Ultrasound accuracy for brachial plexus pathology.

AIM: To determine (a) the accuracy of ultrasound in detecting brachial plexus pathology and (b) outline the advantages and limitations of ultrasound compared to MRI for imaging the brachial plexus. MATERIAL AND METHODS: cases with clinically suspected brachial plexus pathology were evaluated first by ultrasound, followed by MRI. Patients with prior brachial plexus imaging were excluded. The final diagnosis was based on a combination of ultrasound, MRI, clinical follow-up, and surgical findings. The accuracy of the ultrasound was assessed by comparing the ultrasound and the final diagnoses. The mean clinical follow-up time following ultrasound was 1.8 ± 1.4 years. RESULTS: Ninety-two (64%) of the 143 cases had normal brachial plexus ultrasound and MRI examinations. Fifty-one (36%) of 143 cases had brachial plexus pathology on MRI, comprising post-radiation fibrosis (n=25, 49%), nerve sheath tumor (n=11, 21%), traumatic injury (n=7, 14%), inflammatory polyneuropathy (n=4, 8%), malignant infiltration (n=2, 4%), desmoid fibromatosis (n=1,2%), and neuralgic amyotrophy (n=1, 2%). Overall diagnostic accuracy of ultrasound for brachial plexus pathology was 98% (140/143), with three discordant cases (neuralgic amyotrophy n=1, inflammatory neuropathy n=1, postradiation fibrosis n=1) regarded as normal on ultrasound assessment. Sensitivity, specificity, and positive and negative predictive value of ultrasound for identifying brachial plexus pathology were 94%, 100%, 100%, and 97%, respectively. CONCLUSION: Ultrasound identifies brachial plexus pathology with high accuracy and specificity, showing comparable diagnostic efficacy to MRI. Ultrasound can serve as an effective first-line imaging investigation for suspected brachial plexus pathology.

Prognostic implication of the neoadjuvant rectal score and other biomarkers of clinical outcome in Hong Kong Chinese patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy.

BACKGROUND: Neoadjuvant chemoradiotherapy is a standard treatment for locally advanced rectal cancer, for which pathological complete response is typically used as a surrogate survival endpoint. Neoadjuvant rectal score is a new biomarker that has been shown to correlate with survival. The main objectives of this study were to investigate factors contributing to pathological complete response, to validate the prognostic significance of neoadjuvant rectal score, and to investigate factors associated with a lower neoadjuvant rectal score in a cohort of Hong Kong Chinese. METHODS: Data of patients with locally advanced rectal cancer who received neoadjuvant chemoradiotherapy from August 2006 to October 2018 were retrieved from hospital records and retrospectively analysed. RESULTS: Of 193 patients who had optimal response to neoadjuvant chemoradiotherapy and surgery, tumour down-staging was the only independent prognostic factor that predicted pathological complete response (P<0.0001). Neoadjuvant rectal score was associated with overall survival (hazard ratio [HR]=1.042, 95% confidence interval [CI]=1.021-1.064; P<0.0001), disease-free survival (HR=1.042, 95% CI=1.022-1.062; P<0.0001), locoregional recurrence-free survival (HR=1.070, 95% CI=1.039-1.102; P<0.0001) and distant recurrence-free survival (HR=1.034, 95% CI=1.012-1.056; P=0.002). Patients who had pathological complete response were associated with a lower neoadjuvant rectal score (P<0.0001), but pathological complete response was not associated with survival. For patients with intermediate neoadjuvant rectal scores, late recurrences beyond 72 months from diagnosis were observed. CONCLUSION: Neoadjuvant rectal score is an independent prognostic marker of survival and disease recurrence in a cohort of Hong Kong Chinese patients who received neoadjuvant chemoradiotherapy for locally advanced rectal cancer.

Ultrasound-guided lymph node sampling: accuracy of FNAC, end-cutting (Franseen), and side-cutting (Temno) needle biopsy techniques.

AIM: To compare technical success, diagnostic accuracy, and histological yield of fine-needle aspiration cytology (FNAC), side-cutting (Temno) needle biopsy, and end-cutting (Franseen) needle biopsy for ultrasound-guided sampling of groin and axillary lymph nodes. MATERIALS AND METHODS: A total of 270 abnormal groin and axillary nodes were sampled using one of the three techniques. Nodes with a maximum length of <2.5 cm underwent FNAC or Franseen biopsy, while nodes >2.5 cm underwent Temno biopsy. Mean size of nodes sampled by FNAC (21.2 mm) and Franseen (19.7 mm) were similar while nodes sampled by Temno were larger (34.4 mm, p<0.0001). RESULTS: Technical success rates of FNAC (82/93, 88%), Franseen (105/111, 95%), and Temno (59/66, 89%) biopsies were similar (p>0.05 for all). Lymphoid tissue yield by FNAC (mean total area 1.51 mm2) was less than that by Franseen (7.14 mm2, p=0.002) or Temno biopsy (19.44 mm2, p<0.0001). Diagnostic accuracy for malignancy was lower for FNAC (22/30, 73%) than Franseen (25/26, 96%, p=0.02) or Temno biopsy (32/32, 100%, p=0.002). For malignant nodes, determining the likely organ of origin was also lower for FNAC (7/30, 23%) than Franseen (19/26, 73%, p=0.0002) or Temno biopsy (29/32, 91%, p<0.0001), with a similar pattern observed in the identification of lymphoma. CONCLUSION: For similarly sized nodes, Franseen biopsy provided more lymphoid material, a higher diagnostic accuracy for malignancy including lymphoma, and better identification of the likely organ of origin than FNAC. Routine use of Franseen biopsy is advocated rather than FNAC for percutaneous sampling of lymph nodes not suitable for side-cutting needle biopsy.

Five years of national policies: progress towards tackling obesity in England.

Obesity is a major burden on the health system in England and the rest of the UK. Obesity prevalence is high in adults and children and most of the UK population are consuming more energy than required, and not meeting other dietary recommendations, including those for saturated fat, free sugars, fibre, oily fish and fruit and vegetables. Over the past 5 years, a number of cross-government policies, both promoting voluntary action and legislative, have been put in place to tackle diet-related health and obesity. The food environment is complex with many influencing factors, some of which act through individual automatic choices. Other factors such as accessibility, advertising, promotion and nudging drive increased food and drink purchases. With continual changes in the food environment favouring fast-food outlets and meal delivery companies alongside the adverse impact of the COVID-19 pandemic on diets and physical activity levels, further governmental action is likely needed to deliver sustained improvements to diet and health.

Developing a scalable training model in global mental health: pilot study of a video-assisted training Program for Generalist Clinicians in Rural Nepal.

BACKGROUND: In low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists. METHODS: We implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of 'Yes' or 'No' questions to assess attitudes about mental illness, and utilized exact McNemar's test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback. RESULTS: For each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the training's positive impact and complementary nature of the program's components. CONCLUSION: Video lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants.

Acupuncture for the treatment of hiccups following stroke: a systematic review and meta-analysis.

OBJECTIVES: To assess the effectiveness and safety of acupuncture for hiccups following stroke. METHODS: Medline, Embase, CENTRAL, CINAHL, and four Chinese medical databases were searched from their inception to 1 June 2015. The dataset included randomised controlled trials (RCTs) with no language restrictions that compared acupuncture as an adjunct to medical treatment (effectiveness) or acupuncture versus medical treatment (comparative effectiveness) in stroke patients with hiccups. The Cochrane risk of bias tool was used to assess the methodological quality of the trials. RESULTS: Out of 436 potentially relevant studies, five met the inclusion criteria. When acupuncture was compared with other interventions (as sole or adjunctive treatment), meta-analysis revealed a significant difference in favour of cessation of hiccups within a specified time period (CHWST) following intervention when used as an adjunct (risk ratio (RR) 1.59, 95% CI 1.16 to 2.19, I2=0%), but not when used alone (RR 1.40, 95% CI 0.79 to 2.47, I2=65%, ie, high heterogeneity). No safety information was reported in these studies. CONCLUSIONS: Our systematic review and meta-analysis suggests that acupuncture may be an effective treatment for patients suffering from hiccups following stroke when used as an adjunct to medical treatment. However, due to the limited number of RCTs and poor methodology quality, we cannot reach a definitive conclusion, hence further large, rigorously designed trials are needed.

Proyecto de mejora en prevención de infecciones del tracto urinario asociadas a sondaje vesical / Improvement in urinary tract infections rates in a department of internal medicine

Objetivo. Valorar el impacto de una intervención desarrollada en el servicio de Medicina Interna del Hospital Universitario Insular de Gran Canaria para prevenir las infecciones del tracto urinario asociadas a sondaje vesical (ITU-SV). Material y métodos. El proyecto se desarrolló en 3 fases de vigilancia prospectivas de 2 meses de duración cada una entre 2009 y 2011. Durante las fases 1 y 2 se siguieron los criterios diagnósticos de los Centers for Disease Control and Prevention (CDC) de 2004 para la clasificación de las infecciones y se obtuvieron los indicadores de resultado. En la fase 3 se emplearon los criterios de los CDC de 2009 y se obtuvieron tanto indicadores de resultado como de proceso. Se comparó la incidencia acumulada de ITU-SV de las 3 fases mediante el test de tendencia ji-cuadrado. Resultados. El número total de días de sondaje vesical (SV) disminuyó desde la primera a la tercera fase, así como la incidencia acumulada de ITU-SV. Sin embargo, en la segunda fase la media de días de SV aumentó, volviendo a disminuir en la tercera fase. Se realizó una intervención con envío de recordatorios a través de la historia clínica electrónica durante la tercera fase, en la que se logró disminuir las tasas de ITU-SV y reducir la duración media de SV. Conclusiones. Las tasas de ITU-SV podrían ser minimizadas mediante un enfoque multidisciplinar que incluya tanto formación a los sanitarios implicados como vigilancia, retroalimentación y uso específico de recordatorios electrónicos(AU)

Objective. To evaluate the impact on the urinary tract infections (UTI) rates of an intervention implemented in the Department of Internal Medicine of the Hospital Universitario Insular de Gran Canaria. Material and methods. Infection control practitioners implemented a three phase project, each lasting two months, focusing on surveillance and feed-back, between 2009 and 2011. During phases 1 and 2, the 2004 Centers for Disease Control and Prevention (CDC)–diagnostic criteria for nosocomial infections were followed, and only rates of infections were calculated. For phase 3, the criteria published in 2009 were used, and rates of infections plus processes rates were obtained. The cumulative incidence of UTI in the three periods was compared using a chi-square for trends test. Results. The total number of catheter days, as well as the cumulative incidence of UTI dropped from phase 1 to 3. Nevertheless, in phase 2 the mean urinary catheter days increased. We detected a decrease in the UTI rates and urinary catheter days mean after introducing an electronic reminder in the patient electronic charts. Conclusions. A multidisciplinary approach, including surveillance, reminders, and feed-back, has proved useful in controlling UTI rates in our hospital(AU)

[Improvement in urinary tract infections rates in a department of internal medicine]. / Proyecto de mejora en prevención de infecciones del tracto urinario asociadas a sondaje vesical.

OBJECTIVE: To evaluate the impact on the urinary tract infections (UTI) rates of an intervention implemented in the Department of Internal Medicine of the Hospital Universitario Insular de Gran Canaria. MATERIAL AND METHODS: Infection control practitioners implemented a three phase project, each lasting two months, focusing on surveillance and feed-back, between 2009 and 2011. During phases 1 and 2, the 2004 Centers for Disease Control and Prevention (CDC)-diagnostic criteria for nosocomial infections were followed, and only rates of infections were calculated. For phase 3, the criteria published in 2009 were used, and rates of infections plus processes rates were obtained. The cumulative incidence of UTI in the three periods was compared using a chi-square for trends test. RESULTS: The total number of catheter days, as well as the cumulative incidence of UTI dropped from phase 1 to 3. Nevertheless, in phase 2 the mean urinary catheter days increased. We detected a decrease in the UTI rates and urinary catheter days mean after introducing an electronic reminder in the patient electronic charts. CONCLUSIONS: A multidisciplinary approach, including surveillance, reminders, and feed-back, has proved useful in controlling UTI rates in our hospital.

Periorificial and acral dermatitis in a newborn having milk intolerance.

A 2-week-old infant born at 36-week gestation developed diarrhea and metabolic acidosis when he was put on formula feeding. He was treated for sepsis and was screened for metabolic diseases. Blood and cerebrospinal fluid cultures were clear. The diarrhea and metabolic acidosis settled but recurred when formula feeding was resumed. He developed a florid erythematous rash involving the palms, feet, perioral and perineal regions. Zinc deficiency was confirmed and zinc replacement resulted in prompt resolution of the skin rash. The patient was put on Pepti-Junior and remained well. This case illustrates that zinc deficiency must be sought and treated in an infant with a typical rash involving the palms, feet and body orifices.

Detection of circulating fetal nucleic acids: a review of methods and applications.

The discovery of cell-free circulating fetal nucleic acids in maternal plasma has opened up new possibilities in non-invasive prenatal diagnosis. The rapid advancement of this field in the past decade is catalysed by the discovery of new classes of fetal nucleic acid markers and technological developments in nucleic acid detection and amplification. In this review, some of the more significant recent developments in this field will be discussed, including the detection of single molecule, chromosomal aneuploidies, single nucleotide variations and placental microRNAs in maternal plasma.

Induced sputum inflammatory measures correlate with disease severity in children with obstructive sleep apnoea.

OBJECTIVE: To establish the association between airway inflammation and severity of obstructive sleep apnoea (OSA) in children. METHODS: Consecutive children presenting with symptoms suggestive of OSA were recruited. They completed a sleep apnoea symptom questionnaire, underwent physical examination, spirometry, sputum induction and an overnight polysomnography. Adequate sputum contained <50% squamous epithelial cells, and OSA was diagnosed if the obstructive apnoea index was >1. RESULTS: 73 children with a median (interquartile range (IQR)) age of 11.3 (10.0-13.2) years were recruited. There were 21 girls and the median body mass index of the group was 24.0 (18.0-27.0) kg/m2. The most common presenting symptoms were habitual snoring, mouth breathing and prone sleeping position. Sputum induction was successful in 43 (59%) children, of whom 14 were found to have OSA. Children with OSA had significantly greater percentage sputum neutrophil than those without OSA (18.5 (IQR 8.0-42.0) v 4 (IQR 3.0-11.3), p = 0.006). On multiple regression analysis, percentage sputum neutrophil was significantly associated with OSA (odds ratio = 1.1, p = 0.013). CONCLUSION: Children with OSA had airway inflammation characterised by a marked increase in neutrophils. Further studies are needed to confirm these findings and to better define the downstream cellular interactions and molecular pathogenesis in childhood OSA.

Proteus bacteriuria is associated with significant morbidity in spinal cord injury.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: We investigated the morbidity associated with Proteus bacteriuria in a spinal cord injured (SCI) population. SETTING: Michael E DeBakey Veterans Affairs Medical Center in Houston, Texas, USA. METHODS: We reviewed the medical records of all veterans with SCI who received care in our medical center during the past 3 years. Proteus bacteriuria was defined as the growth of Proteus species in any urine culture during the study period. Urinary stones were defined as either renal or bladder calculi. RESULTS: During the study period, 71 of the 501 subjects (14%) had Proteus and 90 (18%) had urinary stones. Twenty-seven percent of the subjects with Proteus had stones, and the association of Proteus with stones was significant (P<0.05). Proteus bacteriuria was likewise associated with complete injury, hospitalization, decubitus ulcers, and history of stones (P<0.001). Subjects using indwelling catheters, either transurethral or suprapubic, were significantly more likely to have Proteus, whereas subjects practising spontaneous voiding and clean intermittent catheterization were significantly less likely to have Proteus. In the 90 patients with stones, Proteus was associated with requiring treatment for stones and having multiple stones (P<0.01). Twenty-five of the 90 patients with stones (28%) required treatment, most often with lithotripsy, and 6 (7%) developed urosepsis. CONCLUSIONS: In persons with SCI, Proteus was found in subjects with a greater degree of impairment who were more likely to be hospitalized, to have decubiti, and to use indwelling catheters. Bacteriuria with Proteus predicted urologic complications in persons with SCI. STATEMENT OF ETHICS: All applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Predictors of recurrent stroke in African Americans.

BACKGROUND: Stroke incidence and mortality are disproportionately higher among African Americans than among whites. OBJECTIVE: To describe the recurrent stroke characteristics and determine the predictability of known vascular risk factors for stroke recurrence in African Americans. METHODS: The authors followed 1,809 African Americans in the African-American Antiplatelet Stroke Prevention Study with recent noncardioembolic ischemic stroke for recurrent stroke, recurrent stroke subtype, and disability. RESULTS: Of the subjects, 10.6% experienced a recurrent stroke during follow-up. The mean interval between eligibility and recurrent stroke was 325 days (median 287 days, SD = 224 days). Stroke recurrence resulted in an average 1.5-point increase in the National Institute of Health Stroke Scale (p < 0.001) and a 3.5-point decrease in modified Barthel Index (p < 0.001). Of previously nondisabled subjects, 48% became disabled or died after stroke recurrence (p < 0.0001). Longitudinal analysis resulted in a hazard for recurrent stroke for each 10-mm Hg increase in systolic blood pressure of 1.103 (95% CI: 1.031 to 1.179, p = 0.004), pulse pressure 1.123 (95% CI: 1.041 to 1.213, p = 0.003), and mean arterial pressure 1.123 (95% CI: 1.001 to 1.260, p = 0.048). Multivariate analysis revealed increases in the recurrent stroke hazard for increases in baseline Glasgow Outcome Score (1.449, 95% CI: 1.071 to 1.961, p = 0.016) and increases in longitudinal pulse pressure (1.009, 95% CI: 1.001 to 1.017, p = 0.029). CONCLUSION: Recurrent stroke leads to disability and disability predicts recurrent stroke. Hypertension is the most predictive modifiable stroke risk factor.

Bone mineral density in children with thalassaemia major: determining factors and effects of bone marrow transplantation.

Osteoporosis and osteopenia affect up to half of patients with thalassaemia major (TM). We investigate the effects of acquired factors and BMT on bone mineral density (BMD) in these patients. In all, 53 patients on regular transfusion (BT group) and 33 patients at 5.7+/-1.9 years post transplant (BMT group) were recruited. BMD was measured by dual energy X-ray absorptiometry. Serum concentrations of osteocalcin, bone-specific alkaline phosphatase (ALP), beta-crossLap and urinary cross-linking deoxypyridinoline (DPD) were measured by chemiluminescence and enzyme immunoassay, respectively. Severe BMD deficit (Z-score <-2.5) at spine and hip were noted in 62 and 35% of BT group. Serum osteocalcin (beta=-0.463; P=0.006) was predictive of spine BMD, whereas age (beta=-0.843; P=0.007) and urine DPD (beta=-0.439; P=0.037) were associated with hip BMD in BT group. Among BMT patients, post transplant duration (beta=0.450; P=0.009) and serum bone-specific ALP (beta=-0.495; P=0.013) were associated with spine BMD. Severe BMD deficit was less common among BMT than BT patients (6 vs 35%; P=0.036). The mean (s.d.) osteocalcin levels in BMT and BT groups were 96.4 (72.7) microg and 68.9 (40.3) microg/l, respectively (P=0.037). In conclusion, severe BMD deficit is common in Chinese TM patients and BMT may reverse BMD deficit in these patients.

Genomic characterisation of the severe acute respiratory syndrome coronavirus of Amoy Gardens outbreak in Hong Kong.

Severe acute respiratory syndrome (SARS) is a global health concern. In Hong Kong, two major outbreaks, one hospital based and the other in the Amoy Gardens apartments, were identified. The frequency of diarrhoea, admission to intensive care, and mortality differed significantly between the two outbreaks. We did genomic sequencing for viral isolates from five Amoy Gardens patients. The virus sequence was identical in four of these five patients. The sequence data from one hospital case and the four identical community cases had only three nucleotide differences. Alterations in the SARS coronavirus genome are unlikely to have caused the distinctive clinical features of the Amoy Gardens patients, and these results highlight the importance of non-viral genomic factors in this outbreak.

Sociodemographic and atopic factors affecting breastfeeding intention in Chinese mothers.

OBJECTIVE: The factors accounting for the low 'ever breastfeeding' rate in Hong Kong remain unclear. The objective of this survey was to study the intention and planned duration of breastfeeding in Chinese women in Hong Kong, and to investigate the sociodemographic and atopic factors affecting the intention to breastfeed. METHODS: All Chinese mothers who were Hong Kong residents and who delivered their babies in a University teaching hospital were given a self administered and anonymous Chinese questionnaire within 1 day postpartum. The questionnaire included items on sociodemographic data, the presence of allergic diseases in the families, and the intention and planned duration of breastfeeding for their newborn babies. RESULTS: A total of 1374 eligible questionnaires were collected. About one-third of mothers were born outside Hong Kong and the majority (78%) of them were aged between 25 and 40 years. Logistic regression revealed that only socioeconomic factors, namely older maternal age (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.14-3.89), parity (OR 3.08, 95% CI 1.02-9.27) and higher educational background (OR 2.87, 95% CI 1.92-4.27), significantly affected the intention to breastfeed. In addition, mothers born outside Hong Kong and those with first babies, had a longer intended duration of breastfeeding (P-values < 0.001 and 0.033, respectively). A family history of atopic disorders in parents or siblings did not influence the breastfeeding intention of these Chinese mothers. CONCLUSION: Several sociodemographic factors, rather than a history of atopic disorders, of Chinese mothers in Hong Kong affected their intention to breastfeed and the planned duration of breastfeeding.

Impact of an ACE inhibitor and calcium antagonist on microalbuminuria and lipid subfractions in type 2 diabetes: a randomised, multi-centre pilot study.

BACKGROUND: Microalbuminuria (MA) is associated with increased cardiovascular risk and lipid abnormalities in people with type 2 diabetes. ACE inhibitors and calcium channel blockers (CCBs) reduce MA and are neutral on total cholesterol and triglycerides. The effect of ACE inhibitors and CCBs on lipid subfractions such as Lp(a), apolipoprotein (apo) A1, apo B, and others, however, is unclear. The current study tests the hypothesis that a fixed-dose combination of an ACE inhibitor, benazepril (B) with the dihydropyridine CCB, amlodipine (A), will further reduce arterial pressure and reduce atherogenic lipid fractions compared to either agent alone. DESIGN: A multicentre, randomised, open-label, parallel group design was used to study 27 participants with type 2 diabetes. Measurements for total cholesterol, high- and low-density lipoprotein (HDL and LDL), triglycerides, apo A1, apo B, Lp(a), MA, arterial pressure and creatinine clearance were obtained at baseline and at 12-week intervals during the 36 week study. RESULTS: Arterial pressure was significantly reduced at 36 weeks in all three groups (P = 0.0078 for A, P = 0.0039 for B, and P = 0.0313 for A+B). MA was lowered in all groups with relatively greater reductions in the B (P < 0.05) and A+B groups (P < 0.03) vs A. An increase in mean HDL-cholesterol from baseline was noted in the B and A+B groups; P < 0.05), but not in the A group. A trend was also observed between the rise in HDL-cholesterol and the reduction in MA in the B and A+B groups. Additionally, only the B group exhibited a decrease in the median value of Lp(a) (P < 0.05). CONCLUSION: These data support the concept that ACE inhibition with B reduces the atherogenic profile by decreasing Lp(a) and increasing HDL-cholesterol, the latter being correlated with reductions in MA. While A+B exhibited similar trends in lipid subfractions and MA as B, this group had the greatest reduction in systolic blood pressure of the three groups. Thus, use of A+B offers the benefits of a decreased atherogenic profile with a higher probably of achieving goal blood pressure as recommended by national guidelines.

Antithrombin deficiency in end-stage renal disease associated with paraplegia: effect of hemodialysis.

Plasma antithrombin III activity and concentration were determined in nine men with end-stage renal disease (ESRD) associated with spinal cord injury (SCI). To determine the possible effects of hemodialysis measurements were repeated following dialysis. Values obtained in the SCI-ESRD group were compared with those obtained in a group of healthy volunteers and a group of 10 ambulatory men with ESRD. A normal pooled plasma was used as the internal standard for all assays. While antithrombin deficiency was observed in both uremic groups it was most severe in the group with SCI. Results demonstrated the association of antithrombin deficiency with ESRD and its potentiation in the presence of SCI. The mechanisms by which SCI compounds the uremia-induced antithrombin deficiency were not known. A mild increase in antithrombin level was noted following dialysis and was thought to be in part due to fluid removal by dialysis.