facilitative work process which included workflow simplification and familiarity with IVT. Two other factors that were consistently identified as barriers in these hospitals included patient factors which largely encompassed delayed presentation, and resource constraints. About 50.0 – 67.6% of ischemic stroke patients missed the opportunity to receive IVT due to delayed presentation. Conclusions In addition to the global effort to explore sustainable measures to improve patients’ emergency response for stroke, attempts to improve the provision of IVT for stroke care should also consider the inclusion of interventions targeting on health systems perspectives such as promoting quality leadership, team cohesiveness and workflow optimisation.

Background: Data on tionwide trends for stroke metrics are crucial to understand the extent of the disease burden to a country’s health system. Yet, this information remains scarce in low- and middle-income countries.Objectives: This study investigated trends of stroke incidence and 28-day all-cause mortality after a stroke from 2008 to 2016 in Malaysia, through linkage across tiol data sources.Methods: Hospital admissions with a principal diagnosis of stroke or transient ischemic attack were included. Cases with first stroke were identified through linkage of hospital admission registers where age and sex-standardized trends of stroke incidence and its subtypes were calculated. By linking hospital registers to the tiol Death Register, the 28-day all-cause mortality rates after a stroke were estimated. Mann-Kendall’s test was used for trend evaluation.Results: From 243,765 records, the trend of stroke incidence showed an increase of 4.9% in men and a drop of 3.8% among women. Incidences were higher in men, at 99.1 per 100,000 population in 2008 and 103.9 per 100,000 in 2016 than women (80.3 per 100,000 in 2008 and 77.2 per 100,000 in 2016). There was a substantial increase in stroke incidence among those below 65 years old, with the largest increase of 53.3% in men aged between 35–39 years and 50.4% in women of similar age group. The trend for 28-day all-cause mortality showed a decline for men at –13.1% and women, –10.6%. Women had higher mortality from stroke (22.0% in 2008 and 19.7% in 2016) than men (19.4% in 2008 to 17.2% in 2016).Conclusion: This first empirical study on stroke trends in Malaysia revealed a worrying increase in stroke incidence among the younger population. Despite a declining trend, mortality rates remained moderately high especially in women. Comprehensive strategies to strengthen the prevention and magement of stroke care are warranted.

The frequency and clinical impact of LRRK2 p.G2385R and p.R1628P risk variants in Parkinson’s disease (PD) remain uncertain, particularly across different Asian populations. We genotyped 3058 multi-ethnic Malaysian PD patients, performed detailed phenotyping in 185, and analyzed disease progression in 635 using longitudinal Clinical Impression of Severity Index for PD scores. p.G2385R was largely confined to Chinese (8.2%), while p.R1628P occurred in mixed ancestry (11.0%), Chinese (8.3%), Malays (7.7%), and is reported for the first time in indigenous groups (3.9%). Double-variant carriers had younger onset and more frequently had positive family history. Compared with non-carriers, p.R1628P carriers had lower rates of dementia and orthostatic hypotension, and slower progression of global PD severity. Our findings highlight ethnic differences in the distribution of LRRK2 Asian variants, and suggest that these variants influence onset age, familial occurrence, non-motor features, and disease course, with implications for personalized approaches to PD in Asian populations.

Abstract Cancer-associated thromboembolism is not an uncommon complication in patients with malignancies. No study has reported the occurrence of thromboembolism prior to the diagnosis of acute myeloid leukemia (AML). Most reports are anectodal and data are scarce on this subject. In this report, we present a case of extensive cerebral venous thrombosis (CVT) that was detected a few weeks before the diagnosis of AML, in which case the patient responded well to chemotherapy and anticoagulation.

The background incidence of viscerotropic- (VLD) and neurotropic-like disease (NLD) unrelated to immunization in dengue-endemic countries is currently unknown. This retrospective population-based analysis estimated crude and standardized incidences of VLD and NLD in twelve hospitals in Brazil (n = 3), Mexico (n = 3), and Malaysia (n = 6) over a 1-year period before the introduction of the tetravalent dengue vaccine. Catchment areas were estimated using publicly available population census information and administrative data. The denominator population for incidence rates was calculated, and sensitivity analyses assessed the impact of important assumptions. Total cases adjudicated as definite VLD were 5, 57, and 56 in Brazil, Mexico, and Malaysia, respectively. Total cases adjudicated as definite NLD were 103, 29, and 26 in Brazil, Mexico, and Malaysia, respectively. Crude incidence rates of cases adjudicated as definite VLD in Brazil, Mexico, and Malaysia were 1.17, 2.60, and 1.48 per 100,000 person-years, respectively. Crude incidence rates of cases adjudicated as definite NLD in Brazil, Mexico, and Malaysia were 4.45, 1.32, and 0.69 per 100,000 person-years, respectively. Background incidence estimates of VLD and NLD obtained in Mexico, Brazil, and Malaysia could provide context for cases occurring after the introduction of the tetravalent dengue vaccine.

The overall prognosis of colorectal cancer (CRC) patients is unsatisfactory due to cancer metastasis after operation. This study aims to investigate the clinical significance of plasma osteopontin (OPN) levels as minimally invasive, predictive, and surrogate biomarkers for prognosis of CRC patients. This randomized study design consists of pre-operative and post-operative plasma samples from a total of 79 patients. We determined plasma levels of OPN by ELISA and examined their correlation with the clinicopathological parameters of CRC patients. The effects of endogenous and exogenous OPN on CRC metastasis were investigated by examination of the effect on regulators of epithelial to messenchymal transition and migration assay. Our findings demonstrated for the first time the clinical correlation of plasma OPN with metastasis of CRC patients. High post-operative plasma OPN level (>153.02 ng/ml) associated with development of metastasis after curative resection (p<0.001). Moreover, post-operative plasma OPN level correlated with disease-free survival of CRC patients (p=0.009) and was an independent factor for predicting development of metastasis in CRC patients after curative resection (p=0.036). Our in vitro model showed that OPN ectopic expression induced DLD1 cell migration through Snail and Twist1 overexpression and E-cadherin repression, and secretory OPN level enhanced cell migration. The results of the current study suggest that post-operative plasma OPN correlated with post-operative metastasis, suggesting that it is a potential non-invasive biomarker for the development of future metastasis in CRC patients. In addition, OPN was shown to be involved in the metastatic process and thus inhibition of OPN is a potential therapeutic approach to treat CRC patients.

CD26, dipeptidyl peptidase IV, was discovered firstly as a membrane-associated peptidase on the surface of leukocyte. We previously demonstrated that a subpopulation of CD26+ cells were associated with the development of distant metastasis, enhanced invasiveness and chemoresistance in colorectal cancer (CRC). In order to understand the clinical impact of CD26, the expression was investigated in CRC patient's specimens. This study investigated the prognostic significance of tumour CD26 expression in patients with CRC. Examination of CD26+ cells has significant clinical impact for the prediction of distant metastasis development in colorectal cancer, and could be used as a selection criterion for further therapy. Tumour CD26 expression levels were studied by immunohistochemistry using Formalin-fixed paraffin embedded (FFPE) tissues in 143 patients with CRC. Tumour CD26 expression levels were correlated with clinicopathological features of the CRC patients. The prognostic significance of tumour tissue CD26 expression levels was assessed by univariate and multivariate analyses. CD26 expression levels in CRC patients with distant metastasis were significantly higher than those in non-metastatic. High expression levels of CD26 were significantly associated with advanced tumour staging. Patients with a high CD26 expression level had significantly worse overall survival than those with a lower level (p<0.001). The expression of CD26 was positively associated with clinicopathological correlation such as TNM staging, degree of differentiation and development of metastasis. A high CD26 expression level is a predictor of poor outcome after resection of CRC. CD26 may be a useful prognostic marker in patients with CRC.