bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel X-linked inhibitor of apoptosis protein inhibitors as probes of apoptosis in biology and medicine
Authors: Hu Qi , Nie Aihua , Welsh Kate , Pinacho Crisóstomo Fernando R , Zhu Xuejun , Li Zhengxiang , An Jing , Reed John C , Zhang Liangren , Huang Ziwei
Published: April 2011

We report here a series of new inhibitors of the X-linked inhibitor of apoptosis protein (XIAP protein) based on the SMAC-tetrapeptide AVPI. The structural novelty of these molecules is the presence of the proline mimetic exo-2-azabicyclo[2.2.1]heptane-3-carboxylic acid, leading to analogs with similar activity to the natural ligand peptide. The structure–activity relationship and computational docking studies support the convenience of this unnatural amino acid as a building block to develop new peptides or small molecules targeting the XIAP-BIR3 domain.
Hydrogen sulfide inhibits macrophage-derived foam cell formation
Authors: Zhao Zhan-Zhi , Wang Zuo , Li Guo-Hua , Wang Ren , Tan Jian-Miao , Cao Xuan , Suo Rong , Jiang Zhi-Sheng
Published: April 2011

Recent evidence indicates that hydrogen sulfide (H2S) exerts an antiatherogenic effect, but the mechanism is unclear. Formation of macrophage-derived foam cells is a crucial event in the development of atherosclerosis. Thus, we explore the effect of H2S on the formation of macrophage-derived foam cells. Incubation of monocyte-derived macrophages with oxidized LDL (oxLDL) alone caused significant increases both in intracellular lipids revealed by Oil-red O staining and in intracellular total cholesterol (TC) and esterified cholesterol (EC) concentrations assessed by high-performance liquid chromatography. Sodium hydrosulfide (NaHS, an H2S donor) remarkably abrogated oxLDL-induced intracellular lipid accumulation, and attenuated TC and EC concentrations and EC/TC ratio, whereas dl-propargylglycine (PPG) (a H2S-generating enzyme cystathionine gamma lyase inhibitor) exacerbated lipid accumulation and augmented TC and EC concentrations and EC/TC ratio. Incubation of 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate (DiI)-oxLDL led to lipoprotein binding and uptake of macrophages, which was blunted by NaHS, but enhanced by PPG. Furthermore, OxLDL markedly induced CD36, scavenger receptor A (SR-A) and acyl-coenzyme A:cholesterol acyltransferase-1 (ACAT-1) expressions in macrophages, which was suppressed by NaHS (50–200 μmol/L). Finally, the down-regulations of TC and EC concentrations as well as CD36 and ACAT-1 expressions by NaHS were suppressed by glibenclamide, a KATP channel blocker, but facilitated by PD98059, an extracellular signal-regulated kinases 1 and 2 (ERK1/2) inhibitor. These results suggested that H2S inhibits foam cell formation by down-regulating CD36, SR-A and ACAT1 expressions via the KATP/ERK1/2 pathway in human monocyte-derived macrophages.
Inhibition of cartilage damage by pro-opiomelanocortin prohormone overexpression in a rat model of osteoarthritis
Authors: Shen Po-Chuan , Shiau Ai-Li , Jou I-Ming , Lee Che-Hsin , Tai Ming-Hong , Juan Hsin-Yi , Lin Pey-Ru , Liu Guei-Sheung , Wu Chao-Liang , Hsieh Jeng-Long
Published: April 2011

Pro-opiomelanocortin (POMC) is a precursor of various neuropeptides. POMC-derived neuropeptides are potent inflammation inhibitors and immunosuppressants. Evidence that osteoarthritis (OA) is an inflammatory disease is accumulating. We assessed whether intra-articular gene delivery of POMC ameliorates experimentally induced OA in a rat model. OA was induced in Wistar rats by anterior cruciate ligament-transection (ACLT) in the knee of one hind limb. Adenoviral vector encoding human POMC (AdPOMC) was injected intra-articularly into the knee joints after ACLT. The transgene expression and the inflammatory responses were evaluated using immunoblotting, immunohistochemistry and enzyme-linked immunosorbent assay. The treated joints were assessed histologically for manifestations of the disease. Human POMC was expressed in the chondrocytes and synovial membrane after the intra-articular injection. POMC gene transfer reduced nuclear factor- κB activity and the levels of interleukin-1 β in HTB-94 chondrosarcoma cells and Raw 264.7 macrophages; it also reduced microvessel density in the synovium. Histological examination showed that symptoms of OA in AdPOMC-treated rats were less severe than in rats treated with either empty adenoviral vector (AdNull) or normal saline. Intra-articular injection of adenoviral vectors expressing POMC significantly suppressed the progression and severity of OA, and reduced inflammatory responses and angiogenesis. POMC gene delivery may offer novel therapeutic approach for treating OA.
The role of the ubiquitin proteasome system in Alzheimer's disease
Authors: Riederer Beat M , Leuba Geneviève , Vernay André , Riederer Irène M
Published: April 2011

Today, Alzheimer's disease (AD) is one of the most important age-related neurodegenerative diseases, but its etiology remains still unknown. Since the discovery that the hallmark structures of this disease i.e. the formation of amyloid fibers could be the product of ubiquitin-mediated protein degradation defects, it has become clear that the ubiquitin–proteasome system (UPS), usually essential for protein repair, turnover and degradation, is perturbed in this disease. Different aspects of normal and pathological aging are discussed with respect to protein repair and degradation via the UPS, as well as consequences of a deficit in the UPS in AD. Selective protein oxidation may cause protein damage, or protein mutations may induce a dysfunction of the proteasome. Such events eventually lead to activation of cell death pathways and to an aberrant aggregation or incorporation of ubiquitinated proteins into hallmark structures. Aggresome formation is also observed in other neurodegenerative diseases, suggesting that an activation of similar mechanisms must occur in neurodegeneration as a basic phenomenon. It is essential to discuss therapeutic ways to investigate the UPS dysfunction in the human brain and to identify specific targets to hold or stop cell decay.
Sympatholytic delta-2 opioid receptors moderate ganglionic vasomotor control
Authors: Barlow Matthew A , Deo Shekhar H , Caffrey James L
Published: April 2011

This study tested the hypothesis that enkephalin increases femoral vascular conductance via the delta-2 phenotype of the opioid receptor (DOR-2) within peripheral sympathetic ganglia. Graded pulses of methionine–enkephalin (ME) were administered (0.03–10 μg/kg) into the terminal aorta of anesthetized dogs proximal to lumbar arteries that perfuse vasomotor ganglia regulating femoral blood flow. Femoral vascular conductance increased sharply (ED50 = 2.6 × 10−9 mol/kg) accompanied by declines in arterial pressure and femoral vascular resistance. A dose-related increase in arterial pressure preceded each subsequent fall in pressure. The DOR-2 antagonist, naltriben (NTB), abrogated the hyperemic effect of ME (ID50 = 1.4 × 10−9 mol/kg). DOR-1 blockade (BNTX) was five-fold less effective. The hyperemic effect of ME was also enhanced when sympathetic activity was reflexly increased by bilateral carotid occlusion. The DOR-2 agonist, deltorphin II, produced exaggerated increases in conductance compared with ME that were also reduced by DOR-2 blockade. DOR-1 blockade eliminated the initial pressor responses, exaggerated the subsequent depressor response, increased baseline femoral conductance 10-fold and shifted the ME-mediated hyperemic threshold one dose lower from 0.3 to 0.1 μg/kg, providing indirect support for a competing DOR-1-mediated constriction. Extended exposure to DOR-1 blockade lowered the maximal ME increase in conductance by 30%, suggesting that BNTX reduces the available pool of DOR receptors. In summary, enkephalin mediates a robust hyperemic effect through sympatholytic ganglionic DOR-2 receptors and DOR-1 antagonist studies provide indirect evidence for constituent opposition from a proposed DOR-1-mediated sympathotonic constrictor pathway.
Alcohol use and HIV sexual risk among MSM in Chennai, India
Authors: Mimiaga M J , Thomas B , Mayer K H , Reisner S L , Menon S , Swaminathan S , Periyasamy M , Johnson C V , Safren S A
Published: April 2011

Men who have sex with men (MSM) in India are a core risk group for HIV. Heavy alcohol consumption is associated with increased sexual risk-taking behaviours in many cultures, in particular among MSM. However, no studies to date have explored alcohol use and HIV risk among MSM in India. MSM in Chennai, India ( n = 210) completed an interviewer-administered behavioural and psychosocial assessment. Bivariate and multivariable logistic regression procedures examined behavioural and demographic associations with weekly alcohol consumption. Twenty-eight percent of the sample ( n = 58) reported using alcohol at least weekly to the point of being buzzed/intoxicated, which was associated with older age, being married to a woman, being panthi (masculine appearing, predominantly insertive partners) versus kothi (feminine acting/appearing and predominantly receptive partners), weekly tobacco use, unprotected anal sex and unprotected vaginal sex in the three months prior to study enrolment (all P < 0.05). In a multivariable model, unprotected vaginal sex in the previous three months and being married to a women were unique variables associated with weekly alcohol use (all P < 0.01). Further investigation of alcohol use within the context of sexual risk taking is warranted among Indian MSM. Panthis and MSM who are married to women may be particularly likely to benefit from interventions to decrease alcohol intake and concurrent unsafe sex.
Factors associated with HIV infection among Indian women
Authors: Ghosh P , Arah O A , Talukdar A , Sur D , Babu G R , Sengupta P , Detels R
Published: April 2011

There is still a paucity of research on the sociodemographic and other underlying factors associated with HIV transmission among women in India. This study was designed to investigate such factors in sexually experienced Indian women. We used data from the National Family Health Survey 3 (NFHS-3), which tested 52,853 women for HIV, including 27,556 husband and wife pairs. Significant risk factors for all women and married women only were: aged 26–35 years (adjusted odds ratios [AORs] = 3.65 and 2.53, respectively), being poor (AORs = 1.57 and 1.79), having had a genital sore in the last 12 months (AORs = 3.16 and 3.01) and having more than one sexual partner (AORs = 5.95 and 5.15). For husband and wife pairs, suffering sexual violence (AOR = 2.63), husband having other wife/wives (AOR = 3.40) and husband's education being secondary level or higher (AOR = 0.43) were significant. Intervention strategies in India should target young married (aged 25–35 years) and formerly married urban women who are poor, as well as those who have suffered sexual violence from their husbands, and/or are (or whose husbands are) multi-partnered. Empowerment of women is fundamental to HIV/AIDS prevention in India.
Pneumomediastinum in an HIV-infected patient with cytomegalovirus pneumonitis
Authors: Katsidzira L , Fana G T , Makunike-Mutasa R , Ferrand R A
Published: April 2011

A pneumomediastinum is an unusual complication of respiratory infections in HIV-positive patients, usually reported in association with pneumocystis pneumonia. We describe a case of an HIV-positive patient with a pneumomediastinum who had cytomegalovirus pneumonitis. This is an important reminder to clinicians, since cytomegalovirus pneumonitis and pneumocystis pneumonia have a similar clinical and radiological presentation.
Mycoplasma genitalium infection among HIV-positive women: prevalence, risk factors and association with vaginal shedding
Authors: Gatski M , Martin D H , Theall K , Amedee A , Clark R A , Dumestre J , Chhabra P , Schmidt N , Kissinger P
Published: April 2011

This study examined the prevalence and factors associated with Mycoplasma genitalium (MG) infection among HIV-positive women and the association between MG and vaginal HIV-1 RNA shedding. HIV-positive women attending an outpatient clinic in New Orleans, Louisiana, USA, from 2002 to 2005 were examined for a battery of sexually transmitted infections (STIs) and underwent a behavioural survey. A selected subset had a measurement of vaginal shedding analysed. Of the 324 HIV-positive women, 32 (9.9%) were infected with MG. HIV-positive women with MG were more likely to be co-infected with Neisseria gonorrhoeae and Chlamydia trachomatis and to have had ≥1 male sexual partners in the last month. In the subset ( n = 164), no differences were found in the presence of detectable vaginal HIV-1 RNA between women infected and not infected with MG (30.8% versus 34.8% shedding; P = 0.69). While MG was a common co-STI in this sample of HIV-positive women, it was not associated with vaginal HIV shedding.
The British HIV Association national audit on the management of subjects co-infected with HIV and hepatitis B/C
Authors: Garvey L , Curtis H , Brook G
Published: April 2011

The aim of this work was to survey current service provision and adherence to the British HIV Association (BHIVA) guidelines for the management of HIV and hepatitis B/C co-infected patients in the UK. Sites were invited to complete a survey of local care arrangements for co-infected patients. A case-note audit of all co-infected attendees during a six-month period in 2009 was performed. Data including demographics, clinical parameters, hepatitis disease status, antiretroviral and hepatitis B/C therapy were collected. Using BHIVA guidelines as audit standards, the proportion of sites and subjects meeting each standard was calculated. One-hundred and forty sites (75%) responded and data from 973 eligible co-infected patients were submitted. Approximately a third of sites reported not re-checking hepatitis serology or vaccination titres annually. Of all co-infected patients, 122 (13%) were neither vaccinated nor immune to hepatitis A and 26 (5%) of patients with hepatitis C were neither vaccinated nor naturally immune to hepatitis B. Of HBsAg-positive subjects, 25 (6%) were receiving lamivudine as the sole drug with antihepatitis B activity. In the UK, the management of HIV and hepatitis B/C co-infection remains highly variable. Optimizing the care of this high-risk patient group is a priority.
Minor surgery activity in primary care
Authors: Serra Marta , Arévalo Antonio , Ortega Cristina , Ripoll Ana , Giménez Nuria
Published: April 2011

Objective

The aim of this study was to describe the activity in our Outpatient Minor Surgery unit during its first five-year period.

Design

Retrospective descriptive study.

Methods

It was carried out in two centres of a Basic Health Area with a catchment area of 73,000 inhabitants.

Participants

Patients who underwent surgery from January 2002 to December 2007 were included in the research.

Main outcome measures

Information on the sociodemographic data of the patients, characteristics of the lesions, risk factors, treatment and its complications was gathered.

Results

A total of 2317 surgical procedures was performed on 1520 patients. The mean was 46 years old and 52% were men. The concordance between clinical and anatomopathological diagnosis was 81%. There were complications in 5% of them. The main pathologies were: epidermoid cysts (22%), nevus (20%) and fibromas (18%). They were mainly located in the back (24%), superior extremities (14%) and head (11%). In 73% mepivicaine was used as anaesthetic. The most current techniques used were: incision (36%), curettage (33%) and fusiform excision (28%). Less than 1% had malignant lesions, 50% of which were not diagnosed clinically. The mean waiting time was 30 days. Ninety-two percent had the informed consent.

Conclusions

Minor surgery in primary care is feasible and has a good clinicopathological concordance and minimum complications, but some malignant lesions are overlooked in the diagnosis based exclusively on clinical criteria.
Achieving 18-week waiting times in elective hand surgery
Authors: Chuo Cb , Wright Tc , Breuning E , Mendonca D
Published: April 2011

Summary

Objective

The Department of Health proposed an 18-week referral-to-treatment time (RTT) as a measure of high quality healthcare, to be achieved by December 2008. In 2007, referrals for elective hand surgery, to the Plastic Surgery Hand Service, were either direct or indirect. Direct referrals were from the general practitioner (GP). Indirect referrals were from other specialties, to which patients had been initially referred. We audited the RTT in elective hand surgery patients to see if 18-week waiting times could be achieved.

Design

The RTT for 152 patients who had elective hand surgery in 2007 were audited prospectively and retrospectively. After the initial audit, managers responsible for the ‘Choose & Book‘ (CAB) GP referral system, managers responsible for ‘Action on Orthopaedics‘ and colleagues who referred, were contacted, to explain the difficulties in meeting the 18-week wait target. The audit cycle was repeated prospectively in 2008 with the audit of a further 94 patients.

Setting

This audit took place in a district general hospital, in the United Kingdom.

Main outcome measure

The main outcome measure was referral-to-treatment time.

Results

The mean RTT for direct referrals decreased from 15 to 12 weeks and that for indirect referrals decreased from 43 to 24 weeks (p < 0.0001). The difference in the average RTT for direct and indirect referrals remained statistically significant (p < 0.0001), in both audit cycles.

Conclusions

The attempts to reduce the RTT, in both groups of patients, did not decrease the average RTT for indirect referrals, to within government targets. Increase in GP awareness of the limitations of the CAB system and availability of local hand surgery services, may help to reduce inappropriate referrals. However we are aware that a multispecialty approach is required to ensure that hand surgery referrals are passed on to plastic surgery as soon as possible.
The World Health Organization's ‘Surgical Safety Checklist’: should evidence-based initiatives be enforced in hospital policy?
Authors: Sivathasan Niroshan , Rakowski Krzysztof R M , Robertson Bernard F M , Vijayarajan Lavnya
Published: April 2011

Summary

Objectives

To assess the awareness and voluntary usage of the World Health Organization's Surgical Safety Checklist (WHO SSC), just prior to its mandatory implementation.

Design

Questionnaire-based, prospective, telephone survey.

Setting

Patients are exposed to systematic risks and principles of surgical safety are inconsistently applied even in sophisticated settings. The evidence-based WHO SSC addresses shortfalls to promote patient safety. It was formally introduced in the United Kingdomin January 2009andbecame a mandatory preoperative requirement in all hospitals from February 2010.

Participants

Two hundred and thirty-eight hospitals, both private and government-run, in the UK.

Main outcome measures

Appreciation among senior theatre personnel as to the existence, implementation and usage of the WHO SSC concept.

Results

Almost all had heard of the SSC, but in only two-thirds of hospitals was its use mandatory. Where the SSC was not compulsory, 80% were using it informally or sporadically. One-quarter of senior theatre personnel in hospitals without compulsory use indicated they did not know or that their department did not plan on using the checklist in the next six months, despite the deadline for implementation.

Conclusions

If the SSC is to optimize safety, then greater education and awareness is required.
The role of education in the promotion of red reflex assessments
Authors: Muen Wj , Hindocha M , Reddy Ma
Published: April 2011

Summary

Objectives

To assess the impact of an information poster on rate and accuracy of referrals of abnormal red reflex from general practioners (GP) and hospital doctors involved in the care of children.

Design

A retrospective audit of all referrals for abnormal red reflex received between the periods September 2005 to September 2006 was carried out. Posters were sent to 200 GP practices in East London as well as our local hospital. Pathways for referrals were given, and a prospective re-audit was conducted from October 2006 to March 2008.

Setting

The Royal London Hospital and practices serving the East End of London.

Participants

GPs serving the East End of London and hospital doctors involved in child care.

Main outcome measures

(1) Increase in the referral rate for abnormal red reflex finding; and (2) accuracy of referral for abnormal red reflex.

Results

Prior to posters being sent, there were no referrals of abnormal red reflexes to our department. Following the posters being sent, 21 abnormal red reflex referrals were made over a period of 18 months; 18 from GPs and three from neonatologists. Thirteen were detected at 6 weeks of age (routine screening). Three patients had a positive finding (two with bilateral cataracts and one with hypermetropic astigmatism).

Conclusions

Although an increase in referrals suggests that the assessment of the red reflex is being performed and public awareness has increased, the sensitivity of this test remains low. Management strategies need to be in place to deal with an influx of patients who may have normal assessments and a strategy in East London will be discussed.
Planned implementations of ePrescribing systems in NHS hospitals in England: a questionnaire study
Authors: Crowe Sarah , Cresswell Kathrin , Avery Anthony J , Slee Ann , Coleman Jamie J , Sheikh Aziz
Published: April 2011

Objectives

To describe the plans of English NHS hospitals to implement ePrescribing systems.

Design and setting

Questionnaire-based survey of attendees of the National ePrescribing Forum.

Participants

A piloted questionnaire was distributed to all NHS and non-NHS hospital-based attendees. The questionnaire enquired about any completed or planned implementation of ePrescribing systems, the specific systems of interest, and functionality they offered.

Main outcome measures

Estimate of the number of NHS Trusts planning to implement ePrescribing systems.

Results

Ninety-one of the 166 questionnaires distributed to NHS hospital-based staff were completed and returned. Of those, six were incomplete, resulting in a total usable response rate of 51% ( n = 85). Eighty-two percent ( n = 46) of the 56 Trusts represented at the Forum were either ‘thinking of implementing’ or ‘currently implementing’ an ePrescribing system, such as Ascribe (13%, n = 7) and JAC (20%, n = 11). Forty percent ( n = 22) of respondents specified other systems, including those procured by NHS Connecting for Health e.g. RiO, Lorenzo and Cerner. Knowledge support, decision support and computerized links to other elements of patients’ individual care records were the functionalities of greatest interest.

Conclusion

There is considerable reported interest and activity in implementing ePrescribing systems in hospitals across England. Whether such developments have the desired impact on improving the safety of prescribing is however, yet to be determined.
Psychiatric misdiagnoses in patients with chronic fatigue syndrome
Authors: Lawn Tara , Kumar Praveen , Knight Bernice , Sharpe Michael , White Peter D
Published: April 2011

Objectives

The aim of this study was to examine the accuracy of doctors at diagnosing co-morbid psychiatric disorders in patients with chronic fatigue syndrome (CFS).

Design

Case series comparing clinical diagnoses with a standardized structured psychiatric interview.

Setting

Secondary care specialist chronic fatigue syndrome clinic.

Participants

One hundred and thirty-five participants of a randomized controlled trial of non-pharmacological treatments at one centre in the PACE trial.

Main outcome measures

Current psychiatric diagnoses made by CFS specialist doctors, compared with current psychiatric diagnoses made independently using a structured psychiatric interview.

Results

Clinicians identified 59 (44%, 95% CI 39-56%) of patients as suffering from a co-morbid psychiatric disorder compared to 76 (56%, CI 53-69%) by structured interview. Depressive and anxiety disorders were most common. Clinicians were twice as likely to miss diagnoses (30 patients, 22%) than misdiagnose them (13, 10%). Psychiatrists were less likely to miss diagnoses than other clinicians, but were as likely to misdiagnose them.

Conclusions

Doctors assessing patients in a chronic fatigue syndrome clinic miss psychiatric diagnoses more often than misdiagnosing them. Missed diagnoses are common. CFS clinic doctors should be trained to diagnose psychiatric disorders.
In what circumstances is telemedicine appropriate in the developing world?
Authors: Wootton Richard , Bonnardot Laurent
Published: April 2011

Summary

Objectives

To review papers reporting actual experience with telemedicine in developing countries and to summarize their findings, including the strength of the evidence.

Design

A retrospective review was conducted. Study quality was assessed.

Setting

Four commonly-used electronic databases.

Main outcome measures

Study quality scores.

Results

From a total of 202 potential articles, 38 relevant papers were identified. Thirty-four articles (89%) reported clinical experience and 14 articles (37%) reported the use of telemedicine for educational purposes. The quality of the reports was rather weak (median quality-score 3, on a scale 0-9); only one study, rated at 7, fell into the high quality score band. The fact that almost all studies reported positively in favour of telemedicine suggests a publication bias. Of the 38 articles, 15 (39%) reported the use of real-time telemedicine and 25 (66%) reported the use of asynchronous, or store-and-forward, telemedicine. Email was the most commonly reported modality (half of all studies).

Conclusion

Some of the longer established telemedicine operations have developed into substantial networks. The review suggests that great potential exists for telemedicine in the developing world. However, some caution is required in future telemedicine work if telemedicine exemplars are to be produced which can be widely copied.
Differential prognostic utility of NTproBNP and Cystatin C in patients with acute exacerbation of chronic pulmonary disease
Authors: Pérez-Calvo Juan I , Sánchez-Marteles Marta , Ruiz-Ruiz Francisco-José , Morales-Rull José-Luis , Nieto-Rodríguez José-Antonio
Published: April 2011

Summary

Objectives

To determine whether serum Cystatin C (CysC) and NTproBNP have prognostic value among patients with long-standing chronic lung disease.

Design

Prospective, observational, non-interventional study.

Setting

CysC and NTproBNP are prognostic markers in several cardiac conditions. In addition, CysC acts as an antiprotease following Cathepsin activation, which has been involved in the pathogenesis of chronic obstructive pulmonary disease.

Participants

Patients with a basal functional status of II-IV (NYHA), admitted for an acute exacerbation of chronic pulmonary diseases and no previous history of symptoms related to pulmonary hypertension or heart failure.

Main outcome measures

NTproBNP and CysC were determined at admission in 107 patients with acute exacerbation of chronic lung disease. During 12-month follow-up, mortality, new hospital admissions and prescription of diuretics were recorded.

Results

During follow-up there were eight patient deaths (7.5%). Mean NTproBNP among the deceased was 1510.20 pg/mL (95% CI 498.44-4628.55) vs 502.70 pg/mL (95% CI 395.44-645.48) among survivors (p= 0.01). Twenty-seven patients (25%) were prescribed loop diuretics. Mean concentration of CysC was 1.45 mg/dL (95% CI 1.21-1.69 mg/dL) vs 1.17 mg/dL (95% IC 1.09-1.25 mg/dL) in those not prescribed (p = 0.004). NTproBNP concentration was 837.14 pg/mL (95% CI 555.57-1274.10 pg/mL) in patients prescribed diuretics vs 473.42 pg/mL (95% CI 357.80-632.70 pg/mL) in those not prescribed (p = 0.03). Kaplan-Meier analysis revealed a significant difference between death and diuretic prescription during follow-up when cut-off value for NTproBNP was 550 pg/mL (p = 0.03 and p= 0.02, respectively). For 1.16mg/dL of CsysC, a significant difference was only observed in diuretic prescription (p = 0.007).

Conclusions

In patients with chronic respiratory diseases NTproBNP has predictive value in terms of mortality whereas CysC does not. However, it is still possible that both can contribute to the early identification of patients at risk of developing clinical ventricular dysfunction.
Frequency of abdominal wall hernias: is classical teaching out of date?
Authors: Dabbas Natalie , Adams K , Pearson K , Royle Gt
Published: April 2011

Objectives

Abdominal wall hernias are common. Various authors all quote the following order (in decreasing frequency): inguinal, femoral, umbilical followed by rarer forms. But are these figures outdated? We investigated the epidemiology of hernia repair (retrospective review) over 30 years to determine whether the relative frequencies of hernias are evolving.

Design

All hernia repairs undertaken in consecutive adult patients were assessed. Data included: patient demographics; hernia type; and operation details. Data were analysed using Microsoft Excel 2007 and SPSS.

Setting

A single United Kingdom hospital trust during three periods: 1985–1988; 1995–1998; and 2005–2008.

Main outcome measures

Frequency data of different hernia types during three time periods, patient demographic data.

Results

Over the three time periods, 2389 patients underwent 2510 hernia repairs (i.e. including bilateral and multiple hernias in a single patient). Inguinal hernia repair was universally the commonest hernia repair, followed by umbilical, epigastric, para-umbilical, incisional and femoral, respectively. Whereas femoral hernia repair was the second commonest in the 1980s, it had become the fifth most common by 2005– 2008. While the proportion of groin hernia repairs has decreased over time, the proportion of midline abdominal wall hernias has increased.

Conclusion

The current relative frequency of different hernia repair type is: inguinal; umbilical; epigastric; incisional; para-umbilical; femoral; and finally other types e.g. spigelian. This contrasts with hernia incidence figures quoted in common reference books.
Impact of visual art in patient waiting rooms: survey of patients attending a transplant clinic in Dumfries
Authors: Cusack Pearce , Lankston Louise , Isles Chris
Published: April 2011

Summary

Background

The clinic waiting area in Dumfries received the highest score among nine units offering transplant follow-up (p< 0.001 for differences between units) in the recent Quality Improvement Scotland Renal Transplant Survey.

Design

The purpose of the present study was to determine which aspects of the Dumfries waiting area patients considered important to their outpatient experience.

Methods

We posted a questionnaire to all 44 renal transplant patients attending the Dumfries Renal Unit in October 2009 in which we asked patients to rate seven aspects of their clinic environment on a scale from 1 (not at all important) to 5 (very important). These were, in random order, comfy chairs, magazines and puzzle books, paintings on the wall, a 42-inch plasma screen TV, views from the windows, potted plants and computers with Internet access.

Results

Thirty-nine (89%) patients responded. The most highly rated feature of our clinic waiting room was the comfy chairs with an average score of 4.4. This was followed by the magazines and puzzle books (3.6), the plasma screen TV (3.6) and the paintings on the walls (3.4). The views from the windows (3.1), the computer (3.0) and the potted plants (2.9)were less highly rated. Respondents expressed a preference for landscapes/nature scenes (84%) and paintings of animals/birds (84%). Fewer wished to look at abstract paintings (27%) or portraits (24%).

Conclusion

The QIS transplant survey has shown large differences in the quality of the environment of the transplant follow-up clinics in Scotland. Our survey of renal transplant patients attending the Dumfries Renal Unit suggests that the paintings we chose to display in our clinic waiting room contributed positively to their outpatient experience.
Effect of age on subjective complaints and objective severity of carpal tunnel syndrome: prospective study
Authors: Povlsen B , Aggelakis K , Koutroumanidis M
Published: April 2011

Objectives

Older patients with carpal tunnel syndrome who are resistant to conservative treatment often have a less than satisfactory outcome after surgery. We therefore investigated whether the age of the patient affects the subjective complaints or the objective severity of the nerve entrapment prior to surgery in patients younger than 40 years compared with those above 70 years of age.

Design

Prospective study.

Setting

NHS specialist neurophysiology department.

Participants

One hundred and six splint-resistant patients scored their subjective complaints and scores were then compared with the neurophysiology results.

Main outcome measures

Nerve conduction speeds and subjective visual analogue score of pain, sensation and motor function.

Results

Conduction speeds were significantly more affected in patients over 70 years of age than in those under 40 years. Older patients scored their subjective complaints lower than younger patients.

Conclusions

Older patients’ subjective complaints misrepresent the severity of the nerve entrapment. Clinicians should have a lower threshold for objective investigation of patients older than 70 years of age to minimize development of irreversible nerve damage.
Axillary lymph node metastasis and survival in breast cancer patients with concurrent cardio-cerebral-vascular disease
Authors: Sennerstam Roland , Schässburger Kai-Uwe , Stormby Nils , Wiksell Hans , Auer Gert
Published: April 2011

Summary

Objectives

Dissemination of tumour cells occurring both spontaneously or caused by diagnostic biopsy procedures is the most serious complication of solid malignancies. In the present work we focus on local tumour spread and how this complication of cancer disease can be counteracted.

Design

From a cohort of 864 breast cancer patients we selected those who died of their primary cancer and those who died because of a simultaneously existing cardio-cerebral-vascular disease (CCVD) and were exposed to anticoagulants.

Setting

The study was based on breast cancer patients diagnosed at Karolinska University Hospital during 1991 ( n = 519) and 1997–1998 ( n = 345).

Main outcome measures

Axillary lymph node metastasis (ALNM) and survival of breast cancer patients with concurrent CCVD.

Results

Breast cancer patients belonging to the group that died of CCVD showed ALNM at the time of tumour diagnosis in 27% of the cases compared with 68% diagnosed in the group that died of their breast cancer (p < 0.0001). Likewise we observed a highly significant (p < 0.0001) difference in mean survival time with an average of 102 months in the group of breast cancer patients who died of CCVD and an average of 61 months in the group who died of breast cancer.

Conclusion

The data presented herein indicate that breast cancer patients regularly involved in treatment with anticoagulants because of simultaneously existing CCVD develop ALNM significantly less frequently and have an increased average survival time compared with breast cancer patients not suffering from CCVD.
Emergency thoracic surgery in elderly patients
Authors: Limmer Stefan , Unger Lena , Czymek Ralf , Kujath Peter , Hoffmann Martin
Published: April 2011

Summary

Objectives

Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any comorbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients.

Design

Retrospective chart review.

Setting

Academic tertiary care referral center.

Participants

Emergency patients treated at the Department of Thoracic Surgery, University Hospital of Luebeck, Germany.

Main outcome measures

Co-morbidities, mortality, risk factors and hospital length of stay.

Results

A total of 124 thoracic procedures were performed on 114 patients. There were 79 men and 36 women (average age 72.5 ± 6.4 years, range 65–94). The overall operative mortality was 25.4%. The most frequent indication was thoracic/mediastinal infection, followed by peri- or postoperative thoracic complications. Risk factors for hospital mortality were a high ASA score, pre-existing diabetes mellitus and renal insufficiency.

Conclusions

Our study documents a perioperative mortality rate of 25% in patients over 65 who required emergency thoracic surgery. The main indication for a surgical intervention was sepsis with a thoracic/mediastinal focus. Co-morbidities and the resulting perioperative complications were found to have a significant effect on both inpatient length of stay and outcome. Long-term systemic co-morbidities such as diabetes mellitus are difficult to equalize with respect to certain organ dysfunctions and significantly increase mortality.
Junior doctor titles following implementation of Modernising Medical Careers in the UK
Authors: Islam Shofiq , Deekes Andrew , Lee Alexandra , Hoffman Gary , Isgar Brian
Published: April 2011

Objective

Recent changes in postgraduate medical training in the UK collectively organized under the auspices of Modernising Medical Careers (MMC) have created new labels for junior doctors in training. It would appear that many nurses and other health workers do not understand the new terminology. We aimed to investigate the knowledge of nursing staff about new junior doctor titles in a district general hospital. As far as we are aware, this is the first survey to determine the views and knowledge of the new terms among staff working in the NHS.

Design

Questionnaire study.

Setting

District general hospital. West Midlands, UK.

Participants

Fifty-five randomly selected staff nurses working in the surgical directorate.

Main outcome measure

Questions were asked about their views and knowledge of the current nomenclature. To objectively assess knowledge of the new titles respondents were asked to match equivalent positions with those based on the old system.

Results

Only 22% ( n = 12) of respondents felt that they fully understand current terms in usage. Seventy-six percent ( n = 42) felt that it was ‘very important’ that titles accurately convey role and seniority of the doctor. The most common titles correctly matched were FY1 and House Officer ( n = 45, 81%) and FY2 and First Year Senior House Officer ( n = 35, 64%). Only 9% ( n = 5) of staff nurses correctly matched ST3 to Junior Registrar and 13% ( n = 7) correctly matched ST7 to Senior Registrar. Ward-based staff nurses demonstrated greater familiarity with titles when compared to nurses who work mainly in the outpatient clinic and theatre setting (p = 0.017). We did not identify a statistically significant association with demographic characteristics (age, gender, experience) and knowledge of the new terms (p > 0.05). Approximately 98% ( n = 54) of the staff surveyed felt that terms are confusing to nurses and need to be simplified.

Conclusions

Our survey revealed that nursing staff lacked knowledge of the current terminology to describe doctors in training. This may have implications for staff expectations regarding specific role of junior doctor in terms of clinical decision-making, working relationships and communication between team members, and ultimately patient care.
Does the academic performance of psychiatrists influence success in the NHS Clinical Excellence Award Scheme?
Authors: Mitchell Alex J , Crowfoot Daniel , Leaver James , Hughes Samantha
Published: April 2011

Summary

Objectives

Given the uncertainty about factors that influence receipt of Clinical Excellence Awards (CEA) and recent availability of advanced research metrics, we examined the factors that predict CEA success using a convenience sample of English psychiatrists.

Design

Observational study examining region, subspecialty, H-index, M-index, number of publications, years since registration and years in specialty.

Setting

ACCEA Nominal Roll, cross-referenced with data from the GMC's list of registered medical practitioners and Thompson's Web of Science database.

Participants

A total of 494 psychiatrists including 245 with national levels awards and a random sample with local level awards.

Main outcome measures

Receipt of local or national CEA awards in 2008 and 2009.

Results

Of those with national awards, 126 had university contracts and 119 NHS contracts. Across all staff, years since qualification in medicine and H-index were the dominant influences. For local awards we found that years worked in the specialty was the main predictor of a CEA award with a smaller contribution from H-index. For national awards to university staff (academics) years on the medical register and publication rate were significant predictors. For national awards to NHS staff (non-academics) H-index and total cites were predictive, but these were themselves related to age.

Conclusions

Progression in CEAs among psychiatrists is strongly influenced by age (years spent in specialty and years on the medical register) with an additional contribution from research productivity. Currently, research impact is crudely assessed in the CEA process. We suggest that CEA committees formally assess the impact of NHS-related research using standardized research metrics which are openly available. We also suggest that supporting organizations and local trusts adhere to the rules mandated by the ACCEA.
MRSA colonisation and subsequent risk of infection despite effective eradication in orthopaedic elective surgery
Authors: Murphy E. , Spencer S. J. , Young D. , Jones B. , Blyth M. J. G.
Published: April 2011

The objective of this study was to determine the effectiveness of screening and successful treatment of methicillin-resistant Staphylococcus aureus (MRSA) colonisation in elective orthopaedic patients on the subsequent risk of developing a surgical site infection (SSI) with MRSA.

We screened 5933 elective orthopaedic in-patients for MRSA at pre-operative assessment. Of these, 108 (1.8%) were colonised with MRSA and 90 subsequently underwent surgery. Despite effective eradication therapy, six of these (6.7%) had an SSI within one year of surgery. Among these infections, deep sepsis occurred in four cases (4.4%) and superficial infection in two (2.2%). The responsible organism in four of the six cases was MRSA. Further analysis showed that patients undergoing surgery for joint replacement of the lower limb were at significantly increased risk of an SSI if previously colonised with MRSA.

We conclude that previously MRSA-colonised patients undergoing elective surgery are at an increased risk of an SSI compared with other elective patients, and that this risk is significant for those undergoing joint replacement of the lower limb. Furthermore, when an infection occurs, it is likely to be due to MRSA.
Effects of the systemic administration of alendronate on bone formation in a porous hydroxyapatite/collagen composite and resorption by osteoclasts in a bone defect model in rabbits
Authors: Sugata Y. , Sotome S. , Yuasa M. , Hirano M. , Shinomiya K. , Okawa A.
Published: April 2011

Several bisphosphonates are now available for the treatment of osteoporosis. Porous hydroxyapatite/collagen (HA/Col) composite is an osteoconductive bone substitute which is resorbed by osteoclasts. The effects of the bisphosphonate alendronate on the formation of bone in porous HA/Col and its resorption by osteoclasts were evaluated using a rabbit model. Porous HA/Col cylinders measuring 6 mm in diameter and 8 mm in length, with a pore size of 100 μm to 500 μm and 95% porosity, were inserted into a defect produced in the lateral femoral condyles of 72 rabbits. The rabbits were divided into four groups based on the protocol of alendronate administration: the control group did not receive any alendronate, the pre group had alendronate treatment for three weeks prior to the implantation of the HA/Col, the post group had alendronate treatment following implantation until euthanasia, and the pre+post group had continuous alendronate treatment from three weeks prior to surgery until euthanasia. All rabbits were injected intravenously with either saline or alendronate (7.5 μg/kg) once a week. Each group had 18 rabbits, six in each group being killed at three, six and 12 weeks post-operatively. Alendronate administration suppressed the resorption of the implants. Additionally, the mineral densities of newly formed bone in the alendronate-treated groups were lower than those in the control group at 12 weeks post-operatively. Interestingly, the number of osteoclasts attached to the implant correlated with the extent of bone formation at three weeks.

In conclusion, the systemic administration of alendronate in our rabbit model at a dose-for-weight equivalent to the clinical dose used in the treatment of osteoporosis in Japan affected the mineral density and remodelling of bone tissue in implanted porous HA/Col composites.
Overlapping allograft in reconstructive surgery for malignant bone tumours in paediatric patients
Authors: Song W. S. , Kong C.-B. , Jeon D.-G. , Cho W. H. , Kim J. R. , Lee S.-Y.
Published: April 2011

The use of allografts for the treatment of bone tumours in children is limited by nonunion and the difficulty of finding a suitable graft. Furthermore, appositional growth can’t be expected of an allograft.

We used an overlapping allograft in 11 children, with a mean age of ten years (4 to 15), with a mean follow-up of 24.1 months (20 to 33). There were five intercalary and six intra-articular resections, and the tumours were in the femur in six cases and the humerus in five. Rates of union, times to union, remodelling patterns and allograft-associated complications were evaluated.

No allograft was removed due to a complication. Of the 16 junctional sites, 15 (94%) showed union at a mean of 3.1 months (2 to 5). Remodelling between host and allograft was seen at 14 junctions at a mean of five months (4 to 7). The mean Musculoskeletal Tumor Society score was 26.5 of 30 (88.3%). One case of nonunion and another with screw protrusion required re-operation.

Overlapping allografts have the potential to shorten time to union, decrease rates of nonunion and have positive appositional growth effect.
Oncological outcomes of patients with Ewing’s sarcoma
Authors: Pradhan A. , Grimer R. J. , Spooner D. , Peake D. , Carter S. R. , Tillman R. M. , Abudu A. , Jeys L.
Published: April 2011

The aim of this study was to identify whether there was any difference in patient, tumour, treatment or outcome characteristics between patients with skeletal or extra-skeletal Ewing’s sarcoma. We identified 300 patients with new primary Ewing’s sarcoma diagnosed between 1980 and 2005 from the centres’ local database. There were 253 (84%) with skeletal and 47 (16%) with extra-skeletal Ewing’s sarcomas. Although patients with skeletal Ewing’s were younger (mean age 16.8 years) than those with extra-skeletal Ewing’s sarcoma (mean age 27.5 years), there was little difference between the groups in terms of tumour stage or treatment. Nearly all the patients were treated with chemotherapy and most had surgery. There was no difference in the overall survival of patients with skeletal (64%) and extra-skeletal Ewing’s sarcoma (61%) (p = 0.85), and this was also the case when both groups were split by whether they had metastases or not.

This large series has shown that the oncological outcomes of Ewing’s sarcoma are related to tumour characteristics and patient age, and not determined by whether they arise in bone or soft tissue.