bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ursodeoxycholic acid attenuates colonic epithelial secretory function
Authors: Kelly Orlaith B. , Mroz Magdalena S. , Ward Joseph B. J. , Colliva Carolina , Scharl Michael , Pellicciari Roberto , Gilmer John F. , Fallon Padraic G. , Hofmann Alan F. , Roda Aldo , Murray Frank E. , Keely Stephen J. 
Published: March 2013

Key points
Although diarrhoeal diseases represent a significant health and economic burden to society, therapeutic options remain limited.
While several bile acids are known to stimulate epithelial Cl− secretion, the major driving force for fluid secretion in the intestine, the effects of ursodeoxycholic acid (UDCA) on epithelial transport function are not well described.
We report that in contrast to other bile acids, UDCA exerts anti‐secretory actions on colonic epithelial cells in vitro.
In contrast, in vivo administration of UDCA enhances epithelial secretory function, an affect we ascribe to being due to its bacterial metabolism to lithocholic acid. In keeping with this hypothesis, in vivo administration of a metabolically stable analogue of UDCA, 6α‐methyl‐UDCA, was anti‐secretory.
Our findings reveal novel anti‐secretory actions of UDCA and suggest that metabolically stable analogues of bile acid may be useful for development as a new class of anti‐diarrhoeal drug.
Abstract  Dihydroxy bile acids, such as chenodeoxycholic acid (CDCA), are well known to promote colonic fluid and electrolyte secretion, thereby causing diarrhoea associated with bile acid malabsorption. However, CDCA is rapidly metabolised by colonic bacteria to ursodeoxycholic acid (UDCA), the effects of which on epithelial transport are poorly characterised. Here, we investigated the role of UDCA in the regulation of colonic epithelial secretion. Cl− secretion was measured across voltage‐clamped monolayers of T84 cells and muscle‐stripped sections of mouse or human colon. Cell surface biotinylation was used to assess abundance/surface expression of transport proteins. Acute (15 min) treatment of T84 cells with bilateral UDCA attenuated Cl− secretory responses to the Ca2+ and cAMP‐dependent secretagogues carbachol (CCh) and forskolin (FSK) to 14.0 ± 3.8 and 40.2 ± 7.4% of controls, respectively (n= 18, P < 0.001). Investigation of the molecular targets involved revealed that UDCA acts by inhibiting Na+/K+‐ATPase activity and basolateral K+ channel currents, without altering their cell surface expression. In contrast, intraperitoneal administration of UDCA (25 mg kg−1) to mice enhanced agonist‐induced colonic secretory responses, an effect we hypothesised to be due to bacterial metabolism of UDCA to lithocholic acid (LCA). Accordingly, LCA (50–200 μm) enhanced agonist‐induced secretory responses in vitro and a metabolically stable UDCA analogue, 6α‐methyl‐UDCA, exerted anti‐secretory actions in vitro and in vivo. In conclusion, UDCA exerts direct anti‐secretory actions on colonic epithelial cells and metabolically stable derivatives of the bile acid may offer a new approach for treating intestinal diseases associated with diarrhoea.
Susceptibility Testing of Extensively Drug-Resistant and Pre-Extensively Drug-Resistant Mycobacterium tuberculosis against Levofloxacin, Linezolid, and Amoxicillin-Clavulanate
Authors: Ahmed Imran , Jabeen Kauser , Inayat Raunaq , Hasan Rumina 
Published: March 2013

ABSTRACT

Pakistan is a high-burden country for tuberculosis (TB). The emergence and increasing incidence of extensively drug-resistant (XDR) TB has been reported in Pakistan. Similarly, the prevalence of multidrug-resistant TB infections with fluoroquinolone resistance (pre-XDR) is also increasing. To treat these infections, local drug susceptibility patterns of alternate antituberculosis agents, including levofloxacin (LVX), linezolid (LZD), and amoxicillin-clavulanate (AMC), is urgently needed. The aim of this study was to determine the susceptibility frequencies of drug-resistant (DR)
Mycobacterium tuberculosis
against LVX, LZD, and AMC. All susceptibilities were determined on Middlebrook 7H10 agar. A critical concentration was used for LVX (1 μg/ml), whereas MICs were determined for LZD and AMC.
M. tuberculosis
H37Rv was used as a control strain. A total of 102
M. tuberculosis
isolates (XDR,
n
= 59; pre-XDR,
n
= 43) were tested. Resistance to LVX was observed in 91.2% (93/102). Using an MIC value of 0.5 μg/ml as a cutoff, resistance to LZD (MIC ≥ 1 μg/ml) was noted in 5.9% (6/102). Although the sensitivity breakpoints are not established for AMC, the MIC values were high (>16 μg/ml) in 97.1% (99/102). Our results demonstrate that LZD may be effective for the treatment of XDR and pre-XDR cases from Pakistan. High resistance rates against LVX in our study suggest the use of this drug with caution for DR-TB cases from this area. Drug susceptibility testing against LVX and AMC may be helpful in complicated and difficult-to-manage cases.
Developing Evidence-Based Clinical Guidelines For Military Use: Case Study Of Smoking Cessation Guidelines
Authors: Croft A M , Geary K G , Irvine D , Brutus E C 
Published: March 2013

Objective:To develop evidence-based clinical guidelines on smoking cessation, for use throughout the British military.Method:A ten-member, multiprofessional smoking cessation working group met five times between October 2000 and July 2001 to develop targeted smoking cessation guidelines for use by military health professionals in the clinical setting. The guidelines were based on the best available scientific evidence at that time, mainly systematic review of controlled trials, and individual randomised trials.Results:The agreed military guidelines on smoking cessation were promulgated in July 2001. Three tiers of support were defined. Military health professionals have a key role as nonsmoking models and advocates, and should be trained to use ‘brief intervention’ at every clinical encounter with a military smoker. ‘Intermediate support’ (defined as a specialist service delivered by military health professionals who have undergone specific training and continuation training) is to be available at local level. The most heavily addicted military smokers will require referral to civilian smoking cessation clinics. Effective technologies for use at any one of the three levels of care are: nicotine skin patches, nicotine gum, nicotine lozenges and bupropion.Conclusions:These are the first ever clinical guidelines for military use which meet accepted modern quality criteria. Informal monitoring of the uptake of these guidelines between July 2001 to December 2001 suggests that they have been well received by military health professionals. An audit of their impact on smoking patterns within the UK Armed Forces will commence in 2002. The guidelines will be updated 5-yearly, or sooner.
Bioterrorism: Preparing For The Unthinkable
Authors: Alexander DA 
Published: March 2013

Terrorism is not a new concept but our need to prepare for the effects of bioterrorism has achieved a particular urgency. The use of biological agents provides a new set of challenges to professional caregivers, emergency personnel and Governments. These agents are generally not readily identified through the senses, have delayed effects and have the power to generate fear and panic. They are also intended to demonstrate that Governments and other organisations are not able to protect their citizens and members.What evidence there is suggests bioterrorist incidents have the potential to create higher levels of psychopathology than physical injury. Therefore, the authorities must identify and rehearse suitable methods of psychoprophylaxis and intervention.
The Experience Of The Intensive Care Unit In A British Army Field Hospital During The 2003 Gulf Conflict
Authors: Roberts MJ , Fox MA , Hamilton-Davies C , Dowson S 
Published: March 2013

Over the last few years the Surgeon General’s Department has overseen a major update in equipment scales for medical units in the field; anaesthesia and intensive care. This is to meet the aspiration of the Defence Chiefs, that injured servicemen on active service should receive the same standard of care as available in the United Kingdom.This paper discusses the experiences of the Intensive Care Unit operating within a Field Hospital both during the initial war fighting phase and subsequent peace keeping phase of the 2003 Gulf conflict (OP TELIC). Observations are made on patient activity, treatment strategy, and equipment adequacy.
Early Failure Of External Fixation In The Management Of War Injuries
Authors: Clasper J C , Phillips S L 
Published: March 2013

ObjectiveTo review external fixation in the management of war injuries.MethodWe prospectively followed up 15 external fixators (14 patients) applied in the management of war injuries. All these patients were treated at 202 Field Hospital during the 2003 Gulf Conflict.ResultsOf the 15 fixators, 13 (86.7%) required early revision or removal due to complications of the injury or the fixator. Instability was a problem with 10 fixators (67%), pin loosening was noted with 5 fixators (33%) involving twelve pins, and a significant pin track infection developed at 14 pin sites (3 fixators – 20%), which failed to resolve despite intravenous antibiotics.ConclusionsThis study demonstrates a very high early complication rate of external fixation in the management of military injuries and cautions against its universal acceptance. If used, consideration must be given to the optimum time of frame application, whether at the time of initial debridement or at a later operation, and the optimal frame design, which will depend on the specific bone and fracture pattern. Pin site care must also be considered, particularly with the restrictions imposed by the military environ-ment.
Forward Surgery On Operation Telic – Iraq 2003
Authors: Parker P J , Adams S A , Williams D , Shepherd A 
Published: March 2013

Two Air Assault Surgical Groups (AASGs) from 16 Close Support Medical Regiment deployed to Kuwait on Operation Telic in February 2003. Each AASG was comprised of a four-table resuscitation facility, a two table FST and a twin-bedded ITU facility. An A+E Consultant and nurse, an experienced radiographer and laboratory technician with two further RGNs and CMTs provided resuscitation support. Each FST had an orthopaedic and a general surgeon, two anaesthetists and eight operating department practitioners. Further equipment consisted of a Polymobil 111 X-ray unit, a Sonosite 180 ultrasound scanner and an ISTAT gas, haematocrit and electrolyte analyser. 100 units of mixed blood were carried by each AASG.Fifty-one surgical procedures were performed on thirty one patients. Twenty one of these patients were Iraqi prisoners of war or civilians. Seventeen wound debridements, five amputations, five laparotomies, four insertions of Denham pins with Thomas splintage for femoral fracture, three external fixations and one axillary artery repair formed the basis of the major cases undertaken. The first field use of activated factor VII by the British Army was successful in the resuscitation of a patient with exsanguinating haemorrhage after an open-book (APC-III) pelvic fracture and a ruptured intrapelvic haematoma. The other cases included eleven manipulations under anaesthetic/application of plaster and four finger terminalisations.Forward military surgery has a continued role to play on the modern fast moving battlefield. 16 Close Support Medical Regiment normally supports 16 Air Assault Brigade with its remit for expeditionary operations and SF support. Its experience on Op Telic should influence planning for future deployment.
Human Bite Injury In North East England – The Impact Of Alcohol Intake On A Mode Of Violent Assault
Authors: Eardley WGP , Harrison M H , Coady MSE 
Published: March 2013

Ninety-two retrospective cases of human bite injury referred to a Plastic Surgery department are presented. Particular emphasis is placed on the relationship of alcohol intake to these injuries, their distribution and subsequent management. A review of the literature is conducted.The human bite is a leisure time injury of the young single male in the North East. It has been shown that there is a clear link to alcohol and in particular weekend drinking. Prompt operative intervention and wounds located at the head and neck have been shown to be associated with a decreased risk of subsequent infection, which reflects findings in the earlier literature.Fifteen cases were infected. One was the result of a postoperative complication. The remainder were infected on admission. The majority of infected cases were upper limb bites and were associated with a delayed presentation.
The Organisation of the RAMC during the Great War
Authors: Atenstaedt RL 
Published: March 2013

IntroductionAt the 90 year anniversary of the Battle of the Somme, it is important to remember the members of the RAMC who served in the Great War, especially the more than one thousand Medical Officers who gave their lives.LeadershipThe RAMC during the First World War was a Corps led by some able officers such as Sir Arthur Sloggett in France and Sir Alfred Keogh in London. Sir Douglas Haig was in overall command, his leadership style impacting on the RAMC.Recruitment of MOsThere were problems in filling the ranks of the Corps, both before the conflict, as well as well as during the War, and a significant number of civilian medical practitioners were recruited to the RAMC. Shortages were only really addressed when the Americans joined the conflict.Training of Civilian MOsThe great need for MOs meant that there was little time for formal training of civilian MOs and many felt unsuited for war work. This was recognised by the authorities, who gradually set up centres of instruction.Work of RMOsThe workhorse of the organisation was the Regimental Medical Officer, who had an important role in disease prevention and the conservation of manpower, in a type of conflict (trench) that required a ready supply of personnel. Although an important role, some doctors found the job frustrating.Casualty EvacuationDuring the War, the RAMC managed to improvise an efficient system for handling casualties, the aim to give speedy treatment and to return the men to the front in the shortest possible time.ConclusionsThe RAMC during the Great War was a highly structured and efficient organisation, geared towards maximising its available manpower, important in trench warfare.
Assessing Airway Patency And Breathing In NBC Category 4R - The RG Method.
Authors: Tong JL , Taylor A , House J , Smith JE 
Published: March 2013

IntroductionConfirming airway patency and the presence of breathing has significant limitations when both the casualty and medical personnel are in NBC category 4R. In casualties with limited signs of breathing, IPE may adversely affect the efficiency of clinical assessment, and when the triage sieve is used this could result in the misdiagnosis of death. This manuscript describes and evaluates the Respirator-Glove (RG) method, of assessing airway patency and breathing in NBC category 4R.MethodsAmedical examination glove was fitted over the primary speech module of the S10 NBC respirator of a volunteer casualty dressed in 4R. Two groups were studied; the first used an intact glove the second used a glove minus one finger. Breathing patterns A, B and C, representing normal breathing, hypoventilation and apnoea respectively, were randomly performed by the casualty for 15 seconds. A blinded observer recorded the glove inflation and movement and using these signs determined if breathing was present.ResultsAll of the randomly performed breathing pattern simulations were correctly identified in both groups, with glove inflation only occurring during exhalation. In the perforated glove group, the large expiratory air leak through the hole limited the development of continuous positive airway pressure and the respirator seal wasmaintained. In the non-perforated glove group the respirator seal was compromised. No difficulty was encountered attaching the gloves to the respirator speech module.DiscussionAs an aid to clinical examination, the Respirator-Glove (RG) method provides a reproducible visual assessment of airway patency and spontaneous ventilation in unconscious 4R casualties. It can be utilised at any point in the evacuation chain, may improve the identification of T1 casualties and could reduce the risk of death being misdiagnosed. The efficiency of clinical assessment in 4R will improve by introducing the RG method into CBRN medical training programmes.
Management of Shoulder Instability in a Military Population
Authors: Pimple MK , DaCosta A , Clasper JC 
Published: March 2013

ObjectivesRecurrent instability is common after shoulder dislocation in the young, particularly those engaged in physical jobs or sport. The management of recurrent traumatic shoulder instability is predominantly operative. However, the best method of surgery i.e. open or arthroscopic is still a matter of debate. We have developed an algorithm to decide on the choice of surgery and the aim of this study is to report this and compare the two different groups of military patients.MethodsA retrospective review of all shoulder stabilisations performed on military personnel, by a single surgeon, between August 2004 and August 2005 at a district general hospital serving both military and civilian population was undertaken. The presentation, clinical and operative findings were noted and compared in the groups treated by arthroscopic or open stabilisation.ResultsUsing our protocol 39 shoulder stabilisations were performed in military personnel. Of the shoulders, 25 (64%) underwent arthroscopic and 14 (36%) underwent open stabilisation. The indication for surgery was more than 2 episodes of shoulder dislocation. Open surgery was found to be more common in those who had their first dislocation at a younger age. Bilateral shoulder laxity was the most common indication to choose the open method. Both open and arthroscopic stabilisation gave good results in the high demand military population. Only one patient had recurrent instability after arthroscopic procedure. However, this was not statistically significant when compared with open stabilisation.
Performance Indicators for Prehospital Command and Control Developed for Civilian Use Tested in a Military Training Setting, A Pilot Study
Authors: Lundberg Lars , Jonsson A , Vikström T , Rüters A 
Published: March 2013

ObjectivesThe aim of this study was to determine if a set of performance indicators for command and control (C2) primarily developed for civilian use could be applied also to a military training context as well.MethodThe initial decision-making in the on-scene medical management in a multinational military medical evacuation exercise in Afghanistan was studied, using this set of indicators.ResultsTwo performance indicators were appropriate to this setting. Of the nine applicable indicators, the standards set for civilian use were met in four, in three other they were not met, and there was a lack of documentation in two indicators.ConclusionMeasurable performance indicators for prehospital command and control were to some extent found to be applicable also to a military environment. Future developments may make it possible for the concept of measuring results using civilian performance indicators to become a quality control tool in a military setting.
Limb Complications following Pre-Hospital Tourniquet Use
Authors: Clasper J , Brown KV , Hill P 
Published: March 2013

It has been stated that the application of a pre-hospital tourniquet could prevent 7% of combat deaths, however their widespread use has been questioned due to the potential risk from prolonged ischaemia. We reviewed members of the UK Armed Forces who sustained severe limb-threatening injuries in Iraq and Afghanistan, and performed a matched cohort study based on the presence or absence of pre-hospital tourniquet application. When a pre-hospital tourniquet had been applied, 19/22 patients had a least one complication compared to 15/22 where no tourniquet had been applied [p=0.13]. There were 10 limbs with at least one major complication in the pre-hospital tourniquet group but only four in the group with no tourniquet [p=0.045].The significant difference in the incidence of major complications is a concern, particularly as the difference was mainly due to a deep infection rate of 32% vs. 4.5%. Although a number of variables could have influenced these small groups, such as choice of fracture fixation implant and method and timing of wound closure, the use of a matched cohort study design with a statistical significance level of p < 0.05, suggests the use of a pre-hospital tourniquet as a factor. Althoughthe use of pre-hospital tourniquets cannot be decried as a result of this study, the need to continually prospectively review their use to determine their risk/benefit ratio remains.
Prevention of Suicidal Behaviour among Army Personnel: A Qualitative Study
Authors: Crawford M. J. , Sharpe D , Rutter D , Weaver T 
Published: March 2013

ObjectivesTo examine the context of suicidal behaviour among soldiers in the United Kingdom and identify factors that could reduce the risk of such behaviour.MethodA series of in-depth interviews with service providers involved in treating soldiers following deliberate self harm. Their responses were compared with those of a small sub-sample of soldiers who presented to Army medical services following self harm.ResultsWe interviewed 21 service providers with a range of experience and professional backgrounds and 10 soldiers. Service providers told us that the rarity of suicide among soldiers together with lower levels of mental illness amongst those who end their lives made suicide prevention in the Army a difficult task. However they highlighted concerns about recruitment and retention of young soldiers, and stated that stigmatisation of mental illness in the Army sometimes prevented those with suicidal ideation seeking help. They also highlighted the role of alcohol use in precipitating self-harm. Soldiers who had self-harmed told us that they struggled to balance the demands of work and family life and described harming themselves impulsively often while intoxicated with alcohol. Soldiers look to sources of support outside the Army, and see commanding officers, rather than healthcare professionals, as helping resolve their problems. Neither service providers nor soldiers mentioned helplines and other ‘independent’ sources of confidential advice and support which are available to soldiers serving with the British Army.Conclusion:Our findings highlight problems associated with efforts to reduce suicide among soldiers but suggest that these should focus continuing to try to reduce stigmatisation of mental distress and specifically on the role of commanding officers. Greater efforts should also be made to publicise existing sources of help and reduce levels of alcohol misuse.