This study evaluated the effect of 4 weeks of low-load resistance exercise with blood flow restriction (BFRE) on increasing strength in comparison with high-load resistance exercise (HLE), and assessed changes in blood, vascular and neural function. Healthy adults performed leg extension BFRE or HLE 3 days/week at 30% and 80% of strength, respectively. During BFRE, a cuff on the upper leg was inflated to 30% above systolic blood pressure. Strength, pulse-wave velocity (PWV), ankle-brachial index (ABI), prothrombin time (PT) and nerve conduction (NC) were measured before and after training. Markers of coagulation (fibrinogen and D-dimer), fibrinolysis [tissue plasminogen activator (tPA)] and inflammation [high sensitivity C-reactive protein (hsCRP)] were measured in response to the first and last exercise bouts. Strength increased 8% with BFRE and 13% with HLE (P < 0.01). No changes in PWV, ABI, PT or NC were observed following training for either group (P > 0.05). tPA antigen increased 30–40% immediately following acute bouts of BFRE and HLE (P = 0.01). No changes were observed in fibrinogen, D-dimer or hsCRP (P > 0.05). These findings indicate that both protocols increase the strength without altering nerve or vascular function, and that a single bout of both protocols increases fibrinolytic activity without altering selected markers of coagulation or inflammation in healthy individuals.

Our prospective study is the first and currently the largest observational study of a multidisciplinary approach in the management of NDT patients. SCG was an independent prognostic factor in predicting survival. In those patients who chose not to dialyse, SCG provides a potentially useful indication of expected prognosis.

No abstract

Predialysis creatinine and interdialytic change in creatinine are both strongly associated with proxies of nutritional status and mortality in hemodialysis patients and are highly correlated. Interdialytic change in creatinine provided little additional information about nutritional status or mortality risk above and beyond predialysis creatinine levels alone.

-General hospitals have commonly involved a wide range of medical specialists in the care of unselected medical emergency admissions. In 1999, the Royal Liverpool University Hospital, a 915-bed hospital with a busy emergency service, changed its system of care for medical emergencies to allow early placement of admitted patients under the care of the most appropriate specialist team, with interim care provided by specialist acute physicians on an acute medicine unit -a system we have termed 'specialty triage'. Here we describe a retrospective study in which all 133,509 emergency medical admissions from February 1995 to January 2003 were analysed by time-series analysis with correction for the underlying downward trend from 1995 to 2003. This showed that the implementation of specialty triage in May 1999 was associated with a subsequent additional reduction in the mortality of the under-65 age group by 0.64% (95% CI 0.11 to 1.17%; P=0.021) from the 2.4% mortality rate prior to specialty triage, equivalent to approximately 51 fewer deaths per year. No significant effect was seen for those over 65 or all age groups together when corrected for the underlying trend. Length of stay and readmission rates showed a consistent downward trend that was not significantly affected by specialty triage. The data suggest that appropriate specialist management improves outcomes for medical emergencies, particularly amongst younger patients. KEY WORDS: acute medicine, mortality, outcome, specialism IntroductionThere is good evidence that patients with acute medical conditions may fare better in respect of a range of clinical outcomes if they are cared for by a medical team whose specialty interest is relevant to their complaint. This has been shown for myocardial infarction, 1 unstable angina, 2 asthma, 3-8 pneumothorax, 9 pleural effusion, 10-11 acute upper gastrointestinal haemorrhage, 12-14 diabetes 15 and stroke. 16 Indeed, it would be a strong indictment of the emphasis on specialty training over the past 20 years if there were no benefit in being looked after by a specialist. Nevertheless, it is common practice in the United Kingdom for patients who are ill enough to warrant emergency admission to be looked after by a specialty team that has been randomly selected according to the day of the week or week of the year, a system that might be termed 'calendar triage' , even though less ill patients, referred to the same hospital for an outpatient opinion, are likely to be seen by the relevant specialists. This widely accepted anomaly has arisen partly as a result of perceived necessity driven by staffing constraints and partly by the need to provide training in general internal medicine. An alternative model, 'specialty triage' , can be developed for the larger general hospital to allow patients admitted as medical emergencies to be placed under the care of the relevant specialty team with initial care directed by specialists in acute medicine. 17 We introduced this system at the Royal Liverpool University Hospital in ...

No abstract

-This prospective observational study assessed the impact of the changes in junior doctors' working hours and waiting-time initiatives on teaching and learning opportunities for junior doctors in acute medicine. An audit cycle of post-take ward rounds including all medical admissions to an urban teaching hospital was conducted. During two sevenday periods in July 2006 and 2008, 317 and 354 patients were admitted respectively. In the two-year interval a number of changes were implemented resulting in a significant increase in patients reviewed by a consultant within 24 hours of admission. Target waiting times were being met but there were many missed learning opportunities for junior staff. Senior doctors continue to perform the majority of post-take reviews in the absence of the doctors who had admitted the patient. Similar patterns are likely to be found in other hospitals attempting to balance training with government targets for waiting times and junior doctors' working hours.

Evidence is presented that reaction of C12-' with vinyl ethers proceeds via the formation of the radical-cations of the parent compounds. These species are not directly detectable by e.s.r., but the spectra of radicals formed in one or more of three further reactions have been characterized. These reactions are hydration, addition to the parent molecule, and deprotonation [e.g., CH,=CHOEt+' (from ethyl vinyl ether) yields the hydroxylated radicals*CH(OEt)-CH,OH and *CH,CH(OH)OEt and the ' dimer ' radical -CH(OEt)CH,CH,CH(OH)OEt].It has been confirmed that analogous radical-cations are also formed during the reactions of the hydroxyl radical with enol ethers at low pH and by elimination reactions of radicals of the type *CH(OR)CH,X (with X = CI, OH, or OMe). It is shown that furan is an effective spin trap for the radical-cations involved in these reactions.E.s.R. studies of the reactions of SO,-' with a variety of aromatic compounds have provided evidence that radical-cations are intermediates ; 2-5 in some cases (e.g. with methoxy-substituted benzoate anions) they are directly detectable.3 Radical-cations have also been proposed as key intermediates in the oxidation of aromatic compounds with, for example, the hydroxyl radical in acid solution,6 and, at least for electron-rich substrates such as p-methoxyphenol, with C1,-' .7 Although radicalcations have often been suggested as participating in the oxidation of aliphatic compounds [e.g. in the oxidation of some alkenes with SO,-' and in the acid-catalysed re-