bluuebunny/crossref_metadata_2025 huggingface dataset:
Modeling alternative future scenarios for direct application in land use and conservation planning
Authors: Lacher Iara , Fergus Craig , McShea William J. , Plisinski Joshua , Morreale Luca , Akre Thomas S.
Published: April 2023

Land use is one of the largest threats to biodiversity, ecosystem function, and ecosystem services. These losses can be mitigated through strategic land use planning efforts that balance the social, economic, and environmental needs of society and the ecosystems that support it. A crucial component in the development of strategic plans is a concrete understanding of land use change and the impacts and influence of it on the landscape. Land change models are one method for quantifying the effect of these relationships and projecting the resulting changes on landscapes of the future. However, in order for the resulting model products to be useful to planners, policy makers, and conservationists, they must be focused on addressing questions of relevance to the community they intend to serve. Scenario planning offers a framework for integrating community‐developed visions of the future with land change models in order to increase relevancy and uptake of products. We developed a land change model for five future scenarios of land use change in northwestern Virginia, integrating regional stakeholder knowledge throughout the process. Across scenarios, we found consistent increases in development across our study area, but the form and configuration of land use types varied sub‐regionally. This manuscript describes not only our results, but the process of integrating stakeholder input throughout. We describe our model outputs in the context of usefulness for planners, policy makers, and conservation decision makers, often through the lens of the importance of geographic scale. This work serves as an additional example of land use modeling across scenarios. We conclude with guidance for scientists interested in integrating similar approaches in their work.
A linked physiologically based pharmacokinetic model for hydroxychloroquine and metabolite desethylhydroxychloroquine in SARS‐CoV‐2(−)/(+) populations
Authors: Steinbronn Claire , Chhonker Yashpal S. , Stewart Jenell , Leingang Hannah , Heller Kate B. , Krows Meighan L. , Paasche‐Orlow Michael , Bershteyn Anna , Stankiewicz Karita Helen C. , Agrawal Vaidehi , Laufer Miriam , Landovitz Raphael , Wener Mark , Murry Daryl J. , Johnston Christine , Barnabas Ruanne V. , Arnold Samuel L. M.
Published: April 2023

Hydroxychloroquine (HCQ) is Food and Drug Administration (FDA)‐approved for malaria, systemic and chronic discoid lupus erythematosus, and rheumatoid arthritis. Because HCQ has a proposed multimodal mechanism of action and a well‐established safety profile, it is often investigated as a repurposed therapeutic for a range of indications. There is a large degree of uncertainty in HCQ pharmacokinetic (PK) parameters which complicates dose selection when investigating its use in new disease states. Complications with HCQ dose selection emerged as multiple clinical trials investigated HCQ as a potential therapeutic in the early stages of the COVID‐19 pandemic. In addition to uncertainty in baseline HCQ PK parameters, it was not clear if disease‐related consequences of SARS‐CoV‐2 infection/COVID‐19 would be expected to impact the PK of HCQ and its primary metabolite desethylhydroxychloroquine (DHCQ). To address the question whether SARS‐CoV‐2 infection/COVID‐19 impacted HCQ and DHCQ PK, dried blood spot samples were collected from SARS‐CoV‐2(−)/(+) participants administered HCQ. When a previously published physiologically based pharmacokinetic (PBPK) model was used to fit the data, the variability in exposure of HCQ and DHCQ was not adequately captured and DHCQ concentrations were overestimated. Improvements to the previous PBPK model were made by incorporating the known range of blood to plasma concentration ratios (B/P) for each compound, adjusting HCQ and DHCQ distribution settings, and optimizing DHCQ clearance. The final PBPK model adequately captured the HCQ and DHCQ concentrations observed in SARS‐CoV‐2(−)/(+)participants, and incorporating COVID‐19‐associated changes in cytochrome P450 activity did not further improve model performance for the SARS‐CoV‐2(+) population.
Impact of a virtual prosthetic case planning environment on perceived immersion, cognitive load, authenticity and learning motivation in dental students
Authors: Liebermann Anja , Lente Isabel , Huth Karin Christine , Erdelt Kurt
Published: April 2023

Introduction

The application of virtual reality (VR) presents a big trend in medical education. The aim of this investigation was the presentation and assessment of a multi‐user virtual prosthetic case planning environment using criteria such as perceived immersion, cognitive load, authenticity and students´ learning motivation during a virtual seminar.

Materials and Methods

The virtual case planning environment consisted of two different virtual environments – the entrance area and the case planning environment. Students and lecturers visited it with the used VR glasses Oculus Quest 2 (Meta Quest). All participants appeared as tooth avatars (molars) during the prosthetic case planning seminar and were able to communicate. These voluntary virtual case planning seminars took place in the clinical prosthetic courses (4th and 5th year). Students were asked to fill in the questionnaire comprising 15 questions separated into four categories, each assessed by a 11‐point Likert scale: perceived presence/immersion, cognitive load, motivation and authenticity. A negative and a positive focus group were built, each consisting of three students answering three guiding questions. An exploratory data analysis was performed with the significance level set at p = .05.

Results

A total of 64 students out of 98 participated in the virtual seminars. The results demonstrated that the students felt very comfortable in the virtual seminar environment and were able to focus well on the content, demonstrated in predominantly positive results for presence/immersion. Cognitive load and authenticity presented positive results. In particular, the motivation of the students showed a high score (median: 2.1–2.6; IQR: 3.9). The cognitive load should be reduced if necessary to increase focus. The cyber sickness is a challenge for some students as well as the technical requirements of the internet connection, which needs to be addressed. Nevertheless, virtual case planning seminars are an essential tool for motivating the new generation of students.

Conclusions

The results of the investigation demonstrate that the students felt very comfortable in the virtual seminar environment and were able to focus well on the content. The prosthetic case plannings were well understood and the students quickly become familiar with the environment. The cognitive load could be reduced to increase focus. In particular, the motivation of the students showed a high score. The cyber sickness is a challenge for some students as well as the technical requirements of the internet connection, which needs to be addressed.
Correlation between attitude towards dental care for older adults and ageism in dental students and clinical trainees: Cross‐sectional study
Authors: Izumi Maya , Fujii Wataru , Akifusa Sumio
Published: April 2023

Introduction

Since the needs for dental care among older adults in Japan are expected to increase in the future, this study aimed to examine the influence of ageism among dental students and clinical trainees on the attitude towards the older adults in dental care.

Materials and Methods

In 2022, we conducted a questionnaire survey of 9th‐, 11th‐semester dental students and first‐year clinical trainees enrolled at Kyushu Dental University, using the Japanese version of Ageism Scale for Dental Students (ASDS‐J), Japanese version of Fraboni Scale of Ageism (FSA‐J). Questions on intention to provide dental care to the older adults, relationships with the older adults and living with the older adults were also surveyed.

Results

There were 162 participants (84 males and 78 females), and the response rate was 71.7%. The participants were divided into the positive group for dental care to older adults (68 respondents) and the negative group (94 respondents). The ASDS‐J score of the negative group was significantly higher than that of the positive group [49 (36–66) vs. 52 (34–88), p < .001]. The binomial logistic regression analysis revealed that the odds ratio of being negative attitude was 1.1 per one point of ASDS‐J (95% confidence interval: 1.0–1.2) in the model adjusted for student grade, interaction with the older adults, gender, experience living with the older adults and FSA‐J.

Conclusion

These findings suggest that ageism specific to dental students and clinical trainees (as assessed using the ASDS‐J) was independently correlated with negative attitudes towards dental care for older adults.
Age‐related changes in sensory and motor components of the Hoffmann‐reflex pathway of the flexor carpi radialis
Authors: Henry Mélanie , Duchateau Jacques , Baudry Stéphane
Published: April 2023

Ageing is accompanied by numerous changes within the sensory and motor components of the muscle spindle pathway. To further document these age‐related changes, this study compared the characteristics of the Hoffmann (H) reflex and M wave, evoked with several pulse durations, between young and old adults. The H‐reflex and M‐wave recruitment curves were recorded at rest in the flexor carpi radialis of 12 young (21–36 years) and 12 older adults (62–80 years). For each pulse duration (0.05, 0.2 and 1 ms), the maximal M‐wave (MMAX) and H‐reflex (HMAX) amplitude, the M‐wave amplitude associated with HMAX (MHmax) and the H‐reflex amplitude for a stimulus intensity evoking an M‐wave of 5% MMAX (HM5%) were measured. The strength‐duration time constant and response threshold were estimated from the charge/stimulus‐duration relation for the H reflex and M wave. Results indicate that varying pulse duration mainly induces a similar effect on H‐reflex and M‐wave recruitment curves between young and older adults. Regardless of pulse duration, old adults had lesser HMAX (p = 0.029) and HM5% (p < 0.001) but greater MHmax (p < 0.001). The H‐reflex and M‐wave response thresholds were greater in old than young adults (p = 0.003), but the strength‐duration time constant was lesser in old than young adults for the H reflex (p = 0.048) but not the M wave (p = 0.21). These results suggest greater age‐related changes in the sensory than the motor component of the H‐reflex pathway, which may be indicative of a greater loss of sensory than motor axons or alterations of synapses between Ia afferents and motor neurones.
Interpretable spectroscopic modelling of soil with machine learning
Authors: Wadoux Alexandre M. J.‐C.
Published: April 2023

Spectroscopic modelling of soil has advanced greatly with the development of large spectral libraries, computational resources and statistical modelling. The use of complex statistical and algorithmic tools from the field of machine learning has become popular for predicting properties from their visible, near‐ and mid‐infrared spectra. Many users, however, find it difficult to trust the predictions made with machine learning. We lack interpretation and understanding of how the predictions were made, so that these models are often referred to as black boxes. In this study, I report on the development and application of a model‐independent method for interpreting complex machine learning spectroscopic models. The method relies on Shapley values, a statistical approach originally developed in coalitional game theory. In a case study for predicting the total organic carbon from a large European mid‐infrared spectroscopic database, I fitted a random forest machine learning model and showed how Shapley values can help us understand (i) the average contribution of individual wavenumbers, (ii) the contribution of the spectrum‐specific wavenumbers, and (iii) the average contribution of groups of spectra taken together with similar characteristics. The results show that Shapley values revealed more insights than commonly used interpretation methods based on the variable importance. The most striking spectral regions identified as important contributors to the prediction corresponded to the molecular vibration of organic and inorganic compounds that are known to relate to organic carbon. Shapley values are a useful methodological development that will yield a better understanding and trust of complex machine learning and algorithmic tool in soil spectroscopy research.
Cytoplasmic localization of Mdm2 in cells expressing mutated NPM is mediated by p53
Authors: Strachotová Dita , Holoubek Aleš , Wolfová Kateřina , Brodská Barbora , Heřman Petr
Published: April 2023

Specific C‐terminal nucleophosmin (NPM) mutations are related to the acute myeloid leukaemia and cause mistargeting of mutated NPM (NPMmut) to the cytoplasm. Consequently, multiple NPM‐interacting partners, e.g., the tumour suppressor p53, become also mislocalized. We found that ubiquitin ligase Mdm2 mislocalizes to the cytoplasm in the presence of NPMmut as well. Since p53 interacts with Mdm2, we searched for the NPMmut‐p53‐Mdm2 complex and interactions of its constituents in live cells and cell lysates using fluorescently tagged proteins, fluorescence lifetime imaging and immunoprecipitation. We proved existence of the ternary complex, which likely adopts a chain‐like configuration. Interaction between Mdm2 and NPMmut was not detected, even under conditions of upregulated Mdm2 and p53 induced by Actinomycin D. We assume that p53 serves in the complex as a bridging link between Mdm2 and NPMmut. This conclusion was supported by disruption of the Mdm2–p53 interaction by Nutlin‐3A, which resulted in relocalization of Mdm2 to the nucleus, while both NPMmut and p53 remained in the cytoplasm. Importantly, silencing of p53 also prevented mislocalization of Mdm2 in the presence of NPMmut.
The toxicity of dysregulated Plk1 activity revealed by its suppressor mutations
Authors: Kamakura Nana , Takahashi Motoko , Jo Minji
Published: April 2023

Polo‐like kinase 1 (Plk1) is a mitotic kinase that has multiple functions throughout the cell cycle. Catalytic activation of Plk1 is known to be regulated by phosphorylation of the kinase domain, including Thr210, and by releasing the kinase domain from its inhibitory polo‐box domain. However, how Plk1 is activated to fulfill its proper roles, in time and space, is not well understood. In this study, we unintentionally found that the expression of a constitutively active form of human Plk1 is toxic to bacterial cells, such that cells contained point mutations that alleviate the kinase activity. Structural prediction revealed that these mutations are adjacent to the amino acids supporting the kinase activity. When human cells express these mutants, we found decreased levels of Plk1's substrate phosphorylation, resulting in mitotic defects. Moreover, unlike in bacterial cells, the expression of activated Plk1 mutants did not affect cell proliferation in human cells unless localized at the right place in mitosis. Our observations identified new suppressor mutations and underscored the importance of spatiotemporal regulation in Plk1, providing a basis for how we might intervene in this kinase for therapeutic purpose in human cells.
Lean nonalcoholic fatty liver disease: Age‐dependent differences in pathology, prognosis, and liver‐related events
Authors: Kawanaka Miwa , Nishino Ken , Kawada Mayuko , Ishii Katsunori , Tanikawa Tomohiro , Katsumata Ryo , Urata Noriyo , Nakamura Jun , Suehiro Mitsuhiko , Haruma Ken , Kawamoto Hirofumi
Published: April 2023

Aim

This study aimed to evaluate the age‐specific characteristics, prognosis, and complications of patients with lean nonalcoholic fatty liver disease (NAFLD).

Methods

Background factors (age, sex, diabetes, dyslipidemia, hypertension, and PNPLA3 gene polymorphism), blood test results, liver histology findings, muscle mass, and grip strength were investigated in 782 patients with NAFLD who underwent liver biopsy. Prognosis and complications were compared among 549 patients with nonlean or lean NAFLD who were followed up for 6.5 years. Additionally, background factors, blood test results, liver histology findings, prognosis, and complications were compared according to age (≥60 years vs. <60 years) in patients with lean NAFLD.

Results

Lean NAFLD patients showed lower aspartate aminotransferase, alanine aminotransferase, homeostasis model assessment–insulin resistance, high‐sensitivity C‐reactive protein, ferritin, and leptin but higher adiponectin and hemoglobin A1c (HbA1c) levels than patients with nonlean NAFLD. Furthermore, lean NAFLD patients showed less liver fibrosis, inflammation, steatosis, and ballooning. Among lean NAFLD patients, those aged 60 years and older were more frequently female, showed higher rates of hypertension, diabetes, and dyslipidemia, had higher HbA1c and type IV collagen 7S levels, lower platelet count, higher liver fibrosis and inflammation grades, and lower muscle mass and grip strength. Lean NAFLD was associated with a worse prognosis in patients aged 60 years and over than in those younger than 60 years of age and with a higher incidence of liver‐related disease, cerebrocardiovascular events, and nonliver cancer.

Conclusions

Age is an important consideration in patients with lean NAFLD. Compared with nonlean NAFLD, lean NAFLD was associated with a worse prognosis and higher risk of complications in patients aged 60 years and older.
Extrusion or alkaline hydrogen peroxide prior to enzymatic hydrolysis by a carbohydrase mixture improves techno‐functional properties of okara
Authors: Yoshida Bruna Yumi , da Silva Paulo Rogério Catarini , Prudencio Sandra Helena
Published: April 2023

Okara is a soyfood processing by‐product with high level of insoluble dietary fibres. It is often underutilised due to undesirable effects on food texture. To improve hydration properties and increase soluble fibre, okara was treated by extrusion (ET) or alkaline hydrogen peroxide (AHP) and then, each modified sample was hydrolysed by a carbohydrase mixture (EH). Other physical, chemical, and techno‐functional properties were studied. ET + EH increased low‐molecular‐weight fibres and oil absorption and holding capacity and reduced water absorption and holding capacity. AHP + EH increased soluble fibres, sugars, water absorption and holding capacity, swelling capacity, and protein solubility in water and decreased oil absorption and holding capacity and solids stability in water. Both changed microstructure, cellulose crystallinity, and colour. This study provided new insights into the transformation of okara residue into a value‐added ingredient.
ALKBH8 as a potential N6‐methyladenosine (m6A) eraser in insects
Authors: Dai Zhenkai , Asgari Sassan
Published: April 2023

The N6‐methyladenosine (m6A) machinery functions through three groups of proteins in eukaryotic cells, including m6A writers, erasers and readers. The m6A cellular machinery has mostly been characterised in mammalian species, and the relevant literature on insects is currently scant. While homologues of m6A writers and readers have been reported from insects, no erasers have been described so far. Here, using BLAST search, we searched for potential erasers in insects. While we found homologues of human m6A eraser ALKBH5 in termites, beetles and true bugs, they could not be found in representative dipteran and lepidopteran species. However, a potential m6A eraser, ALKBH8, was identified and experimentally investigated. Our results showed that ALKBH8 can reduce the m6A levels of Aedes aegypti and Drosophila melanogaster RNAs, suggesting that AeALKBH8 could be a candidate m6A eraser in insects.
Genome sequencing provides insights into the evolution of gene families encoding plant cell wall‐degrading enzymes in longhorned beetles
Authors: Shin Na Ra , Okamura Yu , Kirsch Roy , Pauchet Yannick
Published: April 2023

With more than 36,000 species, the longhorned beetles (family Cerambycidae) are a mega‐diverse lineage of mostly xylophagous insects, all of which are represented by the sole sequenced genome of the Asian longhorned beetle (Anoplophora glabripennis; Lamiinae). Their successful radiation has been linked to their ability to degrade plant cell wall components using a range of so‐called plant cell wall‐degrading enzymes (PCWDEs). Our previous analysis of larval gut transcriptomes demonstrated that cerambycid beetles horizontally acquired genes encoding PCWDEs from various microbial donors; these genes evolved through multiple duplication events to form gene families. To gain further insights into the evolution of these gene families during the Cerambycidae radiation, we assembled draft genomes for four beetle species belonging to three subfamilies using long‐read nanopore sequencing. All the PCWDE‐encoding genes we annotated from the corresponding larval gut transcriptomes were present in these draft genomes. We confirmed that the newly discovered horizontally acquired glycoside hydrolase family 7 (GH7), subfamily 26 of GH43 (GH43_26), and GH53 (all of which are absent from the A. glabripennis genome) were indeed encoded by these beetles' genome. Most of the PCWDE‐encoding genes of bacterial origin gained introns after their transfer into the beetle genome. Altogether, we show that draft genome assemblies generated from nanopore long‐reads offer meaningful information to the study of the evolution of gene families in insects. We anticipate that our data will support studies aiming to better understand the biology of the Cerambycidae and other beetles in general.
Effects of vitamin C combined with rbFGF on inflammatory factors and oxygen environment in patients with high‐voltage electrical burns
Authors: Zhang Han , Qin Beibei , Zhao Yankai , Zhang Rongpin , Zhang Guihua
Published: April 2023

To investigate the effect of vitamin C combined with recombinant basic fibroblast growth factor (rbFGF) on inflammatory factors and oxygen environment in patients with high‐voltage electrical burns. A retrospective analysis of 98 patients with high‐voltage electrical burns admitted to our hospital from January 2021 to April 2022. A total of 98 patients were divided into research group and control group, including 49 cases treated with vitamin C combined with rbFGF and 49 cases treated with only rbFGF. The disappearance time of clinical symptoms, wound healing rate, area of granulation tissue growth, level of inflammatory factors, oxygen environment were compared between two groups after one and three courses of treatment. After treatment, the disappearance time of erythema, pain, swelling, blisters, exudate symptoms, wound healing time, scab formation time, and hospitalisation time in the research group were significantly better than those in control group (P < .05). There was no significant difference in the wound healing rate and area of granulation tissue growth between the two groups after one course of treatment (P > .05), while it is significantly better than those in control group after three courses of treatment (P < .05). The inflammatory factors, succinate dehydrogenase (SDH), lactate dehydrogenase (LDH) scores in research group were significantly better than that in control group after three courses of treatment (P < .05). Vitamin C combined with rbFGF may be worthy to reduce inflammatory factors, regulate oxygen environment, which can be popularised and applied in clinical practice.
THROAT SWABS IN CHRONIC TONSILLITIS: A TIME‐HONOURED PRACTICE BEST FORGOTTEN
Authors: Robinson AC , Hanif J , Dumbreck LA , Prichard AJ , Manners BT
Published: April 2023

We have estimated that in 1995 more than £2 million was spent by the National Health Service on throat swabs used to investigate chronic tonsillitis in the UK. This study was devised to assess the value of this investigation. The surface microflora, obtained using a throat swab, was compared with the microflora of the deep tonsil in 30 cases of chronic tonsillitis. None of the throat swabs grew pathogenic organisms, while in 16 cases, heavy growths of recognised pathogens were grown from the tonsillar tissue. This paper demonstrates that throat swabs have little value in the management of chronic tonsillitis, and if the investigation was omitted in this condition, a substantial saving could be made.
ROUTINE USE OF ULTRASOUND 24 HOURS BEFORE LAPAROSCOPIC CHOLECYSTECTOMY CAN PREDICT THE NEED FOR INTRAOPERATIVE CHOLANGIOGRAM: RESULTS OF A 12‐MONTH PROSPECTIVE AUDIT
Authors: Goodwin AT , Tully J , Charlesworth C , Swift RI , Chadwick SJD
Published: April 2023

Intraoperative cholangiograms and exploration of the common bile duct (CBD) during laparoscopic cholecystectomy are technically more demanding than during open cholecystectomy. This has led to many surgeons using a selective policy for cholangiography. In this study we prospectively assessed whether biliary ultrasound (CBD diameter ≥6 mm) or one or more abnormal liver function tests (LFTs) performed in the 24 hours preoperatively could predict the need for cholangiography. Forty‐five patients were studied (14 male, 31 female), mean age 47.8 years. All patients with one or both tests abnormal preoperatively (19 patients) underwent intraoperative cholangiograms. Seven CBD stones were identified (16%). There was no evidence of CBD stones in patients not undergoing cholangiography at a median follow‐up of 18 months. In patients with stones, three underwent open CBD exploration, and four underwent endoscopic retrograde choledochopancreatography (ERCP) and sphincterotomy in the early postoperative period without complications. CBD diameter ≥6 mm is a useful predictor of CBD stones. These may be treated successfully by postoperative ERCP.
PROLONGATION OF PROTHROMBIN TIME WITH THE USE OF INDOMETHACIN AND WARFARIN
Authors: Chan TYK
Published: April 2023

A patient with a greatly prolonged international normalised ratio (INR) during the combined use of warfarin and indomethacin is described. In patients on warfarin, non‐steroidal anti‐inflammatory drugs (NSAIDs) should be avoided as far as possible. If NSAIDs are absolutely necessary, patients should be closely monitored for prolongation of INR and bleeding.
MISDIAGNOSES IN A CHINESE NARCOLEPTIC PATIENT WITH DELAYED ONSET OF CATAPLEXY
Authors: Chung WS , Wing YK , Chiu HFK , Lee TS , Chen CN
Published: April 2023

Narcolepsy is a chronic condition that usually afflicts the patient for decades. It is more common than is generally appreciated. However, it is likely to be misdiagnosed because doctors are unfamiliar with some of the symptoms. Its significant socioeconomic impact on the patient's quality of life warrants prompt medical attention.
A RANDOMISED, DOUBLE‐BLIND, PARALLEL‐GROUP COMPARISON OF VENLAFAXINE AND DOTHIEPIN IN GERIATRIC PATIENTS WITH MAJOR DEPRESSION
Authors: Mahapatra SN , Hackett D
Published: April 2023

This randomised, double‐blind study conducted at nine sites in the UK and the Netherlands compared the safety and antidepressant efficacy of venlafaxine and dothiepin. Ninety‐two geriatric patients (aged 64‐87 years) with major depression were randomly assigned to receive either venlafaxine or dothiepin for up to 43 days. The dose of venlafaxine or dothiepin was titrated up to a maximum of 150 mg per day for the first 15 days, and thereafter could range from 50 to 150 mg per day. Adjusted mean scores on the MADRS and the HAM‐D decreased significantly (p 0.05) from baseline to the end of the study in both groups. A response to therapy was observed in 60% of patients in the venlafaxine group and 53% of patients in the dothiepin group on the MADRS, and in 60% of patients in both groups on the HAM‐D. Suicidal ideation scores on the MADRS were significantly (p=0.042) lower in the venlafaxine group at week 6. Treatment‐emergent study events were the primary reason for withdrawal in only 7% of venlafaxine‐treated patients and 8% of dothiepin‐treated patients. The results confirm the efficacy and tolerability of venlafaxine for treating major depression in the elderly.
HELICOBACTER PYLORI ERADICATION ‐ COMPARISON OF THREE DRUG REGIMENS AND SYMPTOMATIC ASSESSMENT IN DUODENITIS AND ANTRAL GASTRITIS
Authors: Tan WC , Hogan J , Purkayastha S Kar , Lombard M , Krasner N
Published: April 2023

Helicobacter pylori (Hp) eradication in peptic ulcer disease is associated with a greatly reduced recurrence rate. The optimal drug regimen for Hp eradication remains uncertain. It is also unclear if eradication of Hp in duodenitis and antral gastritis improves symptoms. The aims of this study were to compare the efficacy of three drug regimens in the eradication of Hp and to assess if Hp eradication improved symptoms in patients with duodenitis and antral gastritis. Patients (n=79) found to have duodenal ulcer, duodenitis and/or antral gastritis with a positive urease test (CLO) at endoscopy were allocated to one of three regimens: A. omeprazole 20 mg b.d. and clarithromycin 500 mg t.d.s. for two weeks (n=27), B. De‐Nol 240 mg b.d. for four weeks, metronidazole 400 mg t.d.s. and amoxicillin 500 mg t.d.s. for one week (n=26), and C. omeprazole 20 mg b.d. and amoxicillin 500 mg t.d.s. for two weeks (n=26). In conclusion, traditional ‘triple’ therapy with bismuth and two antibiotics achieved the highest Hp eradication rate and was best tolerated. Recolonisation with Hp was uncommon after eradication. Dyspeptic symptoms improved with Hp eradication in duodenitis and antral gastritis.
AUDIT OF OXYGEN THERAPY
Authors: Gravil JH , O'Neill VJP , Stevenson RD
Published: April 2023

We audited the use of oxygen in our hospital. Over three days we found 119 patients using oxygen, 21 wearing their mask incorrectly or not at all. The commonest indication was chronic obstructive pulmonary disease. Forty patients had no record of arterial gas analysis. Of those who had, 29 did not require oxygen and the average time from last arterial gas analysis was 5.7 days and only eight patients were being monitored with an oximeter. Taking into account the risk of exacerbating carbon dioxide retention and the problems that arise when discharging a patient who has been receiving oxygen therapy for the duration of their admission, we feel oxygen therapy should only be administered with the knowledge of the arterial gases and with frequent reassessment during therapy.
AUDIT OF ONCE‐DAILY DOSING GENTAMICIN THERAPY IN NEUTROPENIC FEVER
Authors: Cooke RPD , Grace RJ , Gover PA
Published: April 2023

During a 12‐month study, 42 adult patients with febrile neutropenia (granulocytes <1 × 109/l) were treated with once‐daily gentamicin (5 mg/kg). Serum gentamicin trough levels were measured 24 hours after the first dose, then twice weekly if <1 mg/l. Gentamicin was halved if the trough level was 1‐2 mg/l and usually stopped if >2 mg/l. One hundred and sixty samples were assayed: 122 (76%) <1 mg/l, 27 (17%) I‐2 mg/l and 11 (7%) >2 mg/l. All 1‐2 mg/l samples and three of the >2 mg/l samples (taken at the wrong time) reverted to <1 mg/l with dosage adjustment. The protocol proved simple and effective with a low incidence of gentamicin‐associated nephrotoxicity (7%) and no sepsis‐related deaths.
HENOCH‐SCHONLEIN PURPURA ASSOCIATED WITH RANITIDINE
Authors: Prajapati C , Casson IF
Published: April 2023

Ranitidine is one of the widely prescribed H2 receptor antagonists in the treatment of peptic ulcer. It is well tolerated and has few side‐effects. Vasculitic rash occurring in association with ranitidine has been described.1 We report a case of a 39‐year‐old man who developed a purpuric rash, polyarthritis, abdominal pain, melaena and impaired renal function characteristic of Henoch‐Schonlein purpura, following treatment with ranitidine.
SLIPPING RIB SYNDROME: AN OVERLOOKED CAUSE OF CHEST AND ABDOMINAL PAIN
Authors: Lum‐Hee N , Abdulla AJJ
Published: April 2023

Slipping rib syndrome is a poorly recognised cause of chest and abdominal pain. It occurs principally in the middle‐aged but may occur at any age. It is equally common in men and women and is frequently confused with other serious causes of chest and abdominal pain. Patients are often subjected to extensive and sometimes invasive needless investigation for unexplained symptoms. Greater awareness of this syndrome among clinicians could save both patient and doctor time and unnecessary concern. Two case reports are presented.
A CASE OF RELAPSING PSITTACOSIS ASSOCIATED WITH A STROKE
Authors: Vassallo M , Shepherd RJ
Published: April 2023

Psittacosis, caused by Chlamydia psittaci, is mainly associated with an atypical pneumonia. We report a case of psittacosis where onset of respiratory symptoms was soon followed by the onset of focal neurological signs, a very uncommon feature. Despite adequate treatment with erythromycin, the patient relapsed when re‐exposed to a sick pet bird. A prolonged course of doxycycline led to resolution of the pneumonia, but it is important to recall that successful management must also include the elimination of the precipitating cause of the infection.
COMPARATIVE EFFICACY AND TOLERABILITY OF NISOLDIPINE COAT CORE AND HYDROCHLOROTHIAZIDE IN MILD‐TO‐MODERATE HYPERTENSION
Authors: Fodor JG
Published: April 2023

This study compared the efficacy and tolerability of nisoldipine coat core (CC) 10‐40 mg o.d. and hydrochlorothiazide (HCTZ) 25‐50 mg o.d. Patients with mild‐to‐moderate essential hypertension received either nisoldipine CC 10 mg o.d. or HCTZ 25 mg o.d. Treatment was titrated at two‐weekly intervals as necessary. The primary efficacy endpoint was a defined reduction in diastolic blood pressure (DBP). Response rates were similar for both the nisoldipine CC‐ and HCTZ‐treated groups (74% and 70%, respectively). Secondary efficacy endpoints were reductions in both diastolic and systolic blood pressures (SBP). At treatment endpoint, the change from baseline in SBP was 16.2 mmHg for the nisoldipine CC group and 14.9 mmHg for the HCTZ group. Both drugs were well tolerated, and adverse events were generally minor and typical of these antihypertensive agents. Drug‐related adverse events were greater in the nisoldipine CC‐ than the HCTZ‐treated patients (50% and 37%, respectively). Nisoldipine CC was shown to demonstrate antihypertensive efficacy similar to HCTZ in the treatment of mild‐to‐moderate hypertension.
THE IMPACT OF PRE‐CLERKING CLINICS ON SURGICAL OPERATION CANCELLATIONS: A PROSPECTIVE AUDIT
Authors: Jones AR , Sandison AJP , Owen WJ
Published: April 2023

Pre‐clerking of all patients undergoing elective general surgical operations was introduced at our hospital in an attempt to reduce an unacceptably high operation cancellation rate. A prospective audit has been performed on the effect of this policy on the cancellation rate. Before the introduction of pre‐clerking there was a marked seasonal variation in the number of patients who failed to attend for surgery, which could be explained by absence on holiday. This seasonal variation disappeared after the start of pre‐clerking clinics, but there has been no reduction in the number of cancellations for medical reasons.
SUICIDE ATTEMPT DUE TO METOCLOPRAMIDE‐INDUCED AKATHISIA
Authors: Chow LY , Chung D , Leung V , Leung TF , Leung CM
Published: April 2023

Akathisia as a side‐effect of metoclopramide has received increasing attention in consultation‐liaison psychiatry in recent years. A case of metoclopramide‐induced akathisia resulting in a suicide attempt is reported in order to highlight the suffering of such patients and the factors that lead to misdiagnosis.
APATHETIC THYROTOXICOSIS
Authors: Feroze M , May H
Published: April 2023

A previously fit 37‐year‐old woman was admitted with acute left ventricular failure, atrial fibrillation and a left‐sided thromboembolic stroke. Her ventricular rate progressively increased despite full digitalisation. She had a cardiac arrest and was successfully resuscitated. Investigations revealed evidence of hyperthyroidism and she was treated for thyrotoxic crisis. She has made a complete recovery from the hemiparesis and is now in sinus rhythm. She denied any symptoms of hyperthyroidism. This patient had apathetic thyroid crisis, which is exceedingly rare in the young.
ORAL DISOPYRAMIDE IN THE TREATMENT OF RECURRENT NEUROCARDIOGENIC SYNCOPE
Authors: Bhaumick SK , Morgan S , Mondal BK
Published: April 2023

In neurocardiogenic syncope the normal compensatory response on assuming an upright posture is interrupted after several minutes and replaced by a paradoxical withdrawal of sympathetic activity and increased parasympathetic activity. The resulting reduction in blood pressure is severe, sympathetic activity is inhibited, plasma norepinephrine levels do not increase and the heart rate decreases. The defect is a paradoxical interruption of sympathetic excitation associated with parasympathetic excitation, causing profound vasodilatation and bradycardia. Disopyramide has been shown not only to treat the bradycardia but also to control the hypotension.
THERAPEUTIC EQUIVALENCE OF DICLOFENAC SUSTAINED‐RELEASED 75 MG TABLETS AND DICLOFENAC ENTERIC‐COATED 50 MG TABLETS IN THE TREATMENT OF PAINFUL OSTEOARTHRITIS
Authors: Le Loët X , Dreiser R‐L , Le Gros V , Febvre N
Published: April 2023

Efficacy and tolerability of diclofenac sustained‐released (SR) 75 mg tablets taken b.i.d. were compared with that of enteric‐coated diclofenac sodium 50 mg tablets given t.i.d. in a seven‐day, randomised, double‐blind, double‐dummy, parallel groups study in 294 outpatients suffering from painful femorotibial or hip osteoarthritis. Primary efficacy criteria were spontaneous joint pain assessed on serial visual analogue scales during the first 36 hours and after 48 hours of treatment. The two treatments had equivalent efficacy since all the 90% confidence intervals of differences between means for pain intensity between the two groups were included within the interval (‐10 mm; +10 mm). Rates of overall efficacy judged good to excellent ranged from 74.3‐78.5% in both groups. One or more drug‐related adverse events, mainly gastrointestinal, was reported by 24.5% and 27.2% of patients in diclofenac SR 75 mg and diclofenac 50 mg groups, respectively. Percentage of good compliance (i.e. >90%) was higher with diclofenac SR 75 mg (p<0.001).
FOSINOPRIL NATIONAL SURVEY: A POST‐MARKETING SURVEILLANCE STUDY OF FOSINOPRIL (STARILTM) IN GENERAL PRACTICE IN THE UK
Authors: Edwards C , Blowers DA , Pover GM
Published: April 2023

This open, non‐comparative, PMS study of fosinopril (StarilTM) involved 12,067 hypertensive patients assessed at baseline and after two and six months of treatment; 10,791 patients provided evaluable data with 5.2 months average treatment totalling 4667 patient‐years. Adverse events were reported in 24% of patients, the most common being mild‐to‐moderate cough (6.05%). Events considered possibly related to fosinopril were reported in 15% of patients, the frequency being lower in younger patients, males and those receiving fosinopril monotherapy. Patient well‐being improved during the study. At the end of the study, most patients were taking fosinopril 10 mg once daily. Mean reductions in systolic and diastolic blood pressures were ‐11.0% and ‐11.7%, respectively; 71.3% of patients were ‘responders’. No important differences were observed between subgroups. This study found fosinopril to be effective, well tolerated in a broad range of hypertensive patients, and with no previously unrecognised adverse events reported.
SUBGLOTTIC STENOSIS SECONDARY TO TUBERCULOSIS
Authors: Almeyda J , Tolley NS , Ghufoor K , Mochoulis G
Published: April 2023

Although the incidence of laryngeal tuberculosis has been declining over the past 30 years, it should still be considered in the differential diagnosis of patients with laryngeal pathology. In contrast to the pre‐chemotherapy era, few, if any, signs of pulmonary tuberculosis are seen in such cases, and presentation is similar to either chronic non‐specific laryngitis or carcinoma. The subglottis is a site rarely involved in laryngeal tuberculosis. Tissue biopsy and culture are diagnostic and a full course of antituberculous chemotherapy usually resolves the condition. Airway insufficiency due to fibrosis, however, often necessitates surgical Intervention. We present a case where the only laryngeal manifestation of tuberculosis was subglottic stenosis.
OCCUPATIONAL ASTHMA IN A CHEESE PACKER
Authors: Fawcett IW
Published: April 2023

Occupational asthma is an increasingly common clinical problem.1 A worker who develops asthma for the first time when starting work in a new environment may be straightforward to diagnose. However, when asthma occurs after a latent period following initial exposure, or when a pre‐existing asthmatic develops work‐related symptoms, the occupational link may be less easy to appreciate. This case report concerns a cheese factory worker with pre‐existing asthma who experienced severe symptoms when a new process was introduced for drying grated cheese and was able to return to work only after the process was modified. The drying agent responsible has not been previously reported as a cause of asthma.
PRIMARY HYPOTHYROIDISM WITH HYPER‐PROLACTINAEMIA AND PITUITARY ENLARGEMENT MIMICKING A PITUITARY MACROADENOMA
Authors: Özbey N , Sariyildiz E , Yilmaz L , Orhan Y , Sencer E , Molvalilar S
Published: April 2023

Hyperprolactinaemia can occur in patients with hypothyroidism. A 32‐year‐old woman with primary hypothyroidism presented with amenorrhoea and galactorrhoea of two years' duration. She had hyperprolactinaemia, low basal morning cortisol levels and evidence of a pituitary macroadenoma on magnetic resonance imaging. Therapy with L‐thyroxine resulted in induction of regular menses, resolution of galactorrhoea, normalisation of hormone levels and disappearance of the image of pituitary macroadenoma. It seems that enlargement of the pituitary due to thyrotroph and/or lactotroph cell hyperplasia secondary to hypothyroidism is responsible for this ‘pseudotumour’ image on radiological study. Recovery of her low basal cortisol values during treatment could also be explained by the dissolution of the pressure effect of enlarged pituitary in addition to the regression of hypothyroidism. In subjects with primary hypothyroidism and hyperprolactinaemia and pituitary enlargement, thyroid hormone replacement should be a first line treatment preceding pituitary surgery and bromocriptine use.
CHILDREN'S CONSENT TO PSYCHIATRIC TREATMENT: ALL OR NOTHING?
Authors: Pang AHT , Lai KYC , Bailey V
Published: April 2023

An adolescent with a history of attempted suicide who refused to involve his father in the treatment plan is presented. Issues surrounding consent to psychiatric treatment in childhood are discussed and the assessment process outlined. Contributions by primary healthcare professionals are emphasised.
ADENOMYOEPITHELIOMA OF THE BREAST
Authors: Parks RW , Clarke MAR , Cranley B
Published: April 2023

Adenomyoepithelioma is a rare disorder characterised by simultaneous proliferation of ductal epithelium and myoepithelial cells. It is more common in salivary glands or skin, and only rarely found in breast tissue. Adenomyoepithelioma of the breast was first described in 1970 by Hamperl.1 Since then, approximately 55 cases have been described in the literature; the largest review, by Tavassoli in 1991, reported 27 of these cases.2 Because of the small number of cases reported, the natural history of adenomyoepithelioma of the breast remains uncertain. We report a further case which was treated by local excision, and follow‐up for two years has revealed no evidence of local recurrence or metastatic spread.
COMPARISON BETWEEN REAGENT STRIPS USED FOR DETECTION OF URINARY TRACT INFECTION IN THE ELDERLY
Authors: Evans PJ , McNabb WR , Lewis RR
Published: April 2023

A comparison was made between the accuracy of Ames and Boehringer reagent strips for detecting urinary tract infections in 100 elderly patients (50 acutely ill patients admitted to hospital and 50 attending the day hospital). The results for urinary nitrite, blood and protein for both strips were documented. Nitrite provided the highest sensitivities and specificities. In the acute hospital patients, the sensitivities were 83% and 89% for the Ames and Boehringer strips respectively, while for the day hospital patients the sensitivities were 90% for both strips. Specificities were 100% for both strips in each group of patients. There was thus little difference between the accuracy of the Ames and Boehringer reagent strips in detecting urinary tract infection.
AN AUDIT OF PATIENTS ADMITTED FOR HOME INTRAVENOUS THERAPY DIRECTLY FROM THE EMERGENCY DEPARTMENT
Authors: Montalto M
Published: April 2023

The Hospital in the Home Unit (HHU) provides home intravenous therapy to acute inpatients. The aim of this audit was to assess the practice of accepting patients for home intravenous therapy directly from the emergency department by describing the frequency and type of clinical conditions managed, and recording the outcome and adverse events of such admissions. Consecutive patient admissions to the HHU directly from the emergency department over a 15‐month period were included. The policy of accepting patients for home intravenous therapy from the emergency department will continue. Care with diagnosis and HHU assessment is required. Complications should be expected, and a reliable on‐call service is essential.
PRIMARY THYROID CARCINOMA AND THYROTOXICOSIS
Authors: Plengvidhya N , Rathanavijitrasilp A , Sangruchi T , Nitiyanant W , Vannasaeng S , Piraphatdist T , Vichayanrat A
Published: April 2023

A 60‐year‐old man noticed rapid enlargement of a long‐standing thyroid goitre, with dysphagia and difficulty in breathing. Thyrotoxicosis was diagnosed. Chest X‐ray revealed multiple pulmonary metastases. He underwent near‐total thyroidectomy. The histopathology revealed an undifferentiated thyroid carcinoma with some areas of papillary carcinoma and its follicular variant. Postoperative 131l total body scan showed residual thyroid tissue in the neck and one functioning metastasis in the right rib, posteriorly. The patient's condition deteriorated rapidly and he died from pneumonia. The autopsy showed widespread metastases of undifferentiated thyroid carcinoma. Only the right rib contained the follicular variant of papillary carcinoma.
MEDIAL ORBITAL WALL BLOWOUT FRACTURE WITH MEDIAL RECTUS MUSCLE ENTRAPMENT
Authors: Cumberworth VL , Valentine PWM , McEwan J , Dawkins RS
Published: April 2023

We report a case of left medial rectus palsy due to entrapment by a fracture of the lateral wall of the ethmoidal sinus following a road traffic accident and discuss the presentation and management of this unusual complication.
THE SIGNIFICANCE OF URINARY N‐ACETYL‐ß‐D‐GLUCOSAMINIDASE FOR PREDICTING EARLY STAGE DIABETIC NEPHROPATHY
Authors: Kato H , Takashima T , Kishikawa H , Emura S , Ohmori K
Published: April 2023

We studied urinary N‐acetyl‐ß‐D‐glucosaminidase (NAG) in the early stage of diabetic nephropathy in 27 non‐insulin‐dependent diabetes mellitus (NIDDM) patients with a microalbumin level below 20 mg on 24‐hour urine sample. Microalbumin and NAG excretion were measured in 24‐hour urine samples collected on three separate occasions within seven days of admission. Creatinine clearance was determined simultaneously. There was a significant negative correlation between the creatinine clearance and 24‐hour urinary NAG (r=‐0.38, p<0.05). Elevation of urinary NAG may indicate decreased renal function during early stage NIDDM nephropathy.