The effect of the intensity of lipid-lowering medications on the LDL cholesterol treatment goals of Asian patients with dyslipidaemia in primary care.

WHAT IS KNOWN AND OBJECTIVE: Dyslipidaemia is the key risk factor for arthrosclerosis, leading to myocardial infarctions and strokes. Achieving LDL cholesterol (LDL-C) treatment goals using lipid-lowering therapy (LLT) mitigates such cardiovascular risks. This study aimed to determine the proportions and factors influencing patients with dyslipidaemia on LLT who achieved their recommended LDL-C treatment goals. METHODS: Adult Asian patients with dyslipidaemia, aged 31-80 years, were enrolled in a questionnaire survey. Using simplified Framingham risk scores, these patients were classified into low (LR), medium (MR) and high (HR) cardiovascular risk groups. Their lipid-lowering therapy was classified into low-intensity (LI), medium-intensity (MI) and high-intensity (HI) groups according to the 2013 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guidelines. Data on their demographic, clinical, self-reported attitude and adherence to LLT were correlated with their latest lipid profiles from their electronic health records. These data were analysed using chi-square test, or independent t-test where appropriate for categorical variables and continuous data. Logistic regression was used to identify factors relating to LDL-C goal attainment. RESULTS AND DISCUSSION: Amongst the 917 patients treated with LLT, 60·9% were females and 56·2% aged >60 years. The commonest statins prescribed were simvastatin (77·7%), atorvastatin (15·3%), rosuvastatin (4·3%) and lovastatin (3·4%). Those who attained LDL-C treatment goals included 89·4%, 77·4% and 70% of the LR, MR and HR groups. Overall, 72·4% of the patients achieved LDL-C treatment goals. Despite 98·4% of them self-reported LLT adherence, only 85·5%, 69·5% and 50% of the LI, MI and HI subgroups attained the desired outcomes, respectively. WHAT IS NEW AND CONCLUSION: Overall, 27·6% of patients with dyslipidaemia, including 30% of the HR group, did not achieve LDL-C treatment goals, despite on LLT. Addressing their concerns and adjusting medication doses of their LLT are needed for better outcomes.

Analysis of body responses to an accelerating platform by the largest-Lyapunov-exponent method.

Various disciplines have benefited from the advent of high-performance computing in achieving practical solutions to their problems, and the area of health care is no exception to this. Non-linear signal-processing tools have been developed to understand the hidden complexity of the time series, and these will help clinicians in diagnosis and treatment. Postural study helps the elderly and people with a balancing problem due to various pathological conditions. In elderly subjects, falls are common and may result in injury. Correct postural balance is basic to well-being and it influences our daily life significantly. These postural signals are non-stationary; they may appear to be random in the time scale and it is difficult to observe the subtle changes for the human observer. Hence, more hidden information can be obtained from the signal using non-linear parameters. In this paper, ten young normal subjects are subjected to the balancing platform whose acceleration is gradually increased from 1 m/s2 to 5 m/s2 to study the postural response. The ankle front-back acceleration and ankle pitch angular velocity sensor data were studied using the largest Lyapunov exponent (LLE). The results show that for higher acceleration of the platform the ankle movement follows a particular rhythm, resulting in a lower Lyapunov exponent. During lower acceleration of the balancing platform, this value is higher because of the random movement of the ankle. In this work, the pattern of the body response was studied using LLE values for different accelerations using ankle data as the base signal for the normal subjects.

Polydopamine-polyethylene glycol-albumin antifouling coatings on multiple substrates.

Aqueous-based coatings using combinations of polydopamine (PDA) (as bioadhesive) and grafted polyethylene glycol (PEG) (as antifouling agent) have been reported to reduce biofouling on multiple material surfaces. However, the achievable PEG grafting density and antifouling performance are limited, leaving exposed PDA to provide sites for attachment of proteins and cells. In the present work, we investigate the polymerization of dopamine on three substrate materials, polycarbonate membrane (PC), polydimethyl siloxane (PDMS), and soda lime glass, to evaluate the utility of the PDA coatings for application to multiple materials. Additionally, we propose that the PDA-PEG method may be improved by "backfilling" with bovine serum albumin (BSA) as a blocker covering exposed PDA. AFM and ellipsometry studies revealed substantial differences in PDA thickness and roughness on each material despite their being modified under the same conditions. X-ray photoelectron spectroscopy (XPS) and water contact angle data revealed differences in PEG grafting on these materials as a consequence of varying PDA surface roughness, with the highest PEG coverage achieved on PC-PDA surfaces of intermediate roughness and lower PEG attachment on smoother PDMS-PDA surfaces. Fibrinogen adsorption experiments showed significantly less fouling on PDA-BSA surfaces compared to PDA-PEG for all three substrates, the larger BSA molecules presumably providing greater coverage of the PDA. On the PC and PDMS substrates, backfilling the PDA-PEG surfaces with BSA gave significant reductions in fibrinogen adsorption, with the lowest adsorption of 75 ng cm-2 achieved on PC-PDA-PEG/BSA.

The computerisation of scientific services.

A full computerised laboratory information management system has been developed in the Department of Scientific Services. The system manages the acquisition and flow of laboratory data. A novel automated reporting procedure has been developed to generate customised laboratory reports. Based on the workload values of laboratory tests, the system integrates the laboratory data with management information to provide rapid and reliable productivity measurement and cost and pricing computations.

Breast reconstruction using permanent Becker expander implants: an 18 year experience.

BACKGROUND: Single-stage reconstruction using permanent expander implants is an established technique following mastectomy. Short and long-term outcome data following breast reconstruction using Becker tissue expanders is limited. METHOD: A retrospective case note review of patients undergoing expander-based procedures between 1989 and 2007 was undertaken. Data recorded included postoperative symptoms and complications, the use of radiotherapy, revisional surgery, and device failure. RESULTS: Three hundred and thirteen expanders were used in 276 patients with a mean age of 48.3 (17-78) years, over the 18 year study period. The mean follow up period was 64.6 (1-199) months. 256 Becker expanders were used during 175 latissimus dorsi (LD) and 52 subpectoral (SP) reconstructions, 13 contralateral augmentations and 16 implant replacements. The postoperative infection rate was 5.8%, leading to an expander loss rate of 3.8%. The use of prophylactic antibiotics was associated with an increased postoperative infection rate (p = 0.046). Six haematomas (2.5%) and 12 cases of skin envelope necrosis (5.0%) required unscheduled intervention. Symptoms of pain, distortion and hardness were experienced by 21.3% of patients, and radiotherapy was associated with a significantly higher risk of adverse symptoms (p < 0.0001). No patient developed symptomatic implant rupture or silicone granuloma but 17.9% of reconstructions underwent revisional surgery, the rate being highest following SP reconstruction (p = 0.029). Nine patients developed injection port complications (3.8%), and the overall device failure rate was 1.3%. The original expander has been retained by 74.2% of women. CONCLUSION: The Becker permanent expander is a reliable implant associated with a low complication rate and a high retention rate when used during breast reconstruction.

Patient satisfaction following nipple-areolar complex reconstruction and tattooing.

BACKGROUND: Nipple-areolar complex (NAC) reconstruction and tattooing complete and compliment reconstruction of the breast mound. Patient satisfaction with NAC reconstruction and tattoo, independent from breast mound reconstruction is evaluated in this study. METHODS: Patients who underwent nipple tattooing between January 2001 and June 2008 were sent a postal questionnaire retrospectively. Questions included those regarding reconstruction type, patient satisfaction with NAC reconstruction and tattoo outcome, and complications. RESULTS: 110 patients with completed questionnaires were included from the 172 patients who were invited. Median follow up time was 38.5 months (1-86). Eighty eight percent reported overall satisfaction with their NAC reconstruction. Seventy percent of patients were satisfied with their nipple tattoos. All procedures were done in a day case setting and eighty-nine patients reported no postoperative complications. The commonest causes for disappointment were lack of projection of the NAC reconstruction and fading of tattoos. Ninety-six percent of women stated that NAC reconstruction and tattooing were important to them, and 93% of the patients would undergo the procedures again. CONCLUSION: We believe that NAC reconstruction is an important and integral part of breast reconstruction. This study should inform surgeons and patients regarding outcome, possible complications and the potential need and timing of further tattooing.