Only half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance.
This case study describes frostbite, a previously unreported complication following cryolipolysis, which resulted in substantial necrosis of the flank. Medical attention was not sought until one week after treatment. On examination, two distinct areas of significant frostbite in the left flank with surrounding erythema were revealed. Surgical intervention was avoided, as is recommended in cases of frostbite, and conservative treatment resulted in recovery of the affected area. Here, the authors highlight the adverse effects related to cryolipolysis, analysing the pathogenesis, clinical manifestations and management of this injury. The necessity of regulation within the cosmetic sector and the challenges associated with its implementation are also described. The authors believe emphasis must be placed on increasing patient awareness on the potential hazards of seeking cosmetic treatment from unregulated providers.
Objective: A number of pre-operative factors predicting nodal burden in females with breast cancer have recently been identified. The aim of this study is to assess if these factors independently influence nodal burden in females with a positive axillary core biopsy. Methods: All node positive patients detected on axillary core biopsy were identified in our cancer audit database. Mode of presentation, age, core tumour grade, core tumour type, ER and HER2 status were evaluated. Tumours were assessed for ultrasound size, distance of tumour-to-skin, presence of invasion of skin and diffuse skin thickening. Axillary lymph nodes were assessed for cortical thickness and presence of ultrasound replaced nodes. Statistical significance was ascertained using univariate logistic regression. A predictive model was produced following a multiple logistic regression model incorporating cross-validation and assessed using receiving operating characteristic curve. Results: 115 patients’ data were analysed. Patients referred because of symptoms (70% vs 38%, p = 0.005), and those with ultrasound skin thickening (87% vs 59%, p = 0.055) have higher nodal burden than those referred from screening or without skin thickening. These factors were significant after multivariate analysis. The final predictive model included mode of presentation, ultrasound tumour size, cortical thickness and presence of ultrasound skin thickening. The area under curve is 0.77. Conclusion: We have shown that mode of presentation and ultrasound skin thickening are independent predictors of high nodal burden at surgery. A model has been developed to predict nodal burden pre-operatively, which may lead to avoidance of axillary node clearance in patients with lower nodal burden. Advances in knowledge: Method of presentation and skin involvement/proximity to skin by the primary tumour are known to influence outcome and nodal involvement respectively but have not been studied with regard to nodal burden. We have shown that mode of presentation and skin thickening at ultrasound are independent predictors of high nodal burden at surgery.
IntroductionEarly changes in the normal functioning of the endothelium are key initiating factors in the development and progression of atherosclerosis and they are present well before the presentation of clinical symptoms. To date, there is a wide range of methods in use to assess endothelial function, each with its own advantages and limitations.1 For diagnostic purposes and for indications of progression and outcomes of disease, a methodology measuring a biomarker in the blood would be convenient. Measurement of mRNA levels could provide a good option as: (1) measurement of this parameter requires small amounts of blood and (2) real-time RT-PCR to measure mRNA is relatively straightforward and technically less challenging than techniques used to measure protein levels.Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is a highly expressed multifunctional protein with diverse physiological functions and activities involved in glycolysis, transcriptional and posttranscriptional gene regulation, vesicular transport, receptor-mediated cell signaling, chromatin structure, and the maintenance of DNA integrity. GAPDH activity is regulated by many factors, one of them being nitric oxide (NO).2 NO synthesized and released from vascular endothelium is an important regulator of vascular tone.3 It has been reported that NO can either inhibit or activate GAPDH in different cell types. 4,5 As it is known that NO derived from the vascular endothelium targets blood cells, 6 it is possible that GAPDH activity could be regulated by endothelial NO. If so, then GAPDH activity in blood cells could be reflective of vascular endothelial NO production and thus indicative of endothelial function in physiological and pathophysiological conditions.Although there was no previous work to support our hypothesis, we decided to explore the potential link between vascular endothelial function and GAPDH mRNA level in the blood in healthy volunteers. We found that real-time RT-PCR Ct values of blood GAPDH correlate with vascular function in healthy subjects. This suggests that GAPDH mRNA level could be a potential biomarker of vascular endothelial function. Subjects and Methods SubjectsSeventy-five young healthy volunteers (41 males, 34 females) were recruited for the study. None of the subjects were smokers, used any medication, or had a history of any symptomatic vascular disease(s). Subject characteristics are shown in Table 1. The study was approved by the Tayside Committee on Medical Research Ethics and written informed consent was obtained from each subject before participation in the study. All subjects attended for one single visit lasting up to 3 hours during which a blood sample was taken and vascular function tests performed (see below). Vascular assessments were conducted in a blood flow laboratory at a temperature of 23°C after 10 minutes of acclimatization. Subjects were asked to refrain from food and drink for at least 2 hours beforehand and also to refrain from physical activity for 1 day before their visit. RNA preparation and ...
We examined the presence of KATP channel subunits, Kir6.1 and SUR2B, mRNAs in the blood and vascular function in healthy volunteers (41 males, 34 females). Real-time reverse transcriptase (RT)-PCR threshold cycles (Ct) was used as an indicator of mRNA levels. Baseline skin perfusion and the post-occlusion reactive hyperemia response exhibited a significant positive correlation with Ct for Kir6.1. There was no correlation between Kir6.1 Ct and brachial artery flow-mediated dilatation. Gender had no influence on relationships between blood Kir6.1 Ct and vascular function. We conclude that blood Kir6.1 mRNA levels could be potentially used as a biomarker of the vascular function.
Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17⋅7 per cent) had SBO due to hernia. Surgery was performed in 312 (75⋅2 per cent) of the 415 patients; small bowel resection was required in 198 (63⋅5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32⋅1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9⋅4 per cent (39 of 415), and was highest in patients with a groin hernia (11⋅1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16⋅3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1⋅05, 95 per cent c.i. 1⋅01 to 1⋅10; P = 0⋅009) and complications (odds ratio 1⋅05, 95 per cent c.i. 1⋅02 to 1⋅09; P = 0⋅001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. *Members of the National Audit of Small Bowel Obstruction (NASBO) Steering Group and NASBO Collaborators are co-authors of this study and are listed in Appendix S1 (supporting information) Funding information
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