bluuebunny/crossref_metadata_2025 huggingface dataset:
Formulation Design, Characterization and In-Vivo Assessment of Cefixime Loaded Binary Solid Lipid Nanoparticles to Enhance Oral Bioavailability
Authors: Kamran Mahwish , Khan Mir Azam , Shafique Muhammad , Alotaibi Ghallab , Mouslem Abdulaziz Al , Rehman Maqsood , Khan Muhammad Asghar , Abdullah  , Gul Sumaira
Published: July 2022

Cefixime; widely employed cephalosporin antibiotic is unfortunately coupled to poor water solubility with resultant low oral bioavailability issues. To solve this problem micro-emulsion technique was used to fabricate binary SLNs using blend of solid and liquid lipids, surfactant as
well as co-surfactant. The optimized nano suspension was characterized followed by modification to solidified dosage form. During characterization, optimized nano-suspension (CFX-4) produced particle size 189±2.1 nm with PDI 0.310±0.02 as well as −33.9±2 mV zeta
potential. Scanning electron microscopy (SEM) presented nearly identical and spherical shaped particles. Differential scanning calorimetry and X-ray powder diffraction analysis ascertained decrease in drug’s crystallinity. In-vitro release of drug pursued zero-order characteristics
and demonstrated non-fickian pattern of diffusion. The freeze dried nano suspension (CFX-4) was transformed to capsule dosage form to perform comparison based In-Vivo studies. In-Vivo evaluation corresponded to 2.20-fold and 2.11-fold enhancement in relative bioavailability of
CFX nano-formulation (CFX-4) as well as the prepared capsules respectively in contrast to the commercialized product (Cefiget®). In general; the obtained results substantiated superior oral bioavailability along with sustained pattern of drug release for CFX loaded binary nano particles.
Thus, binary SLNs could be employed as a resourceful drug carrier for oral CFX delivery.
Solid Lipid Nanoparticles Loaded with Nisin (SLN-Nisin) are More Effective Than Free Nisin as Antimicrobial, Antibiofilm, and Anticancer Agents
Authors: Radaic Allan , Malone Erin , Kamarajan Pachiyappan , Kapila Yvonne L.
Published: July 2022

Bacteriocins are peptides produced by bacteria to inhibit the growth of other prokaryotes. Nisin is a bacteriocin widely used in the food industry and for biomedical applications. However, bacteriocins have some limitations, as they experience mechanisms of resistance, degradation by
proteases, and suboptimal intracellular delivery. Combining bacteriocins with nanoscale drug delivery systems (nano-DDS) is an approach that can help overcome these limitations. Among the nano-DDS, solid lipid nanoparticles (SLN) have been described as promising candidates, because of their
potential for industrial scale-up and lower toxicity. The objective of this proof-of-concept study was to investigate the use of nisin-loaded SLN (SLN-Nisin) as an antimicrobial and anticancer therapeutic. We show that SLN-Nisin can significantly inhibit the growth of the oral pathogen, Treponema
denticola, disrupt oral biofilms, and decrease oral squamous cell carcinoma cell (OSCC) viability compared to free nisin. Further, analysis with scanning electron microscopy (SEM) revealed significant morphological changes in OSCC cells challenged with SLN-Nisin, compared to the empty-nanoparticle
or free nisin, indicating that SLN-Nisin likely decreases cell viability by increasing pore formation. This data reveals that nano-DDS are robust tools that can enhance bacteriocin properties.
Effect of Porous Zirconia Coating on Human Gingival Fibroblasts and Its Mechanism
Authors: Hu Jiangqi , Qie Yue , Luo Yu , Jiang Qingsong
Published: July 2022

Gingival fibroblasts play an important role in the constitution of soft tissue attachment. This study aims to investigate whether porous zirconia coating has a positive effect on promoting human gingival fibroblast attachment. The porous zirconia coating was loaded on zirconia surface
by the dip coating method, surface morphology and composition were confirmed by scanning electron microscope and energy dispersive spectrometer; Tested the tensile bond strength by universal testing machine; Tested the surface roughness by roughness analyzer; Human gingival fibroblast proliferation,
integrin β1 and F-actin immunofluorescence staining explored the influence of porous zirconia on the adhesion and proliferation of human gingival fibroblast. Zirconia0.2 group showed spherical zirconia particles with diameters of 3–8 μm are distributed on the surface;
The bonding strength of zirconia particle coating group reached 16.1±0.1 MPa, and the surface roughness was 0.715±0.091 μm; In comparison with control group (P < 0.01), the percentage of human gingival fibroblasts adhering to zirconia was markedly higher.
In zirconia group, integrin-β1 and F-actin fluoresced more obvious than in control group. Porous zirconia coating can form a porous structure on the surface and the porous structure can promote the attachment and proliferation of human gingival fibroblast, it will be more beneficial
for soft tissue early sealing.
Nano-Hydrogel for the Treatment of Depression and Epilepsy
Authors: Yang Libai
Published: July 2022

This article first combines nano-carrier technology, the electrophysiological mechanism of seizures, and brain targeting technology to prepare new nano-hydrogels. Secondly, through the discharge information generated during the seizure and the electric field responsiveness of the nano-hydrogel,
the free drug concentration in the brain area related to the seizure is increased, thereby, limiting the abnormal discharge of the focus to the local area and suppressing it in time. Finally, this article examines the impact of nano-hydrogel on the epilepsy and depression using relevant studies.
The experimental observations revealed that the yield of the nano-hydrogel synthesized after 24 h of sapon-free emulsion polymerization was 50 to 70%, the swelling rate was 400 to 1700%, and the viscosity of the 20 mg/mL nano-hydrogel dispersion was 3.9 to 17.0 mPa· s. Furthermore,
because the total efficiency was 0.952, the nano-hydrogels have a reduced recurrence rate and a better effect on the depression improvement.
Ferromagnetic Vortex Iron Oxide Nanorings Modified with Integrin β1 Antibody for Targeted MRI Tracking of Human Mesenchymal Stem Cells
Authors: Wang Yujie , Lv Yinjuan , Li Yuxuan , Bao Hongying , Yu Chenggong , Li Xiaodi , Xu Jiaqiang , Huang Jie , Zhang Zhijun
Published: July 2022

Mesenchymal stem cells (MSCs) have demonstrated great potential for tissue engineering and regenerative medicine applications. Noninvasive and real-term tracking of transplanted MSCs in vivo is crucial for studying the distribution and migration of MSCs, and their role in tissue
injury repair. This study reports on the use of ferrimagnetic vortex iron oxide (FVIO) nanorings modified with anti-human integrin β1 for specific recognition and magnetic resonance imaging (MRI) tracking of human MSCs (hMSCs). Integrin β1 is highly expressed at all
stem cell proliferation and differentiation stages. Therefore, the anti-integrin β1 antibody (Ab) introduced in FVIO targets integrin β1, thus enabling FVIO to target stem cells at any stage. This is unlike the traditional MRI-based monitoring of transplanted stem cells,
which usually requires pre-labeling the stem cells with tracers before injection. Because of the ability to recognize hMSCs, the Ab-modified FVIO nanotracers (FVIO-Ab) have the advantage of not requiring pre-labeling before stem cell transplantation. Furthermore, the FVIO-Ab nanotracers have
high T*2 contrast resulting from the unique magnetic properties of FVIO which can improve the MRI tracking efficiency of stem cells. This work may provide a new way for stem cell labeling and in vivo MRI tracking, thus reducing the risks associated with stem cell
transplantation and promoting clinical translation.
Macrophage Membrane-Derived Biomimetic Nanoparticles for Treatment of Cytokine Release Syndrome
Authors: Jiang Huirong , Tai Zongguang , Pan Huijun , Cui Zhen , Chai Rongrong , Zhu Congcong , Tian Jing , Bao Leilei , Zhu Quangang , Chen Zhongjian
Published: July 2022

Cytokine release syndrome (CRS) is a severe complication of infectious diseases like Coronavirus disease 2019 (COVID-19) that cause serious damage to public health. Currently, supportive therapy is still the main therapeutic strategy exists for CRS treatment. Here, we show the potential
of macrophage membrane-derived biomimetic nanoparticles for CRS treatment. By fusing macrophage membrane on the surface of the PLGA nano core, we constructed biomimetic nanoparticles that inherited the membrane receptors from the “parental” macrophages, enabling the neutralization
of CRS-related cytokines. We compared three types of macrophage membranes to screen out more effective biomimetic nanoparticles for CRS treatment. Our results show that M0 macrophage membrane-derived biomimetic nanoparticles could neutralize pro-inflammatory cytokines involved in CRS to the
greatest extent and reduce organ damage in a mouse model.
Synchronous Signal Transmission Method of Minimally Invasive Renal Failure Surgery Based on Nano Molecular Image Probe
Authors: Zheng Fu , Tian Dan , Chen Dan , Yao Nana , Chen Hongbo , Hu Xiaohui , Lan Yong , Chen Su
Published: July 2022

The synchronous signal transmission can promote the successful completion of minimally invasive renal failure surgery, so the synchronous signal transmission method of minimally invasive renal failure surgery based on nano molecular image probe is studied. The nanoprobe is constructed by loading different signal molecules, photosensitizers, acoustic sensitizers and thermosensitives through the method of double emulsion or film hydration; the near-infrared confocal endoscope molecular image diagnosis and treatment equipment is designed based on the nanoprobe, and the intraoperative highfrequency image is obtained through the diagnosis and treatment equipment; the high-frequency injection energy and signal synchronous transmission method is adopted, and the signal is added to the primary and secondary resonance circuit. In the coupling module, a higher frequency alternating signal is added into the resonant coupling voltage to modulate the signal into the transmission resonance system, which is transmitted from the energy transmission coupling coil to the secondary end, and the injected signal part of the coupling coil is demodulated at the other end to complete the transmission of the signal coupling transmission loop, so as to realize the high-frequency image energy and index data signal of minimally invasive renal failure surgery. The experimental results show that the designed nano molecular image probe has good stability, and the simulated signal transmission waveform is consistent with the transmission waveform of the principle analysis. Applying the proposed method to the minimally invasive surgery of renal failure, it is found that the success rate and image signal transmission efficiency of the minimally invasive surgery of patients 1–5 are higher than 99.5%, and the operation image transmission accuracy is high and the operation effect is excellent.
Does ERA5 Mark a New Era for Resolving the Tropical Cyclone Environment?
Authors: Slocum Christopher J. , Razin Muhammad Naufal , Knaff John A. , Stow Justin P.
Published: July 2022

The synoptic environment around tropical cyclones plays a significant role in vortex evolution. To capture the environment, the operational and research communities calculate diagnostic quantities. To aid with applications and research, the Tropical Cyclone Precipitation, Infrared, Microwave, and Environmental Dataset (TC PRIMED) combines disparate data sources. A key part of TC PRIMED is the environmental context. Often, environmental diagnostics come from multiple sources. However, TC PRIMED uses the European Centre for Medium-Range Weather Forecasts fifth-generation reanalysis (ERA5) product to provide a more complete representation of the storm environment from a single source. Reanalysis products usually poorly resolve tropical cyclones and their surrounding environment. To understand the uncertainty of large-scale diagnostics, ERA5 is compared to the Statistical Hurricane Intensity Prediction Scheme developmental dataset and the National Oceanic and Atmospheric Administration Gulfstream IV-SP dropwindsondes. This analysis highlights biases in the ERA5 environmental diagnostic quantities. Thermodynamic fields show the largest biases. The boundary layer exhibits a cold temperature bias that limits the amount of convective instability; also, the upper troposphere contains temperature biases and shows a high relative humidity bias. However, the upper-troposphere large-scale kinematic fields and derived metrics are low biased. In the lower troposphere, the temperature gradient and advection calculated from the thermal wind suggest that the low-level wind field is not representative of the observed distribution. These diagnostics comparisons provide uncertainty so that users of TC PRIMED can assess the implications for specific research and operational applications.
Relationship Between Systemic Inflammation Index and No-Reflow Phenomenon in Patients With ST-Segment Elevation Myocardial Infarction
Authors: Çelik Muhammet Cihat , Karayiğit Orhan , Ozkan Can , Dolu Abdullah Kadir , Kalçık Macit
Published: July 2022

This study aimed to evaluate the relationship between no-reflow phenomenon and systemic inflammation index (SII) and to compare the predictive capacity of SII together with the neutrophil–lymphocyte ratio (NLR), and the platelet–lymphocyte ratio (PLR) in patients with ST-elevation myocardial infarction (STEMI). A total of 785 patients were included. The thrombolysis in myocardial infarction (TIMI) flow degree has been used to describe the no-reflow phenomenon. The study population was divided into two groups regarding the presence of no-reflow phenomenon including 110 patients with no-reflow (TIMI frame count 0-2) and 675 patients without no-reflow (TIMI frame count 3). The NLR [6.6 (4.6-11.6) vs 3.2 (2.0-5.3); P < .001], PLR [175 (121.3-220) vs 102.6 (76.1-150.1); P < .001] and SII [1921(1225-2906) vs 738.5 (450.5-1293); P < .001] were significantly higher in the no-reflow group. High NLR (OR: 1.078, 95%CI: 1.027-1.397; P = .021), PLR (OR: 1.009, 95%CI: 1.003-1.021; P = .041) and SII (OR: 1.216, 95%CI: 1.106-1.942; P = .004) were found to be independently associated with no-reflow phenomenon. The comparison of the receiver-operating characteristic curves showed that area under the curve of SII was greater than that of NLR (.789 vs .766, P = .007) and PLR (.789 vs .759, P = .048). SII levels may predict no-reflow phenomenon better than NLR and PLR.
Rethinking Driving Against Medical Advice: The Situated Nature of Driving After Stroke
Authors: Vander Veen April , Laliberte Rudman Debbie
Published: July 2022

Background: As stroke can result in functional impairments that impact driving ability, many jurisdictions mandate a 30-day period of driving restriction post-stroke. However, between 26% and 38% of clients drive against medical advice during this period. Purpose: Informed by critical reflexivity of the literature and the first author's practice, this critical analysis paper (1) explicates and critiques how adherence to guidelines regarding driving after stroke in the first 30 days is conceptualized in individualistic, biomedically centred research and (2) argues for expanded understandings of driving based on a transactional occupational perspective. Key Issues: Individualistic, biomedical perspectives view driving against medical advice as an individually located phenomenon, generating partial understandings and individually focused solutions. Re-conceptualizing driving after stroke as a transactional occupational choice provides a productive basis for understanding and addressing driving within practice and research. Implications: Concepts from occupational science can generate new insights for research and client-centred practice regarding driving following stroke.
Recent Incarceration Among Individuals Infected With Hepatitis A Virus During Person-to-Person Community Outbreaks, United States, 2016-2020
Authors: Hagan Liesl M. , Montgomery Martha P. , Lauro Priscilla L. , Cima Michael , Stringer Ginger , Kupferman Nikki M. , Leapley Andrea , Gandhi Ami P. , Nims Dawn , Iberg Johnson Jenna , Bouton Lindsay , Burkholder Cole , Grilli Genny A. , Kittle Theresa , Hansen Katrina , Sievers Marla M. , Newman Alexandra P. , Albertson Justin P. , Taylor Brandi , Pietrowski Michael , Stous Sarah , Qiu-Shultz Zuwen , Jones Cassandra , Barbeau Bree , Nicolai Laura Ann , McCombs Katherine , Chan Mary , Cooley Laura , Gupta Neil , Nelson Noele
Published: July 2022

Objectives:

Although many people who are incarcerated have risk factors for hepatitis A virus (HAV) infection, the proportion of hepatitis A cases among people with a recent incarceration is unknown. We examined the relationship between recent incarceration and HAV infection during community-based, person-to-person outbreaks to inform public health recommendations.

Methods:

The Centers for Disease Control and Prevention surveyed health departments in 33 jurisdictions reporting person-to-person HAV outbreaks during 2016-2020 on the number of outbreak-associated cases, HAV-infected people recently incarcerated, and HAV-associated hospitalizations and deaths.

Results:

Twenty-five health departments reported 18 327 outbreak-associated hepatitis A cases during January 11, 2016–January 24, 2020. In total, 2093 (11.4%) HAV-infected people had been recently incarcerated. Of those with complete data, 1402 of 1462 (95.9%) had been held in a local jail, and 1513 of 1896 (79.8.%) disclosed hepatitis A risk factors. Eighteen jurisdictions reported incarceration timing relative to the exposure period. Of 9707 cases in these jurisdictions, 991 (10.2%) were among recently incarcerated people; 451 of 688 (65.6%) people with complete data had been incarcerated during all (n = 55) or part (n = 396) of their exposure period.

Conclusions:

Correctional facilities are important settings for reaching people with risk factors for HAV infection and can also be venues where transmission occurs. Providing HAV vaccination to incarcerated people, particularly people housed in jails, can be an effective component of community-wide outbreak response.
Preventing Suicidal Behavior Among American Indian and Alaska Native Adolescents and Young Adults
Authors: Mpofu Jonetta J. , Crosby Alex , Flynn Michael A. , LaFromboise Teresa , Iskander John , Hall Jeffrey E. , Penman-Aguilar Ana , Thorpe Phoebe
Published: July 2022

From 2009 to 2018, overall suicide rates in the United States increased by 20.3% and increased by 43.5% among non-Hispanic American Indian and Alaska Native (AI/AN) communities. Combining years 2009 through 2018, suicide rates per 100 000 population among non-Hispanic AI/AN adolescents and young adults aged 15 to 34 years were 2 to 4 times higher than those of adolescents and young adults of other races and ethnicities. An estimated 14% to 27% of non-Hispanic AI/AN adolescents attempted suicide during that time. The elevated rates of suicidal behavior among non-Hispanic AI/AN adolescents and young adults reflect inequities in the conditions that create health. In this topical review, we describe school-based educational efforts that are driven by local AI/AN communities, such as the American Indian Life Skills curriculum, that teach stress and coping skills and show promise in reducing suicidal ideation attempts and fatalities among AI/AN adolescents. Using a social-determinants-of-health lens, we review the availability and quality of employment as an important influencer of suicidal behavior, as well as the role of the workplace as an environment for suicide prevention in AI/AN communities. Working with tribal, state, local, and federal colleagues, the public health community can implement programs known to be effective and create additional comprehensive strategies to reduce inequities and ultimately reduce suicide rates.
Testing and Nonpharmaceutical Interventions for Prevention of SARS-CoV-2 in 20 US Overnight Camps in Summer 2021
Authors: Blaisdell Laura , Rising Josh , van Zyl André , Finn Julia , Vergales Jeff
Published: July 2022

Objectives:

Overnight camps are a setting where COVID-19 can easily spread without the diligent use of layered public health interventions. We evaluated 20 camps in the United States to examine COVID-19 transmission and mitigation strategies during summer 2021.

Methods:

For this descriptive cross-sectional study, we examined self-reported information from 20 camps in 6 predominantly northeastern states on geographic information, tests and testing cadences, vaccination rates, and number of COVID-19 cases during summer 2021. Because the camps had hired public health consultants to guide them on reducing COVID-19 introduction and spread, all camps implemented similar interventions, including encouraging behaviors that lower the risk of COVID-19 transmission prior to camp arrival, use of cohorts, testing before and after arrival, and strong encouragement of vaccination among eligible campers and staff members.

Results:

A total of 9474 attendees at the 20 camps came from geographically diverse regions. Camps generally tested before and at arrival, as well as once or twice after arrival. Rates of vaccination were high among staff members (84.6%) and campers (76.2%). Camps identified 27 COVID-19 cases, with 17 (63.0%) detected after arrival, 3 (7.4%) detected on arrival, and 8 (29.6%) detected prior to arrival.

Conclusions:

The spread of cases detected after arrival to overnight camps was limited by the use of 3 key interventions: (1) high vaccination rates, (2) a rigorous and responsive testing strategy, and (3) ongoing use of public health interventions. These findings have implications for successful operation of overnight camps, residential schools and colleges, and other similar settings.
The Deesis on Van Eyck's Ghent Altarpiece: Its Potential for a Liturgical Theology Today
Authors: Geldhof Joris
Published: July 2022

The core argument in this article is that it is meaningful and revealing to look at a world-famous medieval piece of art, in this case, the Ghent Altarpiece, to raise questions relevant for contemporary liturgical theology. The article starts with an evocation of where and how the Altarpiece is today exhibited for the public, and continues by elucidating the historical context for which it was created. This is followed by a brief interpretation of the Altarpiece's complex iconographic program showing how a focus on the Eucharist sheds light on the whole. The assertion is then made to argue that the central figure on the upper level of the opened polyptych is not God the Father, as is often held, but the Son of God. The major argument for this relies on the fact that the three central figures on the upper level together constitute a deesis, as often found in the Byzantine tradition of icons. Mary, the Mother of God, and Saint John the Baptist pray for humankind to Jesus Christ in his eschatological capacity of king, ruler, and judge. If and inasmuch as this is the case, this observation gives rise to intriguing questions for liturgical theologians, in particular questions related to the ways in which the connections between the earthly and the heavenly liturgy are to be understood.
Female with two perineal openings: Do not forget rectovaginal fistula
Authors: Kumar Parveen , Manchanda Vivek , Sengar Mamta , Gupta Natasha
Published: July 2022

Anorectal malformations (ARM) in females are identified by abnormal location of the anal opening. Management is guided by clinical examination to find the number of perineal openings. Two openings in the perineum of a female may be seen in cases of imperforate anus without fistula, vaginal agenesis with vestibular fistula or imperforate anus with recto-vaginal fistula (RVF). We present a case series of ARM with RVF and discuss their diagnosis and management.
Fundamental Considerations of the Design and Function of Intranasal Antrostomies
Authors: Lund Valerie J
Published: July 2022

The natural history of intranasal antrostomy is poorly understood despite the popularity of the procedure. Researches have been conducted to examine this and in particular to establish factors which might be responsible for closure. A complete appraisal of the anatomy of the inferior meatus has been undertaken to determine factors which limit the dimensions of an antrostomy. Retrospective and prospective studies have been performed on patients undergoing the operation to assess patency and size. The results of these studies demonstrate that initial size is important in determining long-term patency in adults, and if an antrostomy is open at one year it usually remains open in the long-term unless infection supervenes; in children, however, antrostomies appear to close more rapidly.
Transcutaneous Measurements of Oxygen Tension at Edges of Leg Ulcers: Preliminary Communication
Authors: Mani R , Gorman F W , White J E
Published: July 2022

Using skin-surface sensors, transcutaneous oxygen tension (Tc Po2) has been measured at the edges of ulcers and at control sites proximal to wounds on the same legs. Tc Po2 at 43°C at the edges of venous ulcers was found to be significantly different ( P < 0.003) from that of arterial and mixed arteriovenous ulcers ( P < 0.05) respectively. Tc Po2 on healed skin was higher than at any wound edge. At this temperature Tc Po2 was also found to be significantly different ( P < 0.001) on the intact skin of patients with venous disease when compared with measurements at identical sites on healthy controls. In the same group, these Tc Po2 values increased with dependency. By contrast, at 37°C Tc Po2 was no different between groups ( P < 0.10), nor did it alter with position. This protocol adopted for investigating ulcers enables a quantitative distinction to be made between ulcers of different aetiologies. The differences in Tc Po2 between different ulcers and healed skin support the fibrin cuff mechanism which has been suggested as the cause of venous ulceration.
Audit of Surgical and Pneumatic/Hydrostatic Treatment of Achalasia in a Defined Population
Authors: Mayberry J F , Smart H L , Atkinson M
Published: July 2022

A retrospective survey was made of all the patients resident in the Nottingham area who presented with achalasia between 1959 and 1983. Initial treatment consisted of pneumatic bag dilatation in 26, hydrostatic bag dilatation in one and surgical cardiomyotomy in 22. Those treated by dilatation were older (mean age 52 years) than those treated by cardiomyotomy (mean age 42 years). Seven patients died without receiving active treatment because of old age and infirmity and in 6 this occurred before the introduction of endoscopic dilatation to the area.

Initial treatment by cardiomyotomy was associated with a lower recurrence rate than treatment by bag dilatation but with a longer stay in hospital and a higher incidence of complications including empyema, chest infections and oesophageal stricture.
Orthopaedic Operations: Variation in Case-Mix over a 10-Year Period
Authors: Williams Keith
Published: July 2022

The variation in case-mix of patients admitted for routine (non-emergency) orthopaedic surgery at a Staffordshire orthopaedic hospital over a 10-year period was studied, with the aid of the BUPA Schedule of Surgical Procedures. Over this period there was a 2% decrease in the total number of operations performed. There was a marked reduction in the number of ‘minor’ operations performed, and a marked increase in the number of ‘major’ and more complex operations performed. The overall workload, as judged by estimated surgeons' fees, rose by 43%. This study offers clear support to the claim that the complexity of orthopaedic operations performed has significantly increased over a ten-year period.
Hearing Loss in Chronic Renal Failure-Hearing Threshold Changes following Haemodialysis
Authors: Gatland D , Tucker B , Chalstrey S , Keene M , Baker L
Published: July 2022

The prevalence of sensorineural hearing loss, measured by pure tone audiometry, was determined in 66 patients with chronic renal failure and threshold changes following haemodialysis were measured in 31 patients.

The incidence of hearing loss was 41% in the low, 15% in the middle and 53% in the high frequency ranges respectively. No correlations with weight changes, haematocrit, metabolic bone disease or ototoxic drug history were found.

Of 62 ears studied, 38% had a decrease in low frequency threshold after dialysis and 9% had an increase. Threshold in 22/31 ears with pre-existing low frequency loss altered after dialysis with little change in other frequencies and no correlation with weight changes.

In conclusion, we find a high incidence of low and high frequency hearing losses in chronic renal failure patients. Fluctuation in low frequencies with dialysis is common. Possible mechanisms include treatment induced changes in fluid and electrolyte composition of endolymph.
Conserving Blood in Preparation for Elective Surgery
Authors: Baraka A , Juma T , Asfar S K , Al-Sayer H
Published: July 2022

A prospective study was carried out for a period of 6 months (September 1987 to 28 February 1988) to evaluate the possible misuse of blood transfusion service in the department of surgery, Amiri Teaching Hospital, Kuwait. There was a monthly wastage of 45 ±13 units of blood. Five hundred and eleven units of blood were crossmatched but never transfused. The time taken by the blood bank technicians in crossmatching blood which was never used amounted to 54.4% of the normal working hours. An annual loss of about US$25000.00 was calculated to have occurred.
Frankincense and Myrrh as Remedies in Children
Authors: Michie C A , Cooper E
Published: July 2022

Two cases of therapy with frankincense and myrrh in children are presented. The long history of this unusual treatment is outlined, demonstrating that for several millenia such agents have been employed in a number of medical contexts, as well as in the perfume and incense industries. Myrrh has found recent pharmacological application in the reduction of cholesterol and triglycerides, as predicted by several traditional therapies.
Impact of an Extensive in Situ Component on the Presence of Residual Disease in Screen Detected Breast Cancer
Authors: Campbell I D , Theaker J M , Royle G T , Coddington R , Carpenter R , Herbert A , Moore I , Rubin C , Taylor I , Guyer P B
Published: July 2022

This study investigates the histopathological characteristics of a consecutive series of 100 screen detected breast cancers in relation to residual disease. Tumour type, size, grade, resection margins and extent of primary or associated in situ disease were all assessed by one pathologist. Thirty-seven women underwent further surgery (wider excision or mastectomy) and the resected specimen was examined for residual in situ or invasive cancer.

In total, 36 cancers had an extensive in situ component, of which 69% were predominantly intra-duct carcinoma of comedo type. Of the 37 women who underwent further resection, 21 (57%) women had residual cancer. Of those with initial disease at the resection margin, 16/25 (64%) had residual disease. Five of 12 (42%) with disease close to (within 2–3 mm) but not at the margin had residual disease. Of those with an extensive in situ component, 18/25 (72%) had residual disease, whereas only 2/12 (17%) women with none or some in situ disease had residual cancer.

In screen detected breast cancer, residual cancer was present in 72% of women with an extensive in situ component at initial surgery. These women comprise a group in whom conservation surgery may be inappropriate if completeness of excision is considered a prerequisite for breast conserving surgery.
Do Routine Clinic Visits Prevent De-Stabilization in Patients Awaiting Coronary Revascularization?
Authors: Lim R , Kreidieh I , Dymond D S
Published: July 2022

We examined retrospectively the usefulness of routine clinic visits in preventing adverse cardiac events in 115 patients awaiting coronary surgery or angioplasty. Mean waiting time from angiography to revascularization was 126 days. A total of 126 visits were made by 80 patients. No deaths occurred, but one patient, despite three visits, suffered myocardial infarction at 316 days post-angiography. Eight patients required admission for unstable angina, five having been on the waiting list for less than 5 weeks. The mean number of clinic visits, number of diseased vessels and proportion on triple anti-ischaemic therapy were similar in the patients suffering such events and those remaining stable. In conclusion, the inherent unpredictability of coronary disease greatly limits the role of interim clinic visits in the prevention of adverse cardiac events in patients awaiting revascularization.
Carbamazepine and Folic Acid in Trigeminal Neuralgia Patients
Authors: Al-Musaed A A , Zakrzewska J M , Bain B J
Published: July 2022

The effect of carbamazepine monotherapy on the red cell folate level of 133 patients with trigeminal neuralgia was evaluated. The patient group had a significantly lower mean value of red cell folate levels compared with 110 controls. No significant correlation was found between the red cell folate levels and the mean cell volume or haemoglobin values in either the carbamazepine or control group. In addition no significant correlation was found between the red cell folate levels and drug dosage. Administration of folic acid supplements raised the mean value of red cell folate significantly. Dietary folate intake was assessed in 43 trigeminal neuralgia patients and 33 matched control patients and there was no significant difference between the groups. Patients taking carbamazepine should be advised on a well-balanced diet rich in folate as opposed to being given a routine prescription of folic acid.
Is Undergraduate Otoscopy Teaching Adequate?-An Audit of Clinical Teaching
Authors: Fisher E W , Pfleiderer A G
Published: July 2022

Otoscopy is an important skill for the general practitioner, yet skill in the technique is rarely assessed formally at undergraduate level. This study aimed to assess the effect of teaching on the acquisition of otoscopic skill. Thirty-five medical students were assessed prospectively during their ENT attachments. Seventeen students were randomized to the standard course and 18 attended an additional seminar on otoscopy. Students' confidence was assessed for various aspects of otoscopy using a visual analogue scale, and clinical skill was assessed in examining four patients. Assessments took place at the beginning and end of the course.

Students gained in their confidence and skill for all parameters, although the clinical ability to distinguish normal from abnormal tympanic membranes changed little from baseline levels. Extra teaching produced better gains in confidence (P<0.05) and skill (P<0.01) in identifying specific features of the tympanic membrane and eliminated errors of the ‘false negative’ variety.

A minimal investment in teaching effort produces appreciable gains in students' otoscopic skills. This has implication for the planning of undergraduate ENT courses and vocational training for general practice.
Criteria for Selective Admission of Patients with Haematemesis
Authors: Harland R , Neilson D
Published: July 2022

A retrospective survey of 157 consecutive admissions for haematemesis was carried out in order to determine whether patients at low risk of adverse events could be identified at the time of admission from simple clinical features. In addition to known prognostic factors such as hypotension, tachycardia and anaemia, we studied the character of the vomit classified into altered or frank blood. Death, surgical intervention and transfusion of more than 2 units of blood were defined as ‘adverse events’. No adverse event occurred in 37 patients who vomited only altered blood and who did not have melaena, or in 42 patients with a concentration of haemoglobin of 12g/dl or more who vomited altered blood only. Classification by other prognostic criteria was not as sensitive. These results suggested that patients with haematemesis who have negligible risk of serious sequelae can be identified at an early stage in the course of their disease from simple features of clinical history and examination. Excessive use of resources should be avoided in such patients, and selective admission may be justified.
Fate of Research Studies
Authors: Easterbrook P J , Matthews D R
Published: July 2022

A retrospective survey was conducted of 720 research protocols, approved by the Central Oxford Research Ethics Committee between 1984 and 1987, to determine the fate of research studies from inception. Forty-five per cent were clinical trials, 23% were observational studies and 32% were laboratory-based experimental studies. Further informationwasobtained on 487 studies, of which 287 (59%) had been completed, 100 (21%) had never started, 58 (12%) had been abandoned or were in abeyance and 42 (9%) were still ongoing, as of May 1990. Forty-three per cent of the original 487 studies were subsequently published or presented. The most frequent reason for not starting a study was failure to obtain funding (40%). The main reason for abandoning a study was difficulty in recruiting study participants (28%). Departure of one of the investigators from the institution and a variety of logistical problems were also common reasons for either not starting or abandoning a study. A thorough review of the pragmatic as well as the scientific aspects of a planned research project is important to minimize the initiation of studies that are unlikely to succeed.
Rectal Polyposis as a Guide to Duodenal Polyposis in Familial Adenomatous Polyposis
Authors: Spigelman A D , Williams C B , Phillips R K S
Published: July 2022

Almost all patients with familial adenomatous polyposis (FAP) develop duodenal polyps, the severity of which is graded stage 1 (minor) to stage V (cancer). Regular endoscopy is recommended for all patients with FAP. To test whether the development of severe duodenal polyposis could be predicted in another way, rectal and duodenal polyp severity were compared in 91 patients with FAP. The fulguration ratio (number of rectal fulgurations divided by number of years since colectomy) supplied the rectal polyp severity index. Patients with stage V duodenal polyposis had significantly higher fulguration ratios (median 0.38) than did patients with stage 1 disease (median 0; P=0.009). However, the wide scatter of results means that rectal polyp severity cannot be used as a guide to duodenal polyp severity in individual patients. The coexistence of populations with severe duodenal and rectal polyposis suggests that environmental factors are important in phenotypic expression in FAP.
Doctors' Views on Anxiety Management in General Practice
Authors: Deans H G , Skinner P
Published: July 2022

Various guidelines have been issued to doctors concerning the treatment of anxiety in primary care and particularly on the use of benzodiazepines. Little has been reported about how this advice has influenced doctors' opinions and practice. This paper describes results of interviews with 15 general practitioners and 15 general practitioner trainees on their management of anxiety problems. Most respondents admitted prescribing benzodiazepines for anxiety but reported doing so only in cases of severe distress and for short periods of time. Trainees appeared more cautious in their use of benzodiazepines than the experienced practitioners. Most doctors agreed, that counselling could be as effective as benzodiazepines in treating moderate anxiety but several respondents felt it too demanding of their time. Two-thirds of doctors were in favour of employing counsellors in general practice though many foresaw practical difflculties in doing so. Increased availability of clinical psychology services was the development which most respondents felt would improve their management of anxiety problems in primary care.
Evaluation of the Alvarado Score in Acute Appendicitis
Authors: Owen T D , Williams H , Stiff G , Jenkinson L R , Rees B I
Published: July 2022

Use of the Alvarado scoring system was assessed prospectively in a consecutive. series of 215 patients with suspected appendicitis over a 12 month period at the University Hospital of Wales, Cardiff. In comparison the high negative appendicectomy rate during the year prior to the study was reduced considerably with the scoring system without increasing morbidity or mortality.
Laparoscopy in Tuberculous Peritonitis
Authors: Hossain J , Al-Aska A K , Mofleh I Al
Published: July 2022

Intra-abdominal tuberculosis remains a significant health hazard in the developing countries. In countries where sophisticated medical facilities are not easily available, laparoscopic examination of intra-abdominal organs is helpful. In this study, 22 patients were found to have peritoneal tuberculosis out of 82 laparoscopic examinations. The major clinical presentation in these patients were abdominal pain, weight loss, fever and ascites. Tuberculin test was not always positive. Direct visualization of the peritoneum and obtaining peritoneal biopsies provide the definitive tissue diagnosis to confirm the clinical diagnosis.
The Centre Thought to Control Sensory and Motor Activity in the Early History of Medicine
Authors: Quin C E
Published: July 2022

In Ancient Greek medicine the heart instead of the brain was sometimes thought to be the organ co-ordinating sensory and motor activity. The history of the origin of this erroneous idea is outlined. The relative importance of observations and theory in early medical investigations is discussed, and the anatomical dissections leading to the establishment of the brain as the centre of sensory and motor function are described.
‘I Thought it Would Go Away’: Patient Denial in Breast Cancer
Authors: Phelan M , Dobbs J , David A S
Published: July 2022

A significant proportion of patients with cancer present late to the doctor. The characteristics of these patients and the reasons behind their delaying behaviour is poorly understood. In this study a group of 30 women with breast cancer who delayed their presentation were compared with a randomly selected group with the same disease. The women who presented late did not appear to fit into any particular socio-demographic category, but examination of their histories revealed widespread denial of illness and a diversity of beliefs and behaviour.
An Audit of University Education in Trauma and Orthopaedic Surgery in Great Britain
Authors: O'Dowd J K , Spencer J D
Published: July 2022

An audit of undergraduate trauma and orthopaedic surgery teaching was carried out in 24 of the 27 medical schools in Great Britain and major differences were found between the medical schools. The range of time spent in teaching trauma and orthopaedic surgery for undergraduates varied from 3 weeks to 12 weeks and in five out of 27 medical schools trauma and orthopaedic surgery tuition was split between various years of the clinical curriculum. In some schools there were 30 students on a firm and in others only one. The opportunity for undergraduates to give feedback to their teachers, the use of objective assessment at the end of such an appointment by the teachers, varied between medical schools.

To avoid some of these very basic differences between our medical schools, the teaching of clinical subjects to undergraduates in medicine should be reviewed nationally and minimum standards set.
Cerebral Blood Flow and Mental Processes in Schizophrenia
Authors: Liddle P F , Friston K J , Frith C D , Frackowiak R S J
Published: July 2022

The patterns of cerebral blood flow associated with three syndromes of schizophrenic symptoms are compared with the loci of cerebral activation in normal subjects during the performance of mental processes implicated in the three syndromes. The psychomotor poverty syndrome, which has been shown to involve a diminished ability to generate words, is associated with decreased perfusion of the dorsolateral prefrontal cortex at a locus which is activated in normal subjects during the internal generation of words. The disorganization syndrome, which has been shown to involve impaired suppression of inappropriate responses (eg in the Stroop test), is associated with increased perfusion of the right anterior cingulate gyrus at a location activated in normal subjects performing the Stroop test. The reality distortion syndrome, which evidence suggests arises from disordered internal monitoring of activity, is associated with increased perfusion in the medial temporal lobe at a locus activated in normal subjects during the internal monitoring of eye movements.
Generic Prescribing of Antidepressants
Authors: Bruck P , Antao C A , Henry J A
Published: July 2022

Analysis of National Health Service prescription data for the antidepressants from 1980 to 1989 shows a consistent secular trend towards the increased use of generic names on prescriptions for this group of drugs. This apparently reflects national trends for all drugs, and was similar for most antidepressants. However, generic prescribing had by 1989 increased significantly more rapidly with fluvoxamine, which was introduced in 1987. The two drugs introduced in 1989, fluoxetine and amoxapine, also had a high generic prescribing rate in their year of introduction. Incrased generic prescribing may become a feature with further new drugs. However, the use of the generic name on the prescription has relatively little influence on what is dispensed to the patient. Pharmacists may dispense a brand name when given a generic prescription. Moreover, pressures on doctors to write generic names on prescriptions may have limited relevance for some drugs; generic alternatives were available for only four out of 22 antidepressants.
APACHE II Scoring System on a General Intensive Care Unit: Audit of Daily APACHE II Scores and 6-Month Survival of 691 Patients Admitted to a General Intensive Care Unit between May 1990 and December 1991
Authors: Campbell N N , Tooley M A , Willatts S M
Published: July 2022

In this paper we present a detailed analysis of the use of the APACHE II (acute physiological and chronic health evaluation) scoring system on all of the patients admitted to the general intensive care unit at the Bristol Royal Infirmary over a 20-month period. The 6-month survival of 691 adult medical and surgical patients following intensive care was recorded and this data was analysed with admission and daily APACHE II scores using a relational database. Our data confirms the relationship between admission APACHE II scores and outcome, with mean scores decreasing as duration of survival increases. We also demonstrate that the best day one scores are approximately 50% less than the admission score, irrespective of outcome, indicating the benefit of intensive care. By contrast, however, the scores on day one have either not improved or have worsened since admission, reflecting the importance of the pre-morbid health status of the patient in determining outcome from intensive care.
60 Years of Chemical Carcinogens: Sir Ernest Kennaway in Retirement
Authors: Waller R E
Published: July 2022

1992 marks the sixtieth anniversary of the publication of the first paper on the production of cancer by pure hydrocarbons, by the team at the Chester Beatty Research Institute headed by Professor Kennaway. Studies on polycyclic aromatic hydrocarbons and other chemical carcinogens continued to thrive under his leadership in succeeding years at the Chester Beatty and beyond, into his ‘retirement’ in 1946. He played a key role in stimulating research on factors contributing to the epidemic of lung cancer that became apparent by then, and with the support of the Medical Research Council (MRC) and other organizations he directed a small team working on analytical and epidemiological studies in a makeshift laboratory at St Bartholomew's Hospital. Published work included the identification and determination of benzo(a)pyrene in domestic soot, urban air pollution, motor vehicle exhausts and cigarette smoke, also arsenic in urban air and cigarette smoke, radon in indoor air and carbon deposits in human lungs. Such studies have been pursued in other laboratories around the world since then, and many of the lines of enquiry are traceable back to the pioneering work of the team at the Chester Beatty 60 years ago.