A randomised feasibility trial comparing needle fasciotomy with limited fasciectomy treatment for Dupuytren's contractures.

PURPOSE: The purpose of this study is to assess the feasibility of conducting a large, multicentre randomised controlled trial (RCT) comparing needle fasciotomy with limited fasciectomy for treatment of Dupuytren's contractures. DESIGN: The design of this study is a parallel, two-arm, multicentre, randomised feasibility trial with embedded QuinteT Recruitment Intervention. PARTICIPANTS: Patients aged 18 years or over who were referred from primary to secondary care for treatment of a hand with Dupuytren's contractures of one or more fingers of more than 30° at the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints and well-defined cord(s). Patients were excluded if they had undergone previous Dupuytren's contracture surgery on the same hand. METHODS: Potential participants were screened for eligibility. Recruited participants randomised (1:1) to treatment with either needle fasciotomy or limited fasciectomy and followed-up for up to 6 months after treatment. Data on recruitment rates, completion of follow-up, and procedure costs were collected. Four patient reported outcome measures (PROMs) and objective outcome measures were collected before intervention and 6 weeks and 6 months afterwards. RESULTS: One hundred and fifty-three of 267 (57%) primary-care referrals for Dupuytren's contractures met the eligibility criteria for the study. Seventy-one of the 153 (46%) agreed to participate and were randomly allocated to treatment with needle fasciotomy or limited fasciectomy. Sixty-seven of these underwent their allocated treatment, two were crossovers from limited fasciectomy to needle fasciotomy, and two (both allocated limited fasciectomy) received no treatment. Fifty-nine participants (85%) completed 6-month follow-up PROMs. Participants felt the MYMOP, PEM and URAM PROMs allowed them to better describe how their treatment affected their hand function than the DASH PROM. The estimated costs of limited fasciectomy (in an operating theatre) and needle fasciotomy (in a clinic room) were £777 and £111 respectively. CONCLUSION: A large RCT comparing treatment of Dupuytren's contractures by needle fasciotomy and limited fasciectomy is feasible. Data from this study will help determine the number of sites and duration of recruitment required to complete an adequately powered RCT and will assist the selection of PROMs in future studies on the treatment of Dupuytren's contractures. (Level 1 feasibility study). TRIAL REGISTRATION: Trial registered with ISRCTN (registration number: ISRCTN11164292), date assigned - 28/08/2015.

The views of children and young people on the use of silk garments for the treatment of eczema: a nested qualitative study within the CLOTHing for the relief of Eczema Symptoms (CLOTHES) randomized controlled trial.

BACKGROUND: Many children suffer with skin diseases but to date most dermatological research has been done 'on' rather than 'with' children; in this study we actively sought the experiences of children and young people. Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects around 20% of children and can impact on the health and wellbeing of children and their families. The role of specialist clothing in the management of AE is poorly understood. OBJECTIVES: The aim of this study, which was nested in a randomized controlled trial, was to qualitatively examine child participants' experiences of using silk garments for the treatment of AE. METHODS: Eighteen children aged 5-15 years, who took part in the CLOTHing for the relief of Eczema Symptoms (CLOTHES) trial, participated in age-appropriate individual interviews or focus groups. RESULTS: Thematic analysis generated four themes directly related to the silk garments: (i) expectations of the garments; (ii) wearing the garments; (iii) asking if the garments helped; and (iv) thoughts about the garments. The conclusions from this nested qualitative study are that there was some limited improvement in eczema for some children but that the hoped-for 'miracle cure' did not transpire. A mixed picture of knowledge, beliefs and experiences of using the silk garments emerged. CONCLUSIONS: Engaging children in the evaluation of the garments provided first-hand nuanced insights that enhanced understanding of the CLOTHES study as a whole. This nested study demonstrates that children can and indeed want to be engaged in dermatological research in meaningful ways that add to our understanding of treatment options.

Absorption of solar radiation by clouds: observations versus models.

There has been a long history of unexplained anomalous absorption of solar radiation by clouds. Collocated satellite and surface measurements of solar radiation at five geographically diverse locations showed significant solar absorption by clouds, resulting in about 25 watts per square meter more global-mean absorption by the cloudy atmosphere than predicted by theoretical models. It has often been suggested that tropospheric aerosols could increase cloud absorption. But these aerosols are temporally and spatially heterogeneous, whereas the observed cloud absorption is remarkably invariant with respect to season and location. Although its physical cause is unknown, enhanced cloud absorption substantially alters our understanding of the atmosphere's energy budget.

Radiative climate forcing by the mount pinatubo eruption.

Radiative flux anomalies derived from the National Aeronautics and Space Administration (NASA) spaceborne Earth Radiation Budget Experiment were used to determine the volcanic radiative forcing that followed the eruption of Mount Pinatubo in June 1991. They are the first unambiguous, direct measurements of large-scale volcanic forcing. The volcanic aerosols caused a strong cooling effect immediately; the amount of cooling increased through September 1991 as shortwave forcing increased relative to the longwave forcing. The primary effects of the aerosols were a direct increase in albedo over mostly clear areas and both direct and indirect increases in the albedo of cloudy areas.

Strategic control at the CEO level.

This study of 108 corporations is intended to identify and validate those strategic control factors that contribute directly to the success of strategic decisions made at the level of the CEO which are subsequently implemented throughout the organization. In direct response to a comprehensive questionnaire, 61 CEOs rated nine strategic control factors. Only the ratings of CEOs were accepted and processed in this study. Their ratings revealed areas of obvious strength and correctable weakness in their perceptions of strategic control within their respective organizations. These ratings tended to validate a conceptual process model of strategic control.

Cloud-radiative forcing and climate: results from the Earth radiation budget experiment.

The study of climate and climate change is hindered by a lack of information on the effect of clouds on the radiation balance of the earth, referred to as the cloud-radiative forcing. Quantitative estimates of the global distributions of cloud-radiative forcing have been obtained from the spaceborne Earth Radiation Budget Experiment (ERBE) launched in 1984. For the April 1985 period, the global shortwave cloud forcing [-44.5 watts per square meter (W/m(2))] due to the enhancement of planetary albedo, exceeded in magnitude the longwave cloud forcing (31.3 W/m(2)) resulting from the greenhouse effect of clouds. Thus, clouds had a net cooling effect on the earth. This cooling effect is large over the mid-and high-latitude oceans, with values reaching -100 W/m(2). The monthly averaged longwave cloud forcing reached maximum values of 50 to 100 W/m(2) over the convectively disturbed regions of the tropics. However, this heating effect is nearly canceled by a correspondingly large negative shortwave cloud forcing, which indicates the delicately balanced state of the tropics. The size of the observed net cloud forcing is about four times as large as the expected value of radiative forcing from a doubling of CO(2). The shortwave and longwave components of cloud forcing are about ten times as large as those for a CO(2) doubling. Hence, small changes in the cloud-radiative forcing fields can play a significant role as a climate feedback mechanism. For example, during past glaciations a migration toward the equator of the field of strong, negative cloud-radiative forcing, in response to a similar migration of cooler waters, could have significantly amplified oceanic cooling and continental glaciation.

High-performance liquid chromatographic determination of N-acetylcysteine in human serum following acetaminophen overdosage.

An analytical method has been developed for the determination of N-acetylcysteine in human serum following acetaminophen overdosage in humans. Serum samples were treated with dithiothreitol and the protein-freed product was derivatized with 2,4-dinitrofluorobenzene. N-Acetylhomocysteine thiolactone was used as an internal standard. Following diethyl ether extraction, the components were separated on a reversed-phase column with retention times of 7.4 and 9.9 min for N-acetylcysteine and internal standard, respectively. Ultraviolet detection at 365 nm was employed and little interference was noted from other serum components. The method has been applied to quantitation of N-acetylcysteine given as treatment for acetaminophen intoxication.

Concomitant use of activated charcoal and N-acetylcysteine.

Activated charcoal is a safe, effective, inexpensive adjunct in the management of most toxic ingestions. It has the ability to adsorb a wide variety of drugs and chemicals, one of which is acetaminophen. N-acetylcysteine (NAC) is the specific antidote available for serious overdoses of acetaminophen. Current management of acetaminophen overdose, however, does not recommend the concomitant oral administration of these two useful agents because adsorption and inactivation of NAC by charcoal is believed to occur. Our study was designed to help evaluate the effect of activated charcoal on N-acetylcysteine absorption. Ten healthy male volunteers were each given in the first, or control, phase of the study an oral dose of 140 mg/kg NAC, and venous blood samples were obtained. In the second phase, after a washout period, each subject received 60 g activated charcoal orally followed immediately by 140 mg/kg NAC. NAC serum levels were measured using gas-liquid chromatography, and levels were compared with and without the concomitant administration of charcoal. Although only a small number of the subjects completed the study, the results showed that in both phases there were no significant differences in the peak NAC levels, the plasma half-life of NAC, or the calculated area under the curve. We recommend that NAC and activated charcoal not be used clinically until further studies are completed.

Antigenic response to topically applied proteins.

Six different proteins varying widely in molecular weight, ribonuclease, lysostaphin, ovalbumin, penicillinase, collagenase, and Varidase were tested for their ability to induce circulating antibody formation in rabbits after repeated topical application of the proteins in a water-soluble gel vehicle. After a 12-week exposure period, significant hemagglutinin titers were noted in rabbits treated with ovalbumin, lysostaphin, or ribonuclease; markedly elevated, passive cutaneous anaphylaxis-reacting sera were obtained only from collagenase- or lysostaphin-treated animals. Precipitin antibodies as evidenced by gel diffusion were also found in sera from collagenas- and lysostaphin-treated animals. Topical application of penicillinase was only marginally effective and Varidase was totally ineffective in elicting a positive circulating antibody response. In all cases, topical application of proteins for periods in excess of 3 weeks was required for induction of circulating antibody formation.

Haloprogin: a topical antifungal agent.

Haloprogin was shown to be a highly effective agent for the treatment of experimentally induced topical mycotic infections in guinea pigs. Its in vitro spectrum of activity also includes yeasts, yeastlike fungi (Candida species), and certain gram-positive bacteria. The in vitro and in vivo antifungal activity of haloprogin against dermatophytes was equal to that observed with tolnaftate. The striking differences between the two agents were the marked antimonilial and selective antibacterial activities shown by haloprogin, contrasted with the negligible activities found with tolnaftate. Addition of serum decreased the in vitro antifungal activity of haloprogin to a greater extent than that of tolnaftate; however, diminished antifungal activity was not observed when haloprogin was applied topically to experimental dermatophytic infections. Based on its broad spectrum of antimicrobial activity, haloprogin may prove to be a superior topical agent in the treatment of dermatophytic and monilial infections in man.