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Chronic obstructive pulmonary disease is a condition commonly present in older people undergoing surgery and confers an increased risk of postoperative complications and mortality. Although predominantly a respiratory disease, it frequently has extra-pulmonary manifestations and typically occurs in the context of other long-term conditions. Patients experience a range of symptoms that affect their quality of life, functional ability and clinical outcomes. In this review, we discuss the evidence for techniques to optimise the care of people with chronic obstructive pulmonary disease in the peri-operative period, and address potential new interventions to improve outcomes. The article centres on pulmonary rehabilitation, widely available for the treatment of stable chronic obstructive pulmonary disease, but less often used in a peri-operative setting. Current evidence is largely at high risk of bias, however. Before surgery it is important to ensure that what have been called the 'five fundamentals' of chronic obstructive pulmonary disease treatment are achieved: smoking cessation; pulmonary rehabilitation; vaccination; self-management; and identification and optimisation of co-morbidities. Pharmacological treatment should also be optimised, and some patients may benefit from lung volume reduction surgery. Psychological and behavioural factors are important, but are currently poorly understood in the peri-operative period. Considerations of the risk and benefits of delaying surgery to ensure the recommended measures are delivered depends on patient characteristics and the nature and urgency of the planned intervention. [ABSTRACT FROM AUTHOR]

Manufacturing complex parts by the laser sintering process requires a minimum amount of energy input for consolidation of polymer particles to occur; however too much energy can result in a decline in mechanical properties. This decrease is thought to be the result of polymer chain degradation. A stable sintering region (SSR) has been proposed to describe the optimum temperature range for successful laser sintering. This article will aim to quantify the SSR for polyamide-12 by using thermogravimetric analysis (TGA) to provide a framework for identifying key laser sintering processing parameters. Weight loss with respect to temperature is the main measurement output of the TGA procedure. However, the precise temperature and thermal history of a material is difficult to quantify during the laser sintering process; instead an energy input approach has been developed. A degradation energy was calculated from the TGA data and was used in conjunction with a laser sintering formula called energy melt ratio to prescribe build parameters for laser sintered parts. The mechanical properties of these parts illustrated the effect of degradation at various levels of energy input. Implications for this work include optimizing the material selection process for polymer laser sintering materials beyond polyamide-12. POLYM. ENG. SCI., 2013. © 2012 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

The article discusses a study of the efficacy and tolerability of prolonged administration of angiotensin-converting enzyme inhibitor quinapril in the management of the peripheral vascular manifestations of limited cutaneous systemic sclerosis (lcSSc) and in the prevention of the progression of visceral organ involvement in the disease. The maximum tolerated dosage of the drug in 210 patients was 80 mg/day. The occurrence of digital ulcers was not affected by the drug.

Objective: The aim of this study was to investigate whether foot and lower limb related symptoms were associated with work participation and poor mobility in people with Systemic Lupus Erythematosus (SLE). Method: A quantitative, cross-sectional, self-reported survey design was utilised. People with SLE from six United Kingdom (UK) treatment centres and a national register were invited to complete a survey about lower limb and foot health, work participation and mobility. Data collected included work status and the prevalence of foot symptoms. The focus of the analyses was to explore potential associations between poor foot health work non-participation. Results: In total, 182 useable surveys were returned. Seventy-nine respondents reported themselves as employed and 32 reported work non-participation. The remaining were retired due to age or reported work non-participation for other reasons. Work non-participation due to foot symptoms was significantly associated with difficulty walking (p = 0.024), past episodes of foot swelling (p = 0.041), and past episodes of foot ulceration (p = 0.018). There was a significant increase in foot disability scores amongst those not working (mean 18.13, 95% CI: 14.85–21.41) compared to those employed (mean 10.16, 95% CI: 8.11–12.21). Conclusions: Twenty-nine% of people with SLE reported work non-participation because of lower limb or foot problems. Our results suggest that foot health and mobility may be important contributors to a persons' ability to remain in work and should be considered as part of a clinical assessment. [ABSTRACT FROM AUTHOR]