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Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients.
A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out.
Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion.
As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.
Current methods of control recruitment for case-control studies can be slow (a particular issue for outbreak investigations), resource-intensive and subject to a range of biases. Commercial market panels are a potential source of rapidly recruited controls. Our study evaluated food exposure data from these panel controls, compared with an established reference dataset. Market panel data were collected from two companies using retrospective internet-based surveys; these were compared with reference data from the National Diet and Nutrition Survey (NDNS). We used logistic regression to calculate adjusted odds ratios to compare exposure to each of the 71 food items between the market panel and NDNS participants. We compared 2103 panel controls with 2696 reference participants. Adjusted for socio-demographic factors, exposure to 90% of foods was statistically different between both panels and the reference data. However, these differences were likely to be of limited practical importance for 89% of Panel A foods and 79% of Panel B foods. Market panel food exposures were comparable with reference data for common food exposures but more likely to be different for uncommon exposures. This approach should be considered for outbreak investigation, in conjunction with other considerations such as population at risk, timeliness of response and study resources.
Detecting gastrointestinal (GI) infection transmission among men who have sex with men (MSM) in England is complicated by a lack of routine sexual behavioural data. We investigated whether gender distributions might generate signals for increased transmission of GI pathogens among MSM. We examined the percentage male of laboratory-confirmed patient-episodes for patients with no known travel history for 10 GI infections of public health interest in England between 2003 and 2013, stratified by age and region. An adult male excess was observed for Shigella spp. (annual maximum 71% male); most pronounced for those aged 25–49 years and living in London, Brighton and Manchester. An adult male excess was observed every year for Entamoeba histolytica (range 59.8–76.1% male), Giardia (53.1–57.6%) and Campylobacter (52.1–53.5%) and for a minority of years for hepatitis A (max. 69.8%) and typhoidal salmonella (max. 65.7%). This approach generated a signal for excess male episodes for six GI pathogens, including a characterised outbreak of Shigella among MSM. Stratified analyses by geography and age group were consistent with MSM transmission for Shigella. Optimisation and routine application of this technique by public health authorities elsewhere might help identify potential GI infection outbreaks due to sexual transmission among MSM, for further investigation.
We have undertaken a study of the 3-D spatial distribution of the older (τ ≥ 1–2 Gyr) stellar population lying beyond ~ 2 kpc in projected radial distance from the centre of the SMC. The study will eventually cover 120 square degrees including six overlapping Schmidt fields. Here we present the results from an area of 80 square degrees including the western, northern and north-eastern outer parts of the SMC.
The flight of barnacle geese at airspeeds representing high-speed migrating flight is investigated using experiments and simulations. The experimental part of the work involved the filming of three barnacle geese (Branta Leucopsis) flying at different airspeeds in a wind tunnel. The video footage was analysed in order to extract the wing kinematics. Additional information, such as wing geometry and camber was obtained from a 3D scan of a dried wing. An unsteady vortex lattice method was used to simulate the aerodynamics of the measured flapping motion. The simulations were used in order to successfully reproduce the measured body motion and thus obtain estimates of the aerodynamic forces acting on the wings. It was found that the mean of the wing pitch angle variation with time has the most significant effect on lift while the difference in the durations of the upstroke and downstroke has the major effect on thrust. The power consumed by the aerodynamic forces was also estimated; it was found that increases in aerodynamic power correspond very closely to climbing motion and vice versa. Root-mean-square values of the power range from 100W to 240W. Finally, it was observed that tandem flying can be very expensive for the trailing bird.
We sought to estimate mortality and associated factors in HIV-hepatitis co-infected individuals in Michigan using a retrospective cohort study. For the study period of 1 January 2006 to 31 December 2009, all HIV-infected individuals were matched to hepatitis B and C cases. In the final Cox proportional hazards regression model, individuals of other [hazard ratio (HR) 2·2, 95% confidence interval (CI) 1·4–3·2] and black (HR 1·3, 95% CI 1·1–1·6) race had decreased survival compared to white race. Similarly, injecting drug users (IDUs) (HR 2·1, 95% CI 1·6–2·6), men who have sex with men (MSM)/IDUs (HR 1·5, 95% CI 1·1–2·2), individuals with undetermined risk (HR 1·5, 95% CI 1·2–1·9) and heterosexual practices (HR 1·4, 95% CI 1·1–1·8) had decreased survival compared to MSM. Additionally, an interaction was found between current HIV status and co-infection. Mortality in HIV-hepatitis co-infected individuals remains a continuing problem. Our study can help in planning interventions to reduce mortality in HIV-infected individuals.
A retrospective cohort study was conducted from 1 January 2006 to 31 December 2009 in Michigan to estimate the prevalence of HIV and hepatitis co-infection and identify associated factors. The prevalence of co-infection was 4·1% [95% confidence interval (CI) 3·8–4·5]. Multivariable logistic regression analysis revealed a significant association between co-infection and being male and: of Black race [odds ratio (OR) 2·0, 95% CI 1·2–3·6] and of Other race (OR 3·5, 95% CI 1·7–7·0) compared to Hispanic race. A significant association was found between co-infection and risk categories of blood products (OR 11·1, 95% CI 6·2–20·2), injecting drug user (IDU) (OR 3·6, 95% CI 2·7–4·8) and men who have sex with men/IDU (OR 3·4, 95% CI 2·4–4·9) in addition to two interactions; one between sex and current HIV status and the other between current HIV status and age at HIV diagnosis. Our results document the changing epidemiology of HIV–hepatitis co-infection which can guide preventive measures and interventions to reduce the prevalence of hepatitis co-infection.
In Type 1 and 2 diabetes tissue stiffening is evident from measurements of the gross mechanical properties of the vasculature. Elastic fibers play an important role in the mechanical function of vascular tissue, however, the effects of diabetes on individual elastic fiber components remains poorly defined. Fibrillin microfibrils, a key elastic fiber component, have a ‘beads-on-a-string’ structure with a periodicity of approximately 56 nm. We tested for possible disruption due to diabetes in fibrillin microfibrils isolated from rat aorta using an experimental model of Type 1 diabetes in rats. The isolated fibrillin microfibrils were imaged with atomic force microscopy (AFM) and image analysis techniques were used to characterise the microfibrils. Although there was no significant difference in mean microfibril length (control 23.2 repeats, SEM 6.2 repeats: diabetic 23.6 repeats, SEM 6.1 repeats: Mann Whitney U-test, p=0.391), mean periodicity was significantly reduced in microfibrils isolated from the diabetic rats (52.7 nm, SEM 0.4 nm) compared with age-matched controls (59.5 nm, SEM 0.4 nm) (p<0.001, Student's t-test). This study shows that diabetes leads to significant ultrastructural morphological changes in fibrillin microfibrils.
To evaluate the impact of intravenous ketorolac on renal function and haematologic values in patients less than six months old following cardiothoracic surgery.
Ketorolac is a potent nonsteroidal anti-inflammatory drug indicated for short term management of moderate to severe post-operative pain. Little data is available related to its safety in infants less than six months of age.
This was a retrospective, case-control chart review of 19 patients aged less than six months of age with biventricular circulations who received intravenous ketorolac following cardiothoracic surgery. They were compared with 19 age-matched control patients. Those with functionally univentricular anatomy were excluded due to their higher risk for renal impairment following surgery. Student’s t-test was used to compare the incidence of renal impairment and haematologic complications between the groups, as well as the number of analgesic doses administered. Charts were reviewed for number of blood transfusions.
Patients receiving intravenous ketorolac had no statistically significant changes in pre-operative versus post-treatment renal function or haematologic effects compared to the control group. No statistically significant differences were detected for number of post-operative blood transfusions or additional analgesic administration between groups.
Intravenous ketorolac appears to be safe when used in infants less than six months of age with biventricular circulations following cardiothoracic surgery. Ketorolac as used in these patients does not decrease the use of standard analgesic therapy.
Numbers of great cormorants Phalacrocorax carbo feeding in inland waters during winter have increased throughout Europe resulting in concerns over their impacts on fisheries. Loch Leven is a world-renowned sport fishery for trout and supports a nationally important population of wintering cormorants. The relationships between brown trout stocking, regional cormorant numbers and cormorants counted during winter on Loch Leven were examined. Stocked brown trout were fin-clipped before release and gut contents from a sample of 96 cormorants shot under scientific licence were analysed. The data suggest that the number of cormorants at this site is influenced by both the stocking policy and the regional population level. Cormorant diet varied with the sex and age of birds. Overall, trout made up c. 85% of the total content by weight. Brown trout predominated in the diet, making up c. 70%, while rainbow trout occurred less frequently, making up c. 6%. Trout which could not be identified to species, made up the remainder (c. 9%). There was no significant difference in the ratios of wild and stocked brown trout sampled from the loch and from cormorant stomachs in winter. A model was constructed to investigate the likely loss of trout to cormorants roosting on the loch. It was estimated that over a 7-month period cormorants consumed 80 803 (41 617–128 248) brown and 5213 (830–12 454) rainbow trout. These estimates compared to average annual fishery catches of 5828 brown and 12 815 rainbow trout (1996–2000). Comparison with published estimates of trout populations in Loch Leven indicated a high potential for competition between the birds and the fisheries for available fish. It is suggested that stocking has led to an increase in cormorant numbers and the subsequent increase in predation may have prevented any increase in the trout population or in fishery catches.
Background and objective: Epidural vein cannulation has long been recognized as a problem in parturients due to distension of epidural veins. Epidural vein engorgement is maximal when the pregnant woman is in the supine position and minimal in the lateral position. Following an initial observation of an apparently high incidence of epidural vein cannulation in the sitting position, a randomized trial was conducted to document whether such an association existed.
Methods: A total of 209 term parturients were randomized to either the sitting or lateral position (107 left lateral, 102 sitting). Epidural catheter placement was achieved using a loss of resistance to air technique with an 18-G Tuohy needle. A data sheet was completed for each patient recording patient position, patient characteristics data, stage in labour and the incidence of epidural vein cannulation. Poor labour analgesia was defined as a visual analogue scale (VAS) >40 mm on a 0–100 mm pain intensity VAS.
Results: The risk of epidural vein cannulation was significantly higher in the sitting group (16 of 102 = 15.7%) compared with the lateral position group (4 of 107 = 3.7%), P = 0.011. There was a significant association between epidural vein cannulation and poor analgesia (P = 0.006). These two variables remained independently significant on multiple regression analysis (position, P = 0.009; analgesia, P = 0.006).
Conclusions: We conclude that there is a direct correlation between the incidence of epidural vein cannulation and patient posture during epidural catheter insertion in parturients.
Carbohydrate ingestion increases both endurance time to exhaustion during prolonged exercise, and the ability to perform resistance exercise. The mechanism(s)underlying the increased performance following glucose ingestion remain(s) unclear. The purpose of the present study was to verify the hypothesis that glucose infusion could attenuate peripheral muscle fatigue in the anaesthetized rat during prolonged indirect electrical stimulation in situ. For this purpose the plantaris muscle was electrically stimulated (50 Hz for 200 ms every 2.7 s; 5 V; pulse width, 0.05 ms) in situ through the sciatic nerve to perform concentric contractions for 60 min while infusing intravenously either saline alone (7.25 ml kg-1 h-1), or saline and glucose (1 g kg-1 h-1: plasma glucose 11 ± 1.1, vs. 4.9 ± 0.2 mM with infusion of saline) (8 rats per group). Glucose infusion attenuated the reduction in submaximal peak dynamic force (55 % decrease vs. 70 % decrease in rats infused with saline alone, P < 0.05). In a third group of rats (n = 8), infusion of glucose 30 min after the start of stimulation partially restored submaximal peak dynamic force (P < 0.05). Maximum dynamic and isometric forces at the end of the period of stimulation were also higher (P < 0.05) in rats infused with glucose (4.0 ± 0.2 and 4.3 ± 0.2 N, respectively) than saline alone (3.0 ± 0.2 and 3.5 ± 0.2 N, respectively). The beneficial effect of glucose infusion on peripheral muscle force during prolonged stimulation was not associated with a reduction in muscle glycogen utilisation, nor with a reduction of fatigue at the neuromuscular junction, as assessed through maximal direct muscle stimulation (200 Hz for 200 ms; 150 V; pulse width, 0.05 ms). However, changes in M-wave peak-to-peak amplitude, duration and total area suggest that glucose infusion, and/or the associated increase in plasma insulin concentration, may prevent the deterioration of electrical properties of the muscle fibre membrane. Experimental Physiology (2002) 87.5, 585-592.
Isolates of Chondrostereum purpureum were characterised on malt agar by rapid growth of white, flat, velvety to cottony mycelium
and formation of yellow fruitbody crusts with apiculate basidiospores. The presence of cystidia was diagnostic, but not a reliable
taxonomic character. Above 33 °C isolates exhibited a differential growth response and only three failed to grow following 20 d
incubation at 36°. Tolerance of high temperature was not correlated with RAPD banding patterns nor geographic origin. All isolates
were pathogenic to willow, poplar and apple regardless of their original host, locality or RAPD profiles. No zones of demarcation
were observed following infection of wounds by multiple isolates. RAPD banding patterns exhibited considerable diversity, enabling
discrimination of isolates with single primers, and this was indicative of the extensive genetic diversity within the NZ population.
No RAPD banding combinations specific to host species or locality were observed. An explanation is given for the wide
dissemination of C. purpureum isolates throughout NZ.