The association between borderline pre-operative anaemia in women and outcomes after cardiac surgery: a cohort study.

Anaemia is common before cardiac surgery and is associated with increased morbidity and mortality. The World Health Organization (WHO) definition of anaemia is lower for women than for men by 10 g.l-1 , potentially putting women at a disadvantage compared with men with regard to pre-operative optimisation. Our hypothesis was that women with borderline anaemia (defined by us as haemoglobin concentration 120-129 g.l-1 ) would have a higher rate of red cell transfusion, morbidity and mortality than non-anaemic women (haemoglobin ≥ 130 g.l-1 ). This retrospective observational study included all adult patients admitted for elective cardiac surgery from January 2013 to April 2016. During the study period, 1388 women underwent cardiac surgery. Pre-operatively, 333 (24%) had a haemoglobin level < 120 g.l-1 ; 408 (29%) 120-129 g.l-1 ; and 647 (47%) ≥ 130 g.l-1 . Compared with non-anaemic women, women with borderline anaemia were more likely to be transfused (68.6% vs. 44.5%; RR 1.5, 95%CI 1.4-1.7; p < 0.0001) and were transfused with more units of red cells, mean (SD) 1.8 (2.8) vs. 1.3 (3.0); p < 0.0001. Hospital length of stay was significantly longer in the borderline anaemia group compared with non-anaemic women, median (IQR [range]) 8 (6-12 [3-45]) vs. 7 (6-11 [4-60]); p = 0.0159. Short- and long-term postoperative survival was comparable in both groups. Borderline anaemia is associated with increased red cell transfusion and prolonged hospital stay. Future research should address whether correction of borderline anaemia results in improved outcomes.

Detection of rotavirus in paediatric oncology patients with diarrhoea: the impact of rotavirus vaccine.

Seven years' data were reviewed to examine stool-testing for rotavirus in patents treated in a regional paediatric oncology unit before and after the introduction of UK-wide rotavirus immunization in July 2013. The prevalence of rotavirus positivity has diminished since the introduction of rotavirus immunization, with 21 of 416 positive samples between 2010 and 2012, but only one positive test out of 122 samples in 2015 and 2016. Based on these results, there seems to be little use for routine rotavirus-testing in children and young people with cancer presenting with diarrhoea.

Postoperative fibrinogen level is associated with postoperative bleeding following cardiothoracic surgery and the effect of fibrinogen replacement therapy remains uncertain.

BACKGROUND: Traditionally, a fibrinogen level > 1 g L(-1) has been viewed as the critical plasma concentration required for hemostasis. No definitive trial has investigated the plasma fibrinogen hemostatic threshold and fibrinogen replacement in complex surgical patients with acquired bleeding. OBJECTIVES: To explore the plasma fibrinogen level required for hemostasis in cardiothoracic surgery patients and assess the association of fibrinogen replacement therapy (using cryoprecipitate or fibrinogen concentrate) with reducing postoperative bleeding rate. PATIENTS/METHODS: Data from a prospectively collated database were used to examine the relationship between postoperative plasma fibrinogen level and the postoperative rate of bleeding within the hour of plasma fibrinogen measurement (n = 430) and to explore the effect of cryoprecipitate infusion (n = 76) or fibrinogen concentrate administration (n = 8) on postoperative bleeding rate. RESULTS: A low plasma fibrinogen level was significantly associated with bleeding, with an odds ratio of 3.06 for every 1 g L(-1) decrease in fibrinogen (95% confidence interval 1.05-8.90) with adjustment for confounders. A fibrinogen threshold associated with excess bleeding was not identified, but this relationship was a continuum. There was no reduction in bleeding following administration of cryoprecipitate or fibrinogen concentrate to raise the post-infusion fibrinogen level to a median of 2.00 and 1.70 g L(-1) , respectively. CONCLUSIONS: There is a continuum of bleeding severity with reducing fibrinogen concentration. Fibrinogen concentrate or cryoprecipitate infusion did not significantly reduce bleeding rate; however, confirmation by a randomized controlled trial is required. It remains uncertain whether low postoperative fibrinogen levels are causally associated with postoperative bleeding.

Survival and length of stay following blood transfusion in octogenarians following cardiac surgery.

Our aim was to assess if peri-operative blood transfusion is an independent risk factor for mortality and morbidity in the elderly. We report the results of a cohort study of all patients aged 80 or more on the day of their emergency or elective cardiac surgery (n = 874), using routinely collected data from January 2003 to November 2007. The primary outcome was all-cause mortality in hospital. The secondary outcomes were duration of stay in the intensive care unit (ICU) and overall hospital stay. Confounding variables were used to build up a risk model using a multivariable logistic regression analysis, and blood transfusion was added to assess whether it had additional predictive value for hospital mortality. Patients were divided into three groups: (i) transfusion of 0-2 units of red blood cells; (ii) transfusion of > 2 units of red blood cells and (iii) transfusion of red blood cells plus other clotting products. The strongest independent predictors of hospital death were logistic EuroSCORE and body mass index. After inclusion of these two variables, the odds ratio for transfusion remained significant. Relative to 0-2 units, the odds ratio for > 2 units was 6.80 (95% CI 2.46-18.8), and for other additional blood products was 14.4 (95% CI 5.34-37.3), with a p value of < 0.001. Duration of stay in the ICU was significantly associated with the amount of blood products administered (median (IQR [range]) ICU stay 1 (1-2 [0-15]) day if transfused 0-2 units of red blood cells, 2 (1-6 [0-128]) days if transfused > 2 units of red blood cells and 3 (1-76 [0-114]) days if other clotting products were used; p value < 0.001). Hospital stay was also associated with the amount of red cells used (p < 0.001).

'Oh it's a wonderful practice... you can talk to them': a qualitative study of patients' and health professionals' views on the management of type 2 diabetes.

This paper uses 85 semistructured interviews with people with type 2 diabetes, and with the health professionals who deliver their diabetes care, to explore the issues that they perceive as central to effective management of diabetes, primarily within a primary care setting. Attention is especially focused on the nature of the patient-practitioner relationship, and on the implications of this for patient empowerment and the effective self-management of diabetes. The paper is organized around five key concepts identified in the qualitative analysis: the importance of having sufficient time for consultations, the significance of continuity of care through a named individual, the need for patients to have an opportunity to ask questions during a consultation, the extent to which patients feel that they are listened to by health professionals, and the variability of each patient's individual experience of living with diabetes. In conclusion, these themes are briefly related to key issues in the geography of health.

Biological tissue adhesive for multiple use in the accident and emergency department.

OBJECTIVE: To assess the strength of the glue and microbial contamination over 28 days from opening a vial of tissue adhesive in the accident and emergency setting, and to quantify cost savings of repeated use of the vials. METHOD: (1) Strips of reinforced nylon and a specially constructed piece of apparatus designed to measure the force at which the glue gave way were used to measure the strength of the tissue adhesive at various times after the glue was opened to assess if the glue strength deteriorated over time. (2) Microbial contamination of the glue was assessed. RESULTS: There was no deterioration in the glue strength over time. There was no evidence of microbial contamination of the glue. CONCLUSION: Cyanoacrylate tissue adhesive can safely be reused for a period of 28 days after opening with no risk of degradation of glue strength or contamination with micro-organisms. In our department this represents a potential saving of l5400 per year.

Multiple causes of size variation in the diploid megabase chromosomes of African tyrpanosomes.

The chromosomes of many protozoans are polymorphic in size, but African trypanosomes contain diploid homologues which are exceptionally size-polymorphic. We present the first complete analysis of the structure of a Trypanosoma brucei megabase chromosome which reveals the concentration of repetitive sequence, non-random distribution of transposon-like elements, and a hemizygous variant surface glycoprotein gene expression site. Subsequent comparative analyses of size-polymorphic homologues show that the repetitive regions are highly polymorphic, as demonstrated in studies on the chromosomes of other protozoan parasites. We show that a large number of the transposon-like elements are located in these regions. However, although we have shown elsewhere that synteny is maintained in coding regions, homologous chromosomes may vary along their entire length. Thus, the variable chromosomal location of variant surface glycoprotein expression gene sites, the expansion and contraction of repetitive DNA, the number of putative transposons, sequence polymorphism at chromosome ends, and expansion and contraction within or between coding regions all contribute to huge chromosomal size polymorphisms in T brucei.

The molecular karyotype of the megabase chromosomes of Trypanosoma brucei and the assignment of chromosome markers.

We present the molecular karyotype of the megabase chromosomes of Trypanosoma brucei stock TREU927/4 (927). We have identified 11 diploid chromosomes ranging in size from 1 to 5.2 Mb approximately and pairs of homologues differ in size by up to 15%. A total of 401 cDNA probes were hybridised to T. brucei stock 927 chromosomes and 168 chromosome-specific markers were defined. Most of these markers were hybridised to the separated chromosomal DNA of two other cloned field isolates and four F1 progeny clones from a laboratory cross. The chromosomes vary in size by up to two and a half times between stocks and the DNA content of the 11 pairs of homologues varies by up to 33% in different stocks. Stock 927 contains the smallest chromosomes and the least nuclear genomic DNA. Nevertheless, all 11 syntenic groups of cDNA probes are maintained in all stocks. In the F1 hybrids only we have identified one extra PFG band to which none of our probes hybridise. We have shown that probes thought to be specific for the bloodstream-form variant surface glycoprotein expression sites hybridise to different chromosomes in different stocks and may hybridise to either one or both of a homologous pair of chromosomes. We have also determined the chromosomal location of the ribosomal RNA gene arrays.

Farmers' occupational health: cause for concern, cause for action.

This study examines occupational health and safety provision from farmers' perspectives, to address the question 'Are farmers' health and safety needs being met?' Given that farmers encounter a variety of health and safety risks in the course of their daily work, and that available statistics clearly indicate they are a high risk group, a review of the literature suggests that this area has attracted little research attention. No study has critically examined the system of occupational health and safety provision for farmers and no attempts have been made to elicit farmers' perspectives on the subject. A telephone survey using a questionnaire divided into four sections, involving a random sample of 150 farmers from the counties of Cumbria, Cheshire and Cambridgeshire in England, found that farmers considered the system of occupational health and safety provision to be inadequate and that their occupational health and safety needs were not being met. Recommendations for improvements are made based on the results of the survey.

Grain weevil,Sitophilus granarius (L.): Antennal and behavioral responses to male-produced volatiles.

Coupled GC-EAG techniques have been applied to the study of volatiles from the grain weevil,Sitophilus granarius. for the first time. The size of EAG response was independent of the sex of the responding insect but was consistently larger to extracts of males than those of females. This difference was reflected in a behavioral preference for the male extracts by mated adults of both sexes tested together and virgin adults of both sexes tested separately. The GC-EAG results provide evidence for two materials that are released specifically by the males. Using circular dichroism. one has been found to be identical stereochemically with the (2S,3R)-sitophilate reported by others as the aggregation pheromone in a different strain. This enhances the prospects for the development of a single pheromone lure that would be generally applicable whatever the origin of the strain. The small amount of sitophilate found in the males suggests that it is not stored in large amounts. The other material, present in such a small amount that it has yet to be fully characterized, elicits a higher antennal activity than sitophilate and may have a significant role to play in enhancing the trap catch of this economically important pest.

The relationships of aerosol deposition, lung size, and the rate of mucociliary clearance.

Although the effect of deposition pattern of an inhaled aerosol upon subsequent mucociliary clearance is well recognized, the influence of lung size on the rate of clearance has not been clearly defined. To examine the relationships of lung size in terms of the forced vital capacity (FVC) and aerosol deposition pattern to the rate of mucociliary clearance, we measured lung retention of an inhaled 8-micron aerosol for 120 min using a gamma camera in 13 healthy nonsmoking volunteers. The deposition pattern of the inhaled aerosol was defined in terms of the initial skew of the distribution of retained activity within the right lung (skew) and the percent retained at 24 hr (R24). Multiple regression analysis showed that FVC was responsible for approximately 36% of the variability in bronchial retention with time, with a lesser contribution from variations in deposition pattern (skew and R24). Mucociliary clearance was significantly slower (i.e., greater bronchial retention) in male subjects than in female subjects which can probably be attributed to the differences in FVC. Variations in lung sizes as well as deposition pattern should therefore be considered when making between subject comparisons of the mucociliary clearance rate.

The effects of acute respiratory virus infection upon tracheal mucous transport.

Tracheal mucous velocity was measured in 13 healthy non-smokers using a radioisotope-labeled aerosol and a multidetector probe during respiratory virus infections. The movement of boluses of tracheal mucous were either absent or reduced in number in five subjects with myxovirus infection (four influenza and one respiratory syncytial virus) within 48 hr of the onset of symptoms and in four subjects 1 wk later. One subject with influenza still had reduced bolus formation 12-16 wk after infection. Frequent coughing was a feature of those subjects with absent tracheal boluses. In contrast, four subjects with rhinovirus infection had normal tracheal mucous velocity at 48 hr after the onset of symptoms (4.1 +/- 1.3 mm/min). Tracheal mucous velocity was also normal (4.6 +/- 1.1 mm/min) in four subjects in whom no specific viral agent could be defined but of respiratory viral infection. During health tracheal mucous velocity was (4.8 +/- 1.6 mm/min) in the eleven subjects who had measurements made. Disturbances in tracheal mucous transport during virus infection appear to depend upon the type of virus and are most severe in influenza A and respiratory syncytial virus infection.

Level of aspiration, life satisfaction, and locus of control in older adults.

The relationship of the level of aspiration disparity score to life satisfaction and locus of control in two groups of aged individuals, the young-old (ages 60 to 69) and the old-old (ages 70-79) was studied. Female volunteers (N = 100) between the ages of 60 and 79, who were living in the community and were relatively well functioning, were administered The Rotter Level of Aspiration Test, The Life Satisfaction Index A, The Philadelphia Geriatric Morale Scale, The Internal-External Scale, and The Health Locus of Control Scale. Partial support was found for the hypothesis that a positive disparity score is associated with increased life satisfaction and a more internal locus of control.

Serum IgE levels in white and metis communities in Saskatchewan.

Serum IgE levels and the prevalence of certain atopic diseases have been studied in 819 individuals in 176 white families living in central Saskatchewan and in 275 individuals in 58 Metis families living in northern Saskatchewan. The geometric mean serum IgE level in the white community (81.3) u/ml) was lower than that in the Metis community (275.4 u/ml). The prevalence of asthma, eczema and urticaria was greater in the white than in the Metis community and contrasted with the increased prevalence of helminth infestation as well as of other untreated viral and bacterial diseases in the Metis community. It is suggested that atopic disease is the price paid by some members of the white community for their relative freedom from diseases due to viruses, bacteria and helminths.

The familial incidence of allergic disease.

The familial incidence of asthma, hay fever, recurrent rhinitis, recurrent bronchitis, eczema and urticaria was studied in 176 normal families. When these diseases, with the exception of urticaria, were present in a parent there was an increase in prevalence of the same disease in the child. This suggests that there is a heritable component in the end organ most easily sensitized in the allergic response.