bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-Dose Radioiodine Given Six-Monthly in Graves' Disease
Authors: Hoskin P J , McCready V R , Harmer C L , Spathis G S , Cosgrove D O
Published: January 2017

Experience using low-dose radioiodine given six-monthly instead of yearly in hyperthyroid patients with Graves' disease is reported. One hundred and thirty-five patients have been treated over a three-year period with 74 MBq (2 mCi) doses of 131I. Thirty-eight percent were controlled with a single dose. Those patients requiring more than one dose were treated with a further 74 MBq (2 mCi) 131I at six-monthly intervals until euthyroid. Using this approach, 46% were euthyroid one year after starting treatment, and 75% were euthyroid at two years. The incidence of hypothyroidism following treatment was 2.2% at one year, with a yearly incidence thereafter of 4–6%. Six-monthly scheduling of low-dose radioiodine in Graves' disease can reduce the time taken to become euthyroid, compared with conventional yearly low-dose treatments. Further follow up is required to confirm the present low incidence of hypothyroidism following treatment.
Practical Applications of a Monoclonal Antibody (NDOG2) against Placental Alkaline Phosphatase in Ovarian Cancer
Authors: Davies J O , Jackson P , Sadowski C , Davies E R , Pitcher E , Stirrat G M , Howe K , Randle B , Sunderland C A
Published: January 2017

A monoclonal antibody (NDOG2) against placental alkaline phosphatase (PLAP) in ovarian cancer has been used in three ways by the Bristol University Department of Obstetrics & Gynaecology. First, in an indirect immunoperoxidase technique, NDOG2 demonstrated positive standing in 64% of 56 ovarian carcinomas as well as in 25% of 44 benign tumours. The majority of these positive tumours were serous cystadenocarcinomas or serous cystadenomas and there was considerable variation in the expression of this antigen from tumour to tumour. NDOG2 was also used as the basis of two serum assays and, when labelled with 123-iodine (123I), in radioimmunoscintigraphy (RIS) to monitor patients' response to therapy. The first serum assay measures the enzymic activity of PLAP and the second recognizes the antigenicity of the molecules. Assay 2 proved more useful in that it predicted the course of the disease in 45% of patients followed up, whereas Assay 1 was only of use in 25% of cases. RIS proved to be a useful imaging technique and was at least as sensitive as conventional imaging techniques. The common causes of false-positive and false-negative results are described.
Erythema Ab Igne in Cancer Patients
Authors: Ashby Michael
Published: January 2017

Five cancer patients were observed to have the skin change erythema ab igne (EAI) associated with painful underlying lesions, for which they had been applying local heating with hot-water bottles. In 4 cases the pain was produced by metastases and in one by the primary tumour. The EAI may be seen directly over the lesion or in an area of pain referral. In cancer patients it may be a helpful localizing sign, and in all patients (apart from the anterior lower legs of old people) it is very suggestive of a serious underlying cause.
Dietary History and Nutritional State in Treated Coeliac Patients
Authors: Collins B J , Bell P M , BSc JM Thomson , BSc D B Fee , Wilson E A , Love A H G
Published: January 2017

The gluten content and nutritional adequacy of the diet of a group of adult coeliac patients supposedly following a gluten-free diet for at least one year were assessed. Results were considered in relation to the nutritional state of these patients, determined by anthropometric measurement, and the histological appearance of jejunal biopsies taken at the time of nutritional assessment. Imperfect gluten avoidance, mild malnutrition and mild histological abnormalities on jejunal biopsy were frequent findings. A careful dietary and nutritional assessment when considered in light of histological findings at jejunal biopsy helps to identify the causes of persisting symptoms or malnutrition in treated coeliac patients. A normal jejunal biopsy in a malnourished patient whose dietary compliance is good should prompt a search for an alternative diagnosis.
Building or Extending a Hospital Department: Radiology a Path through the Planning Minefield (6)
Authors: Roebuck E J , Manton D J , Fordham G L
Published: January 2017

This is the sixth of a series of articles on the planning and building of a new radiology department or the extension of an old one. While the series focuses on a radiology department, it will be of interest to anyone who is planning any part of a hospital, particularly in the detailed information about the planning process and the part to be played by hospital staff during the subsequent building and commissioning. (The first article in the series appeared in the January issue, p 40.)
A new modifier adaptation methodology for real-time optimization
Authors: Chen Chunhua , Jia Mingxing , You Fuqiang , Wang Fuli , Kou Wenqi
Published: January 2017

The traditional modifier adaptation can be used to deal with the optimization problem of mismatched model, and it shows good performance in most cases. However, the method cannot be used directly, when the gradients of the model outputs, with respect to the decision variables, are difficult to calculate directly. Also, the simulation results show that the method cannot achieve the optimum in theory when the gradient estimation is particularly inaccurate. Therefore, a new modifier adaptation methodology for real-time optimization is proposed in this paper. A method similar to Proportion integration differentiation is used to deal with the deviation between the actual gradient and the model gradient and to improve the method of modifier terms computation. In addition, we find that the appropriate relaxation of certain constraints can expand the search area and improve the effectiveness of the optimization. The validation of the method is demonstrated by the solution of an artificial example and the optimal setting problem of the converter entrance temperatures in flue gas acid-making.
An exploration of load-shifting potential in real in-situ heat-pump/gas-boiler hybrid systems
Authors: Stafford Anne
Published: January 2017

Monitoring data from two hybrid air-source heat-pump/gas-boiler systems were used to explore the systems’ potential for energy flexibility, i.e. the potential for shifting electrical load in response to grid requirements while maintaining acceptable performance in the overall hybrid system. In both cases, a significant proportion of the heat-pump load could potentially be shifted to the gas boiler with only a modest increase in the overall energy consumption, provided certain operational conditions were met. Furthermore, under these operational conditions, it is possible to estimate this additional energy consumption for a given system from simple heat output, and gas and electricity consumption data. This provides a potential basis for groups of similar systems equipped with smart technology to offer flexibility to the grid, while minimising the resulting energy penalty by choosing to use the most appropriate systems at any given time with respect to their operating conditions at that time. In addition, this type of flexibility means that the thermal comfort within the dwelling remains unaffected since overall heating requirement is met at all times by one of the two heating sub-systems.

Practical application: The ability to shift or shed electrical load in response to grid requirements is likely to become a significant, commercially incentivised aspect of building energy systems in the future, to mitigate the stress on electrical grids at times of peak consumption. For domestic systems, aggregation will be a key factor, requiring ‘smart’ systems to provide real-time information to potential aggregators or grid operators. This article explores what type of system information may be necessary in the case of hybrid heat-pump/gas-boiler systems if loads are to be shifted from the heat-pump to the gas-boiler element, while minimising the resulting energy penalties.
Language, the “Diabetes Restricted Code/Dialect,” and What It Means for People With Diabetes and Clinicians
Authors: Dunning Trisha , Speight Jane , Bennett Craig
Published: January 2017

Purpose

The purpose of the paper is to explore the notion of a diabetes language restricted code or “dialect” and its effect on people with diabetes. Language is a complex phenomenon comprising verbal and nonverbal components used to communicate in human interactions.

Methods

Information was collected from a literature review, during clinical consultations, and from an email survey.

Results

Language and the way clinicians use language affect motivation, behaviors, and outcomes of people with diabetes. Language is influenced by culture, experience, and familiarity with words and their use and is idiosyncratic. “Diabetes” is a particular restricted code or dialect that people with diabetes gradually learn to speak, usually after they are diagnosed with diabetes. The diabetes dialect contains many metric and target words and very few positive, encouraging words, and it is often discriminatory, negative, judgmental, labelling, distressing, and stigmatizing: for example, victim, sufferer, and lifestyle disease.

Conclusion

Language codes/dialects can compound the already high levels of emotional distress and self-care burden associated with living with diabetes and can affect outcomes. The information presented in this article will be useful for clinicians caring for people with diabetes and will be helpful for professionals who develop information for people with diabetes and those who create policies and guidelines.
Psychological Acculturation and Parenting Behaviors in Mexican-Immigrant Families
Authors: Gassman-Pines Anna , Skinner Ann T.
Published: January 2017

This study examined the relation between mothers’ and fathers’ psychological acculturation and parenting behaviors in two samples of Mexican-immigrant families. The middle childhood sample included 47 mothers, 38 fathers, and 46 children in families with children aged 9 to 12 years, and the early childhood sample included 185 mothers and 155 fathers in families with children aged 2 to 6 years. In both samples, compared with families in which fathers reported feeling connected only to Latino culture, fathers who reported feeling connected to both Latinos and Americans engaged in fewer aversive and withdrawn interactions and more warm interactions with children. In families where fathers reported feeling connected to both Latinos and Americans, mothers also engaged in fewer aversive and withdrawn interactions and more warm interactions with children. Results were consistent across the two samples and across different family member reports of parent–child interactions.
The Effect of Spiritual Care on Stress Levels of Mothers in NICU
Authors: Küçük Alemdar Dilek , Kardaş Özdemir Funda , Güdücü Tüfekci Fatma
Published: January 2017

Hospitalization of an infant is a difficult situation for the family, and parents require support from the health care team during this difficult time. The aim of this study was to investigate the effect of spiritual care on levels of stress in mothers with infants in a neonatal intensive care unit. This spiritual care study was performed by comparing control and spiritual care pre- and posttest groups. The study population included 62 mothers. The Mother–Baby Introductory Information Form and the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) were used for data collection. Prior to spiritual care, no significant difference was found between the mothers’ PSS:NICU scores, whereas following spiritual care, there was a significant difference between PSS:NICU scores of the mothers, in favor of the spiritual care group ( p < .05). Findings indicate that nurses should be aware and consider the spiritual needs of mothers and must identify and meet these needs.
Role of post-mapping computed tomography in virtual-assisted lung mapping
Authors: Sato Masaaki , Nagayama Kazuhiro , Kuwano Hideki , Nitadori Jun-ichi , Anraku Masaki , Nakajima Jun
Published: January 2017

Background

Virtual-assisted lung mapping is a novel bronchoscopic preoperative lung marking technique in which virtual bronchoscopy is used to predict the locations of multiple dye markings. Post-mapping computed tomography is performed to confirm the locations of the actual markings. This study aimed to examine the accuracy of marking locations predicted by virtual bronchoscopy and elucidate the role of post-mapping computed tomography.

Methods

Automated and manual virtual bronchoscopy was used to predict marking locations. After bronchoscopic dye marking under local anesthesia, computed tomography was performed to confirm the actual marking locations before surgery. Discrepancies between marking locations predicted by the different methods and the actual markings were examined on computed tomography images. Forty-three markings in 11 patients were analyzed.

Results

The average difference between the predicted and actual marking locations was 30 mm. There was no significant difference between the latest version of the automated virtual bronchoscopy system (30.7 ± 17.2 mm) and manual virtual bronchoscopy (29.8 ± 19.1 mm). The difference was significantly greater in the upper vs. lower lobes (37.1 ± 20.1 vs. 23.0 ± 6.8 mm, for automated virtual bronchoscopy; p < 0.01). Despite this discrepancy, all targeted lesions were successfully resected using 3-dimensional image guidance based on post-mapping computed tomography reflecting the actual marking locations.

Conclusions

Markings predicted by virtual bronchoscopy were dislocated from the actual markings by an average of 3 cm. However, surgery was accurately performed using post-mapping computed tomography guidance, demonstrating the indispensable role of post-mapping computed tomography in virtual-assisted lung mapping.
Thai Pronouns Revisited
Authors: Hatton Howard A.
Published: January 2017

Once when was in England studying at the University of Leeds, climbed the Pennine mountains right up to the peak. Helped to pull each other up, but slipped and rolled over and over down from the peak. And head struck against a rock. I fainted. Was saved because friends helped to lift and carry back to the university. Was unconscious for two whole days before finally regained consciousness.
Integration against the state: Irregular migrants’ agency between deportation and regularisation in the United Kingdom
Authors: Schweitzer Reinhard
Published: January 2017

Reducing the number of foreigners residing unlawfully within the borders of a state requires either their removal or the legalisation of their presence within the territory. Increasingly, governments also employ measures of internal control and limit irregular migrants’ access to rights and services in order to encourage them to leave autonomously. This article aims to contribute to current debates on how to conceptualise and account for the agency that irregular migrants themselves exercise in such contexts. Within critical migration and citizenship studies, many of their everyday actions have been described as ‘acts of citizenship’ but also as instances of ‘becoming imperceptible’, neither of which captures the whole range of strategies irregular migrants employ to strengthen their fragile position vis-à-vis the state. I argue that conceptualising their agency in terms of (self-)integration allows us to account for both: practices through which they actively become political subjects as well as those that precisely constitute a deliberate refusal to do so. Empirically, this is underpinned by an analysis of recent policy developments in the United Kingdom and a series of semi-structured interviews I conducted during 8 months of fieldwork in London with migrants experiencing different kinds and degrees of irregularity.
Prospective Randomised Trial Comparing Conventional (Babcock) Stripping with Inverting (Pin) Stripping of the Long Saphenous Vein
Authors: Butler C. M. , Scurr J. H. , Smith P. D. Coleridge
Published: January 2017

Objective:

To compare the postoperative morbidity of conventional stripping with inverting stripping of the long saphenous vein in a randomised prospective trial.

Methods:

One hundred and thirty-six patients with primary uncomplicated long saphenous vein incompetence were randomised to either conventional or inverting stripping of the long saphenous vein. Blood loss, operating time and length of vein stripped were measured intra-operatively. Number and size of haematomas, bruising and diameter of thethrombosed channel were assessed 1 week postoperatively by clinical examination and by duplex ultrasonography. Pain, mobility and analgesia consumption were noted in a daily diary for the postoperative week.

Results:

Blood loss was significantly lower in the inverting group than in the conventional group, with a median of 50 ml for the conventional group and 20 ml in the inverting group (p<0.0001, Mann-Whitney U-test). Operating time in the inverting group (median: 20 min, interquartile range (IQR): 15–25 min) was shorter than in the conventional group (median: 25 min, IQR 20–30 min; p = 0.0001). The percentage of length of vein removed was greater in the inverting group (p < 0.05). There was no difference between the groups as regards size of haematoma, bruising, or diameter of thrombosed channel, nor was there a difference in postoperative pain, mobility or analgesia consumption.

Conclusions:

Inverting stripping used less operating time and there was less blood loss perioperatively. There did not appear to be any further benefits to inverting stripping of the long saphenous vein during the early perioperative period.
How I Do Long Saphenous Vein Surgery
Authors: Braithwaite B. D.
Published: January 2017

Objective:

To describe the author's own technique for treating long saphenous vein incompetence.

Method:

The long saphenous vein is stripped using a disposable stripper with the patient under general anaesthesia. Saphenous varices are managed by hook phlebectomy.

Conclusions:

The author's technique is effective in the management of large saphenous varices associated with long saphenous incompetence. The result is cosmetically satisfactory. Any residual varices are dealt with by sclerotherapy.
A Randomised Trial to Compare the Effect of Pre- or Postoperative Nandroparin on Blood Loss during Elective Caesarean Section
Authors: Cornette J. , Jacquemyn Y. , Vercauteren M. , Buytaert P.
Published: January 2017

Objective:

To compare operative blood loss following caesarean section in relation to the timing of administration of nandroparin, given to prevent perioperative deep vein thrombosis.

Patients:

Forty-four patients undergoing scheduled, primary elective caesarean section in full-term singleton pregnancies were included in this study.

Interventions:

A prospective randomised trial was performed, in which 2850 IU of nandroparin was administered either 12 h prior to or 12 h following surgery.

Outcome measures:

Haemoglobin and haematocrit levels, as indirect measures of blood loss, were compared in the two groups before and 2 days after surgery.

Findings:

Both groups were composed of 22 women. No significant differences between the outcome measures were observered.

Conclusions:

Nandroparin can safely be administered 12 h before planned caesarean section without significantly increasing blood loss.
Preventing Venous Ulcer Recurrence: The Impact of the Well Leg Clinic
Authors: Fassiadis N. , Godby C. , Agland L. , Law N.
Published: January 2017

Background:

The aim of this prospective study was to evaluate the effectiveness of a nursing-led clinic within a District Hospital setting in detecting early skin break-down in healed venous ulcers.

Patients and Methods:

A total of 76 patients (45 women, 31 men; age range 24-91 years, mean 74 years) with healed venous ulcers were included in the study between July 1999 and April 2001. Patients were counselled about managemant of ulcers at their initial visit and followed up at 3 and 6 months.

Results:

We received 79 referrals and of those 76 (96%) accepted our invitation. Fifty-six patients did attend the first clinic appointment, 39 (67%) attended their second clinic visit at 3 months and 38 (68%) were followed up by a telephone call at 6 months. During this period 9 recurrent leg ulcers were noted which were referred for further intervention.

Conclusion:

It is important to provide follow-up for patients with healed ulcers in order to minimise the recurrence rate and to re-institute treatment soon, as recurrence can occur early following healing.
Functional Study of the Limb Lymphatic System
Authors: Pecking A. , Cluzan R. , Desprez-Curely J.P. , Guérin P.
Published: January 2017

Radionuclide lymphoscintigraphy with rhenium sulphide colloid (RSC), average particle size 40 nm was used as a functional test of the limb lymphatic system. When injected subcutaneously in the hand or the foot all the RSC which leave the injection site enters the lymphatic system. From the disappearance time-activity curve detected over the injection site, we calculated the half-life and the lymphatic colloidal clearance (LC) of the RSC. These two parameters appeared to be closely depending on the macrophage function and on the permeability of the initial lymphatics. We also measured the necessary time for RSC to reach the knee or the elbow and calculated a lymphatic speed (LS) closely related to the lymph flow. The study was first carried out on 40 healthy volunteers and then on 221 patients with limb lymphoedemas. The reproducibility of the method was good when 4 days at least separate two functional tests ( r = 0.95 for half-life, r = 0.86 for lymphatic clearance at the injection site and r = 0.93 for lymphatic speed). In addition with the lymphatic images detected 1 h after the injection the functional study may become a useful technique to differentiate the lymphatic drainage diseases.
Diagnosis of Recurrent Deep Venous Thrombosis Using B-Mode Ultrasonic Imaging
Authors: Rollins David L. , Semrow Carolyn , Calligaro Keith , Friedell Mark , Buchbinder Dale
Published: January 2017

Accurate diagnosis of recurrent deep venous thrombosis (DVT) in patients with postphlebitic syndrome or a history of previous DVT can be extremely difficult. Real-time B-mode ultrasonic imaging (UI) was compared to ascending contrast venography (ACV) in a prospective study of 38 limbs with suspected recurrent DVT to determine if UI could reliably detect recurrent thrombosis. Six limbs had normal deep veins and 32 had evidence of previous DVT by both techniques. Acute thrombus was diagnosed by both UI and ACV in 9 limbs and by UI alone in an additional three limbs. New thrombus was found in 13 popliteal-proximal and 10 calf veins by UI; while ACV detected 12 popliteal-proximal and five new calf vein thromboses. UI is comparable to ACV in detecting recurrent thrombosis and may be particularly useful in assessing the calf veins.
Indirect Lymphoscintigraphy in Patients with Limb Oedema
Authors: Pecking A. , Cluzan R. , Desprez-Curely J.P. , Guerin P.
Published: January 2017

One thousand four hundred and fifty-five lymphoscintigraphies using a radio-labelled colloid were performed as an objective test for the diagnosis and the survey of lower limb oedemas. It is a non-invasive method involving only a subdermic bipedal injection into the first web space of each foot. Our results demonstrate that in chronic swollen legs due to venous causes occuring from post-thrombotic syndrome or varicose disease the lymphatic system can be insufficient (14.9% and 19.8% of these cases). Abnormal results are found in 91.3% of clinically primary lymphoedemas. In unilateral primary lymphoedemas the clinically healthy controlateral limb can be insufficient (25%). In post-traumatic lower limb oedemas the lymphatic flow remains normal while perilymphatic extravasation and dermal filling are always to be found at the trauma site. The lymphoscintigraphy is a simple, physiological and reliable test. The morphological findings based upon 1455 examinations allow us to think that this method may resolve the clinical problems without recourse to more invasive procedures. We can expect that in a few years this morphological study will be completed with a functional lymphatic test.
What is the Correct Period of Bandaging following Sclerotherapy?
Authors: Reddy P. , Wickers J. , Terry T. , Lamont P. , Moller J. , Dormandy J. A.
Published: January 2017

Two consecutive randomized trials following injection sclerotherapy for varicose veins compared 3 and 6 weeks bandaging in 148 patients and 1 to 3 weeks bandaging in 130 patients. Objective assessment and patient's symptoms, using a scoring system, correlated well and showed that there was no difference whatsoever between 3 and 6 weeks' bandaging after a 6 year follow-up. In the second trial, the patients who were bandaged for 3 weeks were significantly better (P < 0.001) than after only one week of bandaging at a maximum follow up of 4 years. Long term follow up of injection sclerotherapy for primary varicose veins suggests that 3 weeks is superior to 1 week bandaging, but that there is no additional advantage in continuing bandaging for six weeks.
Our Experience on Light Reflection Rheography (LRR): A New Non-Invasive Method for Lower Limbs Venous Examination
Authors: Nuzzaci Giuseppe , Mangoni Nicola , Tonarelli Argene Patrizia , Lucente Eleonora , Righi Daniele , Borgioli Franco , Lucarelli Franco
Published: January 2017

By means of a light reflection rheograph (LRR 100), the authors studied 353 lower limbs: 128 with primary varices, 41 with a post-phlebitic syndrome and 81 controls. The parameters that were selected were: VRT (venous refill time) and ΔLR (as expression of the venous emptying rate). In order to assess the accuracy of LRR measurements, simultaneous recordings of both LRR and venous pressure changes in 97 limbs (58 with primary varicose disease, 21 with post-phlebitic syndrome and 18 normals) were compared with each other. The correlation rate for VRT in the two methods revealed very high agreement, (r = 0.96). A fairly good correlation also occurred between changes in venous pressure and ΔLR (r = 0.74). The reproducibility rates ranged between ± 15.9% s.d. (VRT) and ± 7.7% s.d. (ΔLR), using 100 as the average value obtained from each subject.

The authors conclude that LRR appears to offer high specificity, sensitivity and reproducibility rates for non-invasive assessment of valvular incompetence. It appears also potentially reliable for the evaluation of calf musculo-venous pump efficiency.
The So-Called Primary Venous Aneurysms
Authors: Zamboni P. , Cossu A. , Carpanese L. , Simonetti G. , Massarelli G. , Liboni A.
Published: January 2017

The authors have observed numerous venous aneurysms among patients in Sardinia.

In the past 3 years 30 venous aneurysms have been diagnosed and treated. In seven cases the aneurysms were undoubtedly primary; owing to their position in the very low pressure system of the superior vena cava and because trauma, arteriovenous fistulas and cardiac or thoracic malformations were completely excluded.

After surgical excision the aneurysms were studied by histological and immunohistochemical methods. Antisera to desmin and to alfa-actin demonstrated significant depletion of smooth muscle cells in the wall of the aneurysm.
Topical Human Growth Hormone Treatment of Chronic Leg Ulcers
Authors: Rasmussen Lars H. , Karlsmark Tonny , Avnstorp Christian , Peters Kurt , Jørgensen Merethe , Jensen Lars T.
Published: January 2017

In a double-blind placebo-controlled trial, 37 patients with chronic leg ulceration were randomized to receive either topical human growth hormone, 1 IU cm −2 ulcer area, 5 d per week, or placebo, in addition to a standard treatment (compression, hydrocolloid dressing). The two groups were broadly similar in age, sex, initial ulcer area and underlying aetiological variables. During the study 18 patients were withdrawn (six in the growth hormone group and 12 in the placebo group; NS). Eight of them did not complete the 2 weeks of treatment necessary to establish a healing rate and were consequently not included in the analyses of healing. During a mean treatment period of 8 weeks, the healing rate was 16% per week (95% confidence interval 8.7 to 23% per week) in the growth hormone group and 3% per week (−3.4 to 8.4% per week) in the placebo group, ( P = 0.02). In 11 patients (61%) in the growth hormone group and two patients (18%) in the placebo group, the ulcer area decreased by 50% during the study ( P = 0.03). The treatment was neither accompanied by side-effects nor signs or symptoms indicating a significant absorption of growth hormone. Further studies are needed to address the dose-response relationship and optimal administration frequency of topical growth hormone in the treatment of chronic leg ulcers.
Changes in Skin Microcirculation at Periulcerous Sites in Patients with Chronic Venous Ulcers during Leg Elevation
Authors: Barnes M. D. , Mani R. , Barrett D. F. , White J. E.
Published: January 2017

Objective:

To investigate the effect of limb elevation on the microcirculation of the skin in patients with venous ulceration of the leg.

Design:

Prospective study in patients receiving in patient treatment for venous ulceration.

Setting:

Health Service teaching hospital.

Patients:

Thirteen patients with venous ulceration of the lower limb for more than two years were investigated.

Interventions:

Patients were admitted to hospital and treated by bedrest with elevation of the lower limbs by 10° above the horizontal.

Main outcome measures:

Laser Doppler fluximetry and transcutaneous oximetry of the skin surrounding the venous ulcers was undertaken.

Results:

The laser Doppler fluximetry in the periculcerous region increased by 10.8 A.U. (95% CI 17 to 4.54). However, the transcutaneous oxygen measurements did not change during the period of treatment.

Conclusions:

Admission to hospital with elevation of the limb for patients with venous ulceration results in ***microcirculatory changes which are probably attributable to reduction in lower limb oedema.
The Prevalence of Venous Disease in Primary Lymphoedema
Authors: Chaudhry H. L. , Mortimer P. S. , Evans J. E. , Dormandy J. A.
Published: January 2017

Objective:

To assess the prevalence of venous incompetence in primary lymphoedema.

Design:

Retrospective study.

Setting:

Outpatients attending St George's Hospital, London, UK.

Patients:

Forty-six patients (61 limbs) with primary lymphoedema extracted from a consecutive series of patients presenting with swollen legs. Only those with clinical and lymphoscintigraphic evidence of lymphoedema were included. Patients with any clinical evidence of venous disease were excluded.

Controls:

Seventeen subjects (33 limbs) with no history or clinical evidence of either lymphoedema or venous disease.

Methods:

Light reflective rheography (LRR) and quantitative isotopic lymphoscintigraphy.

Main outcome measures:

Venous refilling times (RT) with and without tourniquet control.

Statistical analysis:

Prevalence of venous incompetence in lymphoedema patients compared with normal controls and literature values.

Results:

In the patients, seven of 61 limbs (11.5%) had a venous RT of less than 25 s; eight limbs (13.1%) had a venous RT between 25 and 40 s. An above-knee tourniquet corrected the RT in all 15 limbs indicating superficial venous incompetence. In the controls, one of 33 limbs (3%) had a venous RT between 25 and 40 s. An above-knee tourniquet corrected the RT indicating superficial venous incompetence.

Conclusion:

Covert venous insufficiency may complicate primary lymphoedema. This has implications for both the pathophysiology of the oedema and its management.
Complexity of brain signals is associated with outcome in preterm infants
Authors: Sortica da Costa Cristine , Placek Michal M , Czosnyka Marek , Cabella Brenno , Kasprowicz Magdalena , Austin Topun , Smielewski Peter
Published: January 2017

A characteristic feature of complex healthy biological systems is the ability to react and adapt to minute changes in the environment. This ‘complexity’ manifests itself in highly irregular patterns of various physiological measurements. Here, we apply Multiscale Entropy (MSE) analysis to assess the complexity of systemic and cerebral near-infrared spectroscopy (NIRS) signals in a cohort of 61 critically ill preterm infants born at median (range) gestational age of 26 (23–31) weeks, before 24 h of life. We further correlate the complexity of these parameters with brain injury and mortality. Lower complexity index (CoI) of oxygenated haemoglobin (HbO2), deoxygenated haemoglobin (Hb) and tissue oxygenation index (TOI) were observed in those infants who developed intraventricular haemorrhage (IVH) compared to those who did not (P = 0.002, P = 0.010 and P = 0.038, respectively). Mean CoI of HbO2, Hb and total haemoglobin index (THI) were lower in those infants who died compared to those who survived (P = 0.012, P = 0.004 and P = 0.003, respectively). CoI-HbO2 was an independent predictor of IVH (P = 0.010). Decreased complexity of brain signals was associated with mortality and brain injury. Measurement of brain signal complexity in preterm infants is feasible and could represent a significant advance in the brain-oriented care.
Safety and efficiency of flow diverters for treating small intracranial aneurysms: A systematic review and meta-analysis
Authors: Yao Xiyang , Ma Junwei , Li Haiying , Shen Haitao , Lu Xiaojun , Chen Gang
Published: January 2017

Background

We evaluated the safety and efficiency of flow diverters (FDs) in treating small intracranial aneurysms (IAs).

Materials and Methods

We reviewed the literature published in PubMed and EMBASE. R for Project software was used to calculate the complete aneurysm occlusion rates, procedure-related neurologic mortality, procedure-related neurologic morbidity and procedure-related permanent morbidity.

Results

Ten observational studies were included in this analysis. The complete aneurysm occlusion rate was 84.23% (80.34%–87.76%), the procedure-related neurologic mortality was 0.87% (0.29%–1.74%), the procedure-related neurologic morbidity rate was 5.22% (3.62%–7.1%), the intracerebral haemorrhage rate was 1.42% (0.64%–2.49%), the ischemic rate was 2.35% (1.31%–3.68%), the subarachnoid haemorrhage rate was 0.03% (0%–0.32%) and the procedure-related permanent morbidity was 2.41% (0.81%–4.83%).

Conclusions

Treatment of small IAs with FDs may be correlated with high complete occlusion rates and low complication rates. Future long-term follow-up randomized trials will determine the optimal treatment for small IAs.
Relationship between hyperuricemia and risk of coronary heart disease in a middle-aged and elderly Chinese population
Authors: Yang Ye , Tian Jian , Zeng Chao , Wei Jie , Li Liang-Jun , Xie Xi , Yang Tuo , Li Hui , Lei Guang-Hua
Published: January 2017

Objective

To investigate the relationship between hyperuricemia and coronary heart disease (CHD) risk based on the Framingham risk score (FRS) in a middle-aged and elderly Chinese population.

Methods

This cross-sectional study enrolled patients undergoing routine check-ups at Xiangya Hospital between October 2013 and November 2014. Hyperuricemia was defined as uric acid ≥416 mmol/l for males and ≥360 mmol/l for females. A 10-year CHD risk was calculated from FRS. A multivariable logistic analysis model was used to evaluate associations.

Results

Of the 6347 patients, 3415 (53.8%) were male, 1543 (24.3%) had a CHD risk ≥10% (i.e. intermediate and high risk) and the prevalence of hyperuricemia was 18.1% ( n = 1148). After adjusting for potential confounding factors, the 10-year CHD risk was increased in patients with hyperuricemia compared with those without hyperuricemia by 0.28 times in the total population (odds ratio [OR] 1.28; 95% confidence interval [CI] 1.09, 1.48), by 0.25 times in the male population (OR 1.25; 95% CI 1.06, 1.47) and by 2.76 times in the female population (OR 3.76; 95% CI 2.08, 6.79).

Conclusion

Hyperuricemia was positively associated with a 10-year risk of CHD suggesting that it might be an independent CHD risk factor in middle-aged and elderly individuals.
Comparison of two preventive treatments for patients with recurrent miscarriages carrying a C677T methylenetetrahydrofolate reductase mutation: 5-year experience
Authors: Merviel Philippe , Cabry Rosalie , Lourdel Emmanuelle , Lanta Segolene , Amant Carole , Copin Henri , Benkhalifa Moncef
Published: January 2017

Objective

To investigate the effect of anticoagulant treatment on pregnancy outcomes in patients with previous recurrent miscarriages (RM) who carry a methylenetetrahydrofolate reductase ( MTHFR) gene mutation.

Methods

In this longitudinal retrospective study, patients with RM were treated during pregnancy with either: (i) 100 mg/day aspirin and 5 mg/day folic acid (group 1); or the same protocol plus 0.4 mg/day enoxaparin (group 2). An age-matched group of triparous women without RM or thrombophilia was used as the control group (group 3).

Results

This study enrolled 246 women with RM (123 per treatment group) and age-matched controls ( n = 117). The delivery rate was significantly lower in group 1 than group 2 (46.3% versus 79.7%, respectively). The miscarriage rate was significantly lower in group 2 compared with group 1 (20.3% versus 51.2%, respectively). In the control group 3, the delivery rate was 86.3% and the miscarriage rate was 12.8%.

Conclusion

Treatment with low-dose aspirin, enoxaparin and folic acid was the most effective therapy in women with RM who carried a C677T MTHFR mutation.
Medication literacy status of outpatients in ambulatory care settings in Changsha, China
Authors: Zheng Feng , Ding Siqing , Luo Aijing , Zhong Zhuqing , Duan Yinglong , Shen Zhiying
Published: January 2017

Objective

To assess medication literacy status and to examine risk factors of inadequate medication literacy of outpatients in ambulatory care settings.

Methods

Study participants were recruited randomly from outpatient departments in four tertiary hospitals (Xiangya Hospital of Central South University, Second Xiangya Hospital of Central South University, Third Xiangya Hospital of Central South University, People’s Hospital of Hunan Province) in Changsha, Hunan, China, between October 2014 and January 2015. Medication literacy was assessed using the Medication Literacy Scale, Chinese version. Demographic and clinical data were collected using structured interviews. Multiple logistic regression analysis was used to estimate the independent effects of demographic and clinical factors on medication literacy.

Results

Of 465 participants, 425 (91.4%) produced valid responses for analysis. The mean medication literacy score was 8.31 (standard deviation = 3.47). Medication literacy was adequate in 131 participants (30.8%), marginally adequate in 248 (58.4%), and inadequate in 46 (10.8%). The risk of inadequate medication literacy was greater for older and unmarried patients but lower for more educated patients.

Conclusion

Many Chinese outpatients in ambulatory care have inadequate medication literacy. Greater age, low education, and unmarried status are important risk factors of inadequate medication literacy.
Genotyping Leishmania promastigotes isolated from patients with cutaneous leishmaniasis in south-eastern Turkey
Authors: Ekşi Fahriye , Özgöztaşı Orhan , Karslıgil Tekin , Sağlam Mustafa
Published: January 2017

Objective

Cutaneous leishmaniasis (CL) is a significant disease in south-eastern Anatolia because it is prevalent among Syrian refugees. We identified the causative Leishmania species in CL patients using molecular methods.

Methods

Novy–MacNeal–Nicolle medium was inoculated with aspirated fluid from suspected CL lesions and tested for amastigotes with Giemsa staining. PCR amplified the internal transcribed spacer 1 (ITS1) of the Leishmania genome in cultures containing Leishmania promastigotes from 100 patients, which were genotyped with a restriction fragment length polymorphism (RFLP) analysis. A phylogenetic tree was constructed from ITS1 sequences of 95 culture fluid samples from these patients.

Results

Leishmania amastigotes were detected in 92% of cultures with growth. Leishmania promastigotes were typed as Leishmania tropica with both PCR–RFLP and sequencing.

Conclusions

Identification of L. tropica as the causative agent of CL in our region allows the clinical course to be predicted, and guides treatment decisions and preventive measures.
Association between Lp-PLA2 and coronary heart disease in Chinese patients
Authors: Yang Li , Liu Yin , Wang Shufeng , Liu Ting , Cong Hongliang
Published: January 2017

Objective

To evaluate the association between plasma lipoprotein-associated phospholipase A2 (Lp-PLA2; known to release inflammatory mediators that promote atherosclerosis) and coronary heart disease (CHD) in Chinese patients.

Methods

This observational, cross-sectional study included a patient cohort who were assessed by coronary angiography and divided into patients with coronary heart disease and patients with normal coronary angiography (controls). Data for several biochemical indicators were collected. Plasma Lp-PLA2 concentrations were measured by enzyme-linked immunosorbent assay. Univariate and multivariate logistic regression were used to analyse the association between Lp-PLA2 concentration and CHD.

Results

A total of 531 patients were included, comprising 391 with CHD and 140 with normal coronary angiography (controls). Plasma Lp-PLA2 concentration was significantly higher in patients with CHD versus controls (median, 251 µg/l versus 219 µg/l, respectively), and particularly among patients with acute myocardial infarction and stable angina pectoris (249 µg/l and 266 µg/l, respectively). Multivariate analysis showed that Lp-PLA2 ≥ 292 µg/l (upper quartile of the whole cohort) was independently associated with CHD (odds ratio 2.814, 95% confidence interval 1.519, 5.214).

Conclusion

Plasma Lp-PLA2 concentration was independently associated with CHD in Chinese patients.
Simultaneous Analysis of the Single and Multiple Dose Pharmacokinetics of the Non-Steroidal Anti-Inflammatory, Alclofenac
Authors: Sennello Lawrence T , Sonders Robert C , Jochimsen William G , Friedmann Nadav
Published: January 2017

Two clinical studies were conducted to study the pharmacokinetics of alclofenac in healthy adult male volunteers when the drug was administered in both single and multiple dosing regimens. The first study involved the participation of thirty-two subjects, each of whom received single 500 mg and 1000 mg oral doses of alclofenac, using a complete crossover experimental design. The second study involved the participation of sixteen subjects, eight of whom received a 500 mg dose, and eight of whom received a 1000 mg dose of alclofenac every eight hours for ninety-six consecutive hours (four days) with no crossover.

In the first study, plasma alclofenac levels were monitored for ten hours post-dosing, while in the second study, drug levels were monitored for four and one-half days (i.e. through twelve hours after the last dose).

Initially, using the programme NONLIN, single dose data were fit to a bi-exponential equation, with output from these fits serving as initial estimates for a second fit to the same equation. The results of these second fits were then used as initial estimates to fit the multiple dosing data to a multiple dosing one-compartment model with first order absorption and elimination. Finally, all sets of data were simultaneously fit to the one-compartment open model, with both single and multiple dosing, in an attempt to obtain a uniform interpretation, with a single set of parameters that would adequately describe the plasma alclofenac levels to be expected with a variety of dosing regimens.

It was found that the kinetics did not significantly change upon going from single to multiple dosing, and that with the exception of the apparent absorption rate constant, a single set of parameters adequately described all the data collected. The rate of absorption seemed to be somewhat dose-dependent at these levels, being slower after 1000 mg doses than after 500 mg doses. For this reason, the simultaneous fitting program was allowed to estimate different absorption rate constants for the 500 mg and 1000 mg doses. The results of these simultaneous analyses were:

Vol Distribution/Fraction Abs = 6.56 Litres Absorption Half-Life (500 mg) = 14 Minutes Absorption Half-Life (1000 mg) = 30 Minutes Elimination Half-Life = 2.1 Hours Absorption Lag Time = 14 Minutes
Irostrene (Ferric Sodium Edetate) Treatment of Anaemic Infants
Authors: Kahn Jarl , Larsen Stig
Published: January 2017

This study deals with haemoglobin (Hb) measurements of healthy 1-year-old children in one district in central Norway. The aim was to study the Hb levels, to treat any children having iron deficiency anaemia (Hb ⩽ 10.8 g/100 ml), and to evaluate the effect of sodium iron edetate after 4 weeks of treatment, with a follow-up after 1 year.

A total of 141 children were examined, of whom 40 had Hb ⩽ 10.8 g/ 100 ml (28.4%).

The study showed that the Hb levels in healthy 1-years-olds have a normal distribution.

Thirty-four children with Hb ⩽ 10.8 g/100 ml were treated for 4 weeks with sodium iron edetate (six drop-outs). The study showed a significant increase in Hb levels immediately after the treatment period as well as 4 weeks later.

Hb decreases significantly immediately after ceasing treatment and continues to do so during the control period of 1 year.

The Hb levels probably increase to a maximum 2 weeks after the treatment period.
Azatadine Maleate/Pseudoephedrine Sulfate Repetabs versus Placebo in the Treatment of Severe Seasonal Allergic Rhinitis
Authors: Tarasido Juan Carlos
Published: January 2017

The symptoms of seasonal allergic rhinitis can be alleviated by the use of an antihistamine and a decongestant. The efficacy and safety of the combination of azatadine maleate and pseudoephedrine sulfate were examined in this double-blind study comparing active drug to placebo. While 74% of the patients administered the combination drug showed marked improvement in the signs and symptoms of seasonal allergic rhinitis, only 29% of patients receiving placebo demonstrated improvement. Adverse reactions were mild and transient.
Bioavailability of a Combination Preparation of Trimethoprim and Folic Acid
Authors: Soininen Kari , Kleimola Terttu
Published: January 2017

The bioavailability of folic acid and trimethoprim was investigated from a combination preparation of folic acid (0·25 mg) and trimethoprim (100 mg) in ten healthy adult volunteers. Peroral administration of the preparation resulted in a mean peak plasma concentration of trimethoprim 1·09 mg/l (SEM 0·06). The AUC values for trimethoprim were 12·42 mg.h/l and 12·77 mg.h/l corresponding to combination preparation and plain trimethoprim, p >0·1. After administration 0·25 mg folic acid in the combination preparation, there was a significant rise in serum folic acid concentrations. The AUC from 0–8 hours was 199·8 nmol.h/l (SEM 8·1) and 166·3 nmol.h/l (SEM 14·2) corresponding to combination preparation and plain trimethoprim, p < 0·001. A loading dose of folic acid 10 mg was given intramuscularly 24 hours before drug intake.

This new type of formulation of trimethoprim and folic acid has been developed in order to prevent in long-term use the adverse haematological effects induced by trimethoprim alone.
Controlled Clinical Study with Fentiazac Suspension in Painful Inflammatory Diseases of Children
Authors: Catti A
Published: January 2017

In a parallel double-blind trial with fifty paediatric patients, the anti-inflammatory, anti-exudative and antipyretic effects of Fentiazac suspension were compared with Benzidamine drops in the treatment of painful inflammatory conditions. Both drugs proved to be effective in relieving the signs and symptoms considered, though Fentiazac was shown to be more rapid and active. Body temperature was lowered by both drugs. Patients treated with Fentiazac suspension had a normal temperature after 3 days of treatment whereas in the Benzidamine-treated group the same result was reached only after 4 days (p < 0·01). There was no subjective or objective evidence of local and/or systemic intolerance to either test drug.