Farihah Haji Suhaimi

The Establishment of Metabolic Syndrome Model by Induction of Fructose Drinking Water in Male Wistar Rats

Background. Metabolic syndrome can be caused by modification of diet by means of consumption of high carbohydrate and high fat diet such as fructose. Aims. To develop a metabolic syndrome rat model by induction of fructose drinking water (FDW) in male Wistar rats. Methods. Eighteen male Wistar rats were fed with FDW 20% and FDW 25% for a duration of eight weeks. The physiological changes with regard to food and fluid intake, as well as calorie intake, were measured. The metabolic changes such as obesity, dyslipidaemia, hypertension, and hyperglycaemia were determined. Data was presented in mean ± SEM subjected to one-way ANOVA. Results. Male Wistar rats fed with FDW 20% for eight weeks developed significant higher obesity parameters compared to those fed with FDW 25%. There was hypertrophy of adipocytes in F20 and F25. There were also systolic hypertension, hypertriglyceridemia, and hyperglycemia in both groups. Conclusion. We conclude that the metabolic syndrome rat model is best established with the induction of FDW 20% for eight weeks. This was evident in the form of higher obesity parameter which caused the development of the metabolic syndrome.

Fructose-Drinking Water Induced Nonalcoholic Fatty Liver Disease and Ultrastructural Alteration of Hepatocyte Mitochondria in Male Wistar Rat

Background. Nonalcoholic fatty liver disease (NAFLD) is one of the complications of the metabolic syndrome. It encompasses a wide range of disease spectrum from simple steatosis to liver cirrhosis. Structural alteration of hepatic mitochondria might be involved in the pathogenesis of NAFLD. Aims. In the present study, we used a newly established model of fructose-induced metabolic syndrome in male Wistar rats in order to investigate the ultrastructural changes in hepatic mitochondria that occur with fructose consumption and their association with NAFLD pathogenesis. Methods. The concentration of fructose-drinking water (FDW) used in this study was 20%. Six male Wistar rats were supplemented with FDW 20% for eight weeks. Body composition and metabolic parameters were measured before and after 8 weeks of FDW 20%. Histomorphology of the liver was evaluated and ultrastructural changes of mitochondria were assessed with transmission electron micrograph. Results. After 8 weeks of fructose consumption, the animals developed several features of the metabolic syndrome. Moreover, fructose consumption led to the development of macrovesicular hepatic steatosis and mitochondrial ultrastructural changes, such as increase in mitochondrial size, disruption of the cristae, and reduction of matrix density. Conclusion. We conclude that in male Wistar rat 8-week consumption of FDW 20% leads to NAFLD likely via mitochondrial structural alteration.

Radial nerve palsy: True anatomical facts

To the Editor: We read with much interest the paper titled ‘‘Radial nerve palsy in the newborn: a report of 4 cases and literature review’’ by Monica et al We do agree that birth injuries related to the radial nerve are rare. It may be mentioned that the authors use the term ‘‘function of muscles,’’ which is incorrect. In medical terminology, we usually define it as an action of the muscle, not as a function. The first sentence of the case report section is highly confusing: ‘‘At birth, allydigital flexion’’. The sentence implies that there was loss of extension of wrist with intact active wrist. According to the authors, there was involvement of the posterolateral part of the arm. The posterior part of the arm is innervated by the posterior cutaneous branch of the radial nerve. In fact, before entering the radial groove, the cutaneous branch to the arm is given. According to the standard anatomy textbook, the posterior cutaneous nerve arises in the region of the axilla. In the radial groove, the radial nerve gives off the lower lateral cutaneous nerve of the arm. Thus, according to the present findings, the posterior cutaneous nerve and the lateral cutaneous nerve are involved. If the lateral cutaneous nerve was involved, it means that the damage was there in the spiral groove and this would imply the obvious involvement of the lateral and medial head of the triceps, which was not observed by the authors; instead the authors mentioned the intact deltoid, biceps, and triceps. If the posterior interosseous nerve (a branch of the radial nerve) is involved in the forearm, then the radial wrist extension and brachioradialis muscle action will be normal. The authors did not mention these facts. The sensory loss in the area of the radial nerve innervation of the dorsum of the hand was not evaluated. The authors mentioned the term ‘‘active shoulder function’’ in the last paragraph. There are various movements taking part in the shoulder joint, with different muscles performing different actions. I suggest that the phrase ‘‘active shoulder function’’ should be explained further. It is not well understood what the authors mean by stating that ‘‘posterior cord involvement can be distinguished from isolated radial nerve palsy, if deltoid weakness is present’’. In fact, deltoid is innervated by the axillary nerve (branch from posterior cord), which has a root value C5, C6 while the radial nerve has a root value of C5, C6, C7, C8, T1 (also a branch from the posterior cord). There are other nerves that arise from the posterior cord, such as the upper and lower subscapular nerve (C5, C6) and the nerve to the latissimus dorsi (C6, C7, C8), and therefore how can the posterior cord involvement be distinguished from isolated radial nerve palsy? The term ‘‘active digital flexion’’ is rather vague. There are 5 digits and the flexion of the second and the third digit is caused by the lateral part of the flexor digitorum profundus and the first and second lumbricals, which are innervated by the median nerve, unlike the medial fourth and fifth digit, which are innervated by the medial part of the flexor digitorum profundus, and the third and fourth lumbricals, which are innervated by the ulnar nerve. Unless the precise locations of the involved digits are highlighted, this is a vague description. In the last sentence, the authors state that the site of injury is distal to the spiral groove. In that case, the involvement of innervated muscles such as the brachioradialis, the brachialis and the extensor carpii radialis should have been tested. Mere speculation may not explain the 4 cases, but a detailed approach to the exact level of injury and the involvement of the muscles gives a better picture. Overall, this is an interesting topic for discussion that may benefit pediatric orthopaedicians, clinicians, and anatomists. The authors and the editorial board need to be applauded for highlighting such an important topic.

The underlying mechanism of action for various medicinal properties of Piper betle (betel).

Piper betle (betel) plant belongs to the Piperaceae family. Piper. betle is widely known for its potent medicinal properties. Various active compounds are present in Piper. betle such as allylpyrocatechol, hydroxychavicol, piperbetol, ethylpiperbetol, piperol A, piperol B, chavibetol, and alkaloids which account for these beneficial medicinal properties. In the present narrative review, we looked into the various active compounds present in the Piper betle and attempted to understand their underlying mechanism of action. Proper understanding of the molecular biology involving the mechanism of action may help in better drug formulation and provide better therapeutic actions in the field of alternative and complementary medicine.

Re: Kozacioglu et al.: Anatomy of the dorsal nerve of the penis, clinical implications (Urology 2014;83:121-125).

We congratulate the authors for describing a new method of clot removal using pancreatic enzymes as intravesical irrigation and/or infusion. Clot removal can sometimes be a really frustrating exercise. While using Ellik evacuator in the setting of clot retention, we have seen many bladder ruptures, especially if the procedure is done by trainee resident. Instead of “sucking out,” the surgeon “pushes” saline inside the bladder suddenly to fragment and suck out clots. To avoid this problem and also to remove really tenacious and large clots, we described the method of “suction” to remove these clots. Subsequently, we also developed a “suction bridge” to make the procedure simpler and more safe and effective (in collaboration with Karl Storz, Germany). In the article “Evaluation of bladder clots using a nonsurgical treatment” the word “Evaluation” should have been “Evacuation”. It would have been more enlightening had the authors also described the clot burden and the duration of clot retention. This is important, as it would be futile to delay definitive evacuation. For example, will the method described by the authors work if the clot bulk is significant? Also, how much time does it take to lyse clots by chymotripsin?

Accessory foramen in the human mandible: anatomical and clinical considerations

We read with interest the published article ‘Anatomical classification of accessory foramina in human mandibles of adults, infants, and fetuses’ by Przystanska and Bruska (2012). The authors performed a meticulous study of the accessory foramen in the mandible. We wish to share few scientific facts related to the published topic. It is always better to visualize an accessory foramen in a radiograph. The best possible means is to insert a wire and visualize the continuity of the canal. An accessory foramen is meant for passage of the neurovascular structures. It would be better to interpret the concerned neurovascular structures according to the position of the accessory foramen. A past study cut the mandible in the midline and measured the dimensions of the canal under dissecting microscope (Liang et al. 2007). Even though the accessory foramina were discussed, no speculation was made about the blood vessels or nerves traversing it. The authors mentioned in their discussion that the accessory foramen was connected to the mandibular foramen. Radiographic investigations may provide exact evidence continuity of the accessory foramina with the mandibular canal but it is quite difficult to believe such in the absence of radiographic studies. The accessory foramen has also been reported to have continuity with the incisive canal (von Arx et al. 2011). If there is continuity of the accessory foramen with the mandibular canal, one wonders if the mental nerve emerges out through this foramen. This raises serious issues for successful nerve blocks. Previous studies have described consideration of additional locoregional anaesthesia in the case of failed mandibular block anesthesia (von Arx et al. 2011). In the second paragraph of the results section, under the subheading Adult mandibles, it was mentioned that four different types of foramina were found but only three were mentioned in pointwise form. We wonder if this really refers to types of foramina or do the authors mean different positions of the foramina. Contrary to the present findings, past research studies depict the accessory foramen varying according to age and race (Kaufman et al. 2000). Interestingly, an earlier study speculated that eruption of wisdom teeth may require additional neurovascular nourishment (von Arx et al. 2011). The present study should have discussed the eventualities of eruption of wisdom teeth or even additional dental spurs. Calculation of the mean distance of this canal with respect to a bony point may have been more beneficial to maxillofacial surgeons. These may be needed for planning graft implants. We congratulate the authors for their valiant effort, and thank the editors for publishing an interesting topic.