Wiyada Punjaruk

The effects of transcranial direct current stimulation in patients with neuropathic pain from spinal cord injury

OBJECTIVE Transcranial direct current stimulation (tDCS) has demonstrated efficacy for reducing neuropathic pain, but the respective mechanisms remain largely unknown. The current study tested the hypothesis that pain reduction with tDCS is associated with an increase in the peak frequency spectrum density in the theta-alpha range. METHODS Twenty patients with spinal cord injury and bilateral neuropathic pain received single sessions of both sham and anodal tDCS (2 mA) over the left primary motor area (M1) for 20 min. Treatment order was randomly assigned. Pre- to post-procedure changes in pain intensity and peak frequency of electroencephalogram spectral analysis were compared between treatment conditions. RESULTS The active treatment condition (anodal tDCS over M1) but not sham treatment resulted in significant decreases in pain intensity. In addition, consistent with the study hypothesis, peak theta-alpha frequency (PTAF) assessed from an electrode placed over the site of stimulation increased more from pre- to post-session among participants in the active tDCS condition, relative to those in the sham tDCS condition. Moreover, we found a significant association between a decrease in pain intensity and an increase in PTAF at the stimulation site. CONCLUSIONS The findings are consistent with the possibility that anodal tDCS over the left M1 may be effective, at least in part, because it results in an increase in M1 cortical excitability, perhaps due to a pain inhibitory effect of motor cortex stimulation that may influence the descending pain modulation system. Future research is needed to determine if there is a causal association between increased left anterior activity and pain reduction. SIGNIFICANCE The results provide new findings regarding the effects of tDCS on neuropathic pain and brain oscillation changes.

Numbers of New Cases and Trends of Cancer 1993-2012: Srinagarind Hospital Based Population, Khon Kaen, North- East Thailand

BACKGROUND Cancer is the most common cause of death in Thailand, where treatment outcomes and prognosis are poor and mortality rates remain high. This study reports new cancer cases and trends of all cancers registered in Srinagarind Hospital from 1993 to 2012 and also provides a picture of the cancer situation in Northeast Thailand. MATERIALS AND METHODS All new cases of cancer registered in the hospital-based cancer registry at Faculty of Medicine, Srinagarind Hospital, Khon Kaen University during 1993-2012 were included in the study. RESULTS AND CONCLUSIONS The number of new cancer cases has gradually increased each year during the last 20 years. The three most common cancers at present in males are liver and bile duct cancer, lung cancer and colorectal cancer, respectively. In females, liver and bile duct, breast and thyroid cancers are now the most frequent. Interestingly, the number of cases of both liver and bile duct cancer and colorectal cancer in males noticeably increased during the second decade of the study. Additionally, breast cancer greatly increased in the same decade and lung cancer in females climbed into the top five most common cancers. Thyroid cancer has also risen steadily in the last decade. Trends of common cancers are similar to those throughout Thailand.

Transcranial Direct Current Stimulation in Neuropathic Pain

Neuropathic pain (NP) is one of the most common problems contributing to suffering and disability worldwide. Unfortunately, NP is also largely refractory to treatments, with a large number of patients continuing to report significant pain even when they are receiving recommended medications and physical therapy. Thus, there remains an urgent need for additional effective treatments. In recent years, nonpharmacologic brain stimulation techniques have emerged as potential therapeutic options. Many of these techniques and procedures – such as transcranial magnetic stimulation, spinal cord stimulation, deep brain stimulation, and motor cortical stimulation – have very limited availability, particularly in developing countries. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation procedure that has shown promise for effectively treating NP, and also has the potential to be widely available. This review describes tDCS and the tDCS procedures and principles that may be helpful for treating NP. The findings indicate that the analgesic benefits of tDCS can occur both during stimulation and beyond the time of stimulation. The mechanisms of cortical modulation by tDCS may involve various activities in neuronal networks such as increasing glutamine and glutamate under the stimulating electrode, effects on the μ-opioid receptor, and restoration of the defective intracortical inhibition. Additional research is needed to determine (1) the factors that may moderate the efficacy of tDCS, (2) the dose (e.g. number and frequency of treatment sessions) that results in the largest benefits and (3) the long-term effects of tDCS treatment.

Histopathological Changes in Tissues of Bithynia siamensis goniomphalos Incubated in Crude Extracts of Camellia Seed and Mangosteen Pericarp

The present study was performed to observe histopathological changes in tissues of Bithynia siamensis goniomphalos (Gastropoda, Bithyniidae) incubated in crude extract solutions of camellia (Camellia oleifera) seed and mangosteen (Garcinia mangostana) pericarp, and furthermore to estimate the molluscicidal effects of 2 plant substances. Substantial numbers of bithyniid snails were incubated in various concentrations of 2 plant solution for 24 hr. As the positive control, snails incubated in various concentrations of niclosamide, a chemical molluscicide, were used. The histopathological findings were observed in sectioned snail specimens of each experimental and control groups. The results showed that both camellia and mangosteen extracts had molluscicidal effects at 24 hr with 50% lethal concentration (LC50) at concentrations of 0.003 and 0.002 g/ml, respectively, while niclosamide had LC50 at concentrations 0.599 ppm. B. siamensis goniomphalos snail tissues (foot, gill, and digestive system) showed disruption of columnar muscle fibers of the foot, reduction of the length and number of gill cilia, numerous mucous vacuoles, and irregularly shaped of epithelial cells. Irregular apical and calciferous cells, dilatation of the digestive gland tubule, and large hemolymphatic spaces, and irregular apical surfaces, detachment of cilia, and enlargement of lysosomal vacuoles of epidermis were also shown in all groups. By the present study, it is confirmed that 2 plants, camellia and mangosteen, are keeping some substance having molluscicidal effects, and histopathological findings obtained in this study will provide some clues in further studies on their action mechanisms to use them as natural molluscicides.

High sugar intake blunts arterial baroreflex via estrogen receptors in perinatal taurine supplemented rats.

In adult rats, perinatal taurine depletion followed by high sugar intake alters neural and renal control of arterial pressure via the renin-angiotensin system. This study tests the hypothesis that perinatal taurine supplementation predisposes adult female rats to the adverse arterial pressure effect of high sugar intake via the renin-angiotensin system, rather than via estrogen. Female Sprague-Dawley rats were fed normal rat chow with 3% taurine (taurine supplementation, TS) or water alone (control, C) from conception to weaning. Their female offspring were fed normal rat chow with either 5% glucose in tap water (TSG, CG) or tap water alone (TSW, CW). At 7-8 weeks of age, the female offsprings renin-angiotensin system or estrogen receptors were inhibited by captopril or tamoxifen, respectively. Body weight, heart weight, kidney weight, mean arterial pressures (MAP), and heart rates were not significantly different among groups without captopril or tamoxifen. Captopril (but not tamoxifen) decreased MAP but not heart rates in all groups. In TSG compared to TSW, CW, and CG groups, baroreflex sensitivity of heart rate (BSHR) and renal nerve activity (BSRA) were significantly decreased. Neither captopril nor tamoxifen altered BSHR in TSG, but tamoxifen (but not captopril) restored TSG BSRA to CW or CG control levels. Perinatal taurine supplementation did not disturb sympathetic and parasympathetic nerve activity in the adult rats on high or basal sugar intake. Compared to its effect in CW and CG groups, tamoxifen increased sympathetic but decreased parasympathetic activity less in TSG and TSW groups. Inhibition of the renin-angiotensin system did not affect autonomic nerve activity in any group. These data suggest that in adult female rats that are perinatally supplemented with taurine, high sugar intake after weaning blunts arterial baroreflex via an estrogen (but not renin-angiotensin) mechanism.

Brain Cancer Cell Detection Optimization Schemes Using Image Processing and Soft Computing

This paper introduces a novel methodology to automatically measure a number of brain cancer cells using optimized image processing and soft-computing for classification. The former approach is used to prepare the cell image from the medical laboratory, such as background removal, image adjustment, and cell detection including noise reduction. Then, Gabor filter is applied to retrieve the key features before feeding into different soft-computing techniques to identify the actual cells. The results show that the performance of Fuzzy C-Mean with image processing optimization is outstanding compared to neural networks, genetic algorithms, and support vector machines, i.e., 96 % versus less than 90 % in precision, in addition to the superior computational time of around two seconds.

Perinatal Taurine Exposure Alters Hematological and Chemical Properties of Blood in Adult Male Rats

Perinatal taurine imbalance alters hormonal, neural, renal, and cardiovascular functions in adult animals. This study tested the effect of perinatal taurine depletion and supplementation on blood cells, plasma electrolytes, and lipid profiles in adult male rats. Female Sprague–Dawley rats were fed normal rat chow with 3 % beta alanine (taurine depletion, TD), 3 % taurine (taurine supplementation, TS) or tap water alone (control, C) from conception to weaning. Male offspring were fed normal rat chow and tap water throughout the study. At 13–16 weeks of age, body, heart, and kidney weights were not significantly different in TD and TS compared to C groups. Compared to control and TD, TS group displayed higher red blood cell count, hemoglobin concentration, and hematocrit. Perinatal taurine depletion or supplementation decreased platelet counts significantly, but only perinatal taurine supplementation significantly increased mean platelet volume compared to control group. Although total white blood cells, lymphocytes, monocytes, eosinophils, and basophils were not significantly altered by perinatal taurine manipulations, neutrophils were significantly lower in TS compared to controls (but not to TD group). Non-fasting blood sugar, plasma sodium, and plasma calcium were not significantly different among the three groups, but both TD and TS showed significantly increased plasma potassium levels. Compared to controls, TD and TS did not affect plasma lipid profiles; however, low density lipoprotein levels were significantly higher in TS compared to TD groups. These data indicate that alterations in perinatal taurine (particularly supplementation) affect hematological parameters, electrolyte balance, and lipid profiles, potentially contributing to disorders in adult animals.

Degree of improvement after hyperbaric oxygen therapy for compromised flap and graft: A case series

Objective: To determine the treatment outcome of hyperbaric oxygen therapy (HBOT) in compromised graft/flap. Method: A retrospective study was conducted to identify patients who had undergone ischemic compromised graft and flap and received hyperbaric oxygen therapy at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand, between 2012 and 2017. Wound improvement was the primary outcome. Results: Eleven patients with ischemic graft/flaps were enrolled in the study (9 adults; 2 children). The results showed that the treatment outcome for all patients undergoing skin flap/graft was improved. Patients classified as grade 3 and 4 (7 flaps in total) had improved wound healing without other adjunctive therapies whereas 4 patients-classified as grades 1 and 2-experienced partial wound healing and required surgical debridement with skin graft or flap reconstruction. Conclusion: In flap or graft ischemia, HBOT represented an additional medical treatment that can enhance wound healing resulting in a satisfactory treatment outcome.

Efficacy of Adjunctive Hyperbaric Oxygen Therapy in Osteoradionecrosis

Abstract Osteoradionecrosis (ORN) is a common consequence resulting from radiation in patients with cancer. Presently, hyperbaric oxygen therapy (HBOT) is proposed to have a role in improving wound healing in ORN patients. There is no strong scientific evidence to confirm the benefits of HBOT for treatment of ORN as an adjunctive treatment. This study aimed to determine the benefits of adjunctive treatment of HBOT in ORN. A retrospective study was conducted at the Srinagarind Hospital, the Faculty of Medicine, Khon Kaen University, Thailand, between 2011 and 2017. The patients diagnosed with ORN, who received adjunctive HBOT before the operation, were enrolled. Complete healing of wounds was the primary outcome. There were 84 ORN patients with a mean age of 58.78 years; 54.76% were male and 45.24% were female. HBOT had a role significant in improving wound healing of ORN patients with stages 1 and 2. Poisson regression analysis showed that stage 3 of ORN negatively correlated with the number of HBOT dives (p = 0.001, incidence rates ratio = 0.85). In conclusion, HBOT improved wound healing of ORN patients with stages 1 and 2. In addition, stage 2 of ORN patients significantly required the highest number of HBOT dives compared to other types of ORN to promote wound healing, whereas stage 3 patients, who underwent bone debridement combined with HBOT, initiated to success of treatment process and required a smaller number of dives.

Brain tumor cell recognition schemes using image processing with parallel ELM classifications on GPU

This paper investigates the possibility to enhance the recognition rate of brain tumor cell images acquired from the medical laboratory. A simplified image processing is first applied to the tumor cell as pre-processing, such as Otsu and unsharp masking methods; then, Histogram Orientation Gradient is our selection of feature extraction based on tumor shape characteristics which is then integrated into Extreme Learning Machine (ELM) as cell classification, called H-ELM. Its precision performance is confirmed against Support Vector Machine and a traditional ELM, i.e., 90% against 64% and 70%, respectively. To further improve H-ELM in aspects of computational complexity with high dimension and large image datasets, the feasibility to utilize the parallelism is investigated and implemented in classification stage using Compute Unified Device Architecture in Graphics Processing Unit resulting into 3 and 7 times speedup over its non-parallel scheme (CPU) and the traditional ELM, called Parallel H-ELM or PH-ELM.