bluuebunny/crossref_metadata_2025 huggingface dataset:
RM Pressfit vitamys: the 10-year follow-up
Authors: Haefeli Pascal C , Zwahlen Zinedine M , Baumgärtner Ralf , Link Björn-Christian , Beck Martin
Published: January 2025

Introduction:

The RM Pressfit vitamys is an uncemented, titanium particle-coated, isoelastic monoblock cup made of vitamin E blended highly cross-linked polyethylene. We addressed the following questions: (1) What are the clinical and (2) radiographic outcomes 10 years after implantation? (3) What is the revision rate?

Methods:

In this prospective observational study in a tertiary care centre we investigated all consecutive cases of total hip replacement with the RM Pressfit vitamys cup between September 2009 and November 2011. It was implanted in 162 hips, 49.4% in women. The mean age was 67.2 years (standard deviation [SD] 9.5), and the mean BMI was 27.3 kg/m2 (SD 4.7). In 153 cases (94.4%), primary or secondary osteoarthritis was the diagnosis. We evaluated preoperative and follow-up data at 6 weeks, 1, 5, and 10 years. A modified Harris Hip Score (mHHS), pain and satisfaction on a visual analogue scale (VAS), radiographic evaluation, complications and revision rate were investigated.

Results:

At the 10-year follow-up (mean 120.5 months, SD 1.4, range 118–126), 99 hips were available for clinical and radiographic evaluation. (1) The mean mHHS was 94.8 (SD 9.9), rest pain 0.2 (SD 0.6), load pain 0.5 (SD 1.5), and satisfaction 9.5 (SD 1.1). The mean improvement as compared to preoperatively was +33.7 (SD 16.8), -3.3 (SD 2.7), -6.0 (SD 2.4) and +5.7 (SD 2.5), respectively. (2) In the radiographic evaluation, no loose cups, no acetabular lucent lines, or acetabular osteolysis were seen. (3) 2 cups were revised, both due to malpositioning. The 10-year cumulative revision rate was 2.0% (95%CI, 0.0–4.2%). The implant survival rate with aseptic loosening as endpoint was 100%. No adverse events were reported.

Conclusions:

At the 10-year follow-up, the RM Pressfit vitamys cup still had promising results with good clinical and radiographic outcomes and a low revision rate.
Sexual wellbeing of sexual minority men living in poverty in Hong Kong
Authors: Jason Sze-To Wing Hon , Yang Chenxi , Huang Yu-Te
Published: January 2025

Sexual well-being is a fundamental human right and a central aspect of human sexuality that contributes significantly to people’s overall well-being. Numerous studies have explored the connections between sexual well-being and a range of shaping factors, including gender and sexual identity, family relationships, education and religious beliefs. However, only limited research has examined the interdependence between sexual well-being and poverty, and even less research has focused on sexual minority communities. This study adopted an intersectionality framework to elucidate the association between poverty and the sexual well-being of sexual minority men in Hong Kong, given its unique socio-political-cultural context. Qualitative data were collected from 10 sexual minority men aged between 20-47 years old living in poverty who participated in a semi-structured, in-depth individual interview to narrate their experiences and insights on poverty and sexual well-being. Interviews were transcribed and analyzed. Our study identified three themes: (1) deprivation of privacy and space, (2) poverty stigma within sexual minority communities, and (3) sexual repression. This study contributes to the scholarship of sexuality research on the impact of poverty on sexual minority men’s sexual well-being in Hong Kong. The intersection of poverty and a sexual minority status impeded with the gratification of their desire for sexual well-being and intimacy. Policy and research implications are provided.
Can co-op supermarkets lead the way to sustainability? Potentials and challenges in the shift from food difference to food democracy in Spain
Authors: Cambra González Antonio
Published: January 2025

This article examines how cooperative supermarkets attempt to scale up alternative food networks whilst creating distinctive consumer experiences that challenge conventional retail practices. Through atmospheric analysis of Spanish co-op supermarkets, I show how these hybrid organisations navigate key tensions between conventional retail efficiency and alternative food values. Using ethnographic methods, the research identifies five interconnected challenges that shape these organisations’ transformative potential: differentiating their consumer experience, aligning consumer-material ethics, fostering community engagement, managing professional-amateur tensions and expanding their consumer base. Whilst these challenges reveal the inherent difficulties of scaling up alternative food practices, the article suggests that co-op supermarkets represent a feasible hybrid model for transforming food consumption. By creating distinctive consumer practices, these initiatives demonstrate how alternative food networks can expand beyond niche activism whilst maintaining their commitment to environmental sustainability and community values during times of increasing ecosocial pressures.
Association of dipeptidyl peptidase-4 with Alzheimer's disease: A new therapeutic prospect
Authors: Wang Xinyi , Chen Li , Li Weijian , He Zhi , Jiang Haiying
Published: January 2025

Alzheimer's disease (AD) is the most common disease associated with cognitive dysfunction, which is closely associated with type 2 diabetes mellitus (T2DM) in clinical manifestations, pathological changes and prevention. Inhibition of dipeptidyl peptidase 4 (DPP-4) can lower blood glucose levels by stimulating insulin secretion. Besides, it can affect cognitive function through the neuroprotective effect of DPP-4 substrates, such as glucose-dependent insulin peptide and glucagon-like peptide-1, the proteolytic effect on amyloid-β and the protective effect on neuronal structure. This review discusses the relationship between cognitive impairment in T2DM and in AD, summarizes the effect of DPP-4 inhibitor (DPP-4i) on improving cognitive impairment in these two diseases based on the current studies. Given the lack of clinical randomized trials that evaluate the effect of DPP-4i on AD, this review is expected to provide preclinical evidence for DPP-4i as a potential therapy for the treatment and prevention of AD.
Integrating network pharmacology and component analysis to investigate the potential mechanisms of Sheng-Hui-Yi-Zhi decoction in the treatment of Alzheimer’s disease
Authors: Wang Peng , Dong Yuan-li , Li Shan-shan , Jin Yi , Sun Wei-liang , Zhao Bao-Sheng , Li Qiu-bing , Chen Xin
Published: January 2025

Background

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive impairment.

Objective

To elucidate the potential mechanisms of Sheng-Hui-Yi-Zhi (SHYZ) for the treatment of AD and explore the effective substances of SHYZ.

Methods

Liquid chromatography-mass spectrometry (LC-MS) was used to identify the active components of SHYZ. Network pharmacology was employed to predict the potential targets and pathways of SHYZ in the treatment of AD. SAMP8 mice were used as a model for AD and were treated with SHYZ. The Morris water maze was utilized to assess the learning and memory capabilities of mice. Additionally, the levels of TNF-α, IL-1β, and IL-6 in the brain hippocampus of mice were quantified using ELISA. The protein expression of PI3 K/p-PI3 K, AKT/p-AKT, MAPK38/p-MAPK38, and NFκB p65/p-NFκB p65 in the hippocampus was analyzed using Western blotting. Additionally, qRT-PCR was employed to assess the gene expressions of TNF-α, IL-1β, and IL-6 in the hippocampus.

Result

The network pharmacological prediction results showed that the treatment of AD with SHYZ was closely related to the inhibition of inflammatory response. Behavioral experiments revealed that SHYZ significantly reduced the time taken to escape, increased the number of times the platform was crossed, and prolonged the residence time in the target quadrant. Meanwhile, SHYZ treatment suppressed the expression of Aβ1−42 protein and inflammatory factors. SHYZ significantly inhibited the expression of proteins of PI3 K, AKT, MAPK p38, and NF-κB p65.

Conclusions

SHYZ has been shown to effectively ameliorate learning and memory impairment in SAMP8 AD mice by inhibiting the expression of Aβ1−42 and reducing the increase of inflammatory factors.
The reproduction of structural inequalities in online job search strategies and outcomes
Authors: De Marco Stefano , Dumont Guillaume , Helsper Ellen Johanna
Published: January 2025

Does digital stratification foster inequalities in access to work and employment? We address this question by examining inequalities related to online job search skills and the outcomes of the online search process. Results from a representative survey of 1103 Spanish jobseekers show that online job search skills positively affect the chances of getting an interview through employment platforms but that they are unevenly distributed. Online job search skills are more important than other digital resources, including basic digital skills, in determining positive outcomes of online job searches though there are still inequalities in getting an interview independent of either. This calls for considering domain-specific digital skills both in research and in practice alongside tackling traditional inequalities.
‘I’ve grown fearful of any rustle behind me’: defining anticipating discriminatory violence as violence
Authors: Orr Celeste E. , Mastrorillo Alessia , Hrynyk Nicholas
Published: January 2025

Marginalised people fear and expect violence, often daily. This prompts us to ask, is anticipating violence a violence in and of itself? Asking and answering this question extends the feminist, critical race, violence and trauma studies project of broadening traditional understandings of violence to name ignored forms of violence as violence (e.g. epistemic or representational violence). Ultimately, we argue that anticipating discriminatory violence is violence in and of itself. To do so, first we contest the common assumption that violence is intentional. The idea that violence needs to be intentional is a long-held myth that functions to deny various forms of violence. Second, we challenge the idea that violence requires a clear perpetrator. Systems of oppression and discriminatory ideologies enact violence, but there often is no clear perpetrator. When we are preoccupied with claiming that violence involves an intentional actor, we neglect to attend to the ways in which oppressive ideologies and systems structure marginalised people's daily lives and experiences of (anticipating) violence. Living under the Western capitalist cisheteropatriarchal regime renders the ‘everyday’ a site of trauma and violence. This framework for reconceptualising what ‘counts’ as violence creates space to move beyond violence in its most traditional forms: the punch, the slur. Anticipating violence is the logical consequence of living under systems of oppression. When a group of marginalised people collectively anticipate violence, it is clear violence has already happened and is happening all around us: we posit that our conceptualisation of anticipating violence as violence is not intended to validate all forms of anticipated violence.
Navigating identity: migration, and (dis)ability, and their cultural geographies in Venice
Authors: Josefson Charles
Published: January 2025

This article explores the Wrecks-Landings exhibition at the Giorgio Franchetti Gallery, Ca’ d’Oro, in Venice, Italy, a city profoundly shaped by waves of migration. The exhibition features works by (dis)abled artists that poignantly reflect on the contemporary experiences of forced migrants. Together, these pieces form an evocative, site-specific installation that urges empathetic understanding and fosters informed dialogue. This installation demonstrates how artistic and creative methodologies, augmented by academic expertise, can offer nuanced insights into the complex political issues surrounding the ongoing forced migrant crisis – a crisis that continues to compel desperate individuals to undertake perilous journeys across the Mediterranean Sea.
ATTITUDES OF DOCTORS AND NURSES TO RELATIVES WITNESSING CARDIOPULMONARY RESUSCITATION
Authors: Blundell A , Rich A , Watson AR , Dale L
Published: January 2025

There is increasing discussion about relatives being allowed to witness cardiopulmonary resuscitation (CPR) attempts. Most reports have emanated from Accident and Emergency (A&E) departments. We undertook a survey of junior doctors and nurses in a university teaching hospital to ascertain their current attitudes to witnessed resuscitation. There was general agreement that if relatives witness resuscitation it may be beneficial to their grieving process. However, only a small majority of nurses and a minority of doctors agreed that relatives should be offered the opportunity to witness CPR. Doctors and nurses strongly agreed that emotional stress can be increased by the presence of relatives who may be traumatised by the procedures involved. Doctors felt more strongly that the presence of relatives may interfere with treatment (p = 0.006) and that allowing relatives to witness resuscitation may inhibit staff performance (p = 0.02). There was universal agreement that if relatives were to witness CPR they should be supported by a member of staff. The survey has provided useful information about current attitudes to witnessed CPR, which should be included for discussion in advanced life support training sessions.
THE ROLE OF SPORT IN THE REHABILITATION OF PATIENTS WITH SPINAL INJURIES
Authors: Silver JR
Published: January 2025

Disabled people have been participating in sport since historical times as a means of improving their physical health. After the First World War, servicemen who had lost limbs or had been blinded took part in competitive sport. Until the development of the modern treatment of spinal injuries, patients with paraplegia died rapidly from overwhelming sepsis but as a result of modern treatment people with paraplegia returned to work and developed their own sports movement. They now compete successfully in dramatic wheelchair sports such as marathon racing and the exciting sport of wheelchair basketball. This paper describes the development of this movement.
Curare: the South American arrow poison
Authors: Lee MR
Published: January 2025

The history of curare is both curious and convoluted. A product of South American culture it emerged in the sixteenth century from the mists of antiquity at the same time as quinine, coca, and chocolate. Like quinine, at first came the extract but no plant, and later the plant but no chemical compound. It took more than 300 years and the efforts of many explorers and scientists to resolve the problem. These included Condamine, Humboldt, Brodie,Waterton, Bernard, Dale,Walker, and King. Finally, the pure compound d-tubocurarine was isolated from the liana Chondrodendron and synthesised. Its specific physiological action was blockade of the effect of acetylcholine at the neuro-muscular junction. Such a paralytic poison could be used to kill oneself or others. The bizarre plot to kill the Prime Minister, Lloyd George, during the First World War is described. Fortunately this nefarious plan was thwarted by the Secret Service!
Effectiveness and safety of blood transfusion: have we lost the plot?
Authors: McClelland DBL , Contreras M
Published: January 2025

Blood safety is a high priority. As a result of many additional safety measures the risks of transmitting known infective agents is remarkably low. However, some blood safety measures are quite remarkably expensive by any conventional health economic standards. It is therefore surprising that much of our current blood prescribing is not founded on any reliable evidence. We question the logic of spending even more on safety measures that offer marginal benefits unless we also invest more to understand rather better when, and for who, transfusion is really beneficial. On 1 March 2005, the Royal College of Physicians of Edinburgh is holding a one-day meeting to investigate this balance of priorities. See www.rcpe.ac.uk/events/transfusion.html
Helicobacter pylori: causation and treatment
Authors: Luman W
Published: January 2025

Helicobacter pylori is strongly associated with chronic active gastritis, peptic ulcer disease, and gastric carcinoma. Understanding the mode of transmission of H. pylori is essential to limit its spread and serious associated diseases. Most infections are acquired in childhood and some risk factors associated with childhood infection include poor sanitation, overcrowding, bed sharing, and lower socio-economic status. The theory of direct person-to-person spread is now generally accepted, but the route of transmission remains open to conjecture. The evidence linking H. pylori with peptic ulcer disease and low-grade MALToma is extremely strong. However, the association with gastro-oesophageal reflux disease, non-ulcer dyspepsia and its synergism with NSAIDs in the causation of ulcers remains controversial. The infection can be diagnosed by invasive (endoscopic) and non-invasive testing. Current therapy is highly effective in eradicating the organism.
Herbal medicines and the EU Directive
Authors: Dawson W
Published: January 2025

On 22 December, Lord Warner, the Health Minister, announced a number of new measures to regulate complimentary medicine in response to report of a House of Lords Select Committee and a DoH Consultation Document published in 2003. Although the final paper, describing the way in which the government proposes to regulate herbal medicines and complementary healthcare professionals, has yet to be published, the DoH has announced that it will make £900,000 available to The Prince of Wales's Foundation for Integrated Health over the next three years to develop robust systems for the regulation of the main complementary healthcare professionals. A new Herbal Medicines Advisory Committee will be set up to advise the Medicines and Healthcare Products Agency on the safety and quality of herbal medicines. The present Advisory Board on the Registration of Homeopathic Products will retain its status as a free-standing committee, able to advise the government directly. This paper reflects on current attitudes and legislation in the herbal arena.
The Profession and the GMC after Dame Janet Smith’s conclusions from the Shipman Enquiry: The personal view of a Fitness to Practice panellist
Authors: Smith RH
Published: January 2025

The GMC has come under harsh criticism after as series of highly public cases of failing doctors or medical systems and culminating in the Shipman Enquiry. As a result the GMC has undergone fundamental reform seperating the elected policy-makers from the process of adjudication. The procedures of adjudication are not widely appreciated and so are broadly described and an argument is made in defence of the reformed procedures. Caution is advised in judging the profession too harshly and bringing even more pressure on a hard pressed and still highly respected group of people, at least by their patients.
Rounded atelectasis mimicking a lung cancer
Authors: Medford ARL , Darby M , Maskell NA
Published: January 2025

This short report illustrates a case of a 70-year-old ex-smoker who worked with asbestos presenting with an abnormal chest x-ray suspicious for lung cancer on initial appearance. However, subsequent investigations confirmed RA, a well recognised pleural condition associated with asbestos. The historical background of RA, its pathogenesis and imaging characteristics are reviewed. Rounded atelectasis remains an important differential diagnosis to consider in asbestos-exposed individuals with an abnormal chest x-ray. Correct diagnosis has important implications for management and avoidance of unnecessary surgical staging and treatment for presumed lung cancer.
Dangerous dissections: the hazard from bodies supplied to Edinburgh anatomists, winter session, 1848-9
Authors: Kaufman MH
Published: January 2025

After the 1832 Anatomy Act, all bodies that were to be used by medical students for dissection were supplied to Schools of Anatomy based on their needs. During the Winter Session of 1848–9, a high proportion of the bodies supplied to the University of Edinburgh, and the majority of those supplied to the Argyle Square School had died of an infectious disease. Most had died from cholera, while others had died of typhus, tuberculosis or other infectious diseases. These bodies were not embalmed before dissection. Therefore, both medical students and their teachers in Departments of Anatomy, in addition to those in the hospitals in which they had died, would have been at risk of becoming infected or even dying as a consequence of exposure to these infected individuals.
Womb flu link to schizophrenia
Authors: MacIntyre DJ , Blackwood D
Published: January 2025

Schizophrenia is a distressing and disabling condition, affecting about 1% of the population worldwide. It is caused by an interaction of genetic and environmental factors which can have their effect in utero and throughout development. Investigation of in utero risk factors for schizophrenia is fraught with methodological difficulties. Recent news reports highlighted work, by Columbia University, which overcomes some of these problems. Dr Brown and colleagues have shown, in line with previous investigations, that maternal influenza infection leads to a modest increase in the risk of developing schizophrenia. The mechanism of this action is unknown, but it is probably indirect. It is too early to make public health policy recommendations regarding flu vaccination.
Therapeutic challenges for 2005
Authors: Patterson D
Published: January 2025

This well attended symposium, co-ordinated by Professor T Macdonald (University of Dundee), brought together leaders in Therapeutics from both the UK and USA. The ‘Cox-2 saga’ was the focal point of the day with presentations by Dr G Fitzgerald and Professor P Dieppe highlighting the issue and producing some lively and engaging debate.
Epilepsy in pregnancy
Authors: Pirie AM
Published: January 2025

Epilepsy is a domestically intrusive disease which is socially concealed, affects all social classes and ethnic groups, and is common in women of childbearing age. Excellence in care during pregnancy produces significant benefits for these mothers and their families. There were 13 maternal deaths due to suboptimal management of epilepsy in pregnancy in the latest report of the Confidential Enquiry into Maternal Deaths in the UK (see Why Mothers Die by James Drife; http://www.rcpe.ac.uk/fellows/CME/maternal/drife/drife_1.html). One additional death was classified as a head injury but occurred following a seizure.

Correct diagnosis, classification and investigation of epilepsy, contraception advice, preconceptual counselling, use of safest monotherapy, close monitoring of drug side-effects and efficacy in pregnancy, screening for fetal anomalies, high dose folic acid and vitamin K, seizure prevention in labour, and supportive advice for parenting are the mainstays of good maternal medicine.
Dr Sophia Jex-Blake and the Edinburgh School of Medicine for Women, 1886-1898
Authors: Somerville JM
Published: January 2025

Set in a period when women were finding new avenues for their intellectual abilities, this article gives a short account of the genesis, achievements and collapse of the first Medical School for Women in Scotland, set up by Dr Sophia Jex-Blake
Duodenal tuberculosis: delays and difficulties in diagnosis
Authors: Baqai MT
Published: January 2025

A young man with abdominal pain and vomiting was diagnosed as having tropical sprue when partial villous atrophy was found on duodenal biopsy. After continuing ill-health for a year, tuberculosis was recognised and treated, and he is now well. Tuberculosis and the upper gastrointestinal tract can occur without evidence of TB elsewhere, and the causes of unexplained partial intestinal villous atrophy should include TB, especially in countries where this disease is common.
Before the welfare state: Bastian’s Civil List pension
Authors: Jellinek EH
Published: January 2025

Bastian, an eminent, if controversial, naturalist, pioneer neurologist, and for 30 years, professor at University College, London, ended with a certain income of only £75 in his last year. Sir James Crichton-Browne initiated the grant of a Civil List pension. Prime Minister H Asquith, after consulting the London Royal Society, advised King George V to disburse a pension of £150.
Rural access to healthcare: lessons from down under
Authors: Weller D
Published: January 2025

Access to medical services in rural areas will be an important policy issue for Scotland over the next decade. Lessons can be learned from rural initiatives in other countries;Australia has developed a strategy which takes account of its sparse population, and the many complexities of its health system.
Why mothers die
Authors: Drife J
Published: January 2025

The UK maternal mortality rate is now 13·4 per 100,000 maternities, which is much lower than in the developing world but still too high. For 50 years in England and Wales the CEMD has published triennial reports, and since 1985 the Enquiry has covered the whole of the UK. Its latest report, Why Mothers Die 2000–2002, published in November 2004, includes 106 Direct (due to complications of pregnancy) and 155 Indirect deaths (due to pre-existing conditions made worse by pregnancy).

Since 1997, Indirect deaths (which are rising) have outnumbered Direct deaths, which fell in the 1990s. The leading Direct cause is thromboembolism, which accounted for 30 deaths in 2000–2002, mainly in women with predisposing risk factors such as obesity or thrombophilia. The leading Indirect cause is cardiac disease, which led to 44 deaths, including eight from myocardial infarction and eight from cardiomyopathy. Obese women accounted for 35% of all maternal deaths. The increasing tendency to delay pregnancy means that 18% of births are now to women aged 35 or over. Maternal mortality in the UK is related to social class, with the rate among socially excluded women being 20 times higher than that in social class 1. Women from ethnic minorities have three times the rate of the overall population, and the risk among black African women is increased sevenfold.

When late deaths (up to one year after delivery) are included, the overall leading cause of pregnancy-related death is psychiatric disease, which accounted for 60 deaths in 2000–2002. Suicide due to puerperal psychosis is usually by violent means and shows no social class gradient. The Enquiry also records Coincidental deaths, among which the leading cause is murder. The 11 murders in 2000–2002, all perpetrated by the woman’s partner, highlight the continuing problem of domestic violence.
Relief for the massive earthquake in Pakistan: efforts of local residents should not go to waste
Authors: Tariq SM
Published: January 2025

Large-scale natural disasters are happening frighteningly too often, and global warming has been implicated. The earthquake in the mountainous region of Pakistan on 8 October last year, however, occurred within a known geological earthquake zone. I originate from the earthquake-ravaged region and I kept a log of the updates that I received from my elderly parents living in Abbotabad through weekly telephone calls. The events described below are largely based on that, and recount the sterling effort of the local community of the town of Abbottabad who took the brunt of the immediate relief work for a large devastated and displaced population. The relief and rescue operations will officially come to an end by May 2006. However, the reconstruction work will continue for a long time to come and will require ongoing generous support of the international community.
The use of Transcranial Doppler ultrasonography as a ‘cerebral stethoscope’ for the assessment and treatment of acute stroke
Authors: Syme PD
Published: January 2025

Transcranial Doppler ultrasonography is a safe technique, which allows non-invasive assessment of intracerebral blood flow. This article focuses on the recognition of physiological and pathological TCD waveforms. Transcranial Doppler can be used at the bedside aiding the diagnosis of stroke and complementing other imaging modalities. Due to the discovery of a new TCD finding called small vessel knock,TCD may detect small vessel arterial occlusion when conventional angiography is negative. This review provides evidence that TCD increases recanalization of occluded arteries with and without rtPA and preliminary but exciting evidence that TCD targeting of SVK using ultrasound alone can result in clinical recovery. Three cases are shown recovering on film using this new technique. Further trials are planned in acute stroke and other areas of medicine that may be associated with small vessel occlusion. This could establish TCD as one of the most important techniques used in medicine.
The neurofibromatoses: more than just a medical curiosity
Authors: Huson SM
Published: January 2025

Until modern methods of clinical and scientific research were applied to neurofibromatosis (NF) over the last 30 years, the disease was largely regarded as a medical curiosity. In 1987, a NIH consensus conference agreed a disease classification system and diagnostic criteria for the two main forms. They are defined by the presence/absence of specific nervous system tumours (neurofibromas in NF1, schwannomas in NF2), skin pigmentation, and ophthalmological features. The recognition of the different types is not just an academic exercise (and one geneticists are fond of!), because the natural history and management of each type is distinct.

One important feature in both forms of neurofibromatosis, and indeed in other phakomatoses like tuberous sclerosis, is that the different disease features develop at different ages. For example in NF1, the café-au-lait spots develop during the first two years of life but dermal neurofibromas are unusual before the late teens or early twenties. Despite developments in molecular diagnosis it is probably still more cost effective to refer unusual patients to a specialist clinic prior to testing.
Myotonic dystrophy
Authors: Longman C
Published: January 2025

Myotonic dystrophy is the most common form of muscular dystrophy in adults, with a prevalence of 1 in 8,000. It is a slowly progressive, multi-system disorder that affects skeletal muscles, the heart, gastrointestinal smooth muscle, uterine smooth muscle, the eyes, and the endocrine and central nervous systems. Myotonic dystrophy is almost always caused by an autosomal dominant gene mutation in the DMPK gene located on chromosome 19. The gene mutation is an expansion in the length of a three base-pair (triplet) repeat sequence (cytosine–thymine–guanine, or CTG) above the normal upper limit of 35 repeats. The expanded CTG repeat is classed as a ‘dynamic’ mutation because the number of repeats tends to increase in size over successive generations in myotonic dystrophy families. In general, larger CTG expansions are associated with earlier age-of-onset and more severe signs and symptoms of myotonic dystrophy. Patients with 50–100 CTG repeats may develop cataract, diabetes, grip myotonia, or mild muscle weakness in mid to late adulthood. Patients with 200–500 CTG repeats are affected earlier and more severely by facial and distal limb muscle weakness and myotonia. A CTG repeat size above 1,000 is associated with prenatal onset of disease and congenital myotonic dystrophy, which may be fatal due to respiratory failure. Feeding difficulties, muscle weakness, club foot deformity, and cognitive impairments are present in surviving infants. Although males and females are equally likely to inherit myotonic dystrophy, the very large mutations (>1,000 repeats) which result in the congenital form of myotonic dystrophy are virtually always transmitted by an affected mother. DNA tests are used to estimate repeat size and permit accurate prenatal, presymptomatic, and diagnostic genetic testing.
John Gregory’s medical ethics and the reform of medical practice in eighteenth-century Edinburgh
Authors: McCullough LB
Published: January 2025

John Gregory (1724–73) wrote the first modern, professional medical ethics in the English language, appearing as Lectures on the Duties and Qualifications of a Physician in 1772. This paper examines Gregory’s medical ethics as a blend of modern methods of medical science and ethics with premodern ideas. The paper begins by situating Gregory’s medical ethics in the context of both private medical practice and the care of patients at the Royal Infirmary of Edinburgh, focusing on the crisis of intellectual and moral trust that prompted Gregory to lecture and write on medical ethics. Drawing on the modern methods of Francis Bacon’s philosophy of medicine, and David Hume’s science of morals, Gregory bases his medical ethics on the complementary capacities of openness to conviction and sympathy. His moral exemplars of the virtues of candour, steadiness, and tenderness were women of learning and virtue, reflecting the premodern idea of chivalry in the life of service to the sick.
Sulphur granules and red herrings: difficulties in anaerobic brain abscess diagnosis
Authors: Demetriades AK , Naik S , Liebenberg AW , Donaldson P , Gunasekera L
Published: January 2025

An initially diagnosed actinomycotic brain abscess was reclassified to Campylobacter gracilis. Structural similarities between Gram-positive anaerobes highlight the diagnostic difficulties in identifying brain abscess-causing organisms. Advances in microbial identification have led to new species and genera recognition and reclassification of existing taxa. Awareness of these is necessary in order to understand the role of newly-described/reclassified organisms in disease processes.
Sudden cardiac death
Authors: Jennings K
Published: January 2025

The majority of the approximately 100,000 sudden cardiac deaths each year in the UK are associated with coronary heart disease, but most sudden deaths in those under 30 years of age are caused by inherited cardiomyopathies and arrhythmias. In those aged 16–64 years, a coroner's post mortem examination is unable to identify a structural cardiac abnormality in 4·0%. The cause of death is therefore uncertain. These deaths are termed ‘sudden arrhythmic death syndrome’ or ‘sudden unexpected death syndrome’.
Device therapy
Authors: Grubb N
Published: January 2025

‘Device therapy’ refers to the use of implantable electronic devices to improve cardiac rhythm and function. Permanent pacemakers, initially developed in the 1960s to prevent bradycardia in patients with sinus node disease and atrioventricular block, represented the first wave of implantable devices that transformed cardiology practice. These devices are now commonplace, and advances in microprocessor and battery cell technology mean that pacemakers are small and highly programmable to patients’ individual requirements. Since then, this same technological revolution has led to the development of other implantable devices used in the treatment of patients with life-threatening ventricular tachyarrhythmias and with heart failure. The main focus of this article will be on these new advances in device therapy
Mukden Medical College (1911–1949): an outpost of Edinburgh medicine in northeast China. Part 2: 1918–1949: expansion, occupation, liberation and merger
Authors: Crawford DS
Published: January 2025

Scottish physician Dugald Christie commenced practice in the city of Mukden (Shenyang) in Manchuria in 1883. In 1911, he founded the Mukden Medical College, the first Western medical school in Manchuria. Edinburghtrained physicians and surgeons largely staffed the college and in 1934 it became the first foreign university to have its medical degree recognised by the University of Edinburgh. It was merged into the China Medical University (Zhongguo yi ke da xue) in 1949. During its separate existence the Mukden Medical College brought modern medicine and medical education to northeastern China, and its legacy continues to influence both medical practice and medical education in China.
Clostridium difficile-associated disease – an increasing burden
Authors: Poxton IR
Published: January 2025

Although Clostridium difficile has been recognised as the cause of antibiotic-associated PMC and diarrhoea for almost 30 years, especially in elderly patients undergoing antibiotic treatment, it is only recently that it has been acknowledged as a major hospital pathogen. It is usually acquired exogenously – in the form of resistant spores – from the contaminated hospital environment, after the normal colonisation resistance afforded by the normal colonic microflora has been disturbed. Production of at least one of two toxins causes damage to the colon wall and subsequent symptoms. Recent recognition of a hyper-virulent type that produces enhanced levels of toxins and is resistant to fluoroquinolone antibiotics is causing outbreaks of serious disease in North America and several European countries – but not yet in Scotland. Current treatment is with metronidazole or vancomycin but relapse is common. Removal of the spores – which are resistant to alcohol and most disinfectants – is crucial to controlling infection.
Acute diarrhoea and fever
Authors: Dundas S , Todd WTA
Published: January 2025

Although infectious agents remain the most common causes of acute diarrhoea and fever amongst otherwise healthy adults, their true incidence remains considerably underestimated and the epidemiology is changing. Campylobacter species are now the most frequently isolated organisms to cause sporadic infective gastroenteritis in the UK. Norovirus infections have increased in importance over the last decade whilst Salmonella infections have declined. Escherischia coli O157 infection has attracted significant media interest but remains a rare, if serious, cause of illness. A clear history and targeted investigations will help to identify the causative organism. Negative stool cultures are relevant and should lead to consideration of alternative diagnoses. Management involves careful infection control, appropriate fluid replacement, and the avoidance of antibiotic therapy except in specific circumstances. The significant likelihood of alternative, non-infectious causes of acute diarrhoeal illness must be considered, particularly in the elderly.
Edinburgh and its role in the foundation of Sydney Medical School
Authors: Smith J Walker
Published: January 2025

In 1882, Thomas Anderson Stuart (1856–1920) was appointed as Foundation Professor of Physiology and Anatomy at the University of Sydney. At the time he was Assistant-Professor of Physiology in the University of Edinburgh. He initiated the building of the Sydney Medical School in Scottish Tudor Gothic style. He attracted notable figures to Sydney Medical School, such as Dr Robert Scot Skirving.

The original medical school (now the Anderson Stuart Building) continues today as the pre-clinical medical school of the University of Sydney. Its stained glass windows and many busts of distinguished figures in the history of medicine are a constant reminder of the history of medicine. The building with its gothic architecture and echoes of northern Britain has given generations of Sydney medical students a powerful message, that they were part of an ancient and noble profession.

The recruitment of Edinburgh academics to Sydney ended with Professor CG Lambie who retired in 1956. The 1950s were a watershed between the Edinburgh heritage and the Australian future.
Solanaceae III: henbane, hags and Hawley Harvey Crippen
Authors: Lee MR
Published: January 2025

Hyoscyamus, the henbane, is one of the drugs of the ancients. Initially used both as a poison and narcotic, it was widely adopted by witches, wizards and soothsayers as a component of their hallucinatory and flying ointments. It was also used by notorious poisoners such as Madame Voisin in France. Eventually, in the nineteenth century its active principle was isolated by Ladenburg and called lhyoscine. It proved to be a tropane alkaloid very similar to atropine. These two alkaloids proved to be very important in the study of the parasympathetic component of the autonomic nervous system, and together with physostigmine, allowed the major neurotransmitter acetylcholine to be isolated and its mechanisms of action to be characterised. The Crippen murder case in 1910 gave hyoscine further fame, indeed, notoriety. The unassuming homeopathic doctor murdered his wife with the alkaloid and then decamped for Canada with his mistress Ethel Le Neve. The case became a worldwide sensation for several reasons: the arrest of the fugitive couple by wireless telegraphy (Marconigram) and the extensive chemical and histological evidence presented by Willcox and Spilsbury. Some authorities claim that this was the beginning of the science of forensic medicine in Britain. Hyoscine is now hardly ever used in modern therapeutics but its history from antiquity to the witches and on to Dr Crippen is both bizarre and fascinating.
Neurological infections
Authors: Da JN , Farrar JJ
Published: January 2025

Neurological infections are a significant cause of morbidity and mortality worldwide. Increasing travel to exotic destinations and the rising HIV prevalence are resulting in increasing incidences of previously rare diseases. Timely treatment is key in determining a successful outcome. This depends upon taking a meticulous history that details the timing and presence of risks and exposures, which, with knowledge of incubation periods, enables generation of a differential diagnosis leading to focused investigations. Recent trials have generated good evidence to improve outcome in important infections: for example, artesunate has been shown to be the best drug to use in severe malaria, and the value of adjunctive steroids in pyogenic bacterial and TBM has been clearly demonstrated. However, evidence is lacking on the best treatment for other infections. The rising incidence of syphilis in the UK in the last few years has posed difficult questions regarding antibiotic choices, since good clinical data do not exist; randomised controlled trials are urgently needed. In HIV, the advent of HAART has reduced the incidence of opportunistic infections in those fortunate enough to receive it. However, central nervous system infections continue to account for considerable morbidity and mortality in these patients around the world and in patients presenting with AIDS in the UK.
Your patient has a blood culture positive for Staphylococcus aureus – what do you do?
Authors: Marwick CA , Ziglam HM , Nathwani D
Published: January 2025

Staphylococcus aureus bacteraemia is an important clinical problem associated with a high mortality rate and a significant burden on healthcare resources. The severity, rate of complications, and prognosis of the infection depend on a multitude of factors including underlying patient factors, the virulence of the strain of S. aureus, and the timeliness of appropriate antibiotic therapy.

Detection of staphylococci in blood culture should trigger a chain of events beginning with assessment of the patient to determine signs of sepsis and the likely significance of the organism isolated. The level of risk of your patient having MRSA must be assessed. A deep-seated source, or metastatic complication, of the bacteraemia must be suspected and sought, with the most important complication being endocarditis. This assessment should not delay urgent treatment with IV antibiotic therapy in a patient with signs of sepsis. Treatment should be guided by local antibiotic policy alongside advice from microbiology and/or infectious diseases consultants.

This overview takes the form of a clinical case scenario with a step-wise approach to the management of a patient from first isolation of staphylococci in a blood culture to the management of MRSA endocarditis.
James Watson, MD, LRCSE – an Edinburghtrained physician and surgeon in northeastern China 1865–1884
Authors: Crawford DS
Published: January 2025

Much has been written about medical missionaries in China, but not much has been published about other Western doctors who practised there in the nineteenth century. James Watson of the Imperial Chinese Maritime Customs Service, the first Western doctor to practice in northeastern China, was an Edinburgh medical graduate and served in Newchwang, from 1865–1884. He then returned to practice in Britain, where he died in 1926.
An unusual cause of abnormal liver function test: hepatic amyloidosis
Authors: Bhat S , Koulaouzidis A , Pattenshetty D , Linaker B
Published: January 2025

We describe a case of systemic amyloidosis predominantly involving the liver. The patient presented with non-specific symptoms and deranged LFTs. Liver biopsy revealed characteristic findings of amyloidosis. The patient was treated with combination therapy and continues to have a good clinical response at four months’ follow-up. We briefly discuss the classification, presentation and management of amyloidosis.
Acute ischaemic stroke
Authors: Jarrett D
Published: January 2025

Stroke is the third most common cause of death worldwide. About 80% of strokes are ischaemic. The only reliable way of distinguishing cerebral infarction from haemorrhage is with neuroimaging, most commonly CT scanning in the UK. The last decade has produced a number of RCTs clarifying former areas of management uncertainty. Three interventions have been shown to be beneficial in acute stroke: admission to a stroke unit; early aspirin; and intravenous thrombolysis. Aspirin and stroke service admission should be available to all patients, thrombolysis is of benefit to a select minority of patients. Accurate diagnosis, investigation, and management of physiological variables such as BP, temperature, glycaemia, and oxygen saturation should improve outcome. Multiprofessional guidelines exist and, when used with education, audit, and other areas of clinical governance, improve the basic standards of care. The National Sentinel Audits of Stroke have repeatedly shown that care is suboptimal. Secondary prevention with anti-platelet drugs (or warfarin in the case of atrial fibrillation), statins, and antihypertensive drugs, reduce recurrent strokes and other vascular events. Patients with 70–99% stenosis of the ipsilateral carotid bulb or internal carotid artery may benefit from early carotid endarterectomy.
A case of chronic eosinophilic pneumonia
Authors: Gallipoli P , Leach M
Published: January 2025

We describe the case of a 58-year-old man who presented with a fourweek history of general malaise, sweats, weight loss and dyspnoea together with pulmonary infiltrates on CXR and a peripheral blood eosinophilia. A clinical diagnosis of CEP was made. He was treated with oral steroids with rapid clinical improvement together with resolution of X-ray changes and blood eosinophilia. The clinical presentation, differential diagnosis, radiology, treatment and prognosis of CEP are discussed.
NICE guidelines and the length of inpatient stay for tuberculosis
Authors: Ward CC , Aliyu SH , Gillham M , Lever AML
Published: January 2025

In response to recently published NICE guidelines on the management of patients with MTB, we conducted a retrospective study of adult patients admitted to a large teaching hospital with a confirmed diagnosis of MTB between January 2000 and December 2005. Fifty-five patients had pulmonary infection, of whom 49 remained in negative pressure rooms throughout admission and 21 had sputum microscopy positive for acid-fast bacilli. The mean time taken to return smear results was 26 hours, cultures 36·8 days and susceptibility testing 64·0 days. The mean length of stay for MDR-TB patients was 83·5 days compared with 39·9 days for non-MDR-TB patients. HIV-positive patients did not have prolonged admissions whereas solid organ transplant recipients did (p<0·0001). The use of automated liquid culture (51%) and rpoB gene (42%) and HIV testing (43%) fell short of suggested standards yet this did not affect length of stay. The study reflected rising numbers of cases of TB nationally with implications for provision of negative pressure facilities.