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Introduction. Alzheimer's disease (AD) is a neurodegenerative disorder with no conclusive remedy. Yohimbine, found in Rauwolfia vomitoria, may reduce brain inflammation by targeting tumour necrosis factor-alpha (TNFα), implicated in AD pathogenesis. Metoserpate, a synthetic compound, may inhibit TNFα. The study is aimed at assessing the potential utility of repurposing metoserpate for TNFα inhibition to reduce neuronal damage and inflammation in AD. The development of safe and effective treatments for AD is crucial to address the growing burden of the disease, which is projected to double over the next two decades. Methods. Our study repurposed an FDA-approved drug as TNFα inhibitor for AD management using structural similarity studies, molecular docking, and molecular dynamics simulations. Yohimbine was used as a reference compound. Molecular docking used SeeSAR, and molecular dynamics simulation used GROMACS. Results. Metoserpate was selected from 10 compounds similar to yohimbine based on pharmacokinetic properties and FDA approval status. Molecular docking and simulation studies showed a stable interaction between metoserpate and TNFα over 100 ns (100000 ps). This suggests a reliable and robust interaction between the protein and ligand, supporting the potential utility of repurposing metoserpate for TNFα inhibition in AD treatment. Conclusion. Our study has identified metoserpate, a previously FDA-approved antihypertensive agent, as a promising candidate for inhibiting TNFα in the management of AD. [ABSTRACT FROM AUTHOR]

The relationship between liver dysfunction and dementia has been researched extensively but remains poorly understood. In this study, we investigate the longitudinal and cross‐sectional associations between liver function and liver diseases and risk of incident dementia, impaired cognition, and brain structure abnormalities using Cox proportion hazard model and linear regression model. 431 699 participants with a mean of 8.65 (standard deviation [SD] 2.61) years of follow‐up were included from the UK Biobank; 5542 all‐cause dementia (ACD), 2427 Alzheimer's disease (AD), and 1282 vascular dementia (VaD) cases were documented. We observed that per SD decreases in alanine transaminase (ALT; hazard ratio [HR], 0.917; PFDR <0.001) and per SD increases in aspartate aminotransferase (AST; HR, 1.048; PFDR = 0.010), AST to ALT ratio (HR, 1.195; PFDR <0.001), gamma‐glutamyl transpeptidase (GGT; HR, 1.066; PFDR <0.001), alcoholic liver disease (ALD; HR, 2.872; PFDR <0.001), and fibrosis and cirrhosis of liver (HR, 2.285; PFDR = 0.002), being significantly associated with a higher risk of incident ACD. Restricted cubic spline models identified a strong U‐shaped association between Alb and AST and incident ACD (Pnonlinear <0.05). Worse cognition was positively correlated with AST, AST to ALT ratio, direct bilirubin (DBil), and GGT; negatively correlated with ALT, Alb, and total bilirubin (TBil); and ALD and fibrosis and cirrhosis of liver (PFDR <0.05). Moreover, changes in ALT, GGT, AST to ALT ratio, and ALD were significantly associated with altered cortical and subcortical regions, including hippocampus, amygdala, thalamus, pallidum, and fusiform (PFDR <0.05). In sensitivity analysis, metabolic dysfunction‐associated steatotic liver disease (MASLD) was associated with the risk of ACD and brain subcortical changes. Our findings provide substantial evidence that liver dysfunction may be an important factor for incident dementia. Early intervention in the unhealthy liver may help prevent cognitive impairment and dementia incidence. [ABSTRACT FROM AUTHOR]

The majority of drug users neglect their health and have limited access to primary and preventative health care services. A health care team was developed in an attempt to provide health care for drug users, to prevent the spread of HIV and provide health education to the drug users. The health problems were related to injecting drugs, comprising abscesses, peripheral neuropathy and poor peripheral circulation. A high level of past infection with hepatitis B virus was noted, indicating the need for hepatitis B vaccination for drug users. [ABSTRACT FROM AUTHOR]

Panton–Valentine leucocidin (PVL) is a virulence factor produced by certain strains of Staphylococcus aureus (SA). Through its cytolytic action on the cell membranes of human polymorphonuclear neutrophils, PVL causes a range of pathologies collectively known as PVL‐SA disease. The hallmark clinical signs of PVL‐SA are recurrent boils and necrotizing skin and soft tissue infections (SSTIs) in otherwise healthy patients; however, it can lead to more severe and invasive presentations, including necrotizing haemorrhagic pneumonia, necrotizing fasciitis and purpura fulminans. Young adults with minimal previous exposure to healthcare settings tend to be at highest risk for acquiring PVL‐SA disease, with close physical contact playing a central role in disease transmission. The prevalence of PVL‐SA varies globally; however, this is often underestimated owing to a lack of routine PVL testing. In the UK, PVL‐positive SA isolates have been rising over the past decade alongside an increasing prevalence of multidrug resistance in larger cities. This review article aims to raise awareness of the PVL toxin, to aid clinicians with diagnostic pointers and to provide guidance with treatment, with an emphasis on the need for further population‐based studies. [ABSTRACT FROM AUTHOR]

Objective: To determine the common clinical signs, with onset and duration, treatments given, and outcome in dogs with acute, accidental exposure to salbutamol. Design: Retrospective study. Animals: Five hundred and one canine cases reported to the UK's Veterinary Poisons Information Service (VPIS). Measurements and Main Results: A review of all records in the VPIS database for dogs exposed to salbutamol was carried out. After applying inclusion and exclusion criteria, the records of 501 dogs were further analyzed. The most common clinical signs were tachycardia (80.6%), tachypnea (32.9%), depression (21.0%), and vomiting (19.2%). The dose was unknown in most cases as the dogs typically pierced a salbutamol inhaler. The blood potassium concentration was measured in at least 142 dogs and hypokalemia was reported in 21.2% (106/501), 18 (17%) of which had associated weakness, twitching, or collapse. Three dogs had paralysis probably as a result of hypokalemia, although no potassium concentration was reported in these cases. Arrhythmias occurred in 17 dogs (3.4%), and 7 required pharmacological intervention. There were no reports of persistent cardiac injury or thermal injury from the compressed gas present in some salbutamol products. Signs were rapid in onset, generally within 1–3 h, and, where time to outcome was recorded (n = 172), 78% of dogs recovered within 24 h. Of the 501 dogs, no treatment was required in 27.9%. Beta‐blockers were used in 39.5%, intravenous fluids in 28.7%, and potassium supplementation in 15.8%. Overall, 30 dogs remained asymptomatic (6.0%), 469 recovered (93.6%), and 2 dogs (0.4%) died. Conclusions: Most dogs exposed to salbutamol rapidly develop clinical signs; these were commonly increased heart and respiration rates. Hypokalemia and arrhythmias (particularly ventricular arrhythmias) are potential complications. Any dog that chews a salbutamol inhaler should be assessed promptly for signs of toxicosis. Prognosis in dogs with acute salbutamol exposure is good, but more guarded in those with severe tachycardia and at risk of cardiac injury. [ABSTRACT FROM AUTHOR]

Background: Tumour neoangiogenesis can be assessed non-invasively by measuring angiogenic cytokine concentrations in peripheral circulation and by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The aim of this study was to assess whether these methods can predict and monitor response to treatment in patients with rectal cancer treated with preoperative chemoradiotherapy. Methods: Serum and plasma vascular endothelial growth factor levels were measured in 31 patients with T3/T4 rectal cancers before quantitating tumour permeability (ln Ktrans) by DCE-MRI. Sixteen patients receiving preoperative chemoradiotherapy had serial vascular endothelial growth factor (VEGF) and DCE-MRI measurements. Response to treatment was assessed using World Health Organization criteria. Results: Serum VEGF and ln Ktrans correlated before treatment (r = 0·48, P = 0·01). Responsive tumours (n = 8) had higher pretreatment permeability values than non-responsive tumours (n = 8) (mean ln Ktrans - 0·46 and - 0·72 respectively; P = 0·03). Compared with pretreatment values, responsive tumours showed a marked reduction in permeability at the end of treatment (mean ln Ktrans - 0·46 and - 0·86 respectively; P = 0·04). Pretreatment serum VEGF levels were not statistically different between the two groups. Conclusion: Rectal tumours with higher permeability at presentation appear to respond better to chemoradiotherapy than those of lower permeability. This may allow preselection of appropriate tumours for these regimens, with patients with low-permeability tumours being considered for alternative therapies. [ABSTRACT FROM AUTHOR]

This study aimed to compare the efficacy of rituximab versus Cyclophosphamide on active secondary progressive multiple sclerosis (SPMS). The randomized clinical trial was performed from 2015 to 2017 in multiple sclerosis (MS) clinics affiliated to Isfahan MS society (IMSS). Patients were randomized to two groups, and one of them received Rituximab that was repeated every six months in case of medical indication. The other one received a monthly pulse of methylprednisolone plus cyclophosphamide (Endoxan, Baxter, UK) until two years. Expanded disabilities status scale (EDSS), clinical, and MRI findings were assessed every six months. Statistical analysis was performed using SPSS software. 39 patients in the Rituximab group and 30 in the Cyclophosphamide group with similar age and gender distribution were entered for analysis. At baseline, the mean number of attacks in the Rituximab group was significantly more than the Cyclophosphamide group (P=0.0001). After 6, 12, and 18 months of treatment, the rate of attacks was similar between groups although it increased significantly in the Rituximab group (P=0.030) after 24 months of treatment. EDSS was increased in the Rituximab group more than the other group at the end of the study. Both drugs were well-tolerated by patients. The EDSS was increased in the Rituximab group but the disability score did not worsen in the Cyclophosphamide group. Both therapies were associated with a reduction in disease attacks and improvement in radiologic findings in a two-year period of follow-up. [ABSTRACT FROM AUTHOR]

Objective: Reliable and objective outcome measures to facilitate clinical trials of novel treatments for systemic sclerosis (SSc)–related Raynaud's phenomenon (RP) are badly needed. Laser speckle contrast imaging (LSCI) and thermography are noninvasive measures of perfusion that have shown excellent potential. This multicenter study was undertaken to determine the reliability and validity of a hand cold challenge protocol using LSCI, standard thermography, and low‐cost cell phone/mobile phone thermography (henceforth referred to as mobile thermography) in patients with SSc‐related RP. Methods: Patients with RP secondary to SSc were recruited from 6 UK tertiary care centers. The patients underwent cold challenge on 2 consecutive days. Changes in cutaneous blood flow/skin temperature at each visit were imaged simultaneously using LSCI, standard thermography, and mobile thermography. Measurements included area under the curve (AUC) for reperfusion/rewarming and maximum blood flow rate/skin temperature after rewarming (MAX). Test–retest reliability was assessed using intraclass correlation coefficients (ICCs). Estimated latent correlations (estimated from multilevel models, taking values between −1 and 1; denoted as rho values) were used to assess the convergent validity of LSCI and thermography. Results: In total, 159 patients (77% with limited cutaneous SSc) were recruited (84% female, median age 63.3 years). LSCI and standard thermography both had substantial reliability, with ICCs for the reperfusion/rewarming AUC of 0.67 (95% confidence interval [95% CI] 0.54, 0.76) and 0.68 (95% CI 0.58, 0.80), respectively, and ICCs for the MAX of 0.64 (95% CI 0.52, 0.75) and 0.72 (95% CI 0.64, 0.81), respectively. Very high latent correlations were present for the AUCs of LSCI and thermography (ρ = 0.94; 95% CI 0.87, 1.00) and for the AUCs of standard and mobile thermography (ρ = 0.98; 95% CI 0.94, 1.00). Conclusion: This is the first multicenter study to examine the reliability and validity of cold challenge using LSCI and thermography in patients with SSc‐related RP. LSCI and thermography both demonstrated good potential as outcome measures. LSCI, standard thermography, and mobile thermography had very high convergent validity. [ABSTRACT FROM AUTHOR]

ABSTRACT: The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to managing diabetic foot ulcers (DFUs) in clinical practice by the UK's National Health Service (NHS), and the associated costs of patient management. This was a retrospective cohort analysis of the records of 130 patients with a newly diagnosed DFU in The Health Improvement Network (THIN) database. Patients' characteristics, wound‐related health outcomes and health care resource use were quantified, and the total NHS cost of patient management was estimated at 2015–2016 prices. Patients were predominantly managed in the community by nurses, with minimal clinical involvement of specialist physicians. 5% of patients saw a podiatrist, and 5% received a pressure‐offloading device. Additionally, 17% of patients had at least one amputation within the first 12 months from initial presentation of their DFU. 14% of DFUs were documented as being clinically infected at initial presentation, although an additional 31% of patients were prescribed an antimicrobial dressing at the time of presentation. Of all the DFUs, 35% healed within 12 months, and the mean time to healing was 4·4 months. Over the study period, 48% of all patients received at least one prescription for a compression system, but significantly more patients healed if they never received compression (67% versus 16%; P < 0·001). The mean NHS cost of wound care over 12 months was an estimated £7800 per DFU (of which 13% was attributable to amputations), ranging from £2140 to £8800 per healed and unhealed DFU, respectively, and £16 900 per amputated wound. Consolidated medical records from a primary care held database provided ‘real‐world evidence’ highlighting the consequences of inefficient and inadequate management of DFUs in clinical practice in the UK. Clinical and economic benefits to both patients and the NHS could accrue from strategies that focus on (i) wound prevention, (ii) improving wound‐healing rates and (iii) reducing infection and amputation rates. [ABSTRACT FROM AUTHOR]

In the UK, the lifetime-documented prevalence of major depressive disorder (MDD) is currently 10%. Despite its increasing prevalence and devastating impact on quality of life, the pathophysiological mechanisms underpinning MDD remain to be fully elucidated. Current theories of neurobiological components remain incomplete and protein-centric, rendering pharmacological treatment options suboptimal. In this review, we highlight the pivotal role of lipids in intra- and inter-neuronal functioning, emphasising the potential use of lipids as biomarkers for MDD. The latter has significant implications for improving our understanding of MDD at the cellular and circuit level. There is particular focus on cholesterol (high and low density lipoprotein), omega-3, and omega-6 polyunsaturated fatty acids due to established evidence in the literature of a link between atherosclerotic disease and major depression. We argue that there is significant potential scope for the use of such peripheral biomarkers in the diagnosis, stratification and treatment of MDD. [ABSTRACT FROM AUTHOR]

An abstract of the article "National Audit of Seizure Management in Hospitals 2" by Tony Marson, Pete Dixon and Mike Pearson is presented.

The article presents a study which examines the signs and symptoms in children and young people with end of life care needs. The study is investigated using Delphi process, second-round questionnaires, and statistical analyses. Results show that prognostic indicators include failure of physiological systems, deterioration of consciousness, and loss of autonomic control.

Background: The association between intraoperative floppy iris syndrome (IFIS) and tamsulosin has been well-described. The rate of IFIS in association with other α-1 antagonists needs further clarification. The objective of this study was to determine the incidence of IFIS and associated cataract surgery complications in patients taking tamsulosin or doxazosin. Methods: Patients receiving tamsulosin or doxazosin, and an equivalent number of controls, were identified using the electronic patient record for cataract surgery performed over 2 years. The presence of IFIS and intraoperative complications were ascertained. Modifications of surgical technique in the form of preoperative 1 % atropine, intraoperative diluted phenylephrine, iris hooks, or highly viscous viscoelastic materials were recorded. Results: Of the 2,785 cataract operations performed in 2,028 patients, 52 cases (1.9 %) were on tamsulosin and 109 were on doxazosin (3.9 %). In the doxazosin group (excluding three cases with incomplete data), significantly more eyes (17 of 106 eyes, 16 %) showed at least one IFIS characteristic than controls, six eyes (6 %) required adjustment of surgical technique, and intraoperative complications occurred in two eyes (1.9 %). In the tamsulosin group, significantly more eyes (25 of 52 eyes, 48 %) demonstrated at least one IFIS feature than control or doxazosin eyes; 18 eyes (35 %) needed adjustment of surgical technique, and seven (13.5 %) suffered intraoperative complications. Conclusion: Incidence of IFIS was significantly higher in tamsulosin and doxazosin patients. The presence of IFIS was associated with a significantly higher complication rate. We would advise that all patients receiving α1 antagonists (not only those receiving tamsulosin) should be identified preoperatively, receive appropriate modifications in preparation, and have alternative techniques and a senior surgeon available at the time of surgery. [ABSTRACT FROM AUTHOR]

Objectives To determine the agreement of fingertip and sternum capillary refill time (CRT) in children. Design Prospective, method-comparison study. Setting Single children's emergency department, UK Participants 92 children aged 0-12 years, with clinical observations within normal ranges for their age, no relevant medical history and presenting to hospital with a minor illness or injury. Main outcome measures Agreement between fingertip and sternum CRT measurements. Results Fingertip CRT ranged from 0.05 to 2.78 s with a mean of 1.08±0.44 and sternum CRT ranged from 0.85 to 2.38 s with a mean of 1.5±0.33. There was a significant difference between fingertip and sternum CRT (t=-9.2, df=91, p=<0.001) and a weak association between the two measurements (r=0.18, p=0.9). A Bland Altman comparison showed the mean difference between fingertip and sternum CRT was -0.49±0.51 with an upper and lower limit of agreement ranging from -1.5 (95% CI -1.69 to -1.32) to 0.53 (95% CI 0.34 to 0.71). Conclusions Measurements of CRT taken at the fingertip and sternum are not comparable. Fingertip CRT was faster than sternum CRT. Normal CRT is 2-3 s. The current study questions the usefulness of CRT in the assessment of circulation in children. [ABSTRACT FROM AUTHOR]

The International Surgical Congress of the Association of Surgeons of Great Britain and Ireland takes place this year in Liverpool, UK (9-11 May 2012). Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Anaphylaxis is a rare adverse event following immunisation (AEFI) and unlikely to be detected in prelicensure vaccine trials. Previous retrospective studies have been hampered by the paucity of information available to passive reporting schemes. The aim of the present study was to estimate the incidence and clinical presentation of anaphylaxis as an AEFI using prospective active surveillance. Methods Children under 16 in the UK and Ireland with suspected anaphylaxis as an AEFI were reported through the British Paediatric Surveillance Unit (BPSU) between September 2008 and October 2009. Paediatricians completed questionnaires on presentation, diagnosis, management and outcome. Results A total of 7 out of 15 reports met criteria for anaphylaxis following immunisation. Four of the seven children reacted more than 30 min after administration of the vaccine. Six children required treatment with intramuscular adrenaline and intravenous fluids, but all made a full recovery. Denominators were not available for all vaccines so an overall incidence was not calculated, however the estimated incidence was 12.0 per 100 000 dose for single component measles vaccine and 1.4 cases per million doses for the bivalent human papilloma virus vaccine (Cervarix, GSK). Conclusions Anaphylaxis remains a rare adverse event following immunisation. No cases were related to vaccines given as part of the 'routine' infant and preschool immunisation programme, despite over 5.5 million vaccines being delivered in this time period. Some children had delayed onset of symptoms and this should be considered when vaccinating those at higher risk of anaphylaxis. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluates the efficacy of an electrical stimulation device, Accel-Heal on the management of oedema in chronic leg ulcers. It states that the study used a high-frequency diagnostic ultrasound to asses the effect of an electrical stimulation device delivering a low-intensity pulsed current on levels of oedema in chronic non-healing venous and leg ulcers. It indicates that the device appeared to be effective in reducing oedema levels.

Objective Expanded populations of CD4+CD28− T cells with a cytotoxic phenotype have been repeatedly reported in patients with granulomatosis with polyangiitis (Wegener's) (GPA). In healthy individuals expansion of this T cell population follows cytomegalovirus (CMV) infection. We undertook this study to investigate whether CMV infection may be responsible for driving the expansion of CD4+CD28− T cells in GPA patients and how this might relate to clinical features. Methods Forty-eight GPA patients and 38 age-matched healthy donors were included in the study. CMV-specific IgG in serum was detected by enzyme-linked immunosorbent assay. Flow cytometric analysis was used to study T cell populations and phenotype. The presence of CMV in renal biopsy tissue from GPA patients was investigated by immunohistochemistry and polymerase chain reaction (PCR). Clinical information was obtained from patient records. Results Populations of CD4+CD28− T cells were only expanded in CMV-seropositive GPA patients and controls. In CMV-seropositive GPA patients we observed negative correlations between the percentages of CD4+CD28− T cells and both the percentage of naive T cells and the glomerular filtration rate at presentation. There was a significant association between the percentage of CD4+CD28− T cells and risk of infection and mortality. CMV could not be detected in renal tissue by PCR or immunohistochemistry. CMV seropositivity itself was not a risk factor for infection in a cohort of 182 patients with antineutrophil cytoplasmic antibody-associated vasculitis who had been recruited into clinical trials performed by the European Vasculitis Study Group. Conclusion The expansion of CD4+CD28− T cells in GPA patients is associated with CMV infection and leads to a reduction in the number of naive T cells in peripheral blood. Patients with expanded CD4+CD28− T cells have significantly increased mortality and risk of infection. [ABSTRACT FROM AUTHOR]

Ovarian cancer is the fourth most common cause of cancer death among women. It has a poor prognosis, withfive-year survival rates of 40 per cent. This article discusses early symptoms and treatments. It explores themanagement of disease, treatment-related symptoms and end of life care and provides practical guidance on ways in which cancer nurses can work in partnership with women to support and educate them to self-manage their symptoms where possible and deal with the challenges posed by their illness. [ABSTRACT FROM AUTHOR]

ABSTRACT: Bovine Neonatal Pancytopenia is an emerging disease of young calves that has been seen across Europe since 2007. Calves present at <1 month old with pyrexia and either signs of external haemorrhage or collapse/sudden death due to internal haemorrhage. The fatality rate is >90%. Haematology from cases reveals a profound thrombocytopenia. Histopathology of bone marrow shows a dramatic depletion of all haemopoetic cell lines, consistent with a definition of trilineage hypoplasia. The aetiology of BNP remains unknown and work is continuing in the UK and Europe to investigate all aspects of this disease. [ABSTRACT FROM AUTHOR]

OBJECTIVE--Type 1 diabetes results from an immune-mediated destruction of β-cells, likely to be mediated by T lymphocytes, but the sensitivity, specificity, and other measures of validity of existing assays for islet autoreactive T-cells are not well established. Such assays are vital for monitoring responses to interventions that may modulate disease progression. RESEARCH DESIGN AND METHODS--We studied the ability of cellular assays to discriminate responses in patients with type 1 diabetes and normal control subjects in a randomized blinded study in the U.S. and U.K. We evaluated the reproducibility of these measurements overall and to individual analytes from repeat collections. RESULTS--Responses in the cellular immunoblot, U.K.-ELISPOT, and T-cell proliferation assays could differentiate patients from control subjects with odds ratios of 21.7, 3.44, and 3.36, respectively, with sensitivity and specificity as high as 74 and 88%. The class II tetramer and U.S. ELISPOT assays performed less well. Despite the significant association of the responses with type 1 diabetes, the reproducibility of the measured responses, both overall and individual analytes, was relatively low. Positive samples from normal control subjects (i.e., false positives) were generally isolated to single assays. CONCLUSIONS--The cellular immunoblot, U.K.-ELISPOT, and T-cell proliferation assays can distinguish responses from patients with type 1 diabetes and healthy control subjects. The limited reproducibility of the measurements overall and of responses to individual analytes may reflect the difficulty in detection of low frequency of antigen-specific T-cells or variability in their appearance in peripheral blood. Diabetes 58:2588-2595, 2009. [ABSTRACT FROM AUTHOR]

The article explores whether the present and past regulatory approach in defendant personal injury work is appropriate both in terms of competition and access to justice in Great Britain. It examines the impact on the market for personal injury claims after the state withdrew from providing finance to such are in England and Wales in 2000. Also analyzed is how the continuation of one aspect of the regulatory regime by the legal disciplinary authorities retained a bar to free competition.

Extracorporeal photopheresis (ECP) has been used for over 30 years in the treatment of erythrodermic cutaneous T-cell lymphoma (CTCL) and over 20 years for chronic graft-versus-host disease (cGVHD). The lack of prospective randomized trials has led to different centres having different patient selection criteria, treatment schedules, monitoring protocols and patient assessment criteria. ECP for CTCL and cGVHD is available only at six specialized centres across the U.K. In the recent Improving Outcomes Guidance the National Institute for Health and Clinical Excellence endorsed the use of ECP for CTCL and because of the complexity of treatment supported its use in specialized centres and also suggested the need for expansion of this service. In 2005 consultants and senior nurses from all U.K. sites and from Scandinavia formed a Photopheresis Expert Group. This group’s first aim was to produce a consensus statement on the treatment of CTCL and cGVHD with ECP using evidence-based medicine and best medical practice, in order to standardize ECP eligibility, assessment and treatment strategies across the U.K. [ABSTRACT FROM AUTHOR]

The article offers a guide to nurses in Great Britain in recognizing and managing patients during and after episodes of anaphylaxis. It describes the clinical features of anaphylaxis and lists some of the common symptoms associated with anaphylaxis. It discusses the two main parts of the immune system implicated in an anaphylactic reaction. It provides a case study which shows the proper care of patients during and after episodes of anaphylaxis.

This article presents abstracts of the papers presented at the 2006 Annual Conference of the British Association of Sport and Exercise Sciences, held at the University of Wolverhampton in Great Britain. The paper "Joint power and work in an elite sprinter at maximum velocity," by I. N. Bezodis, A. I. T. Salo and D. G. Kerwin, is summarized. The article "Relationships between kinetic and kinematic variables during distance running," by B. Hanley and A. Mohan, is also abstracted. The article "Test-retest stability of mood measures," by A.M. Lane and A. Nevill, is also summarized.

The use of pulse oximetry has been recommended to ensure the safety of service users following rapid tranquillisation or restraint. However, as Mark Sheldon explains, practitioners must be mindful of the potential dangers of using such devices. [ABSTRACT FROM AUTHOR]

It is clear that the emerging role of the health facilitator highlights the relevance of screening tools as a pragmatic solution in assessing health deficits. Health Assessment Planned Improvement Tool is a useful strategy for community learning disability nurses to assist people with a learning disability to have good access to health care and health promotion. Guidance documents from the Great Britain Department of Health describe the nurse's role as assistants in primary health care teams and social services to facilitate, advocate and ensure that people with a learning disability gain full access to the health care they require from primary and secondary health services.

Bacterial screening is being considered or implemented in a number of countries as of August 2003, because contamination of platelet concentrates (PCs) with bacteria causes significant morbidity and mortality. Great Britain haemovigilance data for the period 1996-2001 show that of 38 transfusion-transmitted infections, 21 were caused by bacteria, six of which were fatal. Equally, risk-reduction strategies for immune complications such as transfusion-related acute lung injury and the unknown risk of variant Creutzfeldt-Jakob disease transmission act as a driver to replace as much plasma in PCs as possible with platelet additive solutions (PASs), and hence assessment of extended platelet storage in plasma or PAS has become a current topic of interest for many blood services. Storage of platelets for up to 7 days was permitted in the U.S. in the 1980s until 1986, when the Food and Drug Administration (FDA) reduced this to 5 days because of concerns over rates of bacterial contamination in PC towards the end of their shelf life.

The British National Institute for Clinical Excellence (NICE) was established in the light of a perceived need for a regulatory body to review the efficacy of existing and new treatments and to appraise technological developments. It was seen as being important for the following reasons firstly, there was and is slow uptake, even of innovations of perceived benefit. Secondly, judgments on the interpretation or significance of the evidence can be different in different parts of the country, resulting in variations in the access for patients to the new treatments with the widespread perception of inequity. Thirdly, wasteful use of resources can occur when treatments are used outside the range in which they are clinically cost effective, at the expense of alternative uses of those resources, which could give greater benefits to patients.

The insulin-like growth factor (IGF) system, comprising insulin-like growth factor I (IGF-I), insulin-like growth factor II (IGF-II), and their binding proteins (IGFBPs), is linked to cell growth, the development of cardiovascular disease, and several cancers. Little is known about its epidemiology. The authors studied relations of the IGF system to anthropometric and metabolic variables in three population-based ethnic groups in Manchester, England, in 1994–1998 with differing disease risks: African Caribbean (n = 193), Pakistani (n = 130), and local Europeans(n = 142). Standardized anthropometry, glucose tolerance tests, and serum assays were performed. Body mass indices (BMIs) were high in all groups. IGF-I levels were highest in normoglycemic African Caribbeans and declined with age (r = −0.28). IGF-II levels were greatest in Europeans. IGFBP-1 concentrations increased with age in Pakistanis (r = 0.20) and Europeans (r = 0.29), but not in African Caribbeans (r = 0.06), and were inversely related to BMI (r = −0.37). Age- and sex-adjusted IGFBP-1 was inversely related to fasting insulin and proinsulin in all groups; participants with newly detected diabetes were relatively insulinopenic but had higher IGFBP-1 concentrations. Nonesterified (free) fatty acid (NEFA) concentrations increased with declining glucose tolerance. In multiple regression analysis, IGFBP-1 was independently and negatively related to fasting insulin, BMI, and African-Caribbean compared with European ethnicity but positively related to age, fasting glucose, and NEFA. IGF-I was inversely related only to age, NEFA, and Pakistani ethnicity. IGF-II showed a strong ethnic difference but was unrelated to other variables. These data indicate considerable potential for exploring disease-IGF system relations in population samples. [ABSTRACT FROM PUBLISHER]

Examines the correlation among diabetes, atherosclerosis and obesity in Great Britain. Pathogenesis of atherosclerosis; Mechanisms of postprandial hyperglycemia; Risk factors for developing type two diabetes.

The article focuses on the study regarding the importance of the pituitary gland in the control of hormone secretion growth in man in Great Britain. The authors discuss the secretion of growth hormone (GH) and inderstanding the factors that influences secretion. Moreover, he talks about the clinical importance of GH in diabetes as well as its relationship to microvascular complications.

Discusses a proposed wheat-related syndrome which may be linked to toxic pesticides and/or herbicide residues in the grain. Study of all patients at one British homeopathic outpatient clinic; Wheat elimination diet in treating patients thought to be suffering from adverse effects of wheat; Improvements in both physical and psychological symptoms noted in patients treated with wheat elimination diet.

This article discusses various issues related to the early care of severely injured patients in Great Britain. A severely injured patient should be provided with intensive care at the site of accident itself which should be continued in the intensive care unit. Optimal care of severely injured patients provide good results. High standard treatment delivered early by experienced medical staff play an important role in this regard.

There is limited published literature on the use of 8 cm centimetre midlines for vascular access. This clinical audit was undertaken to provide a local evidence base for the insertion of midlines in patients receiving non-vesicant intravenous antibiotic therapy in the community setting over the medium term. The findings show their use has clear advantages for patients and clinicians. Although conducted in the community setting, the audit could be replicated in any community or hospital environment where medium-term intravenous therapy of non-vesicant fluids is administered. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the assessment of children with serious infections in primary care in Great Britain. The diagnosis and treatment of these infections, such as meningococcal disease and pneumonia, is discussed. The National Institute for Health and Care Excellence's guideline for the assessment of these children is also discussed.

Simple Summary: Cetacean strandings are frequent in occurrence and are likely to become even more common globally because of the effects of escalating anthropogenic activities. Due to the compromised state of stranded animals, euthanasia is often recommended or required. However, current knowledge and implementation of euthanasia methods remain highly variable, with limited data on the practicalities and welfare impacts of procedures. This study sought to evaluate the available published data on cetacean euthanasia in order to highlight significant knowledge gaps and provide direction to improve the welfare of stranded cetaceans. Data from the peer-reviewed literature and published reports were analysed, and significant knowledge gaps highlighted. Two main euthanasia methods, chemical and ballistics, were reported, with few details provided on the specific application of these. Few data were available about time to death/insensibility, parameters commonly required to assess the welfare impacts of killing methods. Overall, the findings highlight the lack of available information on cetacean euthanasia and suggest avenues for future work to improve welfare through the use of appropriate methods and increased data collection. The compromised state of stranded cetaceans means that euthanasia is often required. However, current knowledge and implementation of euthanasia methods remain highly variable, with limited data on the practicalities and welfare impacts of procedures. This study evaluated the available published data on cetacean euthanasia, highlighting knowledge gaps and providing direction to improve stranded cetacean welfare. A total of 2147 peer-reviewed articles describing marine mammal euthanasia were examined. Of these 3.1% provided details on the method used, with 91% employing chemical methods. Two countries, the United Kingdom (UK) and New Zealand (NZ), provided euthanasia reports to the International Whaling Commission (IWC) between 2007 and 2020. Methods employed were reported for 78.3% and 100% of individual cetaceans euthanised in the UK and NZ, respectively. In the UK, chemical euthanasia was most common (52%), whilst in NZ only ballistics methods were used. Few data were available about time to death/insensibility (TTD); 0.5% of peer-reviewed articles provided TTD, whilst TTD was reported for 35% of individuals in the UK and for 98% in NZ. However, IWC reports lacked detail on how death/insensibility were assessed, with multiple individuals "presumed instantly" killed. Overall, the findings highlight the lack of available information on cetacean euthanasia, and suggest increased data collection and the application of appropriate methods to improve welfare. [ABSTRACT FROM AUTHOR]

The article discusses two key aspects in the assessment of response to treatment for respiratory impairment, which is the theme of the Royal Society of Medicine's meeting in Great Britain. Discussion focuses on ways to assess the patient's state and the effect of treatment. Also highlighted are a number of points on randomized control trials, including timing of introduction to a controlled trial and matching with reference to the pulmonary arterial pressure.

Lower levels of physical activity (PA) have been associated with increased risk of cardiovascular disease. Worldwide, there is a shift towards a lifestyle with less PA, posing a serious threat to public health. One of the suggested mechanisms behind the association between PA and disease development is through systemic inflammation, in which circulating blood cells play a pivotal role. In this study we investigated the relationship between genetically determined PA and circulating blood cells. We used 68 single nucleotide polymorphisms associated with objectively measured PA levels to perform a Mendelian randomization analysis on circulating blood cells in 222,645 participants of the UK Biobank. For inverse variance fixed effects Mendelian randomization analyses, p < 1.85 × 10−3 (Bonferroni-adjusted p-value of 0.05/27 tests) was considered statistically significant. Genetically determined increased PA was associated with decreased lymphocytes (β = –0.03, SE = 0.008, p = 1.35 × 10−3) and decreased eosinophils (β = –0.008, SE = 0.002, p = 1.36 × 10−3). Although further mechanistic studies are warranted, these findings suggest increased physical activity is associated with an improved inflammatory state with fewer lymphocytes and eosinophils. [ABSTRACT FROM AUTHOR]

The article presents a study on the effect of acute hypoxia on the QT interval corrected for heart rate (QTc) in patients with chronic respiratory disease who are undergoing fitness to fly tests in Great Britain. It notes that the findings of the study reveal that patients who have experienced acute hypoxia do not have significant changes in their cardiac QTc. It was also found out that sudden death in COPD patients is not associated with prolonged QTc.

The article discusses the procedure of stenting of obstructing lesions as a way to avoid emergency surgery for colorectal cancer (CRC), the second common disease in Great Britain. About 30 percent of CRCs show as an emergency with large bowel obstruction and death rate after emergency surgery is high. Studies show that stenting allows assessment and prepares patients for an elective operation that would improve of quality of life and survival.

Significant blood loss during major urological surgery is common and in Great Britain is usually replaced by transfusion of donated homologous blood. Autologous blood transfusion is the collection of blood from an individual for the purpose of re-infusion into the same individual at a later time. Autologous blood transfusion can be in the form of preoperative autologous blood donation (PABD), intraoperative cell salvage (IOCS) or postoperative cell salvage and acute normovolaemic haemodilution (ANH).

Background: Although the vast majority of children with acute infections are managed at home, this is one of the most common problems encountered in children attending emergency departments (EDs) and primary care. Distinguishing children with serious infection from those with minor or self-limiting infection is difficult. This can result in misdiagnosis of children with serious infections, which results in a poorer health outcome, or a tendency to refer or admit children as a precaution; thus, inappropriately utilising secondary-care resources., Objectives: We systematically identified clinical features and laboratory tests which identify serious infection in children attending the ED and primary care. We also identified clinical prediction rules and validated those using existing data sets., Data Sources: We searched MEDLINE, Medion, EMBASE, Cumulative Index to Nursing and Allied Health Literature and Database of Abstracts of Reviews of Effects in October 2008, with an update in June 2009, using search terms that included terms related to five components: serious infections, children, clinical history and examination, laboratory tests and ambulatory care settings. We also searched references of included studies, clinical content experts, and relevant National Institute for Health and Clinical Excellence guidelines to identify relevant studies. There were no language restrictions. Studies were eligible for inclusion if they were based in ambulatory settings in economically developed countries., Review Methods: Literature searching, selection and data extraction were carried out by two reviewers. We assessed quality using the quality assessment of diagnostic accuracy studies (QUADAS) instrument, and used spectrum bias and validity of the reference standard as exclusion criteria. We calculated the positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of each feature along with the pre- and post-test probabilities of the outcome. Meta-analysis was performed using the bivariate method when appropriate. We externally validated clinical prediction rules identified from the systematic review using existing data from children attending ED or primary care., Results: We identified 1939 articles, of which 35 were selected for inclusion in the review. There was only a single study from primary care; all others were performed in the ED. The quality of the included studies was modest. We also identified seven data sets (11,045 children) to use for external validation. The most useful clinical features for ruling in serious infection was parental or clinician overall concern that the illness was different from previous illnesses or that something was wrong. In low- or intermediate-prevalence settings, the presence of fever had some diagnostic value. Additional red flag features included cyanosis, poor peripheral circulation, rapid breathing, crackles on auscultation, diminished breath sounds, meningeal irritation, petechial rash, decreased consciousness and seizures. Procalcitonin (LR+ 1.75-2.96, LR- 0.08-0.35) and C-reactive protein (LR+ 2.53-3.79, LR- 0.25-0.61) were superior to white cell counts. The best performing clinical prediction rule was a five-stage decision tree rule, consisting of the physician's gut feeling, dyspnoea, temperature ≥ 40 °C, diarrhoea and age. It was able to decrease the likelihood of serious infections substantially, but on validation it provided good ruling out value only in low-to-intermediate-prevalence settings (LR- 0.11-0.28). We also identified and validated the Yale Observation Scale and prediction rules for pneumonia, meningitis and gastroenteritis., Limitations: Only a single study was identified from primary-care settings, therefore results may lack generalisability., Conclusions: Several clinical features are useful to increase or decrease the probability that a child has a serious infection. None is sufficient on its own to substantially raise or lower the risk of serious infection. Some are highly specific ('red flags'), so when present should prompt a more thorough or repeated assessment. C-reactive protein and procalcitonin demonstrate similar diagnostic characteristics and are both superior to white cell counts. However, even in children with a serious infection, red flags will occur infrequently, and their absence does not lower the risk. The diagnostic gap is currently filled by using clinical 'gut feeling' and diagnostic safety-netting, which are still not well defined. Although two prediction rules for serious infection and one for meningitis provided some diagnostic value, we do not recommend widespread implementation at this time. Future research is needed to identify predictors of serious infection in children in primary-care settings, to validate prediction rules more widely, and determine the added value of blood tests in primary-care settings., Funding: The National Institute for Health Research Health Technology Assessment programme.