bluuebunny/crossref_metadata_2025 huggingface dataset:
International Donation and Transplantation Legislative and Policy Forum: Methods and Purpose
Authors: Weiss Matthew J. , Cantarovich Marcelo , Chaudhury Prosanto , Dieudé Mélanie , Hartell David P. , Martel Annie-Carole , Patriquin Chelsea , Shemie Sam D. , Simard Marie-Josée , Woolfsmith Jennifer , Delmonico Francis , Domínguez-Gil Beatriz
Published: April 2023

Background:

Organ and tissue donation and transplantation (OTDT) legislation and policies vary around the world, and this variability contributes to discrepancies in system performance. This article describes the purpose and methodology of an international forum that was organized to create consensus recommendations related to key legal and policy attributes of an ideal OTDT system. The intent is to create guidance for legislators, regulators, and other system stakeholders who aim to create or reform OTDT legislation and policy.

Methods:

This Forum was initiated by Transplant Québec and cohosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. Seven domains were identified by the scientific committee‚ and domain working groups identified specific topics for recommendations: Baseline Ethical Principles, Legal Foundations, Consent Model and Emerging Legal Issues, Donation System Architecture, Living Donation, Tissue Donation, and Research and Innovation Systems and Emerging Issues. Patient, family, and donor partners were integrated into every stage of the planning and execution of the Forum. Sixty-one participants from 13 countries contributed to recommendation generation. Topic identification and recommendation consensus was completed over a series of virtual meetings from March to September 2021. Consensus was achieved by applying the nominal group technique informed by literature reviews performed by participants. Recommendations were presented at a hybrid in-person and virtual forum in Montreal, Canada, in October 2021.

Output:

Ninety-four recommendations (9–33 per domain) and an ethical framework for evaluating new policies were developed during the Forum proceedings. The accompanying articles include the recommendations from each domain and justifications that link the consensus to existing literature and ethical or legal concepts.

Conclusions:

Although the recommendations could not account for the vast global diversity of populations, healthcare infrastructure, and resources available to OTDT systems, they were written to be as widely applicable as possible.
Evolutionary investigations of the biosynthetic diversity in the skin microbiome using lsaBGC
Authors: Salamzade Rauf , Cheong J.Z. Alex , Sandstrom Shelby , Swaney Mary Hannah , Stubbendieck Reed M. , Starr Nicole Lane , Currie Cameron R. , Singh Anne Marie , Kalan Lindsay R.
Published: April 2023

Bacterial secondary metabolites, synthesized by enzymes encoded in biosynthetic gene clusters (BGCs), can underlie microbiome homeostasis and serve as commercialized products, which have historically been mined from a select group of taxa. While evolutionary approaches have proven beneficial for prioritizing BGCs for experimental characterization efforts to uncover new natural products, dedicated bioinformatics tools designed for comparative and evolutionary analysis of BGCs within focal taxa are limited. We thus developedlineagespecificanalysis of BGCs (lsaBGC;https://github.com/Kalan-Lab/lsaBGC) to aid exploration of microdiversity and evolutionary trends across homologous groupings of BGCs, gene cluster families (GCFs), in any bacterial taxa of interest.lsaBGC enables rapid and direct identification of GCFs in genomes, calculates evolutionary statistics and conservation for BGC genes, and builds a framework to allow for base resolution mining of novel variants through metagenomic exploration. Through application of the suite to four genera commonly found in skin microbiomes, we uncover new insights into the evolution and diversity of their BGCs. We show that the BGC of the virulence-associated carotenoid staphyloxanthin inStaphylococcus aureusis ubiquitous across the genusStaphylococcus. While one GCF encoding the biosynthesis of staphyloxanthin showcases evidence for plasmid-mediated horizontal gene transfer (HGT) between species, another GCF appears to be transmitted vertically amongst a sub-clade of skin-associatedStaphylococcus. Further, the latter GCF, which is well conserved inS. aureus, has been lost in mostStaphylococcus epidermidis, which is the most commonStaphylococcusspecies on human skin and is also regarded as a commensal. We also identify thousands of novel single-nucleotide variants (SNVs) within BGCs from theCorynebacterium tuberculostearicumsp. complex, a narrow, multi-species clade that features the most prevalentCorynebacteriumin healthy skin microbiomes. Although novel SNVs were approximately 10 times as likely to correspond to synonymous changes when located in the top five percentile of conserved sites,lsaBGC identified SNVs that defied this trend and are predicted to underlie amino acid changes within functionally key enzymatic domains. Ultimately, beyond supporting evolutionary investigations of BGCs,lsaBGC also provides important functionalities to aid efforts for the discovery or directed modification of natural products.
Paradoxes of (un)veiling and the extended self: the experiences of Arab-Muslim women in Kuwait
Authors: Almutawaa Doha Saleh , Nuttall Peter , Mamali Elizabeth , Al-Mutawa Fajer Saleh , AlJuma Doha Husain Makki
Published: April 2023

Purpose

The purpose of this study is to develop understanding of the extended self-theory by focusing on the influence of other people in identity constructions as experienced in collectivist Eastern contexts. It specifically addresses the impact of being treated as an extended self on Arab-Muslim women’s identity constructions.

Design/methodology/approach

This study uses a qualitative research approach consisting of 23 in-depth semi-structured interviews. Nonprobability, purposive sampling is followed as the study targets Kuwaiti women who identify as former hijab/veil wearers. Sample diversity is attained in terms of Kuwaiti women’s demographical characteristics, including their age range, marital status and social class.

Findings

The findings of this study reveal paradoxes of experiencing the collective extended self through familial pressure to (un)veil and the strategies used by women to reject engaging with the collective extended self, including contextualizing, substituting and sexualizing the veil.

Originality/value

Existing studies related to the notion of the extended self are primarily conducted in Western contexts, and as such, are oriented toward personal accountability related to identity constructions. To complement this perspective and address the call for research on the extended self in collectivist societies, this study highlights the importance of recognizing the role of other people in influencing identity constructions in Eastern contexts.
The “war on cops,” retaliatory violence, and the murder of George Floyd*
Authors: Sierra‐Arévalo Michael , Nix Justin , Mourtgos Scott M.
Published: April 2023

The police murder of George Floyd sparked nationwide protests in the summer of 2020 and revived claims that public outcry over such high‐profile police killings perpetuated a violent “war on cops.” Using data collected by the Gun Violence Archive (GVA) on firearm assaults of U.S. police officers, we use Bayesian structural time series (BSTS) modeling to empirically assess if and how patterns of firearm assault on police officers in the United States were influenced by the police murder of George Floyd. Our analysis finds that the murder of George Floyd was associated with a 3‐week spike in firearm assaults on police, after which the trend in firearms assaults dropped to levels only slightly above that which were predicted by pre‐Floyd data. We discuss potential explanations for these findings and consider their relevance to the contemporary discussion of a “war on cops,” violence, and officer safety.
Association between the functional FCGR3AF158V and FCGR2AR131H polymorphisms and responsiveness to biologics in rheumatoid arthritis patients: A meta‐analysis
Authors: Lee Young Ho , Song Gwan Gyu
Published: April 2023

Objectives

This study aimed to investigate the association between functional Fc gamma receptor 3A (FCGR3A) V158F and FCGR2A R131H polymorphisms and biologic therapy in rheumatoid arthritis (RA) patients.

Methods

We searched Medline, Embase, and Cochran databases for available articles. This study is a meta‐analysis of the association between the FCGR3A V158F and FCGR2A R131H polymorphisms and their responsiveness to biologics in RA patients.

Results

Seventeen studies involving RA patients with FCGR3A V158F (n = 1884) and FCGR2A R131H (n = 1118) polymorphisms were considered. This meta‐analysis showed that the FCGR3A V allele was associated with responsiveness to rituximab (odds ratio [OR] = 1.431, 95% CI = 1.081–1.894, P = 0.012), but not with tumor necrosis factor (TNF) blockers, tocilizumab, or abatacept. A significant association was also found between the FCGR3A V158F polymorphism and responsiveness to biologics using the dominant‐recessive model. Additionally, the FCGR3A V158F polymorphism was associated with responsiveness to TNF blockers in the homozygous contrast model. Meta‐analysis revealed an association between the FCGR2A RR + RH genotype and responsiveness to biologics (OR = 1.385, 95% CI = 1.007–1.904, P = 0.045).

Conclusions

This meta‐analysis demonstrates that FCGR3A V allele carriers show better responsiveness to rituximab, and FCGR2A R allele carriers may show a better response to biologics in RA treatment. Genotyping of these polymorphisms could be a useful tool to find associations with the responsiveness of personalized medicine to biologics.
Disclosure policies in all‐pay auctions with bid caps and stochastic entry: The impact of risk aversion
Authors: Wang Xiangyu , Liu Shulin
Published: April 2023

We investigate how risk aversion affects the organizer's disclosing the actual number of bidders in an all‐pay auction with an exogenous bid cap and stochastic entry. With an exogenous probability of participation, the organizer prefers fully concealing the number of participating bidders when bidders are risk neutral. However, this result does not hold with risk aversion. Specifically, whether the organizer prefers fully concealing or fully revealing information depends on the number of potential bidders, the probability of participation, and the size of bid caps. A special case of endogenous entry shows that the organizer's preference is similar to the risk‐neutral case.
Current approach to health care transition and integration into adult care for pediatric liver transplant recipients: A call for partnership
Authors: King Lindsay Yount , Kosmach‐Park Beverly , Parish Alice , Niedzwiecki Donna , Jackson Whitney Erika , Vittorio Jennifer Mary
Published: April 2023

Despite the increased risk of non‐adherence, allograft rejection, and mortality following transfer from pediatric to adult care in liver transplantation (LT), there is no standardized approach to health care transition (HCT). Two electronic national surveys were developed and distributed to members of the Society for Pediatric Liver Transplantation and all adult LT programs in the United States to examine current HCT practices. Responses were received from 40 pediatric and 79 adult centers. Pediatric centers were more likely to focus on HCT noting the presence of a transition/transfer policy (60.2% vs. 39.2%), transition clinic (51.6% vs. 16.5%), and the routine use of transition readiness assessment tools (54.8% vs. 10.2%). Perceived barriers to HCT were similar among pediatric and adult respondents and included patient willingness to transfer and participate in care, failure to show for appointments, and lack of sufficient time and staffing. These results highlight the need for an increased awareness of HCT at both pediatric and adult LT centers. The path to improvement requires a partnership between pediatric and adult providers. Recognizing the importance of a comprehensive HCT program initiated in pediatrics and continued throughout young adulthood with ongoing support by the adult team is essential.
An evaluation of 1654 premolars transplanted in the posterior region—A retrospective analysis of survival, success and complications
Authors: Barendregt Dick , Andreasen Jens Ove , Leunisse Manfred , Eggink Edwin , Linssen Marcel , Van der Weijden Fridus , Louropoulou Anna
Published: April 2023

Aim

The aim of this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars in the posterior region subdivided by developmental stage and patient age.

Materials and Methods

This study included patients who underwent tooth transplantation between April 2004 and December 2021. A total of 1654 premolars were transplanted into 1243 patients. Tooth mobility, oral hygiene and periodontal parameters were clinically evaluated. Intraoral radiographs were used to evaluate pulpal and periodontal healing, and root formation. The cumulative survival rate was calculated using the Kaplan–Meier method.

Results

Data were subdivided into three groups based on the stage of root development and patient age. The mean age at surgery was 14.5 years. The main indication for transplantation was agenesis, followed by trauma and other indications, such as impacted or malformed teeth. A total of 11 premolars were lost during the study period. The overall survival and success rates in the immature premolar group after an observation period of 10 years were 99.7% and 99.4%, respectively. High survival and success rates (95.7% and 95.5%, respectively) were also observed when fully developed premolars were transplanted into the posterior region of adolescents. In adults, the success rate after 10‐year follow‐up is 83.3%.

Conclusions

Transplantation of premolars with developing and fully developed roots is a predictable treatment modality.
Climate‐driven spatial and temporal patterns in peatland pool biogeochemistry
Authors: Arsenault Julien , Talbot Julie , Brown Lee E. , Helbig Manuel , Holden Joseph , Hoyos‐Santillan Jorge , Jolin Émilie , Mackenzie Roy , Martinez‐Cruz Karla , Sepulveda‐Jauregui Armando , Lapierre Jean‐François
Published: April 2023

Peatland pools are freshwater bodies that are highly dynamic aquatic ecosystems because of their small size and their development in organic‐rich sediments. However, our ability to understand and predict their contribution to both local and global biogeochemical cycles under rapidly occurring environmental change is limited because the spatiotemporal drivers of their biogeochemical patterns and processes are poorly understood. We used (1) pool biogeochemical data from 20 peatlands in eastern Canada, the United Kingdom, and southern Patagonia and (2) multi‐year data from an undisturbed peatland of eastern Canada, to determine how climate and terrain features drive the production, delivering and processing of carbon (C), nitrogen (N), and phosphorus (P) in peatland pools. Across sites, climate (24%) and terrain (13%) explained distinct portions of the variation in pool biogeochemistry, with climate driving spatial differences in pool dissolved organic C (DOC) concentration and aromaticity. Within the multi‐year dataset, DOC, carbon dioxide (CO2), total N concentrations, and DOC aromaticity were highest in the shallowest pools and at the end of the growing seasons, and increased gradually from 2016 to 2021 in relation to a combination of increases in summer precipitation, mean air temperature for the previous fall, and number of extreme summer heat days. Given the contrasting effects of terrain and climate, broad‐scale terrain characteristics may offer a baseline for the prediction of small‐scale pool biogeochemistry, while broad‐scale climate gradients and relatively small year‐to‐year variations in local climate induce a noticeable response in pool biogeochemistry. These findings emphasize the reactivity of peatland pools to both local and global environmental change and highlight their potential to act as widely distributed climate sentinels within historically relatively stable peatland ecosystems.
Climate or diet? The importance of biotic interactions in determining species range size
Authors: Galiana Núria , Lurgi Miguel , Montoya José M. , Araújo Miguel B. , Galbraith Eric D.
Published: April 2023

Aim

Species geographical range sizes play a crucial role in determining species vulnerability to extinction. Although several mechanisms affect range sizes, the number of biotic interactions and species climatic tolerance are often thought to play discernible roles, defining two dimensions of the Hutchinsonian niche. Yet, the relative importance of the trophic and the climatic niche for determining species range sizes is largely unknown.

Location

Central and northern Europe.

Time period

Present.

Major taxa studied

Gall‐inducing sawflies and their parasitoids.

Methods

We use data documenting the spatial distributions and biotic interactions of 96 herbivore species, and their 125 parasitoids, across Europe and analyse the relationship between species range size and the climatic and trophic dimensions of the niche. We then compare the observed relationships with null expectations based on species occupancy to understand whether the relationships observed are an inevitable consequence of species range size or if they contain information about the importance of each dimension of the niche on species range size.

Results

We find that both niche dimensions are positively correlated with species range size, with larger ranges being associated with wider climatic tolerances and larger numbers of interactions. However, diet breadth appears to more strongly limit species range size. Species with larger ranges have more interactions locally and they are also able to interact with a larger diversity of species across sites (i.e. higher β‐diversity), resulting in a larger number of interactions at continental scales.

Main conclusions

We show for the first time how different aspects of species diet niches are related to their range size. Our study offers new insight into the importance of biotic interactions in determining species spatial distributions, which is critical for improving understanding and predictions of species vulnerability to extinction under the current rates of global environmental change.
Learning headache triggers through experience: A laboratory study
Authors: Turner Dana P. , Houle Timothy T.
Published: April 2023

Objective

To examine how individuals may learn headache trigger beliefs through sequential symbolic pairings of trigger candidates and headache attacks.

Background

Learning from experience may be a major source of information about headache triggers. Little is known about learning‐based influences on the establishment of trigger beliefs.

Methods

This cross‐sectional, observational study included N = 300 adults with headache who participated in a laboratory computer task. First, participants rated the chances (0%–100%) that encountering specific triggers would lead to experiencing a headache. Then, 30 sequential images with the presence or absence of a common headache trigger were presented alongside images representing the presence or absence of a headache attack. The primary outcome measure was the cumulative association strength rating (0 = no relationship to 10 = perfect relationship) between the trigger and headache using all previous trials.

Results

A total of N = 296 individuals completed 30 trials for each of three triggers, yielding 26,640 total trials for analysis. The median [25th, 75th] association strength ratings for each of the randomly presented headache triggers were 2.2 [0, 3] for the Color Green, 2.7 [0, 5] for Nuts, and 3.9 [0, 8] for Weather Changes. There was a strong association between the “true” cumulative association strength and corresponding ratings. A 1‐point increase on the phi scale (i.e., no relationship to perfect relationship) was associated with a 1.20 (95% CI: 0.81 to 1.49, p < 0.0001) point increase in association strength rating. A participant's prior belief about the potency of a trigger affected their perceived rating of the accumulating evidence, accounting for 17% of the total variation.

Conclusion

In this laboratory task, individuals appeared to learn trigger–headache associations through repeated exposures to accumulating symbolic evidence. Prior beliefs about the triggers appeared to influence ratings of the strength of relationships between triggers and headache attacks.
Defective N‐glycosylation in tumor‐infiltrating CD8+ T cells impairs IFN‐γ‐mediated effector function
Authors: Kim Soyeon , Min Hyungyu , Nah Jinwoo , Jeong Jinguk , Park Kyungsoo , Kim Wooseob , Lee Youngjin , Kim Jieun , An Jungeun , Seong Rho Hyun
Published: April 2023

T cell‐mediated antitumor immunity is modulated, in part, by N‐glycosylation. However, the interplay between N‐glycosylation and the loss of effector function in exhausted T cells has not yet been fully investigated. Here, we delineated the impact of N‐glycosylation on the exhaustion of tumor‐infiltrating lymphocytes in a murine colon adenocarcinoma model, focusing on the IFN‐γ‐mediated immune response. We found that exhausted CD8+ T cells downregulated the oligosaccharyltransferase complex, which is indispensable for N‐glycan transfer. Concordant N‐glycosylation deficiency in tumor‐infiltrating lymphocytes leads to loss of antitumor immunity. Complementing the oligosaccharyltransferase complex restored IFN‐γ production and alleviated CD8+ T cell exhaustion, resulting in reduced tumor growth. Thus, aberrant glycosylation induced in the tumor microenvironment incapacitates effector CD8+ T cells. Our findings provide insights into CD8+ T cell exhaustion by incorporating N‐glycosylation to understand the characteristic loss of IFN‐γ, opening new opportunities to amend the glycosylation status in cancer immunotherapies.
Insight into immune checkpoint inhibitor therapy for colorectal cancer from the perspective of circadian clocks
Authors: Liu Yanhong , Wang Zeqin , Hao Hankun , Wang Yaping , Hua Luchun
Published: April 2023

Colorectal cancer (CRC) is one of the most common malignant tumours and the third most common cause of cancer deaths worldwide, with high morbidity and mortality. Circadian clocks are widespread in humans and temporally regulate physiologic functions to maintain homeostasis. Recent studies showed that circadian components were strong regulators of the tumour immune microenvironment (TIME) and the immunogenicity of CRC cells. Therefore, insight into immunotherapy from the perspective of circadian clocks can be promising. Although immunotherapy, especially immune checkpoint inhibitor (ICI) treatment, has been a milestone in cancer treatment, greater accuracy is still needed for selecting patients who will respond positively to immunotherapy with minimal side effects. In addition, there were few reviews focusing on the role of the circadian components in the TIME and the immunogenicity of CRC cells. Therefore, this review highlights the crosstalk between the TIME in CRC and the immunogenicity of CRC cells based on the circadian clocks. With the goal to achieve the possibility that patients with CRC can benefit most from the ICI treatment, we provide potential evidence and a novel idea for building a predictive framework combined with circadian factors, searching for enhancers of ICIs targeting circadian components and clinically implementing the timing of ICI treatment for patients with CRC.
An unusual case of rectal perforation in a child
Authors: Ross W B
Published: April 2023

A case of perforation of a chronic rectal ulcer occurring nine months after appendicitis complicated by a pelvic abscess is reported. The aetiology is discussed and it is suggested that a retained faecolith may have caused the ulcer.
Influenza vaccination in a boarding school population
Authors: Hall M S , Bryett K A
Published: April 2023

Thirty four boys aged nine to 14 years were randomly allocated to receive two doses of either a split virion influenza vaccine (MFV‐Ject, Institut Merieux) or a subunit influenza vaccine (Fluvirin, Evans). No difference could be found between the two vaccines in either serological response or reactogenicity. The administration of a second dose did not offer any advantages over a single dose regime. The serological response, however, was slightly lower than in adults. The study confirmed that influenza vaccination is a straightforward procedure which is justified in at risk children.
Cholecystocutaneous fistula
Authors: Gibson T C , Howat J M T
Published: April 2023

A report of a case of spontaneous cholecystocutaneous fistula in a patient with undiagnosed gall stones. A review is made of the presentation and management of this uncommon condition.
Carcinoma of the bronchus in young adults
Authors: Seddon D J , Partridge M R
Published: April 2023

Thirty patients with bronchial carcinoma, aged 45 or less, were identified as having attended this or other local chest clinics.

In four cases the diagnosis was reached after four or more months of investigations. In two of these cases, pulmonary tuberculosis was incorrectly suspected to be responsible for the illness of the patient.

Compared with the disease as it affects all age groups, there appeared to be no greater incidence of any particular presenting symptom. In the group of patients studied, there was an excess of small cell carcinoma compared with that expected.
Arterial blood gas sampling using a modified standard plastic syringe
Authors: Campbell J H , Carter R , Milroy R , Campbell L A , Banham S W
Published: April 2023

A simple modification of the standard plastic syringe is described which converts it into a self‐filling system under arterial pressure. This overcomes one of the common errors in arterial blood gas sampling.
Pulmonary function and drug regimens in asthmatics
Authors: Connolly C K , Prescott R J
Published: April 2023

Overall function, persistent obstruction and control of potentially reversible wheeze were related to drug regimen in 624 patients attending review clinics. Pulmonary function before and after correction for the effects of age, duration of asthma and social factors was studied for each drug regimen. The performance of those on regular bronchidilators only, particularly non‐smokers, was disappointing, particularly with regard to control of potentially reversible wheeze. There was a group of patients who expressed dissatisfaction with their condition in whom no change in management was made despite objective evidence of poor control of potentially reversible wheeze. Subjective assessment of control bore little relationship to actual function in those patients on oral steroids. Nevertheless, throughout the clinics as a whole, subjects recorded pulmonary function which was on average 80 per cent of their potential.
Mequitazine in the treatment of hayfever
Authors: Beaumont G , Dobbins S , Latta D , McMillin W P
Published: April 2023

A single‐blind, multicentre, comparative clinical trial was performed in 59 hayfever sufferers to compare the efficacy of mequitazine 5 mg bd and terfenadine 60 mg bd over a period of 14 days.

Clinical assessments of nasal and ocular symptoms were made on admission to the trial and after seven and 14 days treatment by both physicians and patients. Critical flicker fusion threshold was measured at each assessment.

A global assessment of efficacy was determined by both the doctor and patient at the end of treatment. Patients also completed a daily diary card.

Thirty patients on mequitazine and 22 on terfenadine completed the trial. There were seven dropouts (five on terfenadine and two on mequitazine). Both treatments were equally effective in reducing the severity of symptoms over the 14 days of treatment. The overall assessment at the end of treatment showed no important significant differences between the two drugs. According to the physicians, 60 per cent of the mequitazine‐treated patients and 63 per cent of the terfenadine‐treated patients had an excellent or good response. Patients assessed their response as excellent or good in 56 and 62 per cent of cases respectively. Neither drug significantly impaired performance.
Breakthrough seizures with generic carbamazepine: a consequence of poorer bioavailability?
Authors: Hartley R , Aleksandrowicz J , Ng PC , McLain B , Bowmer C J , Forsythe WI
Published: April 2023

The bioavailability of carbamazepine from two products (Ethical Generics and Ciba‐Geigy) and their efficacy with regard to seizure control and incidence of side‐effects were compared in 23 children with tonic‐clonic or complex partial seizures. Mean plasma concentrations of carbamazepine, carbamazepine 10. 11‐epoxideand 10, 11‐dihydro‐10, 11‐trans‐dihydroxy‐carbamazepine at comparable sampling times were not significantly different during treatment with the two drug preparations. The incidence of seizures and occurrence of abnormal EEGs were not significantly different during treatment with the two carbamazepine preparations, and, in addition, the overall incidence of side‐effects was not significantly different during the two treatment periods. However, neurological side‐effects were significantly less during treatment with the Ciba‐Geigy product. On the basis of these observations we are confident that the efficacy of these two carbamazepine preparations in children at steady‐state is the same.
Nephrology and astrology – is there a link?
Authors: Hughes Stephen
Published: April 2023

Astrologers presume a link between the susceptibility of particular organs to disease and signs of the Zodiac.1 A simple test of the positive connection between renal disease and the sign of Libra was undertaken by studying the birth dates of consecutive nephrology in‐patient admissions. No significant link was found on analysis, thus disproving the traditional astrologers' claims.
Colonic lipoma presenting with recurrent rectal bleeding
Authors: Kochhar R , Malik A K , Nagi B , Mehta S K , Wig J D
Published: April 2023

A case of colonic lipoma in a patient who presented with rectal bleeding is presented. The final diagnosis was established at histology. Rarity of the symptomatic colonic lipomas is highlighted.
Wiskott‐Aldrich syndrome: fatal consequences of splenectomy in an unrecognised attenuated variant
Authors: Standen G R , Orchard J A , Hutton R D
Published: April 2023

Monozygotic twin males with an attenuated variant of the Wiskott‐Aldrich syndrome (WAS) are described. Diagnostic features included moderate thrombocytopenia with small platelet size and abnormal platelet aggregation responses, chronic eczema, depressed serum IgM and low isoagglutinin titre. Splenectomy was performed on one twin at age seven years who survived a complicating pneumococcal septicaemia ten days after the procedure, but who succumbed to fulminating infection three years later. The importance of recognising the attenuated variants of WAS is discussed.
Childhood extradural haematomas, not always obvious
Authors: Davies K G , Jamjoom A B , Burgess N A
Published: April 2023

Extradural haematomas in children are rare, but they may occur following a trivial head injury. We report a case where, following an unrecognised head injury to a three‐year‐old child, the insidious non‐specific presentation of the extradural haematoma led to delay in the diagnosis and treatment.
CLINICAL AUDIT OF THEOPHYLLINE USE IN GENERAL PRACTICE
Authors: Neville R G , McDevitt D G
Published: April 2023

SUMMARY The use of therapeutic drug monitoring for theophylline therapy was evaluated in two urban general practices. Of 55 patients studied, 44 (80%) had a sub‐therapeutic serum theophylline concentration, 11 (20%) had a therapeutic concentration (10‐20 μg/ml), and none had an above therapeutic concentration. Patients were reviewed at weekly intervals and had their theophylline dosages adjusted according to serum levels. A therapeutic concentration was achieved in 37 patients (67%). This task proved to be laborious but not difficult'.

Side‐effects were less common than previous reports suggest. The general practice workload involved in adjusting theophylline dosage was approximately four consultations, one dose change and two serum assays per ‘average’ patient.
WHY FLUSH PERIPHERAL INTRAVENOUS CANNULAE USED FOR INTERMITTENT INTRAVENOUS INJECTION?
Authors: Walsh D A , Toeg D , Mellor J A
Published: April 2023

SUMMARY We aimed to investigate whether regular flushing of peripheral intravenous cannulae used for intermittent injections with heparin‐saline, in a unit for acute medicine for the elderly, reduced the incidence of complications necessitating cannula removal. We wanted to see if this could also prolong the time that cannulae may remain functional in situ. In a prospective, open study, 50 consecutively inserted cannulae were flushed regularly and a subsequent 50 consecutive cannulae were not flushed.

The incidence of complications necessitating removal was not significantly different between the two groups (18% flushed, 22% unflushed). Overall, only 5% of cannulae were removed because of blockage. Heparin‐saline flushes did not significantly increase the time that cannulae remained in situ. Antibiotic use was found to be associated with an increased rate of complications necessitating cannula removal. We found no significant advantage in heparin‐saline flushing of peripheral intravenous cannulae used for intermittent administration of medications.
WHICH IMMUNOMODULATOR?
Authors: James D Geraint
Published: April 2023

Immunotherapy has come a long way since George Bernard Shaw lampooned the medical profession in his 1906 play The Doctor's Dilemma. One of the characters, fashionable physician Dr Ralph Bloomfield Bonington, was a devout disciple of immunotherapy at the beginning of this century:‘… Drugs can only repress symptoms; they cannot eradicate disease … There is at bottom only one genuinely scientific treatment for all diseases, and that is to stimulate the phagocytes … they devour the disease and the patient recovers — unless, of course, he's too far gone‘.

In this same play, Shaw also caricatured surgeons and perhaps even predicted thymectomy for cancer prevention, for the surgeon Cutler Walpole said:‘… Phagocytosis is pure rot, the knife is the real remedy … it amuses me to hear you physicians talking about clinical experience. What do you see at the bedside but the outside of the patient. What you need is daily familiarity with people's insides. The nuciform sac is full of decay … cut it out. The operation ought to be compulsory. It's ten times more important than vaccination‘.1
POTENTIAL FOR BED SORES DUE TO HIGH PRESSURES : INFLUENCE OF BODY SITES, BODY POSITION, AND MATTRESS DESIGN
Authors: Allen V , Ryan D W , Murray A
Published: April 2023

SUMMARY Pressures were measured on 10 subjects, supine and sitting, under six anatomical sites prone to bed sores on three different mattresses. Studied were the Clinifloat and Therarest specialist replacement mattresses, and a standard hospital mattress. Mean supine pressures were less than 5 kPa under four sites. Average supine buttock pressure was 2.93 kPa. Occiput and heel pressures were much higher than under other sites, being on average 2.6 and 4.5 times greater respectively than the mean buttock pressure. On sitting up, buttock pressure increased by a factor of 1.7 on average, to a level higher than the accepted capillary closing pressure. Measurements were consistent with mattress design, specific features of which can significantly affect pressure under certain sites.
TO RUN OR NOT TO RUN? THAT IS THE QUESTION: EXERCISE AND REDUCED RISK OF CORONARY HEART DISEASE
Authors: Head A
Published: April 2023

SUMMARYThe recent National Fitness Survey1has drawn attention to the population's low level of physical (aerobic) fitness and low level of activity. About one‐third of middle‐aged men and one‐half of middle‐aged women in England are unfit for continuous walking at a normal pace of about 3 mph. Similar fitness levels were shown for the Welsh population.2At the same time, coronary heart disease (CHD) accounts for about 26% of deaths in England, and for 2.5% of the NHS expenditure.3The suggestion that low fitness levels and low levels of physical activity are associated with a high incidence of CHD has been widely voiced since Morris's first study, and has more recently been the subject of editorials in theBritish Heart Journal5and theBMJ6
CERVICAL RADICULOPATHY: PANCOAST TUMOUR?
Authors: Owen T D , Ameen A
Published: April 2023

SUMMARY An unusual case of Pancoast tumour is described.
WHO NEEDS A NURSING HOME? A SIMPLE AND EFFECTIVE SCREENING TEST
Authors: Miskelly FG , Subuani JM
Published: April 2023

SUMMARY The aim of this study was to determine whether the Barthel Index (BI) or Folstein's Mini‐Mental State Examination (MMSE) could distinguish between patients who might continue at home with domiciliary care and those requiring institutional long‐term care. The results of the BI and the MMSE were compared with decisions made by an expert multidisciplinary team, including geriatricians. A Barthel score of 15 or less had a sensitivity of 90%, a specificity of 83% and a predictive value of 84% for determining those patients requiring nursing home placement. The BI proved to be a simple, accurate and reliable indicator of patients requiring nursing home care. The MMSE was of no predictive value in distinguishing the patients' discharge destinations.
OBJECTIVE VERIFICATION OF TETANUS IMMUNE STATUS IN AN APPARENTLY NON‐IMMUNE POPULATION
Authors: Murphy NM , Olney DB , Brakenbury PH
Published: April 2023

SUMMARY Patients who are not known to be immunised to tetanus are considered to be non‐immune. The appropriate treatment is the commencement of active immunisation with a course of three tetanus toxoid inoculations; if the wound is considered to be tetanus‐prone, 250 IU of human anti‐tetanus immunoglobulin is given concurrently. This study determined the true immune status of 166 patients who were considered to be non‐immune on the basis of the available history. The majority (90 of 166) had protective levels of immunoglobulin (greater than 0.06 IU/ml) and further treatment was not indicated. Only two patients were non‐immune. The remainder had protective levels (between 0.01 and 0.06 IU/ml) and required a tetanus toxoid booster.
THE FRAGILE X SYNDROME
Authors: Patel BD
Published: April 2023

SUMMARYThe contributions of fragile X syndrome to mental retardation have been underestimated. It is the most common form of familial mental retardation and one of the most common genetic diseases. Its long‐term burden upon families and services is considerable.
PAPILLARY CARCINOMA IN A THYROGLOSSAL CYST
Authors: Dekker PJ
Published: April 2023

SUMMARY A thyroglossal duct cyst is a congenital anomaly that arises from remnants of the thyroglossal duct, which in the embryo connects the thyroid gland with the floor of the pharynx. Primary carcinomas of thyroglossal duct tissue are rare, and are usually diagnosed after surgery. Management of such tumours is not clearcut. A case of a papillary carcinoma of thyroglossal duct tissue is presented that has been followed up for 10 years following Sistrunk's operation, and the management of these uncommon tumours is discussed.
LIGAMENTUM FLAVUM AND APOPHYSEAL CYSTS AS AN UNUSUAL CAUSE OF ROOT COMPRESSION
Authors: McBride DJ
Published: April 2023

SUMMARY Patients with symptoms and signs of radicular compression often present to neurosurgeons and orthopaedic surgeons. In an elderly population metastatic disease is often the cause, but degenerative disc disease also occurs. This case shows an alternative benign condition that may be overlooked, and the clinical implications are discussed.
PSYCHOLOGICAL EFFECTS OF AN EPIDEMIOLOGICAL STUDY OF BENIGN PROSTATIC HYPERTROPHY
Authors: McIntosh IB , Power KG , Simpson RJ
Published: April 2023

SUMMARY The psychological impact of an epidemiological study of benign prostatic hypertrophy (BPH) was assessed in a representative sample of practice list patients. Of the 889 men completing a general health self‐report questionnaire previously validated in a screening programme, 75% knew nothing of problems of the prostate, and 84.5% were not at all worried about prostate problems prior to commencement of the study. Receiving the letter of invitation and the procedures neither increased nor reduced anxiety levels for 69% and 70% respectively. In the 227 men referred to hospital for further investigation the procedure increased anxiety in 28%, decreased anxiety in 20%, and had no effect on the remainder. The sample of 137 (16%) men who, prior to interview, were in some way worried about problems of the prostate had significantly more urinary tract symptoms than those who were not at all worried about prostatic problems. Despite being worried about prostatic problems and having significant urinary symptoms, this group was no more likely to have attended a GP for investigation and/or treatment. Results are discussed in relation to the possible psychological effects of general health screening and the reluctance of men to attend for consultation despite awareness and concern regarding urinary symptomatology.
GLUCOCORTICOID‐UNRESPONSIVE FEVER IN A PATIENT WITH WEBER‐CHRISTIAN DISEASE
Authors: Akama H , Tanaka H , Yoshida T , Kameda H , Kawai S
Published: April 2023

SUMMARY Weber‐Christian disease, a disease of unknown aetiology, is characterised by relapsing febrile episodes and systemic panniculitis. Glucocorticoid therapy is often useful during acute phases of the disease. This report describes a patient in whom hyperpyrexia did not respond to high‐dose glucocorticoid treatment, yet did respond to a non‐steroidal anti‐inflammatory drug (NSAID).
ABDOMINAL SYMPTOMS, HYPERCALCAEMIA AND APATHETIC HYPERTHYROIDISM: TREATMENT WITH PAMIDRONATE
Authors: Ghose RR , Palmer DJ , Yaqoob M , Haboubi N , Ratcliffe WA
Published: April 2023

SUMMARY A 24‐year‐old man with anorexia, repeated bouts of vomiting, and wasting was found to have florid thyrotoxicosis and hypercalcaemia. Pamidronate promptly reduced the serum calcium concentration to normal, and simultaneously abated the abdominal symptoms, which did not recur in spite of continuing severe hyperthyroidism, which was eventually controlled by radioactive iodine ablation of thyroid activity.
A COMPARISON OF THE ANTIANGINAL EFFICACY OF NIFEDIPINE ALONE AND THE FIXED COMBINATION OF ATENOLOL AND NIFEDIPINE
Authors: Rees‐Jones DI , Oliver IM
Published: April 2023

SUMMARY The antianginal efficacy of a fixed combination of atenolol (50 mg) and nifedipine (20 mg) was compared with nifedipine (20 mg) alone; 102 patients experiencing three or more anginal attacks on their current monotherapy received each treatment twice daily for 3 weeks in a randomised, double‐blind crossover trial. Both treatments reduced the weekly number of angina attacks compared with existing therapy; treatment with the fixed combination resulted in significantly fewer angina attacks per week than treatment with nifedipine alone. Also, when the fixed combination treatment followed the period of nifedipine therapy a further decrease in weekly angina attack rate was apparent. Comparison of individual patient response to each treatment showed that twice as many patients reported lower attack rates while on the fixed combination: 6 patients were withdrawn while receiving fixed combination compared with 10 patients on nifedipine alone. However, the incidence of commonly reported complaints was similar with both treatments.
LIPOPROTEIN(α) IN HEALTH AND DISEASE
Authors: Byrne CD , Wild SH
Published: April 2023

SUMMARY Elevated plasma levels of Lp(a) do seem to influence the progression of atherosclerosis. Evidence is emerging that certain apo(a) isoforms may be more atherogenic than others, and in transgenic mice free apo(a) has been shown to be associated with accelerated atherosclerosis. Currently it is not known whether treating elevated Lp(a) levels will reduce progression of atherosclerosis and, as therapeutic options are limited, mass screening of Lp(a) levels in populations is not indicated. The presence of raised Lp(a) levels, however, warrants aggressive treatment to reduce other cardiovascular risk factors. Continuing research to investigate the relationship of the apo(a) gene to other genes, including the plasminogen gene and apo(a)‐related genes, will add further information pertaining to the evolution, function, regulation and clinical implications of Lp(a).
CLIMACTERIC SYMPTOMS IN HEALTHY MIDDLE‐AGED WOMEN
Authors: Khan SA , Pace JE , Cox ML , Gau DW , Cox SAL , Hodkinson HM
Published: April 2023

SUMMARY The incidence of climacteric symptoms was determined in 247 healthy premenopausal women in a community setting. These volunteers had been recruited to a longitudinal study of bone density. Of these subjects, 46 ceased to menstruate during the study, and in this subgroup symptoms were compared before and after cessation of menstruation. Only hot flushes increased after cessation of menstruation in the longitudinal study and showed age correlation in the cross‐sectional study. Hot flushes thus emerged as a true menopausal symptom. Although evidence for this is weaker, cold sweats and suffocation seem likely to be genuinely menopausal. Breast discomfort and the four mood symptoms of irritability, excitability, depression and poor concentration improved after cessation of menstruation, and this study gives no support for their being part of the menopausal syndrome; it suggests that these symptoms are more likely to be related to menstruation than to the menopause.
SIMULTANEOUS EXPOSURE TO LEAD, ARSENIC AND MERCURY FROM INDIAN ETHNIC REMEDIES
Authors: Sheerin NS , Monk PN , Aslam M , Thurston H
Published: April 2023

SUMMARY We report the case of an Asian woman who was exposed to toxic levels of lead, arsenic and mercury through the use of Indian ethnic remedies, and who suffered symptomatic lead poisoning. We know of no other case of exposure to such a combination of heavy metals from this source. We believe that control of the dispensing of these compounds is essential.
CONGENITAL DISLOCATION OF THE KNEE AS A CONSEQUENCE OF PERSISTENT AMNIOTIC FLUID LEAKAGE
Authors: Vedantam R , Douglas DL
Published: April 2023

SUMMARY A case congenital dislocation of both knees and dislocation of the left hip in an infant whose mother had a chronic amniotic fluid leakage after mid‐trimester amniocentesis.
COLONIC PERFORATION: RARE COMPLICATION OF CSF SHUNT
Authors: Janjua KJ , Ashraf AN , Sendi A
Published: April 2023

SUMMARY A description of perforation in the sigmoid colon after ventriculoperitoneal shunt.
STRATEGIES FOR INTRACTABLE ASCITES AFTER HEPATIC RESECTION: ANALYSIS OF TWO CASES
Authors: Maeda T , Shimada M , Shirabe K , Taketomi A , Matsumata T , Sugimachi K
Published: April 2023

SUMMARY Intractable ascites after hepatic resection is one of the gravest complications pertaining to deterioration in a patient's quality of life. Two cases are presented with intractable ascites that did not respond to ordinary conservative treatment after hepatic resection but were eventually successfully treated. The authors propose the following strategies: the conducting of aggressive and extensive examinations including angiography; and a peritoneovenous shunt for patients demonstrating no definite cause, to improve their quality of life.
SEVERE HYPERKALEMIA DUE TO MEFENAMIC ACID‐INDUCED HYPORENINAEMIC HYPOALDOSTERONISM
Authors: Chan JCN , Chan TYK , Ko T‐C , Chow C‐C , Critchley JAJH
Published: April 2023

SUMMARY Described is a case of severe hyperkalemia and hyporeninaemic hypoaldosteronism due to the inappropriate use of mefenamic acid. The causes of hyporeninaemic hypoaldosteronism are discussed and the importance of a detailed drug history emphasised.
A COMPLEX TRUE KNOT OF THE UMBILICAL CORD
Authors: Robins JB
Published: April 2023

SUMMARY A case of cord presentation associated with the presence of a complex true knot is described and the aetiology and risks reconsidered.