METHODS: The aforesaid computational TCA framework for sequential injection was applied and adapted to simulate TCA with simultaneous injection of acid and base at equimolar and equivolume. The developed framework, which describes the flow of acid and base, their neutralisation, the rise in tissue temperature and the formation of thermal damage, was solved numerically using the finite element method. The framework will be used to investigate the effects of injection rate, reagent concentration, volume and type (weak/strong acid-base combination) on temperature rise and thermal coagulation formation.
RESULTS: A higher injection rate resulted in higher temperature rise and larger thermal coagulation. Reagent concentration of 7500 mol/m3 was found to be optimum in producing considerable thermal coagulation without the risk of tissue overheating. Thermal coagulation volume was found to be consistently larger than the total volume of acid and base injected into the tissue, which is beneficial as it reduces the risk of chemical burn injury. Three multivariate second-order polynomials that express the targeted coagulation volume as functions of injection rate and reagent volume, for the weak-weak, weak-strong and strong-strong acid-base combinations were also derived based on the simulated data.
CONCLUSIONS: A guideline for a safe and effective implementation of TCA with simultaneous injection of acid and base was recommended based on the numerical results of the computational model developed. The guideline correlates the coagulation volume with the reagent volume and injection rate, and may be used by clinicians in determining the safe dosage of reagents and optimum injection rate to achieve a desired thermal coagulation volume during TCA.
METHODS: A randomised controlled trial involving 197 participants from three institutions was conducted. The control group attended a freestyle lecture on the gross anatomy of the heart, delivered by a qualified anatomist from each institution. The intervention group attended a CLT-bLM-based lecture on a similar topic, delivered by the same lecturer, three weeks thereafter. The lecturers had attended a CLT-bLM workshop that allowed them to prepare for the CLT-bLM-based lecture over the course of three weeks. The students' ratings on their cognitive engagement and internal motivation were evaluated immediately after the lecture using a validated Learners' Engagement and Motivation Questionnaire. The differences between variables were analysed and the results were triangulated with the focus group discussion findings that explored students' experience while attending the lecture.
RESULTS: The intervention group has a significantly higher level of cognitive engagement than the control group; however, no significant difference in internal motivation score was found. In addition, the intervention group reported having a good learning experience from the lectures.
CONCLUSION: The guideline successfully stimulated students' cognitive engagement and learning experience, which indicates a successful stimulation of students' germane resources. Stimulation of these cognitive resources is essential for successful cognitive processing, especially when learning a difficult subject such as anatomy.
METHODOLOGY: This is a prospective study where patients (n=119) blood was tested for anti-HAVIgG and CYP3A4*18 polymorphism.
RESULTS: The overall anti-HAV seroprevalence was 88.2%. The etiology of CLD was hepatitis B in 96 patients (80.7%) and hepatitis C in 23 patients (19.3%). There was a significant increase in the age of the prevalence of this disease after 30 years of age (p=0.008). CYP3A4*18 polymorphism was detected in 3 (2.5%) of the patients with chronic liver disease. However, there was no significant association between CP3A4*18 mutation and anti-HAV serology.
CONCLUSIONS: Age was the most important factor in determining anti-HAV positivity. It is concluded that CYP3A4*18 genetic polymorphism does not play a main role in influencing the seroprevalence of anti-hepatitis A among chronic viral hepatitis B and C liver disease patients.