bluuebunny/crossref_metadata_2025 huggingface dataset:
Precautionary savings and rural‐to‐urban migration: Evidence from Chinese hukou status
Authors: Chen Guowen , DeLoach Stephen B. , Islam T. M. Tonmoy
Published: April 2023

Rural‐to‐urban migrants account for more than one‐third of the total population in China. However, because of China's hukou system, urban migrants can have limited access to different public services in urban areas. Consequently, this can affect their consumption and savings behaviour. However, little is known about how the hukou system changes migrants' allocation of savings across different savings instruments. In this study, we utilize the 2013 round of the Urban and Rural Residents Income Distribution and Living Conditions Survey of China to see if migrants' hukou status affects allocation between short‐term and long‐term assets. Propensity score matching is used to match migrants with migrants who have obtained urban hukou. When comparing the urban migrants having rural hukou with hukou holders who converted their hukou from rural to urban, we find that the migrants hold significantly higher proportions of savings in cash and other short‐term assets. Those who have obtained urban hukou, appear to hold a greater share of their portfolio in long‐term, higher returning assets. The differences in portfolio allocations appear to be larger for migrants with lower household income. We argue that these results are consistent with savings behaviour driven by a precautionary motive.
Long‐term variability in the fish assemblage around Japan over the last century and early warning signals of regime shifts
Authors: Tian Yongjun , Fu Caihong , Yatsu Akihiko , Watanabe Yoshiro , Liu Yang , Li Jianchao , Liu Dan , Pang Yumeng , Cheng Jiahua , Ho Ching‐Hsein , Ma Shuyang
Published: April 2023

The marine ecosystems around Japan are very productive and have typical wasp‐waist structure dominated by small pelagic fishes such as sardine, exhibiting large low‐frequency fluctuations in biomass. Whereas studies on the variability in abundance of individual species such as sardine and anchovy are popular, only a few studies focused on the long‐term variability of fish assemblage around Japan. In this study, 13 species/taxa ranging from small forage to large predatory species and from warm‐ to cold‐water species were selected to indicate essential characteristics of the fish assemblage and their drivers were analysed based on fishery, oceanographic and climatic data sets from 1901 to 2018. Results show that two outstanding peaks during the 1930s and 1980s were characterized by abundant sardine. Additionally, species composition showed high similarities during similar temperature regimes while exhibiting contrasts during different temperature regimes. Variations and regime shifts in dominant patterns and fish community indices coincided well with the Atlantic Multidecadal Oscillation (AMO) and regional sea surface temperature (SST). Furthermore, gradient forest analysis identified AMO and regional SSTs as most important predictors of dominant patterns and fish community indices, suggesting that the decadal and multidecadal variability in the fish assemblage around Japan was forced by basin‐scale climate variability as inherent in the AMO through its connections with regional SSTs. Autocorrelation coefficient demonstrated that the ecological indicators have the potential to be early warning signals of regime shifts, which suggests the possibility of coming cold regime since around 2015 and has important implications for fisheries management.
Contrasting global patterns and trait controls of major mineral elements in leaf
Authors: Xie Yajun , Li Feng , Xie Yonghong
Published: April 2023

Aim

Multiple mineral elements in leaf are the foundation of plant life and regulate many ecosystem functions. However, whether a common mechanism governs the variations of all leaf mineral elements is still unknown.

Location

Global.

Time period

1970–2020. 10.

Major taxa studied: Plants.

Methods

Here, we demonstrate the global‐scale biogeographic patterns of 12 major mineral elements (nitrogen, phosphorus, potassium, calcium, magnesium, sulphur, aluminium, iron, manganese, sodium, zinc and copper) by compiling a global data set including 2710 records of leaf mineral elements for 1073 species and of associated climate and soil indices.

Results

In general, like nitrogen and phosphorus, elements including potassium, calcium, magnesium, sodium and copper in leaf declined towards the equator, which supported both plant physiological hypothesis and soil substrate age hypotheses developed on the basis of nitrogen and phosphorus. By contrast, other elements responded to latitude in a contrary manner as nitrogen and phosphorus, in line with a competing mechanism, temperature–biogeochemistry hypothesis. Besides, plant functional types intrinsically differed in mineral concentrations, and to a certain extent, shifts of their composition in turn exacerbated the latitudinal patterns of respective elements as predicted by the species composition hypothesis.

Main conclusions

The fundamentally different dynamics and control mechanisms of patterns of some elements compared with those of nitrogen and phosphorus challenge the idea that common hypotheses can predict biogeographic patterns across all mineral elements; thus, current paradigms of element biogeochemical models and ecological plant nutrition require revision.
The first 5 years of Helicobacter pylori research—With an emphasis on the United Kingdom
Authors: McNulty Cliodna A. M.
Published: April 2023

In the 1970s, 1% of the UK population consulted with dyspepsia; fiberoptic gastroscopy allowed biopsy specimens under direct vision enabling systematic histopathology. Steer et al described clusters of flagellated bacteria closely apposed to the gastric epithelium associated with chronic active gastritis. The first UK series of Helicobacter pylori following Marshall's 1983 visit to Worcester confirmed the association of H. pylori with gastritis. UK researchers completed much early helicobacter research as there were many UK campylobacteriologists. Steer and Newell proved the Campylobacter‐like organisms grown on culture were the same as those seen in the gastric mucosa using antiserum raised by inoculating rabbits with H. pylori from cultures. Wyatt, Rathbone, and others showed a strong correlation between the number of organisms, type and severity of acute gastritis, immunological response, and bacterial adhesion similar to enteropathogenic E coli. Seroprevalence studies indicated H. pylori increased with age. Histopathologists also showed peptic duodenitis was in effect “gastritis in the duodenum” caused by H. pylori, unifying its role in the pathogenesis of both gastritis and duodenal ulceration. These bacteria were initially called Campylobacter pyloridis and then C. pylori. However, electron microscopy suggested that the bacteria were not campylobacters, and this was supported by differences in fatty acid and polyacrylamide electrophoresis profiles. In‐vitro tests indicated that H. pylori was susceptible to penicillins, erythromycin, and quinolones, but not trimethoprim or cefsulodin allowing development of selective media for culture. Monotherapy with erythromycin ethylsuccinate was ineffective, and patients treated with bismuth subsalicylate initially responded with clearance of H. pylori and the associated gastritis, but then many relapsed. Thus, pharmacokinetic and treatment studies were important to direct suitable dual and triple treatments. Work optimized serology, and the rapid biopsy urease and urea breath tests. The link between H.pylori and gastric cancer was established in large seroprevalence studies, and H. pylori test and treat for dyspepsia became routine.
The effects of dimethyl fumarate on cytoplasmic LPS‐induced noncanonical pyroptosis in periodontal ligament fibroblasts and dental pulp cells
Authors: Gu Fan , Wu Hailin , Huang Zhuo , Wang Fei , Yang Ruihuan , Bian Zhuan , He Miao
Published: April 2023

Aim

Pyroptosis is a type of inflammatory cell death and is related to pulpitis and apical periodontitis. In this study, the aim was to investigate how periodontal ligament fibroblasts (PDLFs) and dental pulp cells (DPCs) respond to pyroptotic stimuli and explore whether dimethyl fumarate (DMF) could block pyroptosis in PDLFs and DPCs.

Methodology

Three methods (stimulation with lipopolysaccharide [LPS] plus nigericin, poly(dA:dT) transfection and LPS transfection) were used to induce pyroptosis in PDLFs and DPCs, two types of fibroblasts related to pulpitis and apical periodontitis. THP‐1 cell was used as a positive control. Afterwards, PDLFs and DPCs were treated with or without DMF before inducing pyroptosis to examine the inhibitory effect of DMF. Pyroptotic cell death was measured by lactic dehydrogenase (LDH) release assays, cell viability assays, propidium iodide (PI) staining and flow cytometry. The expression levels of cleaved gasdermin D N‐terminal (GSDMD NT), caspase‐1 p20, caspase‐4 p31 and cleaved PARP were examined by immunoblotting. Immunofluorescence analysis was used to detect the cellular distribution of GSDMD NT.

Results

Periodontal ligament fibroblasts and DPCs were more sensitive to cytoplasmic LPS‐induced noncanonical pyroptosis than to canonical pyroptosis induced by stimulation with LPS priming plus nigericin or by poly(dA:dT) transfection. In addition, treatment with DMF attenuated cytoplasmic LPS‐induced pyroptotic cell death in PDLFs and DPCs. Mechanistically, it was shown that the expression and plasma membrane translocation of GSDMD NT were inhibited in DMF‐treated PDLFs and DPCs.

Conclusions

This study indicates that PDLFs and DPCs are more sensitive to cytoplasmic LPS‐induced noncanonical pyroptosis and that DMF treatment blocks pyroptosis in LPS‐transfected PDLFs and DPCs by targeting GSDMD, suggesting DMF might be a promising drug for the management of pulpitis and apical periodontitis.
Factors associated with poor outcomes in patients with severe acute respiratory infections in Bahrain
Authors: Mohamed Afaf Merza , Al Sayyad Adel , Matar Ebrahim , Isa Hasan M. , Hasan Wafa Fawzi , Hashim Nawra Sayed Jalal Yusuf , Alajaimi Bayan Abduljalil , Aldolabi Qatrmeer
Published: April 2023

Background

Severe acute respiratory tract infection (SARI) is a major global health threat. This study aimed to examine risk factors associated with poor outcomes in patients with SARI.

Methods

All patients who met World Health Organization's (WHO) SARI case definition and were admitted to Salmaniya Medical Complex from January 2018 to December 2021 were included. Epidemiological and virological data were obtained and analyzed.

Results

Of 1159 patients with SARI included, 731 (63.1%) patients were below 50 years, and 357 (30.8%) tested positive for viral pathogens. The most prevalent virus was Flu‐A (n = 134, 37.5%), SARS‐CoV2 (n = 118, 33%), RSV (n = 51, 14.3%), Flu B (n = 49,13.7%), other viruses (n = 3, 0.8%), and combined infection (n = 2, 0.6%). Six hundred fifty‐eight (56.8%) patients had comorbidities, mainly diabetes (n = 284, 43%) and heart disease (n = 217, 33%). 183 (16%) patients were admitted to ICU, 110 (9%) needed mechanical ventilation, and 80 (7%) patients died.

The odds of ICU admission were higher for patients with hematological (OR 5.9, 95% CI 3.1–11.1) and lung diseases (OR 2.7, 95% CI 1.6–4.6). The odds of mechanical ventilation were higher among patients with lung disease (OR 3.1, 95% 1.7–5.5). The mortality odds were higher among patients above 50 (OR 2.4, 95% CI 1.4–4.1) and chronic kidney disease (OR 2.5, 95% CI 1.1–5.2).

Conclusions

Being 50 years or above or having kidney, lung, or heart diseases was associated with worse SARI outcomes. Efforts and actions in developing better strategies to vaccinate individuals at high risk and early diagnosis and treatment should help in reducing the burden of SARI.
Combating fraudulent returns using blockchain technology
Authors: Liu Zhao , Cai Xiaoqiang , Niu Wenju , Zhang Lianmin
Published: April 2023

Fraudulent returns have become increasingly frequent in the development of online retail platforms, leading to huge losses for retailers. A blockchain‐based system can help eliminate this problem primarily because the data stored in a blockchain network cannot be modified. In this paper, we study the impact of blockchain technology that aims to eliminate fraudulent return behavior on retailers and their upstream suppliers. We develop a game‐theoretic model that comprises a supplier, a retailer, and customers and analyze the equilibrium outcomes. The results show that the retailer would (not) adopt blockchain technology if the efficiency of the supplier's investment in the innovation of its products is high (low). Moreover, if the retailer's loss from the return is low (high), the adoption of blockchain technology decreases (increases) the supplier's investment and the wholesale and retail prices. In terms of its effect on profitability, we reveal that if the fraudulent return losses are high, using blockchain technology always benefits the supplier; otherwise, it increases retailer profitability and supply chain performance but may make the supplier suffer losses in profits. Interestingly, the retailer would adopt blockchain technology to ensure profitability in situations where the number of customers without fraudulent returns and the intensity of losses are low; however, this weakens supplier profitability and meanwhile reduces supply chain performance.
A STUDY OF THE CONTENT OF GENERAL PRACTITIONERS' REFERRAL LETTERS TO AN ACCIDENT AND EMERGENCY DEPARTMENT
Authors: Morrison W G , Pennycook A G
Published: April 2023

A two‐week prospective study was undertaken to assess the quality and content of referral letters from the primary care services to an inner city accident and emergency department. It was found that the majority of letters fell short of commonly accepted minimum standards. A comparison was also made between letters from general practice principals and deputising service doctors. Recommendations for improvement in written communication are discussed.
FATAL PULMONARY FAT EMBOLISM DURING TOTAL HIP REPLACEMENT DUE TO HIGH‐PRESSURE CEMENTING TECHNIQUES IN AN OSTEOPOROTIC FEMUR
Authors: Marshall P D , Douglas D L , Henry L
Published: April 2023

High‐pressure cementing techniques, involving the use of a cement gun and cement restrictor, placed within the femoral medullary cavity, are commonly used to secure the femoral component of hip arthroplasties. Such techniques have been shown to be important in maintaining the integrity of the bone‐cement interface and also the integrity of the cement itself.1 This case report illustrates that such techniques are not without complications.
FLUVOXAMINE IN THE TREATMENT OF DEPRESSIVE ILLNESS. A SERIES OF DOUBLE‐BUND HOSPITAL BASED COMPARATIVE STUDIES CARRIED OUT IN THE UK
Authors: Whitehead A M , Ashford J J
Published: April 2023

A series of double‐blind hospital based studies comparing fluvoxamine with other antidepressants in depressed patients is reviewed. Overall there were no significant differences in terms of efficacy between fluvoxamine and the comparators (amitriptyline, dothiepin, lofepramine and mianserin). Fluvoxamine was shown to be associated with a low incidence of anticholinergic, cardiovascular or sedative effects. This profile of activity, together with low toxicity in overdosage, has established the place of fluvoxamine in the treatment of depressive illness.
COMPARATIVE EFFICACY AND TOLERABILITY OF CEPHRADINE AND CEFUROXIME AXETIL IN THE TREATMENT OF ACUTE DYSURIA AND/OR FREQUENCY IN GENERAL PRACTICE
Authors: Cooper J , Raeburn A , Brumfitt W , Hamilton‐Miller JMT
Published: April 2023

One hundred and thirteen patients with dysuria and/or frequency were treated randomly with either 500 mg cephradine 12‐hourly or 125 mg cefuroxime axetil 12‐hourly, for seven days. A total of 71 patients were found to have urinary infection: bacteriological cure rates were 97% one week post‐treatment, and 96% five weeks post‐treatment, for both antibiotics.

On direct questioning, adverse events were reported by eight patients out of 59 taking cephradine and by three of 54 who had received cefuroxime axetil. However, only three and one respectively stopped taking the antibiotic due to the adverse event. Analysis of diary cards, completed by 109 patients, showed a significantly higher incidence of increased frequency of bowel movements in those taking cefuroxime axetil. It is concluded that both antibiotics are of equal value in the treatment of simple acute urinary infections in general practice.
CORONARY INTERVENTION: WHERE ARE WE NOW?
Authors: Henderson R A
Published: April 2023

Coronary interventional techniques are used widely in the treatment of patients with coronary artery disease. With modern dilatation equipment the angiographic success rate of coronary balloon angioplasty may exceed 90%, but complications due to acute coronary occlusion may require emergency coronary artery bypass surgery (2 – 4%), or result in acute myocardial infarction (2 – 5%) or in‐hospital death (0 – 2%). In most patient groups the long‐term outcome of successful coronary angioplasty is good, but restenosis of a successfully dilated stenosis occurs in about 30% of cases, necessitating re‐intervention in a significant proportion of patients.

Other interventional methods of treating coronary artery stenosis, including directional and rotational coronary atherectomy, endoluminal stenting, and laser angioplasty, have been used in preliminary clinical studies. The acute results of these techniques are encouraging but the restenosis rate remains high and the long‐term results are uncertain. The results of randomised clinical trials comparing coronary interventional techniques with alternative treatment methods are awaited.
HYPOTHALAMO‐PITUITARY‐ADRENAL AXIS SUPPRESSION IN ASTHMATIC ADULTS TAKING HIGH DOSE BECLOMETHASONE DIPROPIONATE
Authors: Brown P H , Greening A P , Crompton G K
Published: April 2023

Inhaled corticosteroids control symptoms of chronic asthma in most patients. Use of drugs such as beclomethasone dipropionate (BDP) and budesonide is being encouraged as the importance of airways inflammation in asthma is increasingly appreciated. Beclomethasone dipropionate is used in doses of up to 2000 μg daily (equivalent to eight puffs of Beclorforte inhaler) and the Data Sheet warns that systemic absorption sufficient to cause suppression of the hypothalamo‐pituitary‐adrenal (HPA) axis may occur in some patients taking 2000 μg. HPA suppression to an extent which is clinically relevant has not been reported in asthmatic adults taking lower doses of BDP. We report six cases of HPA hypofunction occurring in patients on long‐term treatment with BDP, in a dose of 1500 μg daily. Patients taking BDP in a dose of 1500 μg daily might be at risk of adrenal crisis and should carry steroid cards unless HPA function has been assessed and found normal.
EXERCISE IN POST INFARCT REHABILITATION
Authors: Bethell H J N
Published: April 2023

In 1957, Hellerstein and Ford1 defined rehabilitation as ‘the process by which a patient is returned realistically to his greatest physical, mental, social, vocational and economic usefulness and, if employable, is provided an opportunity for gainful employment in a competitive industrial world’. They stressed the importance of starting the rehabilitation process ‘at the moment the patient is first stricken with his disease’, of mobilising the patient as soon as is practical and of paying close attention to the emotional as well as physical consequences of the attack. They believed that 80% of the aftercare of cardiac patients could be managed by the ‘private physician’ and only a minority required the attention of a specialist team.

The time scale used in 1957 (three to four weeks in hospital) was rather different to the one we use today, but otherwise most of what he suggested then has scarcely been improved upon since. In 1968 Hellerstein2 went on to describe the physical training programme he had devised to improve the fitness of ‘habitually lazy, hypokinetic, sloppy, endomesomorphic over‐weight males’ who were the usual victims of myocardial infarction. He wished to ‘add life to years and perhaps add years to life’. The conclusions from his original study were that ‘an active intervention programme of conditioning including exercise, weight reduction, diet therapy, and cessation of smoking is feasible, reasonably acceptable and appears to be of benefit in the treatment of coronary heart disease’.
CAN SELECTION OF MEDICAL STAFF BE IMPROVED?
Authors: Barber S G , Rodd J
Published: April 2023

Selection procedures for medical staff have been reviewed. Much can be learnt from industrial practices, including the adoption of ‘person specifications’, improved references, structured interviews and training for interviewers. Possible supplementation with personality assessments is discussed. The clinical (and financial) importance of appointing the best candidate increased with the seniority of the post.
PRIMARY HYPERPARATHYROIDISM AND RENAL CELL CARCINOMA IN AN ELDERLY PATIENT: A RARE ASSOCIATION
Authors: Safe A F , Cooper S
Published: April 2023

A case of an elderly female patient, presented with a rare association of primary hyperparathyroidism and renal cell carcinoma, is reported. As a common finding in the elderly, the patient had mild hypercalcaemia for many years but she developed several complications from untreated hyperparathyroidism. The mechanisms of malignant hypercalcaemia are discussed and the importance of properly investigating and managing symptomatic primary hyperparathyroidism in the elderly is emphasised.
IDIOPATHIC RETROPERITONEAL HAEMATOMA
Authors: Nair H T , Muscroft T J
Published: April 2023

A case of asymptomatic idiopathic retroperitoneal haematoma presenting as an abdominal tumour, is described. A review of English literature has not revealed any description of this condition.
PERIPHERAL ARTERIAL THROMBOSIS RELATED TO COMMERCIAL AIRLINE FLIGHTS: ANOTHER MANIFESTATION OF THE ECONOMY CLASS SYNDROME
Authors: Teenan R P , McKay A J
Published: April 2023

Venous thromboembolism is a well recognised complication of air travel, particularly on long haul flights.1,2 This has been attributed to relative immobility in cramped surroundings and to dehydration secondary to alcohol consumption and low cabin humidity.3,4

Under these conditions thrombosis at other sites would be expected, and indeed myocardial ischaemia is the commonest emergency in commercial flights. Peripheral arterial thrombosis, however, is not reported, even in comprehensive reviews of flying related medical emergencies.5 We report on three patients who developed acute lower limb ischaemia following long haul air flights.
USE OF THE HICKMAN CATHETER FOR CENTRAL VENOUS ACCESS IN PATIENTS WITH HAEMATOLOGICAL DISORDERS
Authors: Mullan F J , Hood J M , Barros D'Sa A A B
Published: April 2023

Hickman catheters were inserted for access in the management of 70 patients with haematological disorders. Twelve patients received a second and one patient a third catheter. The resultant 16,283 catheter‐day experience is reviewed. The complication rate was 0.28 per 100 catheter days. Sepsis in the form of catheter‐related septicaemia (CRS) and exit site infection was responsible for 72% of complications. Staphylococcus epidermidis was the commonest organism isolated from cases of CRS. Patients receiving broad spectrum antibiotics on the day of catheter insertion were significantly less prone to catheter failure due to CRS or exit site infection (P =0.008). The Hickman catheter is a useful and reliable method of maintaining central venous access, but prospective randomised trials are required to evaluate the role of prophylactic antibiotics in reducing the incidence of CRS.
PROPHYLACTIC DRAINAGE OF CHOLECYSTECTOMY: ANALYSIS OF CURRENT VIEWS
Authors: Borghol M
Published: April 2023

Despite extensive literature on the merits of prophylactic drainage of cholecystectomy this issue remains extremely controversial. According to tradition most surgeons feel safer placing a drain either routinely or selectively in the gallbladder fossa.1 On the other hand, some surgeons do not employ drainage at all and even advise against it. If the data in the literature is carefully and critically analysed, no superiority of a particular practice can be concluded with certainty; however, conclusions are often misleading as they usually reflect opinions rather than facts based on data. This article does not attempt to condemn drainage or non‐drainage, but rather draws attention to the fact that opinions in this respect have been largely based on equivocal data or invalid conclusions.
ILEAL HAEMANGIOPERICYTOMA AND VON RECKLINGHAUSEN'S DISEASE
Authors: Neilly P J D , Cooper G G , O'Hara M D , McGrady B J
Published: April 2023

Haemangiopericytoma is an uncommon tumour of vascular pericytes which usually arises in deep subcutaneous tissues or the retroperioneum.1 There are few reports in the English literature of haemangiopericytoma arising in the ileum.2 Von Recklinghausen's disease, a condition of autosomal dominant inheritance with a prevalence of 1 in 3000, is often associated with tumours of neural origin.3 Tumours of non‐neural origin also occur in Von Recklinghausen's disease but haemangiopericytoma has not been described. We report on a patient with Von Recklinghausen's disease presenting with massive haemorrhage from an ileal haemangiopericytoma.
GENITAL HERPES: AUDIT OF CASES REFERRED BY GENERAL PRACTITIONERS TO A DEPARTMENT OF GENITO‐URINARY MEDICINE
Authors: Scott G R
Published: April 2023

An audit was carried out of all cases of genital herpes referred by a general practitioner to a department of genito‐urinary medicine from 1987‐1990. Attention was paid as to whether or not the diagnosis had been made correctly and what drugs, if any, the patient had been prescribed. A total of 196 patients (78 men, 118 women) were eligible for study. GPs correctly diagnosed herpes in 32/78 (41%) of the men. Among the 46 who were not diagnosed, 12 were prescribed antibacterial drugs, three were prescribed antifungal cream, two were prescribed a combination of the above and three received miscellaneous non‐antiviral agents. GPs correctly diagnosed 56/118 (47%) of the women. Sixty‐two women were not diagnosed, of whom 17 were prescribed anti‐bacterial drugs, 21 were prescribed antifungal cream, seven were prescribed a combination of these and six received miscellaneous non‐antiviral agents. GPs appeared to have difficulty in diagnosing genital herpes in these patients, with the result of prescription of inappropriate and expensive medications.
INTRAHEPATIC BILOMAS – A POSSIBLE COMPLICATION OF CHOLECYSTECTOMY?
Authors: Dasgupta T K , Sharma V
Published: April 2023

Biloma(s) were initially defined as encapsulated extrahepatic collection(s) of bile.1 Subsequently the definition was expanded to include abnormal intrahepatic bile collection(s) located outside bile ducts.2 Most descriptions are of subhepatic or subphrenic collections (extrahepatic bilomas), following surgical procedures involving the biliary system or trauma. We report a case of intrahepatic collections of very large amounts of bile, apparently following cholecystectomy.
HOW SOUND ARE RECOMMENDATIONS FOR LOWERING CHOLESTEROL FOR THE PRIMARY PREVENTION OF CORONARY HEART DISEASE?
Authors: Oliver M F
Published: April 2023

INTRODUCTION

The almost unbridled enthusiasm of many ‘health professionals’ in western societies for lowering everyone's blood cholesterol may have arisen from an extraordinary NIH (National Institute of Health) consensus statement1 in 1985 that ‘Reduction of blood cholesterol levels will reduce the rate of coronary heart disease’ (the italics are from the report). It would have been better to use the word ‘might’ instead of ‘will’, to qualify what is meant by ‘the rate of coronary heart disease’ and to indicate situations where the facts do not actually support this view.

Subsequently, an expert panel2 on detection, evaluation and treatment of high blood cholesterol in adults (the US National Cholesterol Education Programme) stated that their report provided ‘new guidelines for the treatment of high blood cholesterol in adults 20 years of age and over’. However, these ‘guidelines’ and those of other societies3 have come to be regarded by some as inflexible rules with their full implementation being the best or only way to avoid coronary heart disease (CHD). This position is sometimes supported by simulation models of the likely reduction in CHD incidence which would be expected for a given reduction of blood cholesterol over 20 or 30 years – even though no such study has been made. The involvement of the pharmaceutical industry in cholesterol‐lowering is becoming more and more pervasive and reinforces these views. All of this seems to have led to the development of a unified strategy, which should and must not be questioned or doubted!

I propose within the limited space available to examine some of these issues and to suggest that for the primary prevention of CHD some current policies, particularly that of the US NCEP, extrapolate beyond the facts and oversimplify some controversial problems. The place of cholesterol‐lowering in the management of patients with established CHD is not the subject of this paper.
ACE INHIBITION IN THE 1990s
Authors: Maxwell S R J , Kendall M J
Published: April 2023

Angiotensin‐converting enzyme (ACE) inhibitors are now widely prescribed for the treatment of hypertension and heart failure. Their increasing popularity is based on impressive results from studies of efficacy in clinical situations and the realisation that they may have advantages over conventional treatment. This review will highlight some of the recent advances in our knowledge of the role of ACE inhibitors and will develop a rational approach to prescribing.
AN UNCOMMON BENIGN BREAST TUMOUR – HAMARTOMA
Authors: Thirumavalavan V S , Rufaie A L
Published: April 2023

Two patients who presented with mobile breast lumps which were later diagnosed to be hamartomas are presented, along with a brief review of current literature. These benign lesions are likely to be increasingly diagnosed because of routine mammographic screening and hence clinical awareness is paramount to prevent these lesions from being overtreated.

Hamartoma of the breast is a rare benign breast lesion which is unfamiliar to most clinicians. We herein report two examples of such a lesion and review the recent literature. The hamartoma presents as a soft well‐defined lump, causing considerable asymmetry of the breasts.
PARADOXICAL CEREBRAL EMBOLISM ORIGINATING FROM THROMBUS IN TUMOUR VEINS AS PRESENTING MANIFESTATION OF RETROPERITONEAL UPOSARCOMA
Authors: Garrett P J , Mulcahy K , Burden R J , Ng W C , Price P A
Published: April 2023

The coincidence of pulmonary and systemic emboli suggests paradoxical embolism. We present the case of a young man in whom a blood clot travelled from the veins in a retroperitoneal liposarcoma via a patent foramen ovalis to the systemic arterial circulation. Young patients with embolic disease but no obvious source of thrombus may have underlying neoplastic disease.

Venous thrombosis is a frequent complication of neoplastic disease. Arterial embolism associated with neoplasm is, however, not widely recognised.
GROWTH OF A VASCULAR MALFORMATION INTO A CROSS‐FINGER FLAP
Authors: Warwick D J , Milling M A P
Published: April 2023

We describe a vascular malformation which recurred by invading into the previously normal skin of a cross‐finger flap. We suggest a similarity between the progression of a vascular malformation and the neo‐vascularisation of a flap.
ISOLATED SUBGLOTTIC LYMPHOMA: AN INTERESTING CAUSE OF DYSPHONIA
Authors: Yardley M P J , Chui P
Published: April 2023

Isolated laryngeal lymphomas are exceedingly rare tumours: they tend to be greyish submucosal swellings and to respond well to radiotherapy. A case of subglottic lymphoma is presented, along with a review of previously reported cases of subglottic lymphomas.
VOLATILE SUBSTANCE ABUSE: A BRIEF REPORT
Authors: Langa A
Published: April 2023

Volatile substance abuse (VSA) is on the increase: the practice is widespread among young people and concern has often been expressed about its potential dangers. It is estimated that in the United Kingdom between 3.5–10% of current adolescents have at least experimented with solvents, and up to 1% of the secondary school population are currently abusers. Adequate assessment of each individual case is essential as this will lead to appropriate therapeutic interventions and rational management of associated problems.
THE OUTCOME OF SURGERY OF ANEURYSMAL SUBARACHNOID HAEMORRHAGE
Authors: Jamjoom A , Jamjoom Z A , Stranjalis G , Cummins B , Torrens M
Published: April 2023

Aneurysmal subarachnoid haemorrhage is a challenging pathology which remains a cause of considerable mortality and morbidity. To demonstrate to general practitioners the results of surgery for this condition a retrospective study of 160 consecutive cases who had undergone aneurysmal surgery was carried out. On admission 57% of cases had a good Hunt and Hess grade (grades I and II) and 43% a poor grade (grades III, IV and V). Twelve per cent of cases had a pre‐existing hypertension and 73% of cases were treated with nimodipine. Angiography was performed from 0 to 73 days (median 3 days) after the bleed. Early surgery (within the first three days after the bleed) was performed in 41% of cases. Twenty‐two per cent of cases rebled before surgery from 1 to 69 days after initial presentation (median seven days). Delayed cerebral ischaemia was diagnosed in 38% of cases, but only 15% of cases had evidence of low density on the CT scan.

The outcome was determined at six months using the ‘Glasgow outcome scale’. Fifty‐five per cent of cases made a good recovery (back to normality), 15% a fair recovery (moderately disabled but independent), 15% a poor recovery (severely disabled and dependent), and 15% died. The significant poor prognostic factors were: a poor pre‐operative Hunt and Hess grade, the presence of an intracerebral haematoma or angiographic spasm, evidence of rebleeding and early surgery without treatment with nimodipine. Other factors which did not reach a statistical significance include: age, presence of subarachnoid and intraventricular blood on CT, timing of surgery, history of long‐standing hypertension, intraoperative rupture, and the development of hydrocephalus or delayed ischaemia.
POTASSIUM CHANNEL ACTIVATORS IN THE MANAGEMENT OF ISCHAEMIC HEART DISEASE: A FOCUS ON NICORANDIL
Authors: Purcell H , Fox K
Published: April 2023

The treatment of angina pectoris continues to pose challenges. Novel new compounds are a rarity, but the potassium channel activators represent a new class of drugs with novel mechanisms of action. Nicorandil will be the first available potassium channel modulator for treatment of angina, and the following review assesses its clinical potential.
THE MANAGEMENT OF RECTAL BLEEDING
Authors: Jones R , Farthing M , Barnes J , Leicester R
Published: April 2023

Rectal bleeding is a common symptom in the general population;1 it may signal the presence of serious gastrointestinal disease but more frequently is caused by minor and self‐limiting local ano‐rectal conditions. Appropriate and accurate evaluation of rectal bleeding requires an investigative approach which balances an appreciation of the need to provide an adequate explanation for the bleeding against over‐investigation, excessive referral and wasted resources. As doctors of first contact, general practitioners (GPs) are frequently faced with difficult questions concerning the optimum management of rectal bleeding. This paper was prepared as a result of a series of interactive meetings with over 1,000 GPs from throughout the UK, which revealed wide variations in the possession and use of investigative equipment in the surgery, access to secondary care facilities, estimates of the prevalence and potential seriousness of rectal bleeding and the management strategies adopted in response to a series of case histories. We highlight a number of unresolved issues about the roles of GPs and hospital specialists in the management of rectal bleeding and the need for research directed at answering outstanding questions. In addition, a management strategy is proposed which might form the basis for a protocol for care, shared between general practice and the hospital.
GALLSTONE CIRRHOSIS: ARE WE ONLY SEEING THE TIP OF THE ICEBERG?
Authors: Lakshmi M Vijaya , Sridharan G V , Butterworth D
Published: April 2023

Gallstones are common and their incidence increases with age.1 Fifty per cent of these stones are in the common bile duct (CBD) in the elderly.2 Most of them are silent but with time there is an increasing chance of developing symptoms which are more likely to be serious in the elderly.3 Failure to relieve mechanical obstruction of bile flow may lead to secondary biliary cirrhosis.4 It has been estimated that on average secondary biliary cirrhosis develops some seven years after the onset of obstruction from a stricture, four and half years after gallstone obstruction and 10 months after the onset of malignant stricture.5 The characteristic features are the pathological findings of portal‐portal linkages, with a pattern of monolobular cirrhosis and the preservation of normal vascular relationships.6 Secondary biliary cirrhosis may lead to hepatic insufficiency and portal hypertension with the resultant complications, such as bleeding oesophageal varices, hypersplenism with pancytopenia, ascites and encephalopathy. We describe a patient in whom the diagnosis was not suspected until laparotomy and confirmed only at autopsy.
Lattice misorientation at domain boundaries in β‐Ga2O3 single‐crystal substrates observed via synchrotron radiation X‐ray diffraction imaging and X‐ray reticulography
Authors: Yao Yongzhao , Hirano Keiichi , Sasaki Kohei , Kuramata Akito , Sugawara Yoshihiro , Ishikawa Yukari
Published: April 2023

To evaluate the lattice misorientation at domain boundaries (DBs) in β‐Ga2O3, we performed X‐ray diffraction imaging (XRDI), X‐ray reticulography (XRR), and X‐ray topography (XRT) using a synchrotron radiation light source. Four reciprocal lattice vectors (g‐vectors) were applied, and the DBs showed different visibilities in the XRDI maps depending on the g‐vector. By analyzing possible characteristics of the misorientation, the XRDI results suggested that the DB being investigated was associated with a misorientation on the () plane and contained twist and tilt components. The apparent peak change in XRDI caused by the two components was calculated. We further succeeded in separating the tilt and twist components using XRR images in conjunction with simulation. Dislocation arrays at the DBs were observed using XRT, and the average distance between the dislocations in the array was consistent with the misorientation obtained using XRDI and XRR. The distribution of DBs across a wide area was acquired by a combination of XRR images recorded on a charge‐coupled device camera and X‐ray films. The fringe‐patterned XRR on X‐ray films provided a powerful and nondestructive tool to characterize DBs distributed across a large‐diameter wafer with an angular resolution on the order of several arc sec (low 10−5 rad).
First recorded occurrence of the parasitic barnacle (Anelasma squalicola) on a Greenland shark (Somniosus microcephalus) in the Canadian Arctic
Authors: Ste‐Marie Eric , Glenner Henrik , Rees David J. , Hussey Nigel E.
Published: April 2023

A solitary Anelasma squalicola specimen was collected from the cloaca of a Greenland shark (Somniosus microcephalus), the first time this association has been recorded. The specimen's identity was confirmed through morphological and genetic assessment (mitochondrial markers: COI and control region). A. squalicola is a species typically associated with deep‐sea lantern sharks (Etmopteridae) and, until the present observation, had never been observed at a sexually mature size in the absence of a mating partner. Given the reported negative effects of this parasite on its hosts, monitoring Greenland sharks for additional cases is recommended.
Successful treatment of submental fat using a non‐focused pulsed ultrasound
Authors: Somji Munir , Solomon Tino
Published: April 2023

Background

The prevalence of non‐invasive aesthetic treatments is increasing, with patients demanding easier, safer, and more effective non‐invasive cosmetic procedures. Submental fat is usually addressed using liposuction, which is associated with significant adverse events and a long recovery. Although newer, non‐invasive submental fat treatments are gaining popularity, they are often complex, require frequent injections, or have adverse side effects.

Aims

Assess the safety and efficacy of vacuum‐assisted acoustic wave technology for treating submental.

Patients/Methods

Fourteen female patients underwent a total of three weekly 15‐min treatments using ultrasound with a 40 mm bell‐shaped sonotrode. Improvement in submental fat was assessed 3 months after the final treatment using questionnaires for the patients and physicians. Two blinded dermatologists rated each patient using the Clinician‐Reported Submental Fat Rating Scale (CR‐SMFRS) 5‐point scale.

Results

Both physicians rated a significant improvement in all 14 patients. Furthermore, self‐evaluation of the 14 patients on a 1 to 5 satisfaction scale averaged 2.14, indicating that most patients were somewhat satisfied.

Conclusion

This study demonstrates that a three‐treatment course with an acoustic wave ultrasound applicator with 1‐week intervals leads to a significant reduction in submental fat and can be used as a novel, efficient treatment paradigm.
A technical approach for redefinition and volumization of lip area with hyaluronic acid: A case series
Authors: Ribé Natalia
Published: April 2023

Background and Aim

Non‐surgical procedures using injectable filler products for perioral rejuvenation have emerged and evolved rapidly to become one of the most frequently performed aesthetic treatments. We report a case series describing the administration of two hyaluronic acid‐based dermal fillers (HA filler) with excellent characteristics and formulation using a technique developed by the author.

Patient/Methods

We describe a series of nine female subjects who underwent perioral rejuvenation performed by a single physician in her private clinic. The HA filler (Alaxin® FL or Alaxin® LV) was injected into the lips using the specially developed Clodia technique. Patients were given post‐treatment advice for optimal results. Patient‐ and investigator‐perceived outcomes were rated using the Global Aesthetic Improvement Scale (GAIS) and adverse events (AEs) were collected.

Results

All subjects described the injection method as painless and well tolerated, as shown by the immediate post‐treatment photographs. Mean GAIS scores for both the patients and the investigator were 4.8/5, indicating significant improvement 12 months after the treatment. No AEs were reported during follow‐up. The HA filler showed a high degree of dermal integration in all subjects, and the investigator reported excellent handling and injection properties.

Conclusion

Perioral rejuvenation with an HA filler administered using the developed injection technique gave highly satisfactory results in all subjects and was not associated with AEs.
The clinical benefit of a multimodal topical approach to treating skin dyspigmentation
Authors: Draelos Zoe Diana , Diaz Isabel
Published: April 2023

Background

The recent removal of hydroquinone from the over‐the‐counter market has created a need for modern skin lightening formulations. An effective pigment lightening formulation must be non‐irritating to prevent skin darkening from post‐inflammatory hyperpigmentation, penetration enhanced to reach the epidermal/dermal junction, contain anti‐inflammatory ingredients, and address multiple mechanisms of pigment production.

Objective

The objective of this research was to demonstrate the efficacy of a topical multimodal pigment lightening preparation containing tranexamic acid, niacinamide, and licorice.

Methods

Fifty female subjects 18+ years of all Fitzpatrick skin types with mild to moderate facial dyspigmentation were enrolled. Subjects were provided with the study product for twice daily use on the entire face and an SPF50 sunscreen with evaluations occurring at Week 4, Week 8, Week 12, and Week 16.

The investigator used a face map to identify a pigmented target site on the face for dermaspectrophotometer (DSP) measurement. The dermatologist investigator completed a baseline facial efficacy and tolerability assessment. The subjects completed a tolerability assessment.

Results

48/50 subjects completed the study without tolerability issues. The DSP readings demonstrated a statistically significant reduction in target spot pigmentation at Week 16. The investigator assessed a 37% decrease in pigment intensity, a 31% decrease in pigment extent, a 30% decrease in pigment homogeneity, a 45% improvement in brightness, a 42% improvement in clarity, and a 32% improvement in overall facial skin dyspigmentation at Week 16.

Conclusion

The combination of penetration enhanced tranexamic acid, niacinamide, and licorice was effective in inducing facial pigment lightening.
Recognising dispositional leadership among medical learners
Authors: Torti Jacqueline M. I.
Published: April 2023

When we recognize those with the disposition to lead in addition to positional leaders, we create space to recognize the role of character in leadership.
Species distribution and antifungal susceptibility of clinical Aspergillus isolates: A multicentre study in Taiwan, 2016–2020
Authors: Wang Hsuan‐Chen , Hsieh Ming‐I , Choi Pui‐Ching , Wu Wan‐Lin , Wu Chi‐Jung ,   the TSARM Hospitals
Published: April 2023

Background

Epidemiological knowledge is important to guide antifungal therapy.

Objective

This multicentre study aimed to investigate the species distribution and antifungal susceptibility of Aspergillus isolates in Taiwan.

Method

Four hundred and ninety‐two clinical Aspergillus isolates, collected during 2016–2020, were identified by calmodulin sequencing and tested for antifungal susceptibility using CLSI M38‐A3. The Cyp51A sequences of azole‐resistant Aspergillus fumigatus and Aspergillus flavus isolates were analysed.

Results

This collection comprised 30 species from eight Aspergillus sections—Flavi (33.5%), Nigri (26.0%), Fumigati (24.2%), Terrei (10.0%), Nidulantes (5.1%), Circumdati (0.8%), Restricti (0.2%) and Aspergillus (0.2%). Sections Fumigati, Flavi and Terrei were primarily represented by A. fumigatus (99.2%), A. flavus (95.8%) and A. terreus (100%), respectively. Section Nigri comprised nine species, mostly A. welwitschiae (60.2%), A. niger (12.5%), A. brunneoviolaceus (10.9%) and A. tubingensis (10.2%). A. fumigatus (39.6%) and A. flavus (26.4%) predominated among 53 isolates from lower respiratory samples, whereas section Nigri species (46.2%) and A. terreus (29.2%) predominated among 65 isolates from ear samples. Reduced susceptibility to amphotericin B (minimal inhibitory concentration (MIC) > 1 μg/mL) was noted in A. flavus (7.0%), A. terreus (6.1%), A. nidulans and section Circumdati (A. flocculosus, A. subramanianii and A. westerdijkiae) isolates. Acquired azole resistance was observed in seven A. fumigatus (5.9%), all of which carried TR34/L98H or TR34/L98H/S297T/F495I mutation, and three A. flavus (1.9%), one of which carried G441S mutation. Reduced susceptibility to itraconazole (MIC >1 μg/mL) was noted in 55.5% of section Nigri isolates, mainly in A. welwitschiae, A. niger and A. tubingensis, whereas A. brunneoviolaceus, A. aculeatinus and A. japonicus were hypersusceptible to azoles. Anidulafungin was active against all isolates except for one isolate.

Conclusions

This study depicted the molecular epidemiology and species‐specific characteristics of Aspergillus in Taiwan, which aids in appropriate antifungal therapy and underlines the need of speciation and susceptibility testing of disease‐causing Aspergillus.