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Summary Background Sleep disturbance is common in patients with GERD but there has been little evaluation of this problem in primary care in patients already taking therapy. Aim To evaluate the impact of administering a questionnaire (PASS test) to identify patients with sleep problems and evaluate the efficacy of esomeprazole to improve sleep disturbance in patients with GERD. Methods This was a primary care based cluster-randomised, open-label study where practices were assigned to intervention or control groups. PASS test failures continued current therapy (control) or were switched to 4 weeks' once-daily esomeprazole 20 or 40 mg (intervention). Patients were evaluated at the end of 4 weeks and the outcomes that were assessed were the sleep questions from the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire and the presence or absence of sleep disturbance from the PASS test questionnaire. Results A total of 1388 patients with evaluable data at 4 weeks were included in the analysis and 825 reported GERD-related sleep disturbance at baseline. At 4 weeks, 161 of 291 of control patients (55%) reported continued sleep disturbance compared to 120 of 534 (22.5%) of intervention patients [number needed to treat of 3: 95% confidence intervals (CI): 2.5–4]. There was a mean improvement in QOLRAD scores related to sleep in the intervention patients compared to control patients (mean improvement = 4.91; 95% CI: 3.73–6.09). Conclusion A PASS strategy identifies GERD patients with sleep disturbance in primary care that will benefit from a change in acid-suppressive therapy. ClinicalTrials.gov identifier: NCT00392002; study code: D9612L00096.

The arthropod fauna of nine hedgerows subject to three management categories was sampled in Hampshire, U. K. with supporting data from hedges in Northumberland, U. K. The categories were cut, uncut and remnant. Phytophagous species, especially the Psyllidae and the larvae of Lepidoptera and Tenthredinidae were significantly more abundant on the remnant hedges. The cut hedges had a greater number of taxa than the other two types but the most obvious difference between them was the high number of Psyllidae on the remnant hedges. The cut hedges had the highest faunal diversity and the ranking of the hedge types was the same for the three diversity indices used. The way hedge management could affect the arthropod fauna is discussed. Zusammenfassung Untersuchungen uber den Zustand von Hecken und seine Auswirkungen auf die Arthropodenfauna Es wurde die Arthropodenfauna von 9 Hecken in Hampshire und 2 Hecken in Northumberland, England, untersucht, die 3 Zustands-Kategorien angehorten: geschnitten, ungeschnitten, aufgelockert (nur aus einzelnen Baumen oder/und Strauchern bestehend). Die phytophagen Arten, insbesondere die Psyllidae sowie die Larven von Lepidopteren und Tenthrediniden, zeigten in den aufgelockerten Hecken die (signifikant) hochste Abundanz. Die geschnittenen Hecken wiesen eine grosere Anzahl Taxa als die zwei anderen Typen auf. Besonders bemerkenswert war ihre weitaus geringere faunistische Diversitat. Die Auswirkungen der verschiedenen Behandlung von Hecken auf die Arthropodenfauna werden erortert.

Summary Background The reflux disease questionnaire (RDQ) is a short, patient-completed instrument. Aims To investigate the psychometric characteristics of the RDQ in patients with heartburn-predominant (HB) and non-heartburn predominant (NHB) dyspepsia. Methods HB (n = 388) and NHB (n = 733) patients were randomized to esomeprazole 40 mg daily or twice daily for 1 week, followed by 3 weeks of esomeprazole 40 mg daily. Results High factor loadings (0.78–0.86) supported the ‘regurgitation’ dimension of the RDQ. Overlapping factor loadings in the ‘heartburn’ and ‘dyspepsia’ dimensions suggested symptom overlap. All dimensions demonstrated high internal consistency (Cronbach’s alpha: 0.79–0.90). Intra-class correlation coefficients over 4 weeks were good (0.66–0.85). The RDQ showed good responsiveness over 4 weeks of treatment, with high effect sizes (≥0.80). Moderate or large symptom improvements were reported by 90% and 77% of HB and NHB patients, respectively, following treatment. Patients who responded to acid suppression also experienced symptom benefits in all RDQ dimensions. Conclusions The RDQ is reliable, valid and responsive to change in HB and NHB patients. The symptom overlap is important but need not play a major role in determining treatment strategy as both patient groups benefited from proton pump inhibitor treatment.

Summary Background: Uninvestigated dyspepsia is common in family practice. The prevalence of clinically significant upper gastrointestinal findings (CSFs) in adult uninvestigated dyspepsia patients, and their predictability based on history, is unknown. Methods: Prompt endoscopy was performed within 10 days of referral, in 1040 adult patients presenting with uninvestigated dyspepsia at 49 Canadian family practitioner centres. Subsequent management strategies during a 6-month follow-up period were determined by the individual family practitioners. Results: CSFs were identified in 58% (603/1040) of patients. Erosive oesophagitis was most common (43%; N = 451); peptic ulcer was uncommon (5.3%; N = 55). Alarm symptoms were uncommon (2.8%; N = 29). Most patients had at least three dyspepsia symptoms, more than 80% had at least six, and approximately half had eight or more. Based on the dominant symptom, 463 (45%) patients had ulcer-like, 393 (38%) had reflux-like and 184 (18%) had dysmotility-like dyspepsia. The patients' dominant symptom was not predictive of endoscopic findings. Oesophagitis was more common in those with dominant reflux-like symptoms and was the most common finding in all subgroups. The prevalence of gastroduodenal findings was similar in all symptom subgroups. Helicobacter pylori (H. pylori) infection (30%; 301/1013) was associated with gastroduodenal findings. Conclusions: Dyspepsia subclassifications, based on dominant symptom, are of limited value in predicting the presence and nature of CSFs. Oesophagitis was by far the most common diagnosis (43% of patients). CSFs were common in uninvestigated dyspepsia patients and their nature suggests patients could be initially treated effectively, without endoscopy, using empirical acid suppressive therapy.

Myotonic dystrophy is a neuromuscular condition inherited in an autosomal dominant fashion, and is most commonly diagnosed in the neonatal period. With improving levels of care, these patients are now presenting more commonly for anaesthesia. We review the clinical features of the condition, and then discuss the steps in the anaesthetic process, outlining the anaesthetic implications of myotonic dystrophy at each stage.

As industrial applications for polymers and biopolymers have expanded in recent years, the limitations of traditional characterisation techniques have become apparent. Size exclusion chromatography is widely used to determine the molecular weight distribution of a polymer, but suffers from a number of drawbacks when used with ultra-high molecular weight (MW) polymers or polyelectrolytes. As a result, interest in the use of field flow fractionation (FFF) for the separation of macromolecules has grown. FFF relies on a combination of field-driven and diffusive transport mechanisms to separate polymers in the range 10 3 -10 15 gmol -1 and/or particles of 5nm-100μm, allowing MW and size distributions for virtually all macromolecules to be determined without the need for filtration. The open channel geometry minimises shear effects making it possible to separate fragile, high MW polymers, while the absence of a stationary phase means adsorption effects can be minimised. As a result, samples can be run in a mobile phase suitable for the polymer rather than selecting conditions to minimise column interactions which leads to the risk of aggregate formation in polyelectrolytes. While it is possible to calculate the MW of a polymer eluting from an FFF channel using calibration techniques similar to those for size exclusion chromatography, the same problems are encountered as well. When analysing ultra-high MW polymers and/or gels, these are compounded by the need for calibration standards with a MW in excess of 10 6 g mol -1 . The addition of multi-angle light scattering (MALS) to FFF has allowed absolute MW and size distributions to be obtained without the need for calibration, standards or assumptions. Complex mixtures of polymer, microgel, and macrogel can all be studied in a single run. By combining all of the information derived from FFF-MALS, molecular conformation, density and branching levels can also be determined. This paper outlines the principles of operation of FFF-MALS, before moving on to discuss recent applications of the technique for the analysis of macromolecules and sub-micrometre particles.

1. In cultures of rat forebrain neurones, mitochondria buffer glutamate-induced, NMDA receptor-mediated Ca2+ influx. Here, we have used the fluorescent calcium indicator, indo-1 AM to record [Ca2+]i from single cells. We varied either the glutamate concentration or the duration of exposure to investigate the cellular mechanisms recruited to buffer [Ca2+]i within different stimulation protocols. 2. For a 15 s stimulus, the recovery time doubled as the glutamate concentration was raised from 3 to 300 microM. Changing the duration of exposure from 15 s to 5 min increased the recovery time tenfold even when the glutamate concentration was held at 3 microM. 3. We used a selective inhibitor of the mitochondrial Na(+)-Ca2+ exchange, CGP-37157. When applied immediately after a 15 s, 100 microM glutamate challenge, CGP-37157 consistently caused a rapid fall in [Ca2+]i followed by a slow rise after the drug was washed out. A similar pattern was seen with the 5 min, 3 microM glutamate stimulus. The effects of CGP-37157 are consistent with the release of substantial mitochondrial Ca2+ stores during recovery from an intense glutamate stimulus. 4. These studies suggest that mitochondria become progressively more important for buffering glutamate-induced Ca2+ loads as the stimulus intensity increases. The recovery of [Ca2+]i to baseline following glutamate removal is critically regulated by the release of Ca2+ from mitochondrial stores via mitochondrial Na(+)-Ca2+ exchange. The data highlight a previously under-appreciated role for [Na+]i in the regulation of [Ca2+]i in central neurones.