Prevalence of active Charcot disease in the East Midlands of England.

AIMS: To undertake a prospective point prevalence study of the prevalence of active Charcot neuro-inflammatory osteoarthropathy (Charcot disease) in a circumscribed part of England and to audit the time elapsing between disease onset and first diagnosis. METHODS: The prevalence of active Charcot disease of the foot during a single month was assessed by specialist foot care teams at seven secondary care services in the East Midlands region of England. RESULTS: A total of 90 cases were identified, representing 4.3 per 10 000 of the 205 033 total diabetes population of the region. The time elapsed from first presentation to any healthcare professional until diagnosis was also assessed. While the diagnosis was suspected or confirmed in one-third of patients within 2 weeks, it was not made for 2 months or more in 23 patients (24%). CONCLUSIONS: Non-specialist professionals should have greater awareness of the existence of this uncommon complication of diabetes in the hope that earlier diagnosis will lead to lesser degrees of deformity.

Differences between patients' and clinicians' research priorities from the Anaesthesia and Peri-operative Care Priority Setting Partnership.

The James Lind Alliance Anaesthesia and Peri-operative Care Priority Setting Partnership was a recent collaborative venture bringing approximately 2000 patients, carers and clinicians together to agree priorities for future research into anaesthesia and critical care. This secondary analysis compares the research priorities of 303 service users, 1068 clinicians and 325 clinicians with experience as service users. All three groups prioritised research to improve patient safety. Service users prioritised research about improving patient experience, whereas clinicians prioritised research about clinical effectiveness. Clinicians who had experience as service users consistently prioritised research more like clinicians than like service users. Individual research questions about patient experience were more popular with patients and carers than with clinicians in all but one case. We conclude that patients, carers and clinicians prioritise research questions differently. All groups prioritise research into patient safety, but service users also favour research into patient experience, whereas clinicians favour research into clinical effectiveness.

Comparison of HR-pQCT- and microCT-based finite element models for the estimation of the mechanical properties of the calcaneus trabecular bone.

The calcaneus bone is formed of extensive trabecular bone and is therefore well suited to be used as an example of loaded bone to establish the ability of combining microfinite element (microFE) technique with high-resolution peripheral quantitative computed tomography (HR-pQCT) in determining its mechanical properties. HR-pQCT is increasingly used as a tool for in vivo bone clinical research, but its use has been limited to the distal radius and tibia. The goal of this study was to determine the applicability of HR-pQCT-derived microFE models of the calcaneus trabecular bone with 82 µm voxel size with reference to higher-resolution microCT-based models taken as gold standard. By comparing the outputs of microFE models generated from both HR-pQCT and microCT images of the trabecular bone of five calcaneus cadaveric specimens, it was found that the HR-pQCT-based models predicted mechanical properties for fracture load, total reaction force and von Mises stress are considerably different from microCT-based counterparts by 33, 64 and 70%, respectively. Also, the morphological analysis showed a comprehensive geometrical difference between HR-pQCT-based microFE models and their microCT-based equivalents. The results of the HR-pQCT-based models were found to have strong dependency on the threshold value chosen to binarise the images prior to finite element modelling. In addition, it was found that the voxel size has a strong impact on accuracy of imaged-based microFE models compared to other factors such as the presence of soft tissue and image scanning integration time. Therefore, although HR-pQCT has shown to be useful to predict overall structural and biomechanical changes, it is limited in providing local accurate biomechanical properties of trabecular bone and therefore should be used with caution when assessing bone remodelling through local changes of trabecular bone apposition and resorption in disease treatment monitoring.

Using a Systems Pharmacology Approach to Study the Effect of Statins on the Early Stage of Atherosclerosis in Humans.

More than 100,000 people have participated in controlled trials of statins (lowering cholesterol drugs) since the introduction of lovastatin in the 1980s. Meta-analyses of this data have shown that statins have a beneficial effect on treated groups compared to control groups, reducing cardiovascular risk. Inhibiting the HMG-CoA reductase in the liver, statins can reduce cholesterol levels, thus reducing LDL levels in circulation. Published data from intravascular ultrasound studies (IVUS) was used in this work to develop and validate a unique integrative system model; this consisted of analyzing control groups from two randomized controlled statins trials (24/97 subjects respectively), one treated group (40 subjects, simvastatin trial), and 27 male subjects (simvastatin, pharmacokinetic study). The model allows to simulate the pharmacokinetics of statins and its effect on the dynamics of lipoproteins (e.g., LDL) and the inflammatory pathway while simultaneously exploring the effect of flow-related variables (e.g., wall shear stress) on atherosclerosis progression.

Relationship between progesterone suppression and pregnancy in rats.

Four luteolytic agents were administered to groups of pregnant rats to examine the quantitative relationship between serum progesterone levels and the maintenance of pregnancy. Each agent inhibited progesterone in a dose-dependent manner, however only three, azastene, thiosemicarbazone and dihydrotestosterone, adversely affected pregnancy. A statistical analysis of the data suggests that, regardless of the mechanism of action of a particular luteolytic agent, a treatment-induced depression of serum progesterone to concentrations less than 45% of that of the controls on day 11 of pregnancy is incompatible with pregnancy maintenance.

Abdominal pain in a university family practice setting.

Abdominal pain is one of the most common complaints in the family practice setting. Abdominal pain has been the subject of many studies; however, the focus has been on abdominal pain as a final diagnosis rather than as a symptom or presenting complaint. A retrospective audit examined 133 charts of patients 18 years of age or older presenting to the University of Iowa Family Practice Center from July 1976 to October 1978. Abdominal pain, etiology undetermined, accounted for approximately one half of the final diagnoses. The patients tended to be young and female. Almost one half of the patients were seen only once for the problem. Conclusions concerning management are drawn, and suggestions for further studies are made.

Effect of spouse support and health beliefs on medication adherence.

This study addressed the issue of social support for patients' adherence to medical regimens. Social support of wives was assessed by structured interview of 150 male participants in the Coronary Primary Prevention Trial, their wives, and medical staff. In addition, wives were interviewed about their beliefs related to their husbands' health and participation in the trial. Unobtrusive packet counts were used as the measure of adherence. The participants were classified as having high spouse support if wife support scores were in the top one third of the distribution and as having low spouse support if scores were in the bottom one third as measured from inquiry of the participant, the spouse, and the staff. The adherence of men having low support averaged 70 percent, significantly lower than the high-support group, which averaged 96 percent. The correlations between spouses' health beliefs and their level of support were significant for three of four health belief variables. In particular, highly adhering men had wives who believed more strongly in the benefits of the Coronary Primary Prevention Trial.

Language of sport fans: sportugese revisited.

In 1959, Tannenbaum and Noah reported that sports writers and readers possessed a better understanding of sport terminology than nonreaders. The current investigation extended Tannenbaum and Noah's research using current sport terms. A positive relationship between understanding sport terminology, extent of team identification, strength of sport fandom, and self-proclaimed sport knowledge was hypothesized. Scores of 57 participants confirmed the predicted pattern. Discussion concerned research examining sport terminology.

Advances in the prevention of injuries and their effect on emergency medical services.

Much attention has been focused on the response to victims of injuries in the last two decades. During those twenty years, tremendous strides have been made in the medical community's ability to meet the needs of patients in the acute phase of treatment for traumatic injuries. Recent research has reflected these advances in treatment as well as equipment design and development that enable rapid response and access to the injured. Even with these modern miracles of treatment, injuries kill more citizens of the United States 1-34 yr of age than all diseases combined. Traumatic injury is the leading cause of death in people up to 44 yr of age. The emergency medical services community identifies the best "treatment" for traumatic injury as its prevention by means of pre-incident interventions that ultimately reduce the severity of the injury and the potential disablement of the victim.

The incidence of awareness, and amnesia for perioperative events, after cardiac surgery with lorazepam and fentanyl anesthesia.

One hundred patients (mean age 59 +/- 10 years) were premedicated with morphine, 0.15 mg/kg, and scopolamine, 0.008 mg/kg. Anesthesia was induced with lorazepam, 50 microg/kg, followed by fentanyl, 50 microg/kg, oxygen and pancuronium, 0.15 mg/kg. Isoflurane was given for short periods before and after cardiopulmonary bypass to 57 patients when hypertension was uncontrolled by addition of fentanyl and/or nitroglycerin. Morphine was used as the sole sedative postoperatively. Patients were interviewed following discharge from the surgical intensive care unit to assess the incidence of operative awareness, and to assess amnesia for events occurring during four preoperative and two postoperative periods of the patients' hospital stay. During three preoperative periods (day of admission, evening before, and morning before operation), 1%, 3%, and 2% of patients had complete amnesia, and 19%, 41%, and 31% had partial amnesia of events. Fifty-five percent of patients exhibited complete, and 34% of patients exhibited partial amnesia to events occurring in the preinduction period. Two patients reported intraoperative awareness (noises, conversation) occurring at the end of the anesthetic. In the two postoperative periods (morning of the day after surgery and intensive care stay), 9% and 15% of patients had complete, and 35% and 47% of patients exhibited partial amnesia. Amnesia was statistically significantly greater in patients over 60 years of age in the preinduction period. Duration of cardiopulmonary bypass did not affect the incidence of amnesia.

The biological properties of aspartame. IV. Effects on reproduction and lactation.

Intragastric administration of approximately 300 mg/kg/day of aspartame (APM) to female rats for seven days and to female hamsters for five days after mating did not affect postcoital fertility as measured by the number of implantation sites and normal appearing fetuses. In additional studies, the effect of APM fed at 1 to 14% in the diet to lactating rats and their litters of suckling young was studied using a pair-feeding experimental design. Levels of APM up to 4% in the diet (about 7 g/kg/day) did not affect food consumption, body weights, serum prolactin, serum gonadotropins, the mammary gland histology of the dams or the growth and survival rates of their pups. However, higher levels of 7.5 and 14% APM (about 9 g/kg/day) caused reduced food consumption due to diet palatability and resulted in body weight loss in dams and retarded growth rates in the young.