Changing trends in the UK management of upper GI bleeding: is there evidence of reduced UK training experience?

OBJECTIVE

The aim of this study was to evaluate UK trainee experience in endoscopy for acute upper gastrointestinal bleeding (AUGIB).

METHODS

Data was prospectively collected from all patients presenting to South Yorkshire Hospitals with AUGIB from September 2011 to December 2011 and compared with data from 1996. Concurrently, all gastroenterology trainees registered with the British Society of Gastroenterology were invited to respond to a web-based questionnaire regarding their experience in AUGIB management.

RESULTS

77% (589/766) of the patient cohort underwent endoscopy for AUGIB; 15% (90/589) were performed by trainees. 7.2% (9/125) of the out of hours endoscopy case load was performed by trainees; all were low-risk or medium-risk cases (pre-endoscopy Rockall score ≤4). During the study period, dual therapy was delivered by a trainee on only four occasions. Comparison with the 1996 cohort demonstrated a marked reduction in the number of trainee performed endoscopies (76% vs 15%; p<0.001). Questionnaires were returned by 51% (245/478) of British Society of Gastroenterology trainees. 81% (198/245) thought that <10% of the gastroscopies they had performed involved therapeutic intervention. 23% (57/245) felt they would not be competent in AUGIB endoscopy by completion of specialty training.

CONCLUSIONS

This study demonstrates the decline over time in trainee experience in AUGIB endoscopy. It also highlights a lack of trainee exposure to more challenging cases, out of hours endoscopy and therapeutic procedures. Furthermore, trainees are concerned that a level of competency may not be attained during specialty training. We advocate reviewing UK endoscopic training provision for AUGIB to ensure that experienced endoscopists are produced to meet future service needs.

Effect of donor strength of extended alkyl auxiliary groups on optoelectronic and charge transport properties of novel naphtha[2,1-b:6,5-b']difuran derivatives: simple yet effective strategy

The present study spotlights the designing of new derivatives of 2,7-bis (4-octylphenyl) naphtho [2,1-b:6,5-b'] difuran (C8-DPNDF) by substituting the alkyl groups (methyl, ethyl, propyl, butyl, pentyl, hexyl, and heptyl groups) at para position. Density functional theory (DFT) and time-dependent density functional theory (TD-DFT) methods are employed to optimize the molecular structures in ground and first excited states, respectively. Several electro-optical properties including hole/electron reorganization energies (λh/λe), electron affinities (EAs), ionization potentials (IPs), molecular electrostatic potentials (MEP), and frontier molecular orbitals (FMOs) have been evaluated. Furthermore their transfer integrals and intrinsic mobilities values have also been calculated. From this study, it is found that hole mobility of octyl containing derivative is raised to 4.69 cm(2) V(-1) s(-1). Moreover with attaching octyl group, hole transfer integral values have also been enhanced in newly designed derivatives. The balanced hole and electron reorganization energies, and improved transfer integrals lead to enhanced mobility in derivatives with octyl group, highlighting them as an efficient hole transfer material. Unlike the other electro-optical properties, the intrinsic hole mobility has increased because of transfer integral values of octyl containing derivative C8-DPNDF due to the dense and close crystal packing of C8-DPNDF. However, photostability of furan-based materials has not changed by increasing length of extended alkyl chain. Thus our present investigation highlights the importance of alkyl auxiliary groups that are often neglected/replaced with simple methyl group to save computation costs. Graphical Abstract The hole and electron reorganization energies of naphtho[2,1-b:6,5-b']difuran derivatives.

Development of an effective and efficient DNA isolation method for Cinnamomum species

Different species of Cinnamomum are rich in polysaccharide's and secondary metabolites, which hinder the process of DNA extraction. High quality DNA is the pre-requisite for any molecular biology study. In this paper we report a modified method for high quality and quantity of DNA extraction from both lyophilized and non-lyophilized leaf samples. Protocol reported differs from the CTAB procedure by addition of higher concentration of salt and activated charcoal to remove the polysaccharides and polyphenols. Wide utility of the modified protocol was proved by DNA extraction from different woody species and 4 Cinnamomum species. Therefore, this protocol has also been validated in different species of plants containing high levels of polyphenols and polysaccharides. The extracted DNA showed perfect amplification when subjected to RAPD, restriction digestion and amplification with DNA barcoding primers. The DNA extraction protocol is reproducible and can be applied for any plant molecular biology study.

The contribution of primary prevention medication and dietary change in coronary mortality reduction in England between 2000 and 2007: a modelling study

OBJECTIVE

To analyse the falls in coronary heart disease (CHD) mortality in England between 2000 and 2007 and quantify the relative contributions from preventive medications and population-wide changes in blood pressure (BP) and cholesterol levels, particularly by exploring socioeconomic inequalities.

DESIGN

A modelling study.

SETTING

Sources of data included controlled trials and meta-analyses, national surveys and official statistics.

PARTICIPANTS

English population aged 25+ in 2000-2007.

MAIN OUTCOME MEASURES

Number of deaths prevented or postponed (DPPs) in 2007 by socioeconomic status. We used the IMPACTSEC model which applies the relative risk reduction quantified in previous randomised controlled trials and meta-analyses to partition the mortality reduction among specific treatments and risk factor changes.

RESULTS

Between 2000 and 2007, approximately 20 400 DPPs were attributable to reductions in BP and cholesterol in the English population. The substantial decline in BP was responsible for approximately 13 000 DPPs. Approximately 1800 DPPs came from medications and some 11 200 DPPs from population-wide changes. Reduction in population BP prevented almost twofold more deaths in the most deprived quintile compared with the most affluent. Reduction in cholesterol resulted in approximately 7400 DPPs; approximately 5300 DPPs were attributable to statin use and approximately 2100 DPPs to population-wide changes. Statins prevented almost 50% more deaths in the most affluent quintile compared with the most deprived. Conversely, population-wide changes in cholesterol prevented threefold more deaths in the most deprived quintile compared with the most affluent.

CONCLUSIONS

Population-wide secular changes in systolic blood pressure (SBP) and cholesterol levels helped to substantially reduce CHD mortality and the associated socioeconomic disparities. Mortality reductions were, in absolute terms, greatest in the most deprived quintiles, mainly reflecting their bigger initial burden of disease. Statins for high-risk individuals also made an important contribution but maintained socioeconomic inequalities. Our results strengthen the case for greater emphasis on preventive approaches, particularly population-based policies to reduce SBP and cholesterol.

Survival of Shiga toxin-producing Escherichia coli in broth as influenced by pH, water activity and temperature

This study examined the effects of and interactions between pH, aw and temperature on the survival of the top six non-O157 STECs and Escherichia coli O157:H7. All variables significantly affected the survival of all STEC serotypes. However, aw bore the most significant effect, followed by temperature and then pH. Examination of the effect of the interaction between these variables revealed that the interaction between aw and temperature was the most significant followed by the interaction between pH and temperature and then aw and pH. Decrease in aw resulted in population reduction of all serotypes studied. This reduction in population was significantly increased with the increase in temperature and was further significantly enhanced with decreasing pH. Examination of the differences in the survival among the individual serotypes revealed that the response of each serotype to aw or temperature changes was significantly different, while their response to pH changes was similar. Analysis of the relative survival of individual non-O157 STECs to O157:H7 revealed that the survival of O121 and O45 was not significantly different to O157:H7 while O103, O111, O145 and O26 showed less tolerance to the combined treatments, and their survival was significantly different from O157:H7.

SIGNIFICANCE AND IMPACT OF THE STUDY

Results of this study estimate the interaction between pH, aw and temperature on the survival of the top six non-O157 STECs relative to Escherichia coli O157:H7 and provide important growth and no-growth condition which will offer risk assessors a means of estimating the likelihood of these pathogens, if present, would grow in response to the interaction between the three variables assessed.

An ovary as unusual contents of an incarcerated umbilical hernia

We present the unusual case of a woman presenting with an incarcerated umbilical hernia. Intraoperatively, the contents of the hernia were found to be an ovary. We outline the clinical presentation of our patient, investigations and management as well as a discussion on unusual contents of umbilical hernias. To our knowledge, this is the first case of a non-malignant ovary incarcerated in an umbilical hernia.

Synthesis of novel ZnV₂O₄ hierarchical nanospheres and their applications as electrochemical supercapacitor and hydrogen storage material

Hierarchical nanostructures (Hs) have recently garnered enormous attention due to their remarkable performances in catalysis, electronic devices, energy storage and conversion. Considering the advantage of hierarchical nanostructures, we have formulated a facile and template free method to synthesize novel hierarchical nanospheres (NHNs) of ZnV2O4. Both zinc and vanadium are earth abundant, relatively economical and can offer several oxidation states, which can render a broad range of redox reactions favorable for electrochemical energy storage applications. Keeping these points in mind, we investigated for the first time the electrochemical supercapacitor performance of NHNs. The electrochemical measurements were performed in 2 M KOH solution. The measured specific capacitance of ZnV2O4 electrode is 360 F/g at 1 A/g with good stability and retention capacity of 89% after 1000 cycles. Moreover, the hydrogen storage properties of NHNs were measured at 473, 573, and 623 K with an absorption of 1.76, 2.03, and 2.49 wt %. respectively. These studies pave the way to consider ZnV2O4 as prospective material for energy storage applications.

Are Canadian youth still exposed to second-hand smoke in homes and in cars?

INTRODUCTION

The objective of this manuscript is to examine the prevalence of youth exposed to second-hand smoke (SHS) in homes and cars, changes in SHS exposure over time, and factors associated with beliefs youth hold regarding SHS exposure among a nationally representative sample of Canadian youth.

METHODS

Descriptive analysis of SHS exposure in homes and cars was conducted using data from the Canadian Youth Smoking Survey (2004, 2006 and 2008). Logistic regression was conducted to examine factors associated with beliefs youth had about SHS exposure in 2008.

RESULTS

In 2008, 21.5% of youth reported being exposed to SHS in their home on a daily or almost daily basis, while 27.3% reported being exposed to SHS while riding in a car at least once in the previous week. Between 2004 and 2008, the prevalence of daily SHS exposure in the home and cars decreased by 4.7% and 18.0% respectively.

CONCLUSION

Despite reductions in SHS exposure over time, a substantial number of Canadian youth continue to be exposed to SHS in homes and cars. Further effort is required to implement and evaluate policies designed to protect youth from SHS.

Alleviation of chronic venous leg ulcers with a hand-held dielectric barrier discharge plasma generator (PlasmaDerm(®) VU-2010): results of a monocentric, two-armed, open, prospective, randomized and controlled trial (NCT01415622)

BACKGROUND

Cold atmospheric plasma (CAP, i.e. ionized air) is an innovating promising tool in reducing bacteria.

OBJECTIVE

We conducted the first clinical trial with the novel PlasmaDerm® VU-2010 device to assess safety and, as secondary endpoints, efficacy and applicability of 45 s/cm(2) cold atmospheric plasma as add-on therapy against chronic venous leg ulcers.

METHODS

From April 2011 to April 2012, 14 patients were randomized to receive standardized modern wound care (n = 7) or plasma in addition to standard care (n = 7) 3× per week for 8 weeks. The ulcer size was determined weekly (Visitrak® , photodocumentation). Bacterial load (bacterial swabs, contact agar plates) and pain during and between treatments (visual analogue scales) were assessed. Patients and doctors rated the applicability of plasma (questionnaires).

RESULTS

The plasma treatment was safe with 2 SAEs and 77 AEs approximately equally distributed among both groups (P = 0.77 and P = 1.0, Fisher's exact test). Two AEs probably related to plasma. Plasma treatment resulted in a significant reduction in lesional bacterial load (P = 0.04, Wilcoxon signed-rank test). A more than 50% ulcer size reduction was noted in 5/7 and 4/7 patients in the standard and plasma groups, respectively, and a greater size reduction occurred in the plasma group (plasma -5.3 cm(2) , standard: -3.4 cm(2) ) (non-significant, P = 0.42, log-rank test). The only ulcer that closed after 7 weeks received plasma. Patients in the plasma group quoted less pain compared to the control group. The plasma applicability was not rated inferior to standard wound care (P = 0.94, Wilcoxon-Mann-Whitney test). Physicians would recommend (P = 0.06, Wilcoxon-Mann-Whitney test) or repeat (P = 0.08, Wilcoxon-Mann-Whitney test) plasma treatment by trend.

CONCLUSION

Cold atmospheric plasma displays favourable antibacterial effects. We demonstrated that plasma treatment with the PlasmaDerm® VU-2010 device is safe and effective in patients with chronic venous leg ulcers. Thus, larger controlled trials and the development of devices with larger application surfaces are warranted.