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This study investigates the effect of thermal modification on the flexural properties, transverse fracture energy, and hardness of western hemlock, a material which is finding increasing applications in construction. Flexure tests on specimens featuring longitudinal and transverse grains showed that thermal modification at 167 °C leads to less statistical variability compared to unmodified samples. Additionally, thermal modification leads to a decrease in the transverse flexural strength. On the other hand, the fracture and Janka hardness tests revealed a more pronounced brittleness of the thermally modified samples. In fact, the total mode I fracture energy of modified single-edge notch bending samples was about 47% lower for radial–longitudinal systems and 60% lower for tangential–longitudinal systems. Similarly, the average Janka hardness in the tangential and transverse planes was 8.5% and 9.4% lower in the modified specimens, respectively. The results presented in this work show that thermal modification can have a significant effect on the fracturing behavior of western hemlock and its energy dissipation capabilities. For design, this must be taken into serious consideration as these properties significantly influence the damage tolerance of this wood in the presence of stress concentrations such as those induced in bolted joints and cut outs. Fracture energy and hardness are also strongly correlated to ballistic performance. [ABSTRACT FROM AUTHOR]

Hydrogen-induced cracking (HIC) occurs in pipeline steels used in oil and gas applications that are rich in hydrogen sulfide gas also known as sour service environments. In this study, an experimental X65 steel was produced by intercritically finish rolling, accelerated cooling, then air-cooling to room temperature. This thermo-mechanical processing scheme resulted in a mixture of quasi-polygonal ferrite and martensite/austenite (M/A) microconstituents, also known as granular bainite. Sections from the steel were also tempered at 300 °C, 400 °C, 500 °C, and 600 °C for 40 min, which resulted in a significant increase in HIC resistance and impact toughness, along with a marginal increase in yield strength and maintenance of untempered hardness. The evolution of HIC resistance, tensile properties, and impact toughness is discussed in the context of phase fraction, dislocation density, and microstructural evolution. The current work demonstrates the potential for tempering after thermo-mechanical processing to reduce HIC susceptibility and increase impact toughness while nominally maintaining yield strength and hardness in microalloyed pipeline steels. [ABSTRACT FROM AUTHOR]

Access to a comprehensive molecular alteration screening is patchy in Europe and quality of the molecular analysis varies. SPECTAlung was created in 2015 as a pan-European screening platform for patients with thoracic malignancies. Here we report the results of almost 4 years of prospective molecular screening of patients with thoracic malignancies, in terms of quality of the program and molecular alterations identified. Patients with thoracic malignancies at any stage of disease were recruited in SPECTAlung, from June 2015 to May 2019, in 7 different countries. Molecular tumour boards were organised monthly to discuss patients' molecular and clinical profile and possible biomarker-driven treatments, including clinical trial options. FFPE material was collected and analysed for 576 patients with diagnosis of pleural, lung, or thymic malignancies. Ultimately, 539 patients were eligible (93.6%) and 528 patients were assessable (91.7%). The turn-around time for report generation and molecular tumour board was 214 days (median). Targetable molecular alterations were observed in almost 20% of cases, but treatment adaptation was low (3% of patients). SPECTAlung showed the feasibility of a pan-European screening platform. One fifth of the patients had a targetable molecular alteration. Some operational issues were discovered and adapted to improve efficiency. [ABSTRACT FROM AUTHOR]

Nova explosions are caused by global thermonuclear runaways triggered in the surface layers of accreting white dwarfs1–3. It has been predicted4–6 that localized thermonuclear bursts on white dwarfs can also take place, similar to type-I X-ray bursts observed in accreting neutron stars. Unexplained rapid bursts from the binary system TV Columbae, in which mass is accreted onto a moderately strong magnetized white dwarf from a low-mass companion, have been observed on several occasions in the past 40 years7–11. During these bursts, the optical/ultraviolet luminosity increases by a factor of more than three in less than an hour and fades in around ten hours. Fast outflows have been observed in ultraviolet spectral lines7, with velocities of more than 3,500 kilometres per second, comparable to the escape velocity from the white dwarf surface. Here we report on optical bursts observed in TV Columbae and in two additional accreting systems, EI Ursae Majoris and ASASSN-19bh. The bursts have a total energy of approximately 10−6 times than those of classical nova explosions (micronovae) and bear a strong resemblance to type-I X-ray bursts12–14. We exclude accretion or stellar magnetic reconnection events as their origin and suggest thermonuclear runaway events in magnetically confined accretion columns as a viable explanation.The identification and characterization of rapid bursts in three accreting white dwarfs have shown that magnetically confined thermonuclear runaways resembling type-I X-ray bursts may occur in the surface layers of white dwarf atmospheres. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: This study was to evaluate changes in attitude over a 20-year period. Findings: Alzheimer diagnosis disclosure has evolved from being viewed as evoking a negative emotional response to being information that can positively facilitate proactive future life planning. Message: Regarding AD disclosure, Irish family members historically valued paternalism and now place an increased value on patient autonomy. Purpose: Exploring family members' attitudes to an Alzheimer's disease diagnosis compared to that of a study 20 years prior by Maguire et al. (BMJ 313:529–530, 1996). Methods: The survey was a replica of that completed 20 years prior in the same department by Maguire et al. (BMJ 313:529–530, 1996). With ethics approval and consent, family members were surveyed regarding their attitudes towards a dementia diagnosis. Completed by doctors with 100 consecutive respondents accompanying patients to scheduled memory clinic appointments. Themes were generated, results compiled and compared to the previous study. Results: Respondents are now over four times more likely to favour disclosure over non-disclosure to a patient (chi-squared 68.142, p < 0.0001). A substantial decrease is evident in those listing fear of evoking a negative reaction. Accordingly, there is an increase in those referring to the benefits of disclosure. Conclusion: The emerged theme was that of autonomy versus paternalism, with attitude shift reflecting that patient privacy is an established patient right, taking precedence over paternalistic preferences. [ABSTRACT FROM AUTHOR]

Background: Candidaemia is an important nosocomial infection, seen frequently in immunocompromised and critically ill patients and increasingly recognised in cystic fibrosis (CF) patients with totally implantable venous access devices (TIVADs). This study aims to investigate the incidence and risk factors for the development of TIVAD-associated candidaemia and to assess the rate of TIVAD-related complications in CF patients.Methods: A 10-year retrospective study was carried out on adult CF patients attending a single centre. Complications were recorded including the incidence of candidaemia and correlated to clinical parameters. Complication rates were calculated based on incidence per 1000 catheter days. Statistical analysis was performed using Mann-Whitney U test and Fisher’s exact test.Results: Fourteen cases of candidaemia were observed in the CF cohort, primarily caused by Candida parapsilosis and Candida albicans. Candidaemia was associated with lower FEV1 (p = 0.0117) and higher frequency of pulmonary exacerbation (p < 0.0001). A TIVAD complication rate of 0.337/1000 catheter days was observed in the CF cohort. Complications included venous thrombosis, stenosis, and port extrusion; complications were independently associated with more frequent pulmonary exacerbations (p = 0.04).Conclusions: TIVAD complications are observed more commonly in those with lower FEV1 and frequent pulmonary exacerbations, suggesting that candidaemia may be related to antibiotic use and furthermore can occur following invasive procedures causing translocation of fungal species allowing transformation from colonisation to pathogenic infection. [ABSTRACT FROM AUTHOR]

A net $$(x_\alpha )$$ in a vector lattice X is unbounded order convergent to $$x \in X$$ if $$|x_\alpha - x| \wedge u$$ converges to 0 in order for all $$u\in X_+$$ . This convergence has been investigated and applied in several recent papers by Gao et al. It may be viewed as a generalization of almost everywhere convergence to general vector lattices. In this paper, we study a variation of this convergence for Banach lattices. A net $$(x_\alpha )$$ in a Banach lattice X is unbounded norm convergent to x if for all $$u\in X_+$$ . We show that this convergence may be viewed as a generalization of convergence in measure. We also investigate its relationship with other convergences. [ABSTRACT FROM AUTHOR]

Introduction: Bibliometrics is the statistical analysis of written publications. Bibliometric analyses have been performed across a range of biomedical disciplines. The aim of this study was to provide a comprehensive qualitative and quantitative analysis of Irish urology and nephrology research and to analyse how this compares internationally. Methods: We performed a retrospective bibliometric analysis of the top 20 ranking journals in the field of 'Urology and Nephrology' based on their 5 years impact factor, as obtained from the ISI Journal Citation Report database over the 15-year study period, 2000-2015. Utilising the Pubmed database, a search phrase was constructed using country of affiliation, year of publication and journal title. The abstracts of the Irish publications identified were analysed for their institution of origin, article theme and content. Results: A total of 67,740 article abstracts were analysed over the 15 years study period. As anticipated, the USA accounted for the largest number of publications by a country [28,206 (41.64 % of all articles)]. Ireland contributed 347 articles in total (0.51 % of all articles); however, ranking according to population per million was 13th worldwide. Ireland's contribution to urology and nephrology research was highest in the BJUI-British Journal of Urology International [76 articles (21.90 % of Irish total)]. Conclusion: We believe this study to be the largest bibliometric analysis in the field of urology and nephrology internationally. This study provides a novel overview of the current Irish urology- and nephrology-related research, and examines how our results compare within the international community. [ABSTRACT FROM AUTHOR]

Goals Of Work: The study purpose was to evaluate a nurse-led supportive care clinical case management program in the community using multi-methods to delineate care processes prior to outcome evaluation.Materials and Methods: Multiple data sources including program service records, chart reviews and interviews with nurses and key interdisciplinary informants were used to identify population served (coverage and reach), processes of care (implementation), and providers' perceptions of the effectiveness of the nurse-led program (reaction).Main Results: The program provided care to over 700 cancer patients in a 1-year period. Nurse-led support interventions were focused on direct care inclusive of teaching/coaching for symptom management, counseling and support, and mobilization of services through system navigation based on an initial comprehensive assessment of supportive care needs.Conclusions: Nurse-led models of supportive care have the potential to reduce unmet supportive care needs, improve continuity of care, and overall health-related quality of life that should be tested in future trials. [ABSTRACT FROM AUTHOR]

Cancer patients receiving cytotoxic chemotherapy often become anaemic and may require blood transfusions. A large-scale audit of patients with a variety of solid tumours receiving chemotherapy at 28 specialist centres throughout the UK was undertaken to quantify the problem. Data were available from 2719 patients receiving 3206 courses of cytotoxic chemotherapy for tumours of the breast (878), ovary (856), lung (772) or testis (213). Their mean age was 55 years (range 16-87). Overall, 33% of patients required at least one blood transfusion but the proportion varied from 19% for breast cancer to 43% for lung. Sixteen per cent of patients required more than one transfusion (7% for breast, 22% in lung). The mean proportion of patients with Hb < 11 g dl(-10 rose over the course of chemotherapy from 17% before the first cycle, to 38% by the sixth, despite transfusion in 33% of patients. Of the patients receiving transfusions, 25% required an inpatient admission and overnight stay. The most common symptoms reported at the time of transfusion were lethargy, tiredness and breathlessness. Further research is needed to evaluate the role of blood transfusions in patients receiving cytotoxic chemotherapy. [ABSTRACT FROM AUTHOR]

Introduction: The 2005 international society of urological pathology consensus statement on Gleason grading in prostate cancer revised Gleason scoring in clinical practice. The potential for grade migration with this refinement poses difficulties in interpreting historical series. We report the characteristics of a recent cohort of consecutive Gleason score 9 or 10 prostate cancers in our institution. The purpose of this study was to define the clinicopathologic variables and staging information for this high-risk population, and to identify whether traditional prostate staging techniques are adequate for this subcohort of men. Materials and methods: A computational review of our pathology database was performed. Between May 2010 and September 2012, 1,295 consecutive biopsies were undertaken, 168 of which were high-grade tumours (12.97 %). This group were divided into two cohorts of which 84 (12.05 %) had a highest reported Gleason score of 9 ( N = 79) or 10 ( N = 5) and 84 were reported as Gleason 8. All biopsies were double-reported by pathologists with a special interest in uropathology. Results: Men diagnosed with a Gleason pattern 5 tumour were statistically far more likely to have advanced disease on direct rectal examination of the prostate compared with Gleason sum 8 tumours ( p < 0.001) and a positive first-degree family history of prostate cancer ( p < 0.001). Overall, Gleason sum 9/10 prostate cancers were also found to be statistically more aggressive than Gleason sum 8 tumours on TRUS core biopsy analysis with significantly higher levels of perineural invasion ( p < 0.0001) and extracapsular extension ( p = 0.001) as well as a higher levels of tumour found within the core biopsy sample. Those men diagnosed with Gleason pattern 5 prostate cancer also had radiological indicators of increased tumour aggressiveness compared with Gleason sum 8 cancer with respect to bone ( p = 0.0002) and visceral ( p = 0.044) metastases at presentation. Conclusions: This series of Gleason score 9/10 prostate cancers serves to highlight the large disease burden, adverse pathologic features, and locally advanced nature of this aggressive subtype, which has previously been under-described in the literature, and differs from historical series in having a large high-grade cohort demonstrating high rates of metastatic disease. A history of prostate cancer amongst first-degree relatives was particularly prevalent in this population raising the issue of screening in a high-risk population. The high incidence of visceral metastatic disease at presentation supports upfront staging with CT thorax, abdomen, and pelvis in patients with Gleason 9 or 10 prostate cancers. [ABSTRACT FROM AUTHOR]

Several different mutations collaborate with the fusion proteins in core-binding factor acute myeloid leukemia (CBF-AML) to induce leukemogenesis, but their prognostic significance remains unclear. We screened 354 predominantly younger (<60 years) adults with t(8;21) (n=199) or inv(16) (n=155) entered into UK MRC trials for KIT, FLT3 tyrosine kinase domain (FLT3TKD), N-RAS, K-RAS and c-CBL mutations and FLT3 internal tandem duplications (FLT3ITD) and assessed the impact of relative mutant level on outcome. Overall, 28% had KIT, 6% FLT3ITD, 10% FLT3TKD, 27% RAS and 6% CBL mutations. Mutant levels for all genes/loci were highly variable. KIT mutations were associated with a higher cumulative incidence of relapse but in multivariate analysis this was only significant for cases with a higher mutant level of 25% or greater (95% confidence interval (CI)=1.01-1.52, P=0.04). Similarly, only FLT3ITD-HIGH was a significant adverse factor for overall survival (OS; CI=1.27-5.39, P=0.004). Conversely, FLT3TKD-HIGH and CBLHIGH were both favorable factors for OS (CI= 0.31-0.89, P=0.01 and CI=0.05-0.85, P=0.02, respectively). KIT mutations were frequently lost at relapse, which is relevant to minimal residual disease detection and the clinical use of KIT inhibitors. These results indicate that relative mutant level should be taken into account when evaluating the impact of mutations in CBF-AML. [ABSTRACT FROM AUTHOR]

Lead is a highly toxic metal known to be an important cause of morbidity and mortality in waterbirds and terrestrial birds worldwide. The risk to birds of poisoning from lead has resulted in the introduction of legislation in many countries, such as UK restrictions on the use of lead in angling weights and lead gunshot. In this study, we examined data on current and historical trends in lead poisoning in British waterbirds and related these to the introduction of legislation restricting the use of lead. Our results indicate that lead poisoning has continued to affect a wide range of British waterbirds long after legal restrictions were introduced. Elevated levels of lead (i.e. >20.0 μg/dL) were found in the blood of 34 % ( n = 285) of waterbirds tested at four sites in Britain during the 2010/2011 winter and accounted for the deaths of at least 10.6 % ( n = 2,365) of waterbirds recovered across Britain between 1971 and 2010 and 8.1 % ( n = 1,051) between 2000 and 2010, with lead gunshot being the most likely source of poisoning. The proportion of birds dying from lead poisoning in England did not vary significantly after the introduction of legislation, accounting for 13.7 % of non-infectious causes of death between 1971 and 1987 ( n = 204), 20.8 % ( n = 360) between 1988 and 1999 and 11.8 % ( n = 423) between 2000 and 2010, despite a significant change in lead-related mortality in mute swans found during the same time period, 25 % ( n = 12) between 1971 and 1987, 4.6 % ( n = 65) between 1988 and 1999 and 2 % ( n = 100) between 2000 and 2010. Existing legislation needs review and extension to ensure the delivery of international commitments and a broad-scale transition to the use of non-toxic shot and angling materials in all environments. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Prognostic features in acute megakaryoblastic leukemia in children without Down syndrome: a report from the AML02 multicenter trial and the Children's Oncology Group Study POG 9421" published in a previous issue.

The clinical syndrome of spontaneous intracranial hypotension (SIH) was first proposed in 1938 and describes a headache syndrome virtually identical to the headaches, which may follow dural puncture. Orthostatic headache, low cerebrospinal fluid opening pressure, and diffuse meningeal enhancement on post-contrast T1-weighted MRI brain studies are the major features of this increasingly recognised syndrome. We describe a case series of patients diagnosed with SIH, their treatment and outcome, and a review of the literature. We propose that this is an important cause of new daily persistent headaches, which is usually relatively easy to diagnose, and if recognised early, is eminently treatable. [ABSTRACT FROM AUTHOR]

Background: The National Cancer Control Programme is developing standards for access to diagnostics and treatment of prostate cancer. The Rapid Access Prostate Cancer (RAPC) clinic in St. James's Hospital commenced in May 2009 allowing general practitioners (GPs) more streamlined access for patients. Aims: To demonstrate that RAPC clinics allow GPs direct access to a designated cancer centre improving the prostate cancer referral process. This ultimately should reduce referral delays. Methods: A prospective analysis of all patients referred to the RAPC clinic in St. James's Hospital over a 12-month period beginning from May 2009. Results: Over the 12-month period 215 patients were referred to the RAPC clinic. The median age was 63 years (range 45-78). The median waiting time between referral and review at the RAPC clinic was 13 days (range 1-37). The median PSA was 7.7 μg/L (range 2.6-150). In total 199 TRUS biopsies were performed, of which 46% were positive for prostate cancer. We found that 70% of all patients had a PSA ≤10 μg/L and of these 32% were positive for prostate cancer. For the remaining 30% of patients who had a PSA >10 μg/L, we found 63% were positive for prostate cancer. Regarding patients diagnosed with prostate cancer 56% have been referred for radiotherapy, 13% for surgery, 13% for hormonal treatment, 10% for active surveillance and 8% watchful waiting. Conclusion: RAPC clinics allow GPs easier access to specialist urological opinion for patients suspected of having prostate cancer. [ABSTRACT FROM AUTHOR]

Background: Recent UK clinical guidance advises against continuing trastuzumab (T) beyond disease progression (PD) in the absence of brain metastases in patients with HER-2 positive (+ve) advanced breast cancer .We have retrospectively evaluated the outcome of patients with HER-2+ve locally advanced (LA) or metastatic breast cancer (MBC) who continued T beyond PD, treated in our unit.Methods: All HER-2+ve patients on our prospectively maintained database with LA or MBC who received T beyond PD after adjuvant or one line of T for advanced disease were assessed for response and outcome. From the timepoint of T continuation beyond PD, we calculated the overall disease control rate, time to progression (TTP), and overall survival (OS).Results: One hundred and fourteen patients with HER-2+ve LA or MBC treated with T beyond PD were identified. The main site of disease was visceral in 84 (74%) patients. Seventy-six (66%) had one line of chemotherapy before continuation of T beyond PD and 21 (19%) had two or more. Post-progression, 66 (58%) received T combined with chemotherapy. Of the 93 (82%) patients with documented clinical or radiological response evaluation, 67 (59%) were considered as having stable disease or better. The median TTP was 24 weeks (95% CI: 21-28) and the median OS was 19 months (95% CI: 12-24).Conclusion: Our results from an unselected group of patients provide additional evidence that continuation of T beyond PD is of clinical benefit. [ABSTRACT FROM AUTHOR]

Small cell lung cancer (SCLC) is a significant health problem worldwide because of its high propensity for relapse. This review discusses existing and future therapies for the treatment of SCLC. [ABSTRACT FROM AUTHOR]

Referrals to Urology OPD of men with a likely diagnosis of BPH are common. To review referrals to OPD of men with lower urinary tract symptoms (LUTS) to establish how many could have been managed without specialist assessment. We reviewed records of 200 male patients referred to OPD with LUTS. We assessed whether the referral source had performed digital rectal examination (DRE), International Prostate Symptom Score (IPSS), Bother Score or PSA level. 74% of patients were referred by GPs. In 31.5% of cases DRE was performed prior to referral. One GP had completed an IPSS, none a Bother Score. 96% had a PSA checked before OPD. Ultimately, 88.5% of our patients were diagnosed with BPH. With better pre-assessment in the form of DRE, IPSS and Bother Score, allied to a PSA check, many patients with LUTS could be managed in a primary care setting. [ABSTRACT FROM AUTHOR]

One of the most frequently encountered causes of failure in engineering fasteners is fatigue. Typical locations for the fatigue of fasteners are the stress concentrations represented by the head to shank fillet, the first engaged thread and the thread runout. These locations are examined in relation to design rules known for over 60 years to be effective in reducing the stress concentration effect, but seldom used in engineering bolts, despite their relative simplicity. These design rules are also examined in relation to common fastener standards and their silence with regard to fatigue considerations. [ABSTRACT FROM AUTHOR]

Accelerated (dose-dense) chemotherapy, in which the frequency of administration is increased without changing total dose or duration, may increase the efficacy of cancer chemotherapy. We performed a randomised Phase II study to assess the safety and relative toxicity of AC (doxorubicin; cyclophosphamide) vs E(epirubicin)C given by conventional or accelerated schedules as neoadjuvant or adjuvant chemotherapy for early breast cancer. Furthermore, the relative toxicity of doxorubicin and epirubicin remains uncertain. Patients were randomised to one of four arms; four courses of standard 3 weekly cyclophosphamide 600 mg m(-2) in combination with doxorubicin 60 mg m(-2) (AC) vs epirubicin 90 mg m(-2) (EC) 3 weekly vs the same regimens administered every 2 weeks with pegfilgrastim (G-CSF). A total of 126 patients were treated, 42 with standard AC, 42 with accelerated AC, 19 with standard EC and 23 with accelerated EC. Significantly more grade 3/4 day one neutropenia was seen with standard (6/61, 10%) compared to accelerated (0/65,) regimens (P=0.01). A trend towards more neutropenic sepsis was seen in the combined standard and accelerated AC arms (12/84, 14%) compared to the combined EC arms (1/42, 2%), P=0.06. Falls in left ventricular ejection fraction were not increased with accelerated treatment. Accelerated AC and EC with pegfilgrastim are safe and feasible regimens in the treatment of early breast cancer with less neutropenia than conventional 3 weekly schedules. [ABSTRACT FROM AUTHOR]

Paclitaxel poliglumex (PPX), a macromolecule drug conjugate linking paclitaxel to polyglutamic acid, reduces systemic exposure to peak concentrations of free paclitaxel. Patients with non-small-cell lung cancer (NSCLC) who had received one prior platinum-based chemotherapy received 175 or 210 mg m(-2) PPX or 75 mg m(-2) docetaxel. The study enrolled 849 previously treated NSCLC patients with advanced disease. Median survival (6.9 months in both arms, hazard ratio=1.09, P=0.257), 1-year survival (PPX=25%, docetaxel=29%, P=0.134), and time to progression (PPX=2 months, docetaxel=2.6 months, P=0.075) were similar between treatment arms. Paclitaxel poliglumex was associated with significantly less grade 3 or 4 neutropenia (P<0.001) and febrile neutropenia (P=0.006). Grade 3 or 4 neuropathy (P<0.001) was more common in the PPX arm. Patients receiving PPX had less alopecia and did not receive routine premedications. More patients discontinued due to adverse events in the PPX arm compared to the docetaxel arm (34 vs 16%, P<0.001). Paclitaxel poliglumex and docetaxel produced similar survival results but had different toxicity profiles. Compared with docetaxel, PPX had less febrile neutropenia and less alopecia, shorter infusion times, and elimination of routine use of medications to prevent hypersensitivity reactions. Paclitaxel poliglumex at a dose of 210 mg m(-2) resulted in increased neurotoxicity compared with docetaxel. [ABSTRACT FROM AUTHOR]

Variations of the posterior tributaries of the left renal vein (LRV) are frequently encountered during various urological and vascular procedures. This can be explained by the complex embryological and anatomical arrangements of these tributaries, as well as variations in their nomenclature. To increase awareness of the anatomical variations of the posterior tributaries of the LRV. Twenty-one kidneys were dissected. All anatomical variations of the posterior tributaries of the LRV were recorded. This study highlights lumbar tributaries are common on the left side. A single left lumbar tributary was found entering the posterior surface of the LRV in 10 out of 11 specimens. However, their drainage patterns showed varied anatomical configurations. This cadaveric study was aimed to draw attention to surgically important variations of the posterior tributaries of the LRV. Increased awareness among surgeons can considerably reduce the potential risk of vascular injuries during renal surgery. [ABSTRACT FROM AUTHOR]

Objective:To investigate ecological correlates of the development of overweight in a multisite study sample of children followed from age 2 to 12.Design:Longitudinal examination of covariates of overweight status throughout childhood, with covariates drawn from three ecological levels: sociocultural or demographic, quality of the child's home environment, and proximal child experience that could directly affect the balance between energy intake and energy expenditure.Subjects:A total of 960 children participating in a long-term longitudinal study provided growth data at least once; 653 of the children had complete data on covariates.Measurements:Height and weight measured seven times between ages 2 and 12 were converted to a body mass index (BMI) and entered into a latent transition analysis to identify patterns of overweight across childhood. Ecological correlates measured longitudinally included demographic characteristics obtained by maternal report, home environment quality obtained by observation and maternal report, and proximal child experience factors obtained by observation, maternal report and child report.Results:Four patterns of overweight were found: never overweight, overweight beginning at preschool age, overweight beginning in elementary school, and return to normal weight after being overweight at preschool age. The weight status groups differed on home environment quality and proximal child experience factors but not on demographics. Children overweight at preschool had less sensitive mothers than never overweight children. Children overweight at school age had fewer opportunities for productive activity at home than did never overweight children. School-age overweight children also watched the most TV after school. Multivariate logistic regression analyses further indicated the significance to children's weight status of proximal child experience variables. Less physically active children and those who watched more television after school were more likely to become overweight. Results did not vary by child sex.Conclusion:The results support the idea that childhood overweight is multiply determined. The one potentially important and changeable factor identified as a target for intervention centers on how children spend their time, especially their after-school time. Children who are more physically active and spend less time watching TV after school are less likely to become overweight by age 12.International Journal of Obesity (2007) 31, 1469–1478; doi:10.1038/sj.ijo.0803611; published online 3 April 2007 [ABSTRACT FROM AUTHOR]

This cadaveric study of 22 knees described the anatomy of the deeper structures of the posterolateral corner, the popliteus–tendon complex, arcuate ligament complex, the popliteofibular ligament, and the coronary ligament. Most variations occurred in the popliteofibular ligament; the variations and the different nomenclatures used in the literature for these structures make it difficult to diagnose and repair injuries to them. Untreated injuries may result in chronic functional instability to the posterolateral corner of the knee. [ABSTRACT FROM AUTHOR]

We report on a Canadian longitudinal qualitative case study of midlife women with fragility fractures, their treating orthopaedic surgeons and family physicians. Women and their treating physicians were followed for an average of one year post fracture to investigate the health outcomes and what, if any, follow-up occurred aimed at secondary fracture prevention. The final dataset includes 223 interviews gathered from women aged 40 to 65 with fragility fractures, orthopaedic surgeons and family physicians. The circle of care for those with fragility fractures is disrupted at vital communication junctures: (1) the inconsistent flow of information between acute care institutions and family physicians; (2) unidirectional and inconsistent communication from orthopaedic surgeons to family physicians; and (3) competing demands of the cast clinic environment and patient expectations. It is not the lack of will that is undermining the consistent and detailed communication among patients, physicians and institutions. It is the episodic nature of fracture care that makes communication among involved parties difficult, if not impossible. Communication about events, acuity and clear expectations around roles and follow-up is urgently needed to improve communication throughout the circle of care to support secondary fracture prevention. Fractures from a standing height or similar trauma in women aged 40 to 65 should be treated as suspicious fractures and followed-up to investigate the underlying bone condition. This article reports on challenges and barriers to clear communication among women, their orthopaedic surgeons and family physicians that is necessary for follow-up and prevention of future fractures. [ABSTRACT FROM AUTHOR]

No national benchmark figures exist for early mortality due to chemotherapy unlike for surgical interventions. Deaths within 30 days of chemotherapy during a 6-month period were identified from the Royal Marsden Hospital electronic patient records. Treatment intention--curative or palliative, cause of death and number of previous treatments--were documented. Between April 2005 and September 2005, 1976 patients received chemotherapy with 161 deaths within 30 days of chemotherapy (8.1%). Of these, 124 deaths (77.0%) were due to disease progression. Of the other 37 deaths, 12 (7.5%) were related to chemotherapy, six each for solid tumours and haematological malignancies, of which seven (4.3%) were due to neutropenic sepsis. For the remaining 25 deaths (15.5%) there was insufficient information. There were more deaths after third and subsequent lines of therapy than with first and secondlines of therapy. Only 12 of the 161 deaths occurred in patients who were receiving potentially curative chemotherapy to give a mortality rate in breast and gastrointestinal malignancy of 0.5 and 1.5%, respectively. It is possible to audit mortality within 30 days of chemotherapy and this should become a benchmark for standard practice nationally. Most deaths were due to disease progression in the palliative setting. We practice this form of audit each quarter and feed back to the treating teams so that deaths are discussed and practice monitored. [ABSTRACT FROM AUTHOR]

To assess vitamin D status during summer and winter in Irish girls and elderly women, and to estimate vitamin D intake in these two age-groups. Ambulatory free-living, elderly Irish women (aged 70–76 years; n = 43) and girls (aged 11–13 years; n = 17) were recruited. Fasting serums were collected during August/ September 2002 and February/March 2003 and analysed for 25 (OH) D by HPLC. Mean daily intakes of vitamin D were 4.6 μg and 2.1 μg in elderly women and girls, respectively. Serum 25 (OH) D was significantly lower (P<0.001) during winter than summer in both age-groups. Eight (20%) and one (during late summer) and sixteen (37.2%) and eight (47%) (during late winter) of the elderly women and girls, respectively, had inadequate vitamin D status (serum 25 (OH) D <40 nmol/l). Inadequate vitamin D status during winter time is quite common in elderly women and adolescent girls in Ireland. [ABSTRACT FROM AUTHOR]

A multicentre, single-arm, phase II trial designed to determine the efficacy of single-agent vinflunine in patients with advanced non-small-cell lung cancer (NSCLC) previously treated with a platinum-based regimen. The objectives were to assess efficacy in terms of tumour response rate (primary end point), duration of response, progression-free survival (PFS) and overall survival (OS), and to evaluate the toxicity associated with this treatment. Patients with advanced NSCLC with progressive disease having failed prior platinum-based first-line treatment for advanced disease. Five responses out of the 63 treated patients were documented by WHO criteria and validated by an independent panel review (IRP), yielding a response rate of 7.9% (95% CI: 2.6-17.6) in the intent-to-treat analysis and 8.3% (95% CI: 2.8-18.4) in the evaluable population. Disease control was achieved in 35 out of 60 evaluable patients (58.3%). The median duration of response (complete response+partial response), according to modified WHO criteria was 7.8 months (95% CI: 4.6-NR). Median PFS was 2.6 months (95% CI: 1.4-3.8), and the median survival was 7.0 months (95% CI: 5.8-9.2). Grades 3-4 neutropenia was reported in 50% of patients; febrile neutropenia was observed in two patients (3.2%); grades 3-4 myalgia and grade 3 constipation were experienced by 10 (15.9%) and six (9.5%) of patients, respectively. Constipation was manageable, non-cumulative and could be prevented with laxative prophylaxis. The encouraging results from this phase II study with vinflunine warrant further investigations in phase III trials as second- or first-line treatment of advanced non-small-cell lung carcinoma, as a single agent or in combination with other active drugs. [ABSTRACT FROM AUTHOR]

Platinum-based treatment for small cell lung cancer (SCLC) has been established since 1995. This study investigates treatment outcome of elderly patients (age >/=70 years) with SCLC over the past 20 years in a large UK cancer centre. Comparison of all-cause survival was assessed in patients presenting between two predefined time periods: 1982-1994 and 1995-2003. All the survival analysis were adjusted for stage and performance status and age if appropriate. Survival between different chemotherapy treatment regimens was compared. A total of 322 elderly patients (31% of all) registered between 1982-2003 received chemotherapy for SCLC. Patients presenting in 1995-2003 had an overall better median survival (43 vs 25 weeks) and a 1-year survival (37 vs 14%) than patients presenting in 1982-1994 (P<0.001). This applied to patients with both limited and extensive stage disease and all age groups. There was a trend towards the use of more platinum-based treatments in the later cohort but the use of radiotherapy remained constant. Patients who received platinum combinations (Carboplatin or Cisplatin) had significantly improved survival over those who received single agents or other combinations (P<0.001) and there was no significant difference between carboplatin and cisplatin (P=0.7). The analysis demonstrates that there has been a significant improvement in survival for elderly patients with lung cancer treated by chemotherapy in the past 20 years despite more very elderly patients being treated with a poorer performance status. This change is probably multifactorial and may be due to the increased use of platinum-based treatment and improved supportive care. [ABSTRACT FROM AUTHOR]

This study examined the anatomy of the infrapatellar fat pad (IFP) in relation to knee pathology and surgical approaches. Eight embalmed knees were dissected via semicircular parapatellar incisions and each IFP was examined. Their volume, shape and constituent features were recorded. They were found in all knees and were constant in shape, consisting of a central body with medial and lateral extensions. The ligamentum mucosum was found inferior to the central body in all eight knees, while a fat tag was located superior to the central body in seven cases. Two clefts were consistently found on the posterior aspect of the IFP, a horizontal cleft below the ligamentum mucosum in six knees and a vertical cleft above, in seven cases. Our study found that the IFP is a constant structure in the knee joint, which may play a number of roles in knee joint function and pathology. Its significance in knee surgery is discussed. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To determine the vitamin D status (serum 25-hydroxyvitamin D; S-25OHD) in adolescent girls and elderly community-dwelling women living in four countries of northern Europe and to explain differences in S-25OHD concentrations between and within the countries. DESIGN:: A cross-sectional observational study conducted in a standardised way during February-March. S-25OHD was analysed by high-performance liquid chromatography. Vitamin D and calcium intake was calculated using a standardised food composition database. SETTING:: Denmark, Finland, Ireland, and Poland. SUBJECTS:: A total of 199 girls (mean (s.d.) age 12.6 (0.5)?y) and 221 women (mean (s.d.) age 71.8 (1.4)?y). RESULTS:: The median (inter quartiles) concentration of S-25OHD was 29.4 (20.3, 38.3)?nmol/l for the girls and 40.7 (28.0, 54.2)?nmol/l for the women. S-25OHD below 25?nmol/l was found in 37%of the girls and 17%of the women, and S-25OHD below 50?nmol/l was found in 92%of the girls and 37%of the women. Positive significant determinants for S-25OHD in girls were use of vitamin D supplements, and in women sun habits, dietary vitamin D intake, use of vitamin D and calcium supplements. Body mass index and smoking were negative determinants in women. For women predictors could explain the differences between countries (Pcountry=0.09, R2=0.39), but for girls the difference remained significant even after including predictors (Pcountry=0.03, R2=0.15). CONCLUSION:: Vitamin D status is low in northern Europe during winter. More than one-third of the adolescent girls have vitamin D status below 25?nmol/l and almost all are below 50?nmol/l. Two-thirds of the elderly community-dwelling women have vitamin D status below 50?nmol/l. Use of vitamin D supplements is a significant positive determinant for S-25OHD for both girls and women (P=0.001). SPONSORSHIP:: The European Fifth Framework Programme (Contract No. QLK1-CT-2000-00623).European Journal of Clinical Nutrition (2005) 59, 533-541. doi:10.1038/sj.ejcn.1602108 Published online 16 February 2005 [ABSTRACT FROM AUTHOR]

Parsimony analysis ofmatK sequence data from 81 taxa representing 68 genera of Myrtaceae sensu lato, and a representative of each of three related families as outgroups, produced an estimate of the phylogeny of the family with little basal resolution but a number of well-supported clades containing most of the genera. Monophyly of Myrtaceae sensu stricto has moderate support but a broader circumscription, including the small generaPsiloxylonandHeteropyxisthat are frequently placed in monogeneric families, is more strongly supported. Analysis ofmatK plus available sequences for the 5' spacer region for a subset of 56 taxa resolved 14 major clades that received strong jackknife support. Relationships between these were, for the most part, incompletely resolved or poorly supported. A new infrafamilial classification is proposed which recognises two subfamilies (Myrtoideae, Psiloxyloideae) and 17 tribes (Backhousieae stat. nov., Chamelaucieae, Eucalypteae stat. nov., Heteropyxideae, Kanieae, Leptospermeae, Lindsayomyrteae trib. nov., Lophostemoneae trib. nov., Melaleuceae, Metrosidereae stat. nov., Myrteae, Osbornieae trib. nov., Psiloxyleae, Syncarpieae trib. nov., Syzygieae trib. nov., Tristanieae trib. nov., Xanthostemoneae trib. nov.). [ABSTRACT FROM AUTHOR]

OBJECTIVE:: The objective of this study was to assess vitamin D status during late-summer and late-winter/early-spring in postmenopausal Irish women, and whether it was influenced by vitamin D-containing supplement use. DESIGN:: A longitudinal observational study. SETTING:: Cork City, Ireland (51°north). SUBJECTS:: A total of 59 apparently healthy, free-living, postmenopausal women aged between 51 and 69?y were sampled during February/March 2002. Of these, 48 and 47 returned during August/September 2002 and February/March 2003, respectively. None of the women were suffering from any medical condition likely to affect vitamin D status. Fasting serums were collected and analysed for 25-hydroxyvitamin D (25 (OH) D) and parathyroid hormone (PTH) by enzyme immunoassays. RESULTS:: Mean daily intake of vitamin D was 3.2?µg from food sources alone and 5.8?µg when vitamin D-containing supplements were included (P<0.01). Serum 25 (OH) D was significantly lower (P<0.001) during February/March 2002 than both August/September 2002 and February/March 2003. Serum 25 (OH) D was also significantly higher (P=0.05) in women who were vitamin D-containing supplement users than nonusers during all three sampling points. Between 17 and 36%of women had inadequate vitamin D status (defined as serum 25 (OH) D<40?nmol/l) during late-winter, but only 4%had inadequate vitamin D status during late-summer. Serum 25 (OH) D was inversely related to serum PTH (r=-0.33; P=0.028). CONCLUSION:: Suboptimal vitamin D status is common in postmenopausal Irish women during winter. Vitamin D supplementation is associated with improved vitamin D status, even during summertime. SPONSORSHIP:: Irish Government under the National Development Plan 2000-2006.European Journal of Clinical Nutrition (2005) 59, 404-410. doi:10.1038/sj.ejcn.1602088 Published online 22 December 2004 [ABSTRACT FROM AUTHOR]

One unique property of a machine-augmented composite (MAC) is its ability to convert a compressive force into a shear force, and vice versa, simply by the geometry of its angled sidewalls. The authors have discovered that a non-spinning ball dropped at a normal angle onto the MAC's surface rebounds from that surface at an oblique angle and develops a significant rotational velocity. Through finite-element analyses, analytical study, and experiments, the magnitude and direction of the spin can be precisely controlled by tailoring the stiffness of the MAC through the properties and dimensions of its constituent materials. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To estimate vitamin D intakes in a representative sample of Irish adults and to assess the contribution of foods to these intake estimates. DESIGN:: Vitamin D intakes in 1379, 18-64-y-old adults from the North/South Ireland Food Consumption Survey were estimated using a combination of new analytical data for vitamin D in foods, determined by HPLC, and used to revise recipe calculations, together with existing data from McCance and Widdowson's The Composition of Foods, 5th Edition plus supplements. RESULTS:: The total mean daily intake (MDI) of vitamin D (1?µg=40?IU) from all sources was 4.2?µg. The MDI was significantly higher (P<0.001) when the contribution from nutritional supplements was included (4.2?µg) compared with food sources only (3.2?µg). Men had significantly higher intakes (4.4?µg) than women (4.0?µg; P<0.001), which increased significantly (P<0.001) with age in both sexes. Meat/meat products (30.1%), fish/fish products (14.3%) and eggs/egg dishes (9.1%) were the main contributors to vitamin D intake. Supplements contributed 6.8 and 12%to MDI in men and women, respectively. In all, 74%of adults had an MDI of vitamin D that was less than the median (5?µg) of the recommended daily range of 0-10?µg. CONCLUSION:: The findings of this study suggest that a large number of Irish adults have low vitamin D intakes. This, along with emerging evidence of low vitamin D status in at least some population subgroups, suggests that strategies to increase vitamin D intakes, including fortification of food, should be investigated.European Journal of Clinical Nutrition (2004) 58, 1509-1517. doi:10.1038/sj.ejcn.1602001 Published online 12 May 2004 [ABSTRACT FROM AUTHOR]

Background: The determination of laparoscopic surgeon ability is essential to training error avoidance. The present study describes a practical method of surgical error analysis.Methods: After review of practice videotapes of the excisional phase of laparoscopic cholecystectomy, consensus on the identification of eight errors was achieved. Interrater agreement at the end of this phase was 84-96%. Fourteen study videotapes of gallbladder excision were then observed independently by expert reviewers blinded to surgical team identity. Procedures were assessed using a scoring matrix of 1-min segments with each error reported each minute.Results: Interrater agreement was 84-100% for all error categories.Conclusions: The present study demonstrates that excellent interrater agreement of procedural errors can be achieved by carefully defining and training recognition of targeted events. Extension of this simple and reliable analysis tool to other procedures should be feasible to define behaviors leading to adverse clinical outcomes. [ABSTRACT FROM AUTHOR]

Motor neurone disease (MND) has a severe impact on patient quality of life, especially in later stages of the disease. This study assesses the health-related quality of life (HRQL) of MND patients, and for the first time elicits health state values from patients for their present health state. A structured interview was conducted with 77 patients. Patients completed a disease specific health status measure (ALSAQ-40), a generic health status measure (EuroQol EQ-5D), a visual analogue scale (VAS) and a standard gamble (SG) exercise. The ALSAQ-40 was sensitive to disease severity. Patients' mean VAS rating of their own health ranged from 0.74 for stage 1 (early) disease severity (n = 15), to 0.37 for stage 4 (late stage) disease severity (n = 19). Utilities elicited via SG varied from a mean of 0.79 for stage 1 disease severity to a mean of 0.45 for stage 4 disease severity. The EQ-5D derived single index ranged from a mean of 0.63 for stage 1 disease severity to a mean of -0.01 for stage 4 disease severity. This study demonstrates that it is feasible and practical to obtain health state values from MND patients and it provides evidence that patients place a high value on their HRQL, even in cases where health status is very poor. [ABSTRACT FROM AUTHOR]

There are now fully six classes of pulsators among white dwarfs and their immediate precursors among central stars of planetary nebulae and on the extended horizontal branch. In this review, we outline those observational and theoretical considerations that link them together and set them apart from other kinds of pulsating stars. We summarize some select astrophysical puzzles to which studies of such pulsators might speak, and we discuss current applications in the fields of atomic, nuclear, and neutrino physics. Finally, we suggest how future observing programs might solve some general problems common not only to the white dwarf and pre-white dwarf pulsators but to many types of variable stars. [ABSTRACT FROM AUTHOR]

Asthma prevalence in athletes is variable, depending on the sport and training conditions. To investigate the prevalence of obstructive airflow limitation, asthma control and lung volume differences in a control group and five groups of collegiate athletes — outdoor field, indoor court, endurance, combat sports and swimming. Three hundred and five athletes completed a respiratory questionnaire and performed spirometry during normal training conditions, to determine FEV1, FVC and PEFR pre- and at 5, 10 and 15 minutes post-exercise. Between and within group analysis was carried out using single factor and repeated measures ANOVA. Previous diagnosis of asthma was reported by 24%, outdoor field sports 4.9%, indoor court sports 2.3%, endurance events 2.6%, combat sports 3%, swimming 6.9% and controls 4.3%. Mean FEV1 and FVC data, expressed as percentage of predicted, were greatest in swimming and lowest in controls. Swimming showed a significant rise in FEV1 post-exercise, indoor court and endurance sports demonstrated no change and outdoor field, combat and control groups showed a fall in FEV1 post-exercise. Warm humid training conditions appear protective against exercise-induced asthma. The greatest reductions in lung volumes occurred following high intensity exercise under cool conditions in the poorly aerobically conditioned. [ABSTRACT FROM AUTHOR]

Pre-eclampsia is a disorder of human pregnancy occuring in 5-10 % of all births, and represents the leading cause of infant morbidity and mortality and maternal death. In pre-eclampsia, invasion of fetal trophoblasts into maternal arteries during early pregnancy is shallow or absent. Here we examined the hypothesis that HLA-G, a non-classical class I HLA expressed in cytotrophoblasts, may act as a key gene in pre-eclampsia. We analysed HLA-G at the level of transcription and genotyped a silent CAC-CAT polymorphism in exon 3 and a 14-bp insertion/deletion in the 3′ untranslated region. A deficit in levels of the HLA-G3 transcript was observed in mild pre-eclampsia compared to normal placentas. The distribution of HLA-G polymorphisms was different between normal and pre-eclampsia samples. A correlation between the alteration in transcription of the HLA-G gene and certain HLA-G genotypes was also observed. Thus we provide the first evidence for a possible role of HLA-G in genetic susceptibility to, and pathogenesis of pre-eclampsia. [ABSTRACT FROM AUTHOR]

Lithium chloride, more specifically the lithium cation, has been implicated in interference in biological systems. In the case of Escherichia coli, interference involves the Na+(Li+)/H+ antiporter transport system. The study reported here concerns the effects of LiCl on a mixed enrichment culture that is able to biodegrade both methanol and acetone under aerobic conditions. The results obtained using unsteady state continuous flow culture techniques demonstrate a significant disruptive effect of LiCl on culture performance. In addition, a reduction in the substrate-based biomass yield coefficient, which is a clear advantage as far as biotreatment process performance is concerned, also occurs. The ultimate fate of the LiCl was not determined. [ABSTRACT FROM AUTHOR]

Immunosuppressed oncology patients who develop pulmonary infiltrates during treatment have a mortality rate of the order of 55–90%. Early diagnosis and treatment is associated with increased survival. At present, diagnosis relies on invasive sampling of the respiratory tract using fibre-optic bronchoscopy. We have looked at a 30-month period, from June 1997 to December 1999, where 25 bronchoscopies were performed on patients from the Lymphoma and BMT units at The Royal Marsden Hospital for the further investigation of pulmonary infiltrates. Nine bronchoscopies (36%) yielded a positive result and seven (28%) led to a change in management. Analysis of the data showed that neither a positive result nor a change in management had any impact on overall survival. After reviewing the background literature on the investigation of pulmonary infiltrates in this group and discussion of the respective merits and limitations, we propose a management flowchart, with high-resolution computed tomography (HRCT) as the test arm in a future randomised trial of these patients. Bone Marrow Transplantation (2001) 27, 967–971. [ABSTRACT FROM AUTHOR]

Osteoporosis is a systemic skeletal disease characterised by low bone density and micro architectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. It is a silent disease. It is the result of the negative balance between bone formation and bone resorption, i.e. more bone is lost than is formed. It is the most common bone disease worldwide and is now a major health problem. Bones require a normal level of systemic hormones, adequate caloric intake, particularly protein, calcium and vitamin D and regular weight-bearing exercise throughout life. A large bone mass early in life protects against osteoporosis. Peak bone mass is determined by sex, heredity family history, race, diet and exercise. Sixty per cent of bone growth occurs during adolescence. Moderate exercise protects against osteoporosis, but too little or excessive exercise may cause osteoporosis. [ABSTRACT FROM AUTHOR]

Serum p53 antibodies have been shown to be a poor prognostic marker in resected non-small-cell lung cancer (NSCLC), but studies in small-cell lung cancer (SCLC) have been contradictory. We have studied the incidence of p53 antibodies in a large SCLC cohort treated at one oncology centre and correlated the results with survival. 231 patients (63% male, median age 65), diagnosed and treated for SCLC between 1987 and 1994 at The Royal Marsden Hospital NHS Trust, had sera stored pretreatment. All samples were tested for p53 antibodies (p53-Ab) using a standardized ELISA technique with a selection of strongly ELISA positive, weakly ELISA positive and negative samples being confirmed with immunoprecipitation. 54 patients were positive for p53-Ab (23%). The presence of a high titre of p53-Ab (titre ratio >5) appears to be associated with a survival advantage with a relative risk of death of 1.71 (95% CI: 1.14-2.58) in those without the antibody (P = 0.02). This study, the largest homogenous group so far looking at p53-Ab in SCLC, suggests that p53 antibody detection may have a role in predicting outcome in this type of cancer. [ABSTRACT FROM AUTHOR]

Mycobacterial preparations have been used with limited success against cancer apart from superficial bladder cancer. Recently, a therapeutic vaccine derived from Mycobacterium vaccae has been given to patients with prostate cancer and melanoma indicating a possible beneficial effect on disease activity in such patients. We have recently initiated a series of randomized studies to test the feasibility and toxicity of combining a preparation of heat-killed Mycobacterium vaccae (designated SRL172) with a multidrug chemotherapy regimen to treat patients with inoperable non-small cell lung cancer (NSCLC) and mesothelioma. 28 evaluable patients with previously untreated symptomatic NSCLC and mesothelioma were randomized to receive either 3 weekly intravenous combination chemotherapy alone, or chemotherapy given with monthly intra-dermal injections of SRL172. Safety and tolerability were scored by common toxicity criteria and efficacy was evaluated by survival of patients and by tumour response assessed by CT scanning. The toxicity of chemotherapy was similar in the two groups. SRL172 caused mild inflammation at the injection site. In the group of patients randomized to receive chemotherapy combined with SRL172, there was a trend towards improved response rate (54% vs. 33%) with more patients in the combined arm receiving radical surgery and radiotherapy, improved median survival (9.7 months vs. 7.5 months) and improved 1 year survival (42% vs. 18%). SRL172 appeared to improve sleep (P = 0.08) and improved appetite (P = 0.01). There was no detectable change in serum cytokine levels for gamma-interferon and TNF-α before and after treatment. In patients with NSCLC and mesothelioma, there may be a beneficial interaction when chemotherapy is administered in combination with SRL172. Confirmation of this effect and further investigation is underway in a randomized phase III trial and in laboratory models. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the subjective opinions of junior doctors on their adequacy of training and confidence levels for performing transurethral catheterisation (TUC) and to investigate their subjective interest in a 'safety mechanism' that would eliminate the potential for urethral trauma during TUC. Methods: An anonymous online survey was emailed to all interns that had a documented email address on the Royal College of Surgeons Ireland registry (2012-2013). The survey consisted of eight questions pertaining to TUC of male patients. Results: The survey was delivered to 252 email addresses and the response rate was 52 % (130/252). The vast majority (99 %; n = 128) of interns felt confident inserting a transurethral catheter independently and 73 % ( n = 95) subjectively received appropriate training for catheterising male patients. The incidence of trauma after mistakenly inflating the catheter's anchoring balloon in the urethra was 3 % ( n = 4). The majority (90 %; n = 116) of respondents were interested in a safety mechanism for preventing urethral trauma and 71 % ( n = 92) felt that a safety mechanism for urethral trauma prevention should be compulsory for all transurethral catheterisation among male patients. Conclusion: Despite pre-emptive training programmes, it appears that iatrogenic urethral trauma secondary to TUC remains a persistent morbidity in healthcare settings. Designing a safer transurethral catheter may be necessary to eliminate the risk of unnecessary urethral trauma in patients. [ABSTRACT FROM AUTHOR]

Previous studies have shown that abnormal rotation of the scapula is associated with shoulder pathology. Among the methods which have been proposed, planar x-ray measurements are probably the only methods, which enable clinicians to assess accurately and objectively the scapulohumeral function in vivo. The aim of this study was to develop a method for the assessment of scapulohumeral kinematics using digital fluoroscopy. Anteroposterior images of the right glenohumeral joint were taken, in thirty-four healthy males, with the arm at rest, 30°, 60°, 90°, 120°, 150° and maximum abduction, in the scapular plane. High inter- and intra-examiner reliability was observed regarding the arm and scapular angle measurements (ICC = 0.92–0.99). The positioning of the arm at the proposed angles was also highly accurate (< 2.3° misplacement) and reproducible (CV% < 5.3%). The mean radiation dose was 0.075 mSv (± 0.027 mSv). At the resting position the scapula was in slight downward rotation (−2.4° ± 4.3°) and the arm in slight abduction (1.5° ± 6.6°). The mean maximum scapular rotation and the mean maximum arm abduction was 61.4° (± 5.2°) and 162.4°(± 6.6°) respectively. A curvilinear relationship was found between the arm angle (AA) and the scapular angle (SA) (p < 0.0001). The AASA ratio for the entire range of abduction was 2.51. The greatest contribution of the scapula (1.71) achieved at 30°-60° of arm. The high accuracy and reliability of our method and the low radiation recordings suggests that digital fluoroscopy may be considered for further investigation of the scapulohumeral kinematics in both healthy and pathological shoulders. [ABSTRACT FROM AUTHOR]