Identifying the position of the right atrium to align pressure transducer for CVP : Spirit level or 3D electromagnetic positioning?

The central venous pressure, CVP, is an important variable in the management of selected perioperative and intensive care cases and in clinical decision support systems, CDSS. In current routine, when measuring CVP the health care provider may use anatomical landmarks and a spirit level, SL, to adjust the pressure transducer to the level of the tricuspid valve, i.e. the phlebostatic axis. The aim of the study was to assess the agreement in the postoperative setting between the SL method and electromagnetic 3D positioning (EM). CVP was measured with patients in positions dictated by nursing routines. The staff members measured CVP using SL to position the transducer at the perceived phlebostatic level. This position was compared to coordinates based on an electromagnetic field with external sensors at anatomical landmarks and an internal sensor in the CV catheter for 3D determination of the phlebostatic axis. An electronic survey took bearing on the accepted error in measurement among colleagues at the department. There was a clinically relevant difference between the CVP measured by the staff members and the CVP based on the 3D EM positioning. The limits of agreement extended in excess of ±8 mmHg and half of the measurements had deviations outside an accepted error range of ±2.5 mmHg. There was a large variation in CVP measurements when assessing the agreement with the current method. This may indicate the need for improvement in accuracy, e.g. using the electromagnetic field positioning system, in association with routine monitoring and clinical decision support systems.

Developing regional surveillance of sexually transmitted infection: a survey of the views of healthcare professionals in north west England.

Current surveillance of sexually transmitted infections in England and Wales relies on aggregated data collected by genitourinary medicine clinics. This system only allows limited analysis especially at a local level. A change to a disaggregate form of data collection could provide additional outputs at a local level. We undertook a survey of the views of those working in the prevention and control of sexually transmitted infections in the North West to determine what additional surveillance outputs would facilitate their work. Of respondents, 89% believed surveillance should deliver between four and nine types of analyses that can only be delivered by a surveillance system that is based on disaggregate data. Respondents indicated that it was acceptable for clinics to provide the data items required but that currently it was not feasible to do so because of workload constraints.

An outbreak no longer: factors contributing to the return of syphilis in Greater Manchester.

BACKGROUND: In the past few years, increased diagnoses of syphilis have been reported in cities around Britain and Europe. Enhanced surveillance of cases began in 1999 to identify the epidemiology of this increase in Greater Manchester. METHODS: Information was collected on all cases of syphilis newly diagnosed in genitourinary medicine (GUM) clinics in Greater Manchester between January 1999 and November 2002. The data collected included demographic information and information about other sexually transmitted infections, sexual behaviour, perception of risk of infection, and awareness of syphilis transmission. RESULTS: The majority of cases identified were white homosexual men resident in Greater Manchester. Of the 414 cases diagnosed, 74% had either a primary or secondary stage of syphilis infection and 37% of cases were HIV positive. High numbers of individuals practised unprotected oral sex despite good awareness of the risk of infection with syphilis. There is evidence that the way people are meeting sexual contacts is changing, with increasing numbers meeting most of their partners through the internet. CONCLUSIONS: These findings have implications for targeting interventions. The provision of rapid diagnostic and treatment services is likely to be key for the control of syphilis and potentially of subsequent increases in HIV in the region.

A CHARMM analysis of the conformations of the metastasis-inhibiting laminin pentapeptide.

The metastatic invasion of basement membrane by tumor cells involves the binding of tumor cells to laminin. Laminin, a glycoprotein, is a major component of basement membrane. Both tumor and normal cells express a high-affinity receptor for laminin; however, the expression is more pronounced with tumor cells. The pentapeptide, Tyr-Ile-Gly-Ser-Arg, (YIGSR), an amino acid sequence from the B1 chain of laminin, was found to compete with laminin for binding to the laminin receptor. The binding of tumor cells to laminin can be inhibited competitively by YIGSR and, in mice, this has been shown to be translated into a reduction in metastasis. Reports of structural modifications of YIGSR leading to molecules with enhanced activity led us to attempt to learn more about the secondary structure of YIGSR. Through the use of CHARMM, a molecular mechanics program, we were able to discover a conformation of N-acetyl-YIGSR-NHCH3 that is stable over a wide range of dielectric constants. In this conformation the arginine side chain acts to hold Tyr, Ile, and Gly in a partial right-handed alpha helix. We speculate that this partial alpha helical structure is necessary for binding to the lamin receptor and thereby its antimetastatic activity.

Hypocalcemia in a dog.

A case of hypocalcemia was presented with a concurrent hyperphosphatemia. Normal renal function tests excluded primary renal insufficiency. The diet was thought to contain a normal ratio of calcium and phosphorus and, therefore, nutritional secondary hyperparathyroidism was not considered. The radiographs showed normal bone density and the dog was not lame. Concentrations of immunoreactive parathyroid hormone were measured in an attempt to classify the etiology. The dog was successfully managed with calcium supplementation and vitamin D(3) or oral calcium alone.