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Introduction We have seen unparalleled changes in our healthcare systems globally as a result of the COVID-19 pandemic. As we strive to regenerate our full capacity elective services in order to contest the increasing demand for lower limb arthroplasty, this pandemic has allowed us a rare opportunity to revise and develop novel elective arthroplasty pathways intended to improve patient care and advance healthcare efficiency. We present an extensive evidence-based review of the approaches used to achieve day-case unicompartmental arthroplasty (UKA) as well as the development of a day-case UKA care pathway in a UK NHS institution based on the evidence provided in the literature. Methods An extensive search of the literature was performed for articles that reported on readmission or complication rates ≥30 days postoperatively following day-case UKA. Findings Fifteen manuscripts reporting the results of day-case UKA, defined as discharged on the same calendar day of surgery, were included in our review. Mean reported complication rates for day-case and inpatient UKA within the follow-up periods were 4.05% and 6.52%, respectively. Mean readmission rates were 2.71% and 4.36% for day-case and inpatient UKA, respectively. The mean rate of successful same-day discharge was 92.45%. Conclusion We introduce our institutional Elective Day Surgery Arthroplasty Pathway (EDSAP) founded upon the evidence presented in the literature. Stringent patient selection complimented by a well-defined day-case arthroplasty pathway is fundamental for successful commencement of day-case UKA in the NHS.

In this article we examine harmonic mappings defined on the punctured unit disk in the spirit of Clunie and Sheil-Small [J. Clunie and T. Sheil-Small (1984). Harmonic univalent functions. Ann. Acad. Sci. Fenn. Series A. I. Math., 9, 3–25] and Hengartner and Schober [W. Hengartner and G. Schober (1987). Univalent harmonic functions. Trans. Amer. Math. Soc., 299, 1–31]. We develop a family of mappings such that the members possess finitely many terms in their power series form. Moreover, there is a close coefficient relation between the analytic and co-analytic parts to guarantee the mappings are sense-preserving. After developing the family, we examine conditions for which mappings from the family are sense-preserving, typically real, and univalent, calling this family UTF. In closing, an example of the coefficient region for the sub-class of degree four UTF is included.

The argument principle is an important and useful result for meromorphic functions on domains in the plane. Duren, Hengartner and Laugesen have obtained an argument principle for harmonic mappings on Jordan domains. This paper is concerned with proving an argument principle for harmonic mappings that have isolated singularities. Examples are included to show how the geometric behavior of harmonic mappings differs from the meromorphic case. Also included in the paper is a definition of “pole” at an isolated singular point of a harmonic mapping and a “partitioning theorem” for the image space that yields components whose values are assumed the same number of times in the appropriate region.

OBJECTIVE: To determine whether tight control of blood pressure prevents macrovascular and microvascular complications in patients with type 2 diabetes. DESIGN: Randomised controlled trial comparing tight control of blood pressure aiming at a blood pressure of

Electroanalgesia has been practised since ancient times, but had not gained widespread popularity with patients until the advent of transcutaneous electrical nerve stimulators in the 1970s. These electrical stimulator units have now been developed into highly effective relievers of pain, offering significant long term benefit to around 40% of chronic pain sufferers. A number of variations to the units have been designed to improve the efficacy of stimulation, however there remain 3 basic forms: continuous, pulsed and acupuncture-like. Before rejecting the method as ineffective for any patient, it is important to have an adequate trial of treatment of at least a fortnight during which all forms of available stimulation are tried, with electrodes placed in a variety of positions on the skin for a minimum of an hour at a time. Failure is generally due to lack of perseverence or unrealistic expectations.

Three patients with unilateral auditory disturbances (singing voices, rockets and gongs, and whistling kettles) are described. The symptoms occurred during benzodiazepine withdrawal in two patients and the instigation of nefopam treatment in one. All patients had mild hearing loss and abnormal auditory evoked potentials. Two showed marked asymmetry of background EEG rhythms over the temporal lobe. In two of the patients the symptoms responded partially to TENS and/or acupuncture.

Our wish to know more about the paths taken by electrical currents in electroacupuncture (EA) with special reference to the heart, particularly in patients with an implanted pacemaker, prompted us to undertake this study. Using ourselves as subjects, we have developed a safe oscillographic method to detect, visualise and record the EA currents that avoids the use of equipment requiring mains electricity. After two trials with unsatisfactory equipment, we found that the newly developed model 3425 PicoScope™ (Pico Technology Ltd), with a four channel differential amplifier input connected to a laptop PC operating in battery mode, satisfied our criteria. With this recording system, we carried out two sets of experiments in which EA was provided by a Cefar acus4™ stimulator. The results confirm that the placement of a pair of acupuncture needles for EA can be used to predict the paths taken by the stimulating currents, and thus their areas of likely influence. When the needles are placed in closely adjacent acupuncture points in a limb, there is little or no detectable spread of the currents along the limb or into the chest. By contrast, when the needles are placed far apart, the electrical currents spread widely. Thus, when each of a pair of needles is placed in a point on opposite arms, the electrical currents recorded in the area of the pectoral muscles is of an order that might trigger an abnormal cardiac rhythm in a susceptible heart or activate a cardiac pacemaker incorporating an intracardiac defibrillator (ICD). Our results confirm the guidelines for EA safe practice recommended by the British Medical Acupuncture Society (BMAS) to avoid adverse events, ie EA should not be applied such that the current is likely to traverse the heart. We can now be confident that electric fields generated by pairs of needles below the knee or elbow do not create detectable currents in the chest. It is likely that similar results would be obtained with the use of transcutaneous electrical nerve stimulation (TENS) but this remains to be established by additional experiments.

Amy D'Andrea and Jessica Sjogren 464 pages, paperback, £41.99. Wiley-Blackwell. 2013. ISBN 978 0 8138 1621 0 ![Graphic][1] THIS is a comprehensive reference guide aimed at the more experienced reader. The authors have spent some 15 years compiling the data and presenting it in an easy-to-reference format. In over 400 pages, the authors cover a wide range of subjects from preventive health care, nutrition, reproduction and anatomy to emergency and critical care; there's even a small chapter on holistic medicine. There is very little narrative text, with most of the … [1]: /embed/inline-graphic-1.gif

It is with very great sadness that the Society learnt of David Bowsher's death on 17 June 2011 at the age of 86. David, an honorary member of the Society (he was also a member of both the research committee and the international editorial board), made many important contributions to the British Medical Acupuncture Society (BMAS) by way of presenting talks, publishing papers and chapters on acupuncture, as well as on forms of stimulation-induced analgesia. He willingly and generously gave valuable advice, help, guidance, encouragement and inspiration to members and others. Those who were fortunate enough to hear him present a lecture or to have a discussion with him, quickly realised that he was someone with a multitude of exceptional gifts. …

1.Animal and human work has indicated that maternal oxytocin secretion is under the control of endogenous opiates. Previous workers have described the fetal production of oxytocin in addition to maternal production. The study of the interaction between exogenously administered opiates and oxytocin secretion may give insight into the activity of any opiate-mediated regulatory mechanism of oxytocin secretion in the fetus. This study was designed to investigate the effect of an opiate (5 mg of morphine) given to the mother on the fetal production of oxytocin in labour. 2.Morphine was given by the attending clinicians for analgesic purposes to women in the first stage of labour. After delivery umbilical artery vein and maternal vein specimens were taken. 3.Four groups of patients were studied: women after normal vaginal delivery without analgesia in labour (n = 10); women after normal vaginal delivery who had morphine administration in the first stage of labour (n = 12); women who had an emergency Caesarean section in the first stage of labour (n = 11); women who had an elective Caesarean section at term who were not in labour (n = 11). 4.Oxytocin levels were measured by radioimmunoassay in the maternal vein, umbilical artery and umbilical vein specimens. Morphine was measured by radioimmunoassay in the umbilical vein specimens. 5.The umbilical artery minus vein concentration of oxytocin was calculated for each patient (A-V). There was no change in the umbilical (A-V) concentration of oxytocin if morphine had been given to the mother in labour; this applied to fetuses delivered vaginally or by Caesarean section. When the fetuses who were exposed to morphine were analysed separately, there was no correlation between the umbilical vein morphine concentration and the umbilical (A-V) oxytocin concentration either in Caesarean or vaginal deliveries. 6.Fetal oxytocin production was not affected by the maternal administration of morphine in the first stage of labour. This applies to the oxytocin production in the first and second stage of labour.

The relation between blood carboxyhaemoglobin (COHb) and plasma nicotine concentrations was studied in a group of 12 smokers smoking cigarettes of three levels of standard delivery. While the intake of carbon monoxide from a single cigarette was unrelated to the intake of nicotine, presmoking "trough" concentrations of the two substances (reflecting longer-term exposure) were highly correlated. Various other measures of nicotine exposure were at best only moderately correlated with blood nicotine concentrations. Thus trough COHb concentrations might be used to provide a reliable indication of the exposure to nicotine of individual smokers smoking the same type of cigarette, and of the relative exposure to nicotine of populations smoking cigarettes of different standard deliveries.

The infrared spectra of gaseous and solid 1, 1‐dibromoethane and 1, 1‐dibromoethane‐d4 have been recorded from 140 to 3500 cm−1. The corresponding Raman spectra of the liquid and solids have also been recorded and depolarization values have been measured. All spectra have been interpreted in detail and the 18 normal vibrations have been characterized on the basis of band contours, isotopic shifts, depolarization values, and normal coordinate calculations. The internal torsional mode was observed at 253 cm−1 in the far infrared spectrum of gaseous CH3CHBr2 and the assignment was confirmed by the shift with deuteration. The threefold barrier to rotation was calculated to be 4.3 kcal/mole. This determination allows a comparison of the barriers for a series of bromoethanes.

An 11-week crossover study was carried out in which 12 subjects smoked high-nicotine (1.84 mg standard yield) and low-nicotine (0.6 mg) cigarettes after an initial period of smoking their usual brands with a medium-nicotine yield (mean 1.4 mg). Plasma and urine nicotine concentrations, carboxyhaemoglobin (COHb) concentration, puffing behaviour, 24-hour cigarette consumption, and butt nicotine content were measured. The changes in plasma nicotine and blood COHb concentrations showed that the smokers compensated for about two-thirds of the difference in standard yields when switched to either high- or low-nicotine cigarettes. Thus, compared with the medium-nicotine brand, the intake of nicotine and carbon monoxide was only about 10% higher when subjects smoked the high-nicotine cigarettes, which had a standard yield 30-40% higher than the medium brands; and only about 15% lower when they smoked the low-nicotine cigarettes, which had a standard yield about 50% lower than the medium brands. But nicotine content and urine nicotine concentrations followed a similar pattern. Changes in puffing behaviour and in 24-hour cigarette consumption were only slight.The results show clear evidence of both upward and downward self-titration of nicotine and carbon monoxide (and tar) intakes when smokers change to cigarettes with standard yields that differ over the range studied.

The Raman spectra of B2F4 have been recorded from 25 to 1500 cm−1 with the sample in both the gaseous and crystalline states. An assignment of the normal vibrations of the molecule in the planar form is presented. No evidence could be found for the conversion from the D2h form in the solid to a nonplanar D2d form in the gas as had been previously reported. It appears that the rule of mutual exclusion is retained in the spectra for the vapor and liquid states and that the molecule has D2h symmetry in all physical states. The optically active translations and librations have been observed in the low frequency infrared and Raman spectra of the solid, respectively. Intermolecular force constants have been calculated.

In cats and rabbits procainamide (20 to 50 mg, intravenously) produced a fall of blood pressure of 20 to 50 mm Hg which reached a maximal effect within 1 min and lasted for about 5 min. Procainamide reduced the pressor responses to nicotine and to carotid arterial occlusion and reduced the depressor response to vagal stimulation, but did not antagonize the actions of adrenaline or noradrenaline on blood vessels. The contractions of the nictitating membrane to stimulation of the preganglionic cervical sympathetic nerve were partially or completely blocked by 20 to 50 mg of procainamide given intravenously. The ganglion blocking effect was more abrupt in onset and more slow to recover than that due to hexamethonium and had about 1/250th of the activity of the latter. Procainamide (1 mg) reduced the acetylcholine output of the perfused superior cervical ganglion to below 30% of the control value and blocked transmission completely. Small doses (10 μg) reduced the acetylcholine output but hardly affected ganglionic transmission. Procainamide, injected into the perfused superior cervical ganglion, blocked contractions elicited by stimulation of the preganglionic cervical sympathetic nerve for a longer period than those produced by acetylcholine injected into the perfusion circuit to the ganglion; the reverse was true for hexamethonium. Procainamide reduced the size of action potentials recorded from the superior cervical ganglion without altering the resting potential of the ganglion. The ganglion blocking activities of procainamide and hexamethonium often potentiated each other, especially when the preparation had been set up for several hours. On the guinea-pig isolated ileum preparation, procainamide (0.5×10-4 g/ml.) antagonized responses due to acetylcholine, histamine and, most effectively, to nicotine. On the isolated heart, procainamide (1 mg) almost abolished the bradycardia produced by acetylcholine; 10 mg slowed and weakened the heart, while 100 mg stopped it. We conclude that procainamide, like procaine, blocks ganglionic transmission by (1) depressing the release of acetylcholine from preganglionic nerve endings; and (2) competing, with the acetylcholine which is released, for receptor sites on the ganglion cells. The amounts required to produce significant effects in vivo and in vitro are comparable. The methods available for detecting this type of ganglion blocking action are discussed.

A comprehensive clinical drug information service, established in the Northern Region in May 1975, is manned by eight doctors--all clinical pharmacologists--and is available 24 hours a day. In the first year of operation 451 inquiries were received, 354 (78-5%) of which were "consultative." Though junior hospital doctors used the service most, almost half of the inquiries about adverse reactions to drugs came from consultants.

Excerpt The first pre-requisite for an intelligent approach to the treatment of peptic ulcer by any method is an accurate conception of the pathologic changes in the gastroduodenal mucous membrane ...

Dill and his associates 1 have submitted for publication physiologic studies of a group of Negro sharecroppers; this paper is written primarily as a clinical appendix to those reports. The persons studied were selected by Dr. I. I. Pogue, the resident physician retained by the Delta and Pine Land Company on its plantation located at Scott, Miss. Aside from restricting the group to male Negroeś within certain age limits (17 to 24) living on this plantation, the selection was made at random among the sharecropper families. A family and personal history was obtained from each subject and a routine clinical examination performed. All negative observations are omitted from this report, and the positive ones are compared with data obtained on a group of Harvard students by Dr. Clark Heath. The exacting criteria required to be met for admission into Dr. Heath's series render these persons well above the average from